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.
We have just posted a description of the kind (of) dentist that we are seeking to join us at the Winning Smiles dental practice.
The dentist vacancy has been created by a steady increase in patient numbers over the last couple of years. And the only way we can continue being able to serve more people whilst still giving patients the time they deserve, is to find some help. We’re nothing if not logical around here.
So if anyone reading this knows someone special in the field of dentistry, if you would be kind enough to point this job out to them, then we would be very grateful. We feel we should ask because we know that special people are always busy and aren’t always looking for a new role at exactly the time the perfect opportunity comes up!
We’ll update you on our search when we have some news.
The Winning Smiles Team.
Almarie Odendaal is the new orthodontist at Winning Smiles and is an expert in fitting braces using the new Damon System.
Here are the top three reasons why Almarie thinks Damon braces are a great treatment to choose if you need a full brace:
1. Damon braces typically provide excellent results in a shorter treatment time than conventional braces, and patients have to make less appointments.
2. Using the Damon System means that it’s very rare that a patient will need to have any teeth extracted, and they won’t have to wear any headgear during treatment.
3. Patients are a lot more comfortable during treatment.
Damon braces use a new passive slide mechanism to maintain the shape of the archwires within the bracket.
This allows the wires to move freely and reduces friction and binding, so your teeth can move quickly and comfortably. Other types of braces use elastic ties or active clips that bind archwires in place, this results in friction, making treatment slower and less comfortable. Elastics ties also attract a lot of plaque and so Damon System braces are also a lot easier to keep clean.
Almarie Odendaal, joined our team in June. Almarie qualified as a dentist from the University of Pretoria in South Africa in 1993. She is a member of the British Orthodontic Society, the Faculty of General Dental Practice and the British Dental Association.
You can book a consultation with her by dropping us a note via the form on the web site, or call us on 08000 90 10 60. Consultations are currently FREE!
Or the story of how three techniques (alignment, bleaching and bonding), when skilfully combined, can save you money and give you better results than just one (wall to wall teeth veneers)…
Alignment Bleaching and Bonding vs Wall to wall teeth veneers
Here in Essex, Cosmetic dentistry is evolving. A decade ago when decent porcelain veneers came along cosmetic dentists were very keen on placing lots of veneers – in 2010 there are still a lot of veneers being placed by cosmetic dentists, but here at Winning Smile we believe that the Age of the Veneer is on the wane.
A colleague of mine Dr Tif Qureshi (www.dentalelegance.co.uk) recently addressed the profession with his ‘evolved’ concept of Cosmetic Dentistry – updated to reflect the progress in dental knowledge and treatments within the profession and changing attitudes among our patients. Tif brought the Inman Aligner to the UK from the States and combines this brilliant little brace with 2 other treatments to produce significant dental transformation without the need to grind away good teeth as is the case with veneers.
Tif’s concept is called ABB: ‘Alignment, Bleaching and Bonding’
Using the inman aligner the front teeth can be lined up orthodontically in as little as 10 weeks
The cosmetic dentist’s best friend – professional teeth whitening to noticeably ‘lift’ the colour of all the teeth
The addition of cosmetic filling material (like our Italian HFO system) where necessary to add the finishing touches.
Here at Winning Smiles we have been using the bleaching and bonding techniques for years and Michael Fennell one of our orthodontists has been doing the straightening. We are no strangers to these ideas. But Tif has put a label on it for us, and we think people will be hearing of this costmetic dental technique a lot more.
As always my regular readers will notice that I like to bullet point the pros and cons
ABB Advantages over Teeth Veneers
- No grinding off of the front surfaces of the teeth
- No porcelain veneers that can fracture easily and begin to lose their looks after a few years – ABB simply enhances your own teeth
- Cost – ABB costs around £2000 at Winning Smiles, 6-8 veneers cost £3600-£4800!
- ABB is one hit: veneers usually need to be replaced every 10 years or so (think of the cost implication of that)
- ABB is kind to the teeth – occasionally a veneered tooth will need a root filling because the nerve reacts badly to the grinding process
Disadvantages of ABB vs Veneers
- Very badly discoloured teeth or teeth with lots of visible fillings may be better treated with crowns or veneers
- Teeth that have always been the wrong shape (eg too small, or misshaped) usually benefit from veneers/crowns despite the drawback
- ABB will take on average 12 weeks – veneers can be done in 2-4 weeks
Jodie Marsh lookalikes need porcelain veneers for that level of whiteness
How old, dodgy dentures have given way to beautiful, permanent replacement teeth
Truly transformational: the full arch titanium/acrylic fixed implant bridge:
Times (they are) a changing. I’m actually not listening to Bob Dylan as I write this, but times are definitely changing in the world of UK dentistry, and where dentures are concerned, the change is accelerating.
20 years ago if you had lost all your teeth, false teeth or ‘falsies’ were your only option. Cheap and cheerful, available free on the NHS…and utterly hopeless as a functioning pair of teeth. Some of them looked ok and even stayed in when you were talking, sometimes!
20 years ago dental implants were in their infancy, only a few brave dentists with hugely rich patients ventured into such unchartered territory..
Fast forward 10 years and things had changed dramatically:
10 years ago if you had lost all your teeth (or a complete top or bottom set) then it was possible to find a few dentists with the ability to replace a whole set of top or bottom teeth – but the costs, although vaguely affordable for those with serious property equity, were still somewhat eye-watering. A full set of porcelain teeth needed 10 implants to support them and each tooth was lovingly crafted – the dental technician would spend days or even weeks making them.
Some dentists realised that there must be ‘another way’ and started to use fewer implants to fix dentures in place: the implant-denture was born. The beauty of the implant denture is that instead of needing 10 implants to hold a complex custom made porcelain bridge in place, with the extra support that the implant denture gained from resting on the gums, the implant dentists could use fewer implants to hold these teeth in place:
Result! Dentures that stay put and can be used for eating most food without any fear of them falling out when discussing the latest episode of the Simpsons [Grandpa should have implant-retained dentures by now surely? -ed]
The only problem with implant retained dentures is that in patients’ eyes they are still dentures! They need to be removed for cleaning purposes every night….and no matter how well they stay in with their super-duper implant-connectors, they still have the ‘false teeth’ label.
Enter the new era of ‘full arch’ implant dentistry [full arch: aka a top set, bottom set or complete set of implant-teeth].
Combining the ease of construction of implant-dentures with the satisfaction of having a set of fixed teeth that really feel like your own, without resorting to using 10 implants at a time and without the days and weeks of painstaking construction time at the dental lab…..it has become possible to completely replace a top set, bottom set or both for a rather less eyewatering fee than those huge ceramic bridges….
This has been made possible by using digital scanning/CNC technology to produce titanium ‘backbones’ with micro-tolerances that are screwed into place on as little as 4 implants for a full set.
Top quality acrylic teeth are then firmly attached to the titanium backbone and the full arch titanium/acrylic fixed implant bridge is complete.
How do they look? The photographs speak for themselves.
It should be fairly obvious that in order to fit dental implants safely and successfully, you need to have a skilled and experienced surgeon. But did you know just how much the procedure also relies on having incredibly precise 3D images of the jaw bone? These are the X-ray images that allow the surgeon to plan the exact position and placement of an implant and they make sure that:
-the implants don’t ‘hit’ any vital structures during insertion (like arteries and nerves)
-the implants are placed so that the final implant crown or bridge ends up in the right position in the mouth
So what are the consequences of getting this wrong?
-a numb lip (possibly forever)
-a haemorrhage during surgery
-teeth ending up in the wrong place and looking ‘goofy’!
At Winning Smiles we know how crucial this precise 3D imaging of the jaw bone is. That’s why we use the latest Specialist Dental CT scanner to produce 3D images of the jaws before surgery. These machines provide superb high resolution, high definition images. Armed with this level of information we have safely and successfully fitted around 600 dental implants in the last few years.
And because the new generation of ‘cone beam’ dental CT units work with a radiation dose many times below that of hospital CT Scanners, they are not only more convenient (the whole procedure can be carried out here at our clinic), but they are also much safer.
So if you’re looking for safe, convenient, successful implant surgery…..you can rest assured that that all comes as routine for you here.
The truth about Peri-implantitis….(which in English means HELP, my implants are failing!!)
I recently had a new patient consultation with a chap who had had a quote for implant work at another practice. Nothing extraordinary about that I hear you say….except that
he had been told – your implants will last a lifetime
Which prompted some immediate questions from me, like for instance
- who’s lifetime, the dentist, the patient or the implant?!
- who’s going to guarantee those implants for a life-time?
Because it’s all very well making longevity-promises to people but without a back-up plan and some ‘what-ifs’ in the
contract, those promises start to sound rather hollow!
Here’s what we do at Winning Smiles to ensure that our implants survive for the longest time possible
Having the right attitude helps!
- Admit that implants can and do fail both short term and long term (denial is indefensible, see above)
- Keep abreast of the latest evidence-based studies on what causes implant failure and what the best failure avoidance strategies are recommended – (Like the European Forum on Peri-implantitis held in London in January 2010)
Having a clear, well defined follow up protocol for each and every implant patient, tailored to individual needs eg
- – Regular implant-hygiene sessions with our implant-trained hygienists
- – Bi-annual inspections (x-rays when indicated) with the implantologist
- – Hygienists trained to carry out our screening protocol for signs of early problems (eg the beginning of peri-implantitis)
Giving patients the right information
- Peri-implantitis leads to implant failure if undetected (or not looked for – head in sanditis)
- 15% of implant patients will suffer from some form of peri-implantitis (from recent long term studies in Europe)
- Patients who have lost their teeth from gum disease have a much higher risk of losing implants
- Patients who don’t manage to keep plaque off the implants also at higher risk
- Patients who smoke have a much higher risk of peri-implantitis and implant failure
- Patients don’t know when they haver peri-implantitis because it doesn’t hurt, right up until the implant tooth falls out!
But look on the bright side!
- we detect problems early using our screening protocol
- we can treat them easily in the early stages
- late stage treatment is more complex but still possible
And most of all, as with teeth, as with implants: keep them clean, stay off the fags and please please turn up for routine checks
and maintenance…..implants are not fit and forget…
It is quite common that patients who are considering, or about to undergo dental implant surgery to be in the dark when it comes to predicting how much pain to expect.
We hope this will help understand the implications from
a) the surgery itself
b) during the recuperation period immediately post-surgery (ie the next week or two)
And although at Winning Smiles we always encourage new implant patients to have a chat with patients who have had the whole ‘implant experience’, most patients won’t actually take us up on that offer – even though our previous implant patients are usually very happy to talk about it!
So I thought it might be useful to pen a broad classification of what pain and trouble you might expect from our implant procedures here at Winning Smiles. All implant surgery is not the same, so I have divided it up a bit (with a note on sinus surgery/bone grafts at the end)
1) Simple implant surgery ie 1-2 implants, no ridge splitting, no sinus work, no grafting
No need for sedation unless you are a nervous patient
Pain during surgery: none
Recuperation period: 2 days, mild soreness around gums, most patients will go back to work next day without the need to take even an aspirin.
2) ‘Middle of the road’ cases ie 3-4 implants or 2 implants with ‘extras’ like sinus surgery/sinus ‘tap up’/simple bone grafting/ridge expansion
Pain during surgery: none! (No, really!)
Recuperation: 3-10 days. Mild to moderate soreness around gums, mild swelling. Individual patients respond very differently in these cases.
For some patients it is very easy and they get only minor post-op soreness. At the other end of the spectrum a few patients will have to take painkillers for a few days and may bruise (in fair skinned patients the bruising can be quite noticeable).
3) Complex cases ie a whole upper jaw/lower jaw, 4-16 implants, ‘block’ bone grafts, etc
Sedation strongly recommended
Pain during surgery: none
Recuperation: 7-14 days. Moderate soreness around gums, moderate swelling, pain killers for the first week. Bruising can be quite widespread in fair skinned patients (ladies – buy concealer before you come!)
4) Sinus surgery:
no pain during surgery, little or no pain afterwards with mild swelling. Bruising on fair skinned patients.
5) ‘Block’ bone grafts – where we take bone from the chin or lower jaw and screw it into place somewhere else (often upper front area)
Ok, again we would expect no pain during the surgery but considerable soreness/bruising and some swelling for 1-2 weeks afterwards.
Similar to ‘complex’ cases above, it’s not something we enjoy doing to patients but in some cases the only way forwards – and they do work very well.
This is a lot of detail, but we find people would rather know these things up front, rather than find out after the event.
[media id=11 height=”216″ width=”384″]
Andrew explains the pros and cons of the implants vs bridges argument and why he generally prefers to use dental implants to replace missing teeth these days. This is the blog about dental bridges referred to in the video.
Length: 1 minute 50 seconds.
[media id=9 height=”216″ width=”384″]
We are open, with new operating procedures to keep us all safe.
For those patients who are booking in to see us now please look out for our pre-appointment email which explains how we have had to change the way we work to safeguard you and the team from any risk of viral spread – here it is:
Ahead of your upcoming appointment we have made a number of necessary changes to how we practice to ensure your safety and our safety during the pandemic. Although the UK has passed the infection rate peak the Government has advised all of us to remain on high alert and maintain social distancing.
At Winning Smiles we will be using a 6 part protocol to minimise the risk of viral transmission
Please cancel your appointment if you have experienced any of the following symptoms over the last 14 days:
- Sore throat
- Runny nose/sneezing
- Shortness of breath
- Loss of smell
Please cancel your appointment if anyone in your household has displayed any of these symptoms in the past 14 days
Please cancel your appointment if you have been asked to self isolate due to COVID 19 over the past 14 days, if you are being tested for COVID 19, or if you have been in contact with anyone suspected of having COVID 19 in the past 14 days.
We will phone you 24 hrs before your visit to check the above.
Maintaining social distancing during your visit
Please drive to the clinic if you can and phone us when you arrive in the car park so that we know you are there. Stay in your car and keep your phone handy so that we can call you in when we are ready for you. Please do not bring any family members with you when you are called in.
If you don’t drive please let us know before your appointment and an alternative arrangement will be made.
Please maintain a distance of 2 metres/6 feet between you and any other patients you encounter during your visit.
Entering the building
Please wear a face mask if you have one. If not we will provide you with one at the door.
We will check your temperature using a non-contact forehead thermometer.
There will be a table on your left with hand sanitiser on it. Please sanitise your hands.
You will need to continue wearing your mask until you enter the treatment room.
Entering the treatment room
Once you are sat in the dental chair we will give you a mouth rinse to use for 1 minute prior to starting your treatment.
Leaving the treatment room
Before leaving the treatment room we will ask you to sanitise your hands again, gel will be provided.
At this time we will only be taking card payments, no cash transactions. If you require a receipt we can text or email it to you. You will notice that all of us are wearing face-masks and face shields for the duration of your visit. I know this will make some people uncomfortable but I trust that you understand why we must continue to take such precautions at this time.
Thank you for your understanding and for taking the time to read this.
Dr Andrew Fennell
Thank you for your support in keeping everyone safe.
With best wishes,
The Winning Smiles Team
What happens to your teeth after 3 months 6 months and 10 months without a dental hygienist cleaning?
Well this is really a very difficult question to answer because each person responds in a different way to bacteria. In dentistry, this is called “host response”.
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 😉