It’s surprising how often a new client turns up in my office and tells me – unhappily – how they have been told they can’t have dental implants because their jaw has the wrong sort of bone, not enough bone, or bone in the wrong place…. it reminds me of that classic excuse that train operators used to trot out every time a train was late in the Autumn “train delayed due to leaves on the line”!
As of last month the General Dental Council – our governing body – has ruled that patients who want to visit a hygienist can do so without the need to have an examination with a dentist.
What this means
In practice these new hygienist regulations mean that if you feel the need to have your teeth cleaned you can go to a hygienist without the need for your dentist to officially ‘refer’ you.
Furthermore if your dentist doesn’t have a hygienist and you feel that you would benefit from seeing one you can turn up and see any hygienist at any dental clinic where they have decided to operate on this basis.
Well up until now hygienists were not allowed to see patients who had not been directly referred to them by a dentist – if they did this would have been an ‘illegal’ practise and they could lose their job!
At Winning Smiles we think this is a fantastic leap of common sense in the world of dentistry. Any legislation which helps to remove barriers between patients who want and need our help is legislation to be celebrated!
So to anyone out there who wants to check in with our lovely hygienist, please pick up the phone and call us for an appointment.
We can usually fit you in within a week!
I was reminded this week of the what a brilliant tool the humble dental checkup is…(assuming it is carried out with some thoroughness and enthusiasm)..
Often I think patients wonder why we do it?
And listening to the dentist counting teeth with the nurse repeating the numbers and tapping away on a keyboard, it must feel like a bit of waste of time for some….and it would be if all we did was look.
(Guess what – if all we do is look, it only takes 3 minutes….and in my opinion we may as well just take a photograph and send the patient home).
Looking for change
But the value of a decent dental check up is often about looking back and – probably more importantly – looking forwards. A good dentist will look in the mouth and compare the current situation to the last check up – looking for change. Change can be good (eg less plaque, better brushing, flossing etc) or change can be bad (fillings wearing out, crowns cracking etc). Often though the real value is in crystal gazing.
We all wish we could predict the future – well in dentistry it’s actually not that hard. Careful examination and an up to date dental examination history will give strong clues as to how long our teeth and our dentistry will last.
The positives for the patient are that
- they can focus their resources on dealing with issues that need immediate attention (ensuring they stay out of pain and continue to be able to eat a normal diet and smile at people)
- they can plan ahead for problems ‘on the horizon’ ie 6, 12, 24 months and even 5 or 10 years ahead.
A good dentist can give you realistic predictions about the longevity of your teeth and dentistry for years ahead.
Long range forecasting ultimately brings peace of mind.
Well I think in the end it’s all about being mentally prepared. When issues have been predicted well in advance and then happen, people feel ok with it. It’s not a shock, some patients may even have been quietly building their rainy day fund in expectation…
Knowing is better, and less expensive, than not knowing. And that’s why we developed our dental plan
So even the worst problems have been dealt with in advance and managed correctly it is that preparedness which brings peace of mind.
As time goes by we have noticed an increasing number of young adults turning up at Winning Smiles with..
- crooked and crowded teeth (especially at the front)
- narrow upper or lower jaws
- one or more missing adult teeth (usually front incisors or canines)
- very unhappy with their smile
With all the problems we have seen above, the cause is an adult tooth (or teeth) that never grew down in to place during childhood.
The other teeth crowded around the space that was left, and whilst often there has been an attempt at correcting the problem with orthodontics, for whatever reason it didn’t work very well….
One other common factor is that again, some patients tell us that their dentist has told them nothing can be done – or if it could it would involve horrible and expensive surgery….
Does this sound like you? What to do about a missing incisor tooth?
Here’s the good news
At Winning Smiles we have been successfully treating these cases since the mid 90’s!
Though it is true to say that these cases are challenging – and involve both orthodontics (braces) and one short session with our surgical dentist – the results are very predictable and our patients invariably end up with exactly what they want
- nice straight teeth
- wider smile
- all their own teeth (no implants needed here – your own tooth pulled into the correct position is much better)
- very happy with their smile!
How does it work?
As always it starts with a free consultation to see if you are suitable for this sort of treatment – (most people with ‘trapped’ canines or incisors are)
We then need to utilise our 3D CT specialist dental CT scanner – this is the diagnostic tool we need to accurately visualise the position of the trapped tooth in the bone.
Once we know exactly where it is (to the nearest half millimetre) the surgery to uncover the tip of the tooth becomes easy and keyhole – the CT scan image shows where to go. Normally we can uncover the tip of the tooth within 40 minutes using the Dental Laser! We then bond a little hook onto the tip of the trapped tooth.
The best thing about using lasers instead of scalpels is the wounds heal up much faster and there is much less bleeding during the procedure – truly ‘minimally invasive’
At this stage the (very minor) surgery is all done.
The patient goes to see our friendly orthodontic team along the corridor and they will fit one of our discreet adult braces which attach to the little hook to pull the wayward tooth back down into its proper position.
The process normally takes from 12-18 months.
And the bonus? The same discreet brace is used to widen the smile, and get all those crooked/twisty teeth back into a nice straight line at the same time as pulling down that tooth no one ever thought could be reached!
We love these treatments because they showcase the best of what we can achieve at Winning Smiles with our friendly enthusiastic multi-disciplinary team backed up with state of the art technology!
We love our job.
A wise old dentist once told me ‘dentistry is 85% communication and 15% manual dexterity’ (I’d like to think some of that 15% includes a level of artistry as well!)
What my dad meant was that without a high level of communication – in his opinion – good dentistry can’t happen.
What do we mean
- make the patient feel at home – on the first visit!
- explain all the options and their pros and cons
- talk about fear and pain upfront and how to minimise both
- be honest about the fees
- take time to explain all the issues that can and do occur for a given treatment
- discuss honestly how long the treatment will last and the necessary maintenance
The more we know about a new situation, the less frightened we are by our ‘imagining’ about what may occur. If the patient feels able to approach the dentist and the team at any time with any concern, or question, no matter what it is, then it often happens that 90% of the previous nervousness, phobia or plain fear disappears.
Communicating gets the right results
With the right level of understanding, there need be no second thoughts or surprises, and we are given the proper permission to carry through with our high level dentistry. Building a level of confidence that the results will always match the expectations agreed between dentist and patient, means that patients feel right about things the whole way through
- they know the dentistry looks good and will last
- they are happy and comfortable and devoid of fear
- they get to know how passionate we are about our work!
In the end. It’s all about connecting with people for me too. And that’s what gets me to work every day. That’s what inspires me.
That’s why I do it.
I am often asked why my white fillings are significantly more expensive than Dr.A.N.Other’s just around the corner. They’re white, right? What more is there to ask?
So I thought that I’d tell a little story about how I ended up spending a considerable number of long weekends hanging out with arguably the best cosmetic filling dentist in the world. He calls them ‘aesthetic composite restorations’ and his name is Dr Lorenzo Vanini (google him and you’ll see). Now Lorenzo, apart from being the best cosmetic dentist in the world is also a fine pianist and jazz-composer, a black belt in karate, and lives on the shores of Lake Como not far from George Clooney.
I went to find Lorenzo because my experience of white fillings was that:
- They didn’t last very long (less than 5 years)
- They didn’t look like tooth, they often looked like murray-mints surrounded by a dark brown leakage-line
- They often had decay underneath them (so if anything, they looked worse underneath than they did on top)
- They were weak and prone to fracture
In short – mercury fillings were better in every way except they looked a bit black!
Lorenzo opened my eyes and proved beyond a doubt that:
- Quality white, cosmetic fillings can last 20 years!
- Quality white, cosmetic fillings are indistinguishable from natural tooth tissue
- They won’t decay underneath (providing a strict placement protocol is adhered to as prescribed by Lorenzo)
- They are strong and not prone to fracture
- They are so much better (for the tooth and patient) than mercury fillings – and they look good to!
Lorenzo opened my ears too, because being a keen musician myself, we inevitably found ourselves jamming after a long hard day’s teaching/learning (and some decent italian wine of course).
Lorenzo also taught me to use his material to produce free-hand immediate veneers which have become a very popular cosmetic treatment here at Winning Smiles over the years.
Anyway here is my recipe for making the best white fillings in the world (and our ‘routine’ procedure here at Winning Smiles)
- Purchase the best white filling material in the world (‘Enamel Plus’ from Italy, produced by Mycerium, designed by Lorenzo and his chemists)
- Ensure that the tooth is properly numb (using ‘The Wand’ our painless injection system from the US)
- Apply ‘rubber dam’ to the tooth so that it is isolated from the saliva in the mouth (saliva + white filling = disaster, also we use the rubber dam to prevent bits of mercury filling being ingested!)
- Remove old filling/decay etc, the cavity has to be prepared precisely as prescribed by Lorenzo (margins polished, etc etc)
- Chemically clean cavity (Lorenzo technique)
- Apply bonding agent (Lorenzo technique, the bonding agent is also one of the best in the world – cheap bonding agent = leakage and brown lines around the filling)
- Apply different shades of Enamel Plus filling material, laminating/layering technique as per Lorenzo
- Finish with specific tungsten-carbide tipped drills and specific polishing brushes and pastes (as per Lorenzo’s technique)
- Voila! A white filling that can be (easily) guaranteed for 5 years, will last much much longer, and actually looks like a tooth – even after years of use!
Using the best materials and the best technique and ensuring the best environment for the alchemy to take place takes time, and those materials cost double what the cheap stuff does….but is it worth it?? Of course it is. Anybody for a cheap white filling now?
So here’s the follow up to my last blog about fit and forget implants:
If you think that you might benefit from dental implants..
here’s a few questions to put to the dentist before you choose to go ahead:
Q. What guarantees do you offer on your dental implants?
Q. Will you replace an implant if it doesn’t take – free of charge?
Q. And in the long term – how will you ensure that I still have my implants in 10 years?
Q. What are the ongoing maintenance requirements for dental implants, and how much does that maintenance cost?
Q. Can I see some before and after photos of your work?
Q. Can I speak to any of your patients who have had implants placed by you? (Ask for testimonials)
Q. How long have you been placing dental implants?
Q. How many implants have you placed?
Q. How many of those implants have failed?
Q. Talk to me about peri-implantitis!
Q. I’m a smoker – am I still suitable for dental implants?
Q. I have had gum disease, this is how I lost my teeth (they got wobbly and fell out), will the same thing happen to my dental implants?
Its important to know everything before you choose, and of course, we’ll answer all these questions for you in the Free Consultation.
I love talking my patients. They are my lifeline to the real world out there – (you know the one where most people don’t spend all day every day thinking about teeth!)
This lady is one of my long standing dental implant patients – a few years ago we completely rebuilt her upper teeth using custom porcelain bridges supported on titanium implants
The thing is, they look as good today as the day we fitted them all that time ago. But this is no accident. This lady follows Laura’s (one of our lovely hygienists – yes they’re out there, honest!) advice to the letter. She cleans the bridges and implants twice a day, and visits us every 6 months for her Healthy Mouth Review to allow us to monitor the health of her mouth and implants, to clean those areas even she can’t get to, and to carry out our Oral Cancer Check.
This is routine at Winning Smiles.
Implants need as much – possibly more – upkeep than natural teeth…they are a great copy of the real thing (better than a chinese rolex) but even I don’t claim to have beaten mother nature at her own game!
So when Gill told me yesterday that she is coming across more and more people who are benefiting from this sort of dental treatment – but some of them can’t understand why she has to keep coming back to see us for what they see as ‘unnecessary maintenance’, I had to press her for further clarification! ‘Why?,’ I said. And Gill went onto explain that these patients are popping into dental practices (yes in the UK) and having implants placed ‘as if they are just expensive fillings’!
This is a worrying trend. Problems with dental implants rarely cause pain, so for a patient who has been advised in this way the first time they realise there is a problem with their dental implants might be the day they fall out! The fact that this may take 5-10 years is what is protecting both these dentists (and their patients – ignorance is bliss) for the time-being. But it’s a ticking time-bomb. These cheap ‘quick-fit’ (and forget) implants have been placed in the last couple of years as more and more of the profession learn about them – in response to greater and greater demand from patients….alas it is only a matter of time before the chickens come home to roost. And when they do, the only winners (as usual) will be the lawyers.
Leaving the cost issue aside, once implants fail it is not nearly as easy to do them a 2nd time. The bone around them disappears – which is why they fall out – so if they fall out, by definition there is often no bone left to put another one in….and this puts us right back to the 1970s: dentures for all.
Happy Easter. Lay off the eggs 😉
Minmally Invasive, Oral Health conscious, High Tech Cosmetic Dentistry
As seen in ‘The Times Raconteur Supplement‘ Monday 20th Feb
For years I’ve been banging on, extolling the virtues of a philosophical approach that puts Cosmetic Dentistry and Healthy Dentistry in bed together – often in the face of a seemingly increasingly agressive approach being driven by our Atlantic cousins.
If you were to have followed my musings over the years you will know that I am inclined to be kind to both patients and their teeth. Our emphasis at Winning Smiles is pain free dentistry (eg use of the wand) and tending to try and enhance the natural tooth (eg Alignment, Bleaching and Bonding or ‘ABB’ rather than wall to wall enamel destruction and shed-loads of porcelain veneers).
These treatments are not only better for the teeth, they are better for the patient experience, better for their pocket! More ‘Gentle’ in every way!
So for me to read in the National Press that they have dedicated a whole supplement to Gentle, Healthy Cosmetic dentistry, well it’s music to my ears [grist to your mill? – ed].
As the title page of ‘Raconteur’ (linked above) says: previously ‘Cosmetic Dentistry’ was all about grinding miles of enamel off teeth to make room for great big ultra-white porcelain veneers – and this aggressive approach continues today. But clearly the New Wave is on the ascendent and the old way of doing things is being replaced by a more health conscious, gentle approach.
Sadly there are still well known clinics in well known parts of London encouraging patients to spend ‘A grand a tooth’ on that ‘Perfect Smile’:
A 2nd Opinion
Only last week a young lady of 20 came to me for a 2nd opinion. She smiled broadly at me to reveal a perfect set of straight teeth albeit for one upper central incisor which was grey…’I’ve been told I need 10 veneers’ she confided. On further investigation it was revealed that she had had an ‘E-consult’with a West London Clinic who had advised her that to get a perfect smile she needed 10 veneers at a grand each.
Needless to say, she is coming to us to have a single EMAX crown fitted to the grey front tooth after we have internally bleached it. The colour matching will take a while and will probably involve re-shading that crown a couple of times to get it to blend seamlessly with the natural teeth.
Matching a single front tooth to its natural neighbours is one of the hardest things to do.
I wonder how many times people have been recommended to fit 6, 8 or 10 veneers because the dentist finds it easier than the alternative. At best, a lazy approach, and it does all make you wonder sometimes.
But veeners will always match each other, won’t they?! (it’s hard to do sarcasm written down)
Shaping and restoring teeth to their former glory:
- Better for teeth – tick
- Better for patient – tick
- Less expensive – tick
- More challenging (and therefore more rewarding) for the dentist – tick
That’s our kind of dentistry!
I never thought I’d say it, but the Jeremy Kyle show had quite an impact one day last month on our dental practice.
Thanks to a recent programme featuring new cosmetic dentistry techniques and ‘instant’ veneers, our phone rang off the hook all day. Who’d have thought the show would have that much influence!
You’ve probably heard of porcelain veneers, they’ve been around for quite some time. They’re the reason so many celebrities have perfect teeth and bright, white smiles. Simon Cowell, Miley Cyrus, 50 Cent, Katie Price and Hilary Duff are all rumoured to have got themselves a set of veneers – and at a celebrity price. A full set of porcelain veneers can cost thousands, and yes, we do still fit these when the occasion demands it.
However, ‘instant’ or ‘composite’ veneers, at a fraction of the cost, put a fantastic smile within the reach of the rest of us, which I guess is why Jeremy Kyle’s show provoked such as response. But then, a dazzling smile, a more confident and youthful look – it’s a service that was always going to be popular, if only people knew it existed!
The flexibility of this new material does mean that Instant, or Immediate Veneers are the modern answer to crooked teeth, staining or gaps between teeth. They are fitted quickly and easily over your existing teeth in just one visit to the surgery, and there’s no need for your own teeth to be filed down (as with porcelain veneers) so it’s pain-free too. Yes, really.
If you think that sounds too good to be true – we thought that too, but there really isn’t a downside to this. Instant veneers do look great, they are long lasting, and easily repaired if chipped. The cost is just £350 per tooth, which is about half the price of the porcelain method.
When choosing instant veneers our main piece of advice is to find an experienced composite dentist. I know, we would say that, but not all dentists follow the same career path.
It is different, because whereas porcelain veneers are made in a lab by a technician, instant veneers are shaped by the dentist in the surgery so your dentist needs to have a good eye and a little artistic flair!
“Keep smiling – it makes people wonder what you’ve been up to.” Author unknown.