Education | Dental Clinic in Abu Dhabi , UAE

Mouth Guard

A mouth guard provides protection to the teeth and masticatory system (jaw joints and muscles) and is, usually, worn while you are asleep. In severe cases, your dentist will provide two mouth guards, one for the upper jaw and one for the lower jaw.

A mouth guard has several positive effects:

Reduces teeth wear and tear: Instead of grinding away teeth you grind the mouth guard.
Relieves tension in the jaw joints. Many people suffer from pain in the jaw joints. Sometimes the jaw will lock or produce a loud annoying sound when being used. The mouth guard relieves tension built up in the jaw.
Stabilises the bite (occlusion). The design of a mouth guard provides maximum protection to the individual teeth. As it stabilises the bite, it helps the muscles and joints to relax more. If the overload on the teeth is extreme we sometimes see teeth being moved out of their position. A mouth guard will, in most cases, prevent this movement.

Things to consider

A mouth guard is worn during sleep. In some cases, it is recommended during the day as well. A patient may use the guard for longer than the recommended duration.

The length of the treatment period varies. If the main objective of the treatment is to get rid of pain, we often see that 3-4 months will suffice. When the objective is to prevent wear and tear of teeth, we recommend longer usage.

The mouth guard is custom-made to suit your bite. It may ache when you begin using it. This will wear off after a few days. The effect of the mouth guard will kick in once it feels comfortable in your mouth. If you feel tension and pain after the first couple of weeks it is important to contact your dentist.

If you stop using the mouth guard for a while, you can experience problems when you try to fit it again. This is because your teeth could have moved slightly over time. In this case you must contact your dentist.

When you remove the mouth guard in the morning your bite will feel peculiar. This is because the jaw muscles have been relaxing all night. The bite will adjust itself after a short while. Rarely do we need to make a bite adjustment.

Initially when using a mouth guard you may experience increased saliva production. It usually returns to normal levels in a few days.

While using a mouth guard it is very important to have good oral hygiene. Brush your teeth before inserting the guard. Floss your teeth daily. The actual mouth guard needs to be cleaned twice daily. When not in use store it in freshwater. When travelling keep it in a plastic bag with some wet wipes.

Always bring the mouth guard to any dentist appointment.

If you have any problems or queries please contact us.

Veneers

Teeth can become discoloured for different reasons. This means that bleaching is not always the best solution. Some teeth cannot be bleached. Old fillings have visible borders that become more pronounced when bleached, making it unsightly. To avoid these problems, your dentist might recommend using a crown made from ceramic. This is particularly helpful if most of the tooth is either filled or damaged, where bleaching would be unsuitable. However, if the tooth is healthy, crowns are not recommended, as much of the healthy tooth would have to be destroyed to make way for the crown.

Veneers
A modern alternative is a veneer. A veneer is a very thin shell made of porcelain and customised to fit individual patients’ teeth. It will be glued to the outer surface of the tooth, forming a strong bond. The appearance is natural because the veneer mimics the layers of enamel.

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This patient was unhappy with the colour of her teeth and the old fillings (yellow).

First, all her teeth were bleached. Then, veneers were placed on the front four teeth. Veneers allow you to alter the shape of the teeth. So this patient requested an increase in length of her front teeth.

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A natural look
Enamel is a relatively thin and transparent layer on the surface of the tooth. Under the enamel is the dentine, which is darker and coloured. The veneer is glued to the enamel and masks the darker underlying dentine. The porcelain used for veneers is very similar to enamel, making the appearance natural – almost like a new layer of enamel.

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A tooth gets its natural colour from reflections of light through the different layers of the tooth. In order to create a natural appearance, the dentist will try to mimic the natural construction of the tooth. Veneers are highly precise, very thin shells of porcelain. They are customised to fit each individual patient and tooth. The veneer is glued to the outer surface. It mimics the natural appearance of the tooth, almost like a new layer of enamel.

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This patient’s front tooth was broken in an accident and repaired with composite (above). Over time, it turned slightly yellow. This was fixed using a porcelain veneer (below).

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It is not necessary to remove any tooth substance if you choose to increase the size of a tooth with the veneer treatment. However, your dentist might need to remove a thin layer of enamel – usually 0.5mm – to accommodate the veneer. Next, your dentist will take an impression of your tooth and create a cast. Our dental laboratory will then make your customised veneer and your dentist will schedule a fitting. If the fit and appearance are to your liking, the veneer will be “cemented” (glued) in place, and you can enjoy your new smile.

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This patient had veneers made for six front teeth.

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At Snö, our dental technician works like an artist to craft veneers in-house. During an inlay, onlay or crown procedure, we can usually fabricate it on the same day or the next. To make aesthetic veneers usually takes a few more days due to the customisations.

Thanks to our advanced digital scanners, we also save you from the discomfort of taking tooth impressions. A two-minute scan is all we need to get all the information of your teeth in full detail and the highest resolution. The crown is cemented to the tooth – aesthetic, durable and strong.

The quality and lifespan of the veneer has a direct relation with the technique and time spent on the treatment and oral hygiene going forward.

A treatment can look and feel good, but can still have quality concerns. At Snö, we always document everything during treatment in order to insure our high quality standard. This applies to veneers too. The veneer treatment also carries a two-year warranty. If you follow our protection plan you can get up to five years of warranty.

Amalgam problems

Continuous wear
Tooth wear is based on the environment. In the same way that cars used for races require more repair than those used for display purposes, tooth wear depends on what we expose our teeth too. For instance, if you grind your teeth during night (bruxism), they will wear over time without you being aware of it.

An intact tooth is the best
The most durable tooth is one without any fillings. Most people have amalgam fillings that function fine. However, with age, the amalgam filling changes its form so it does not fit the tooth anymore.

A cavity alongside the fractured amalgam filling

Amalgam cannot bind itself to the tooth. A dentist will usually make the cavity wider at the bottom than at the top so that when the amalgam sets, it swells and becomes “trapped” in the cavity. Amalgam is good at resisting bite forces, but over time small cracks in the tooth are created, increasing the risk of fracture. The bigger the filling, the greater the risk.

A side view of a tooth with caries (left), detected during a routine dental examination. The tooth (right) with the caries and bacteria removed. If the tooth were to be filled with amalgam at this stage, the amalgam would simply fall out.

The dentist is, therefore, forced to remove healthy tooth substance in order to make the cavity bigger at the bottom.

A cavity filled with amalgam (left). Over time the amalgam swells up (right), creating a risk of fracture to the tooth.

A tooth with a large old amalgam filling. A crack is visible and the wall of the tooth will soon fall off (left). Another example (right) where the wall has broken off. A crown or dental onlay will greatly reduce the risk of fracture. Tooth fractures also quite often lead to root canal treatment.

The first time a cavity is filled with amalgam, it usually lasts a long time – 20 years is not uncommon. When an old filling needs to be redone, the prognosis is not always as good. Even the unfilled parts of the tooth are often damaged, forcing the dentist to remove more of the tooth. The longevity is now greatly reduced. A crown or dental inlay/onlay will improve the prognosis of the tooth.

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Molars in the lower jaw with big, old amalgam fillings.

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After treatment with bonded ceramic crowns/onlays.

Modern techniques make it possible to restore teeth back to how they originally looked, putting a smile on the patient’s face again.

In the early stage of a cavity, composites are much better, and more aesthetic than amalgams. At Snö we do not provide amalgams as an alternative.

Tooth sensitivity

Your tooth is complex
A tooth consists of a crown and a root. The root is attached to the surrounding bone by thin threads. The gum surrounds the lower part of the crown, covers the bone and functions as a protective barrier against bacteria in the mouth.

Tooth sensitivity can be caused by many things like, caries, overload, inflammation, infections. A common cause is that the gum recedes and exposes the root surface. Inside the root is the pulp tissue and it consists of nerves and blood vessels. The outer surface of the crown is protected by enamel, but there is no enamel protecting the root surface.

With age the gum recedes, but behaviour like teeth clenching or periodontitis and even the wrong cleaning technique can make it worse.

Sensitivity is annoying but mostly harmful
If we magnify (below) the exposed root surface we can see it consists of small canals. The canals are narrow and filled with liquid. If the root is exposed to heat, cold, sweet, dryness, the liquid will move. This causes the nerve to react which manifests as a sharp, icy sensation. It can be painful, but is not harmful. In some rare cases, a root canal might be necessary to treat the pain.

The root surface consists of millions of microscopic canals. The canals are filled with liquid that stimulates the nerve when there is a change on the surface (heat or cold). Caries builds easier on the softer root surface than the enamel covered crown.

Bone recession
When the root surface is exposed it is because the bone underneath has receded. The bone can recede for various reasons. The most common ones are:

Load: Overload, caused by teeth grinding at night may result in bone recession.
Oral hygiene: If cleaning – especially in the area between the teeth – is compromised, the gums respond with inflammation, swelling and/or bleeding . This may cause the bone to recede. In some cases, the bacteria build-up may lead further bone loss and eventually tooth mobility and tooth loss (periodontitis). This can be prevented by practising proper oral hygiene.
Old fillings and crowns: Fillings and crowns with bad fits can cause bacteria to accumulate and initiate the reaction described above (oral hygiene).

What to do about tooth sensitivity
In some cases, the icy sensation can be a sign of possible tooth damage. You dentist will look for signs of damage, but if the condition worsens, your dentist might ask you to visit the clinic again and prescribe a topical fluoride treatment. Certain toothpastes, like Sensodyne and Zendium, might be effective at closing the canals on the root surfaces so that the nerve is not stimulated. In most cases the pain from tooth sensitivity gradually disappears. If it persists, please contact your dentist.

If the symptoms are not severe and the dentist does not find a reason, it is not harmful to wait. Occasionally the reason surfaces later, but in most cases it is just a temporary sensitivity that gradually diminishes. However, if it worsens, do contact the dentist.

A root canal treatment will remove the icy pain, but the modern approach to dentistry is to keep the teeth alive as long as possible.

Aesthetic dentistry

There are a million reasons to smile every day of our life. At Snö we want to give you the confidence to smile whenever you have the opportunity. Unfortunately, many people are concerned about the appearance of their teeth, and smile a lot less. Aesthetic dentistry is here to change that.

For us, aesthetics go much beyond superficial looks. First and foremost, your mouth should feel and be healthy. But beyond this, the Snö team of aesthetic dentists can help with any correction, no matter how small or big. Some adjustments are quite big and require careful planning, while many smaller treatments can be performed quickly, like a routine correction of the colour of your teeth.

Aesthetic services we provide:
Cosmetic consultation
Veneers
Whitening/bleaching

Crowns

A Composite filling is both good and bad
A composite filling is usually done in one visit. Composites are tooth coloured. In contrast to an amalgam filling, composite can bond to the tooth, seal the filling and is more durable.

When setting, a composite will not expand. It will shrink. The shrinkage of the composite does not affect smaller cavities, but for larger cavities, the shrinkage increases and stresses the bond.

If the majority of the occlusal surface (tooth surface in contact with a tooth in the other jaw) consists of composite, the wear of the tooth will increase due to the less resistant nature of the composite material.

The shrinkage during bonding also creates tension leaving the tooth with increased sensitivity. While this is temporary, it is not harmful.

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During cleaning, deep cavities are often found between the teeth.

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Same tooth, as above, seen from the side. Note how deep the cavity is.

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The shrinkage of composite during bonding creates a gap for bacteria to migrate into, increasing the risk of new caries.

Deeper cavities between the teeth
The deepest cavities are often located between the teeth due to the difficulty of cleaning this area.

The deeper the cavity, the bigger the risk of leakage from the bond, resulting in higher risk of new caries.

Crown or onlay
If the majority of the natural crown of the tooth is missing, it is better to build a new crown or an onlay.

There are a number of advantages with this kind of treatment: There is minimal tension between the tooth and the crown; it is easier to imitate the shape of the natural tooth; and the fit is more precise. Since the crown is more durable, it ensures a longer lifespan for the tooth.

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The composite filling failed to recreate the contact point between the teeth. As a result, food will get trapped in the gap while eating. An inlay/crown will solve the problem.

Composite is a good restoration option, but best suited for small- to medium-sized cavities for the reasons mentioned above.

Crowns and inlays/onlays are more expensive because they have to be custom-made in a laboratory – we make our own at Snö – but due to the improved durability, it is a recommended treatment for larger cavities.

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An onlay has a precise fit to the tooth and reduces the attrition. Materials of choice are gold or ceramic.

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When a large portion of the tooth is missing, a ceramic crown is the best treatment, as it bonds to the tooth well.

Learn more about our services in teeth restorations

Choice of material

Caries and cracks
The most common reasons for teeth to require fillings are caries and cracks. However, the most durable tooth is an intact one, without any filling. The first time a tooth gets a filling, it usually lasts a long time. But, as fillings get replaced, the tooth becomes weaker. This also depends on which filling material is used.

Types of fillings

Amalgam
Amalgam is a material that will last a long time when a tooth is filled for the first time. It is common to have amalgams that are over 20 years old. An amalgam filling will normally be done in one visit.

When a decayed tooth needs to be filled with amalgam, the dentist will begin by removing the decayed part. If the dentist fills the prepped tooth straight away, the amalgam would soon fall out, as it is not possible to bond the amalgam to the tooth. Therefore, the dentist has to prepare the tooth with a cavity larger at the bottom than at the top.

Usually, when the amalgam sets, it expands and becomes “trapped” in the tooth. Then, later during eating, the filling is pushed downwards, stressing the walls of the tooth and small cracks are created. Eventually this will lead to a collapse of a wall of the tooth and the tooth will be more complicated to fill.

Amalgam becomes “trapped” in the tooth. Over time, the wall of the tooth will collapse.

Composite
A composite filling is usually done in one visit. Composites are tooth coloured. In contrast to amalgam, a composite filling can be bonded to the tooth. This means that the tooth will not need the same degree of preparation compared to amalgam fillings. When setting, a composite will not expand, instead it will shrink. It is a huge advantage that composites bond to teeth, but for the bond to be strong, it requires a dry, isolated cavity. This is why composites are technically more demanding than amalgam fillings.

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It is an advantage that composites can bond to the tooth so only the deceased part of the tooth is removed

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With larger cavities it is a better to proceed with an inlay/crown

If the caries is situated at the side of a tooth facing the tooth next to it, filling it with a composite can be very difficult. Not only should the cavity be closed, but the contact point between the decayed tooth and the neighbouring tooth must be recreated. Without a contact point, a small gap between the teeth could lead to food collection and additional infections, if the space is not cleaned on a regular basis. An inlay/crown can be a solution here.

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The composite filling failed to recreate the contact point between the teeth and food will get trapped when eating. An inlay/crown will solve the problem

Inlay
The recommended restoration for larger cavities is an inlay or onlay, which is completed over two dental visits. Unlike standard fillings that are done at the clinic, both are made at our laboratory and bonded to the tooth during a second visit.

An inlay is done by filling the space between the cusps, or rounded edges, at the centre of the tooth. If the walls are very thin, the inlay can be made to cover the walls and one or more cusps, in order to protect it from cracks. This is called an onlay. Inlays and onlays are made of either gold or ceramic.

Gold
A gold inlay is amongst the most durable of fillings. Gold inlays have been around for a long time and results have proved its longevity.

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An inlay fills the cavity more precisely than a filling. Materials of choice are ceramic, gold or composite.

Ceramic
Ceramic or porcelain, as it is often called, is tooth coloured. The result is a very natural looking tooth. Since the beginning of the ’80s ceramics have been used for inlays to the tooth. Bonding the ceramic to the tooth is a complicated treatment compared to the gold inlay.

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Inlay Onlay

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Fit of inlay Fit of onlay

Crown
If the majority of the crown of the tooth is missing after a caries removal, a crown is the best option. Like the inlay, the crown is made at our laboratory and it involves two visits to the dentist to be set. The crown is placed as a cap on the tooth, protecting it from further cracks in the future. Crowns are made of porcelain or gold.

Although considered the best material for crowns, gold is not that popular anymore and today’s crowns are almost entirely made of porcelain materials, bonded to the tooth in the same way as inlays.

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Tooth prepared for crown Fit of crown

Popular filling materials
Today, composite is a very popular filling material. It is usually done in one visit. The durability is dependent on the size of the cavity. The larger the cavity, the shorter the lifespan of the composite filling. In these cases, inlays or crowns of ceramic might also be considered.

Learn more about our services in teeth restorations

Root canal (Endodontics)

Tooth pain does not necessarily have to be because of a root canal. You can experience pain even if the nerve of the tooth is dead (to learn more, see pulp damage). Quite often, the symptoms are obvious, and a “root canal treatment” (root filling) where we remove inflammation/infection is the best treatment. Simply put, we gently remove the soft tissue inside the tooth (the pulp), clean it and seal it. Today, this can be done without any pain. However, we always try to save the pulp in order to not perform a root filling.

There are four different scenarios depending how extent of the damage:

Pulp inflammation with a chance for recovery
Pulp inflammation with no chance for recovery
Pulp partially or fully infected with bacteria
Already root filled teeth with problems

Pulp inflammation with a chance for recovery
If possible we always begin by removing the trauma (eg caries) to the pulp in order to save the pulp.

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Above is a schematic example of a healthy tooth (left) and one with a caries lesion (right) filled with bacteria that irritates the pulp. The tooth is very sensitive, especially to cold. This inflammation will create pressure inside the pulp chamber, making the nerve even more sensitive. A quick way to alleviate the pain is to remove the pulp and do a root filling. But this would be very destructive to the tooth and require even more root canal treatments. In many cases, when most of the caries is removed and, more importantly, the cavity is sealed from the mouth with a tight temporary filling, the pulp relaxes and the inflammation disappears. After a while (usually two months) we check the tooth to see if we have managed to save the pulp tissue. This also saves you the cost of a root filling. In some cases, however, the inflammation spreads causing pain, making it necessary for a root canal treatment.

Pulp inflammation with no chance for recovery
When the symptoms are more severe and/or when we can diagnose an irreversibly damaged pulp, the two options are to remove the tooth or try to save it with a root canal treatment. The root canal treatment is similar to the treatment for an infected tooth, but generally has a little bit better prognosis and can sometimes be done a bit faster.

Depending on the case, we always inform you about the prognosis and the alternatives.

Pulp partially or fully infected with bacteria
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When bacteria gets into the pulp (eg: above via a caries lesion) the infection spreads down the root canals and even comes in close contact to the bone. Common symptoms at this stage are tenderness to touch and chewing, discolouration of the tooth, and swelling, drainage and tenderness in the lymph nodes, as well as nearby bone and gum tissues. Sometimes, however, there are no symptoms. When treating this, we remove the diseased and dead pulp tissue from the tooth with specially designed instruments used to clean out the root canals and pulp chamber (at Snö we always use new instruments).

This stage is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain. If there is an infection outside the root, it can cause some pain, but usually disappears. In difficult cases, we leave a special paste inside the tooth to fight the bacteria. In other cases we do the filling of the tooth in the same session.

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Root canal fillings are selected to exactly fit into the freshly prepared canals. Usually, a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape), which is heated and then compressed into and against the walls of the root canals to seal them. Together with an adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria. When the infection is gone, the bone will heal (right) into the cavity it created during the infection.

Your tooth will then need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal to the top of the tooth. This step is particularly important.

Already root filled teeth with problems
The prognosis of a root canal treatment depends on how thoroughly the dentist does the treatment. If it is done very quickly, or without good infection control, it might feel right, but could develop problems later. It might get reinfected due to leakage. This is why we put so much effort in performing the treatment as thoroughly as possible.

Sometimes, even after being thorough, the tooth could become reinfected due to hidden canals or small fractures. It may be possible to redo the cleaning/filling procedure. The last option for a problematic tooth is to remove it. Then the infection always disappears.

At Snö we give you pain-free techniques. You will always get information regarding all available scientifically proven techniques, alternatives, risks and prognosis. You can always ask your Snö team any questions you have regarding your procedures.

Pulp (root) damage

The tooth and the pulp
If your dentist tells you there is an inflammation or an infection in a tooth, it means the pulp of the tooth has been damaged.

Signs of damage to the pulp can be:

Heightened sensitivity to heat or cold
Pain and swelling
Pain when chewing
Fistulas that drain pus into the mouth
In some cases, no symptoms at all

Let us take a closer look at a tooth to understand how the pulp can become damaged.

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Every tooth consists of a crown and a root. Teeth further back in the mouth often have two or three roots while teeth in the front normally have one root. The crown of the tooth is covered by a hard shell called enamel. Under the enamel is a softer substance called dentine. At the core of the tooth is a chamber extending into the root through a narrow canal. Inside this chamber is the pulp. Every root canal ends with an opening towards the surrounding bone.

The pulp consists of soft tissue connected to blood vessels and nerves. The blood vessels supply the tooth with nutrition and help with the defence against infections. The nerve in the pulp is part of a complicated network of nerves in the jaw and face. This nerve network ensures, amongst other functions, we can use the mouth for chewing.

A tooth will do best with a pulp that is alive, but if the pulp dies, the tooth can often be saved by the right treatment.

Reasons for pulp damage

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Leaky fillings: Old fillings (composite or amalgam) can develop gaps allowing food and bacteria to seep into and down and damage the pulp.

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Receding gums: The gum can occasionally recede and expose a part of the root of the tooth. The enamel that normally protects the tooth is not present here and the pulp can get damaged.

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Tooth grinding (bruxism): Many people grind their teeth during night without knowing it. This can also damage the pulp.

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Caries: Dental cavities are, probably, the most common reason for pulp damage. Caries irritates the pulp and causes swelling. Inflammation (pulpitis) is the body’s response to a trauma like a caries lesion. It makes the tissue more sensitive and swollen. However, since the pulp cannot expand as normal tissue, the pain is more often worsens. The tooth becomes sensitive to hot/cold. The closer the caries is to the pulp, the bigger the risk of the pulp dying. At this stage there is sometimes a possibility to treat the tooth without a root canal (root filling). We will then remove all or most of the caries, seal the cavity and wait, usually several months, before doing the final filling. The pulp can actually build new dentine beneath the caries. We always recommend this treatment when possible in order to do as little treatment as possible and to save as much pulp tissue as possible.

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Inflammation becomes bacterial infection.
If untreated the pulp eventually becomes infected with bacteria (osteitis) from the caries lesion. The sensitivity becomes reduced or totally absent. You might think the tooth does not need any treatment, but the truth is that the infection will not go away by itself, and antibiotics will not help. The reason the sensitivity has disappeared is that the nerves in the tooth are dead. If pain exists at this stage, it is because of the surrounding bone (usually tender on biting) swollenness, and fistulas that can drain pus in the mouth.

The only way to treat this tooth is with a root canal treatment or to remove the tooth.

Shooting pain can be a sign of damage to the pulp (inflammation).

If your dentist does not find an obvious reason for the pain, the tooth will be observed for a while.

Sometimes it can be helpful to apply a protective substance such as fluoride on the tooth. Certain toothpastes claim to plug the small canals on the root surface. While there are limited proven results, it is not harmful to try these products; for example, Sensodyne or Zendium.

If the symptoms are not severe and the dentist does not find anything during the examination, it is recommended to wait and check for any changes in the tooth’s condition. In certain instances, the reason will reveal itself later, but often this is just an irritation that will diminish over time. However, if the pain worsens, please contact your dentist.

A root canal treatment will eliminate the shooting pain but a modern approach is to keep the pulp alive as long as possible. If the pain becomes too severe, a root canal treatment is a sure way of saving the tooth.

Previously, one was forced to have an infected tooth taken out. Today, treatments to save the tooth are available. The appropriate treatment will depend on the extent of the damage. Modern root canal treatment is painless.

Root canal treatment (or not)

Toothaches can have many causes. You may experience pain even though the nerve of the tooth is gone (read more about pulp damage). But quite often the symptoms are obvious and a “root canal treatment” (root filling) is the best treatment. We gently remove the soft tissue inside the tooth (the pulp), clean it and seal it. Today this can be done completely pain-free. It is a common misconception that the best way to end toothaches is to remove the nerve. But without a nerve, the tooth loses its strength. At Snö, we believe it is always better to save the pulp, whenever possible.

There are basically four different scenarios depending how far the process has gone:

Pulp inflammation with chance for recovery
Pulp inflammation without chance for recovery
Pulp partially or fully infected with bacteria
Already root filled teeth with problems

Pulp inflammation with chance for recovery
If possible, we always begin by removing whatever causes trauma (eg caries) to the pulp. This is in order to save the pulp.

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Above a schematic example of a healthy tooth (left) and one with a caries lesion (right) filled with bacteria that irritates the pulp.

The tooth is typically very sensitive, especially to cold. The inflammation creates pressure inside the pulp chamber making the nerve even more sensitive. The quick fix is to remove the pulp and do a root filling, but we do not believe that this is always necessary. In many cases, when most of the caries is removed and, more importantly, the cavity is sealed with a tight temporary filling, the pulp relaxes and the inflammation disappears. After a while (usually two months), if the tooth looks and feels better, it is an indication that we managed to save the pulp tissue. This also saves you the cost and trouble of a root filling. However, in some cases the inflammation is too widespread, making a root canal treatment necessary.

Unfortunately, dentists cannot easily tell which tooth will heal and which will not. Hence, many dentists play it safe by administering root canals. At Snö, we do not believe this is right, which is why we recommend a thorough exam (Snö Exam) and we carefully monitor your progress.

Pulp inflammation without chance for recovery
When the symptoms are more severe and/or when we can diagnose an irreversibly damaged pulp, the two options are to remove the tooth, or try to save it with a root canal treatment. The latter is similar to the treatment for an infected tooth, but generally has a slightly better prognosis, and is sometimes faster.

Depending on the severity of your case, we will inform you of your prognosis and the alternatives.

Pulp partially or fully infected with bacteria
orthodontic-questions-icon - dental clinics, abu dhabi orthodontic-emergencies-icon - dental clinics, abu dhabi When bacteria gets into the pulp; eg, via a caries lesion, the infection spreads down through and out to the root canals, in close contact with the bone. Common symptoms at this stage are tenderness to touch and while chewing, discolouration of the tooth, swelling, pus drainage and tenderness in the lymph nodes, nearby bone and gum tissue. In some cases there may be no symptoms. To treat this, we remove the diseased and dead pulp tissue from the tooth with specially designed instruments.

This procedure is not painful as the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain. If there is an infection outside the root, it could cause some discomfort. But this will gradually dissipate. For particularly difficult cases we leave a special paste inside the tooth to fight bacterial build-up. But for most cases, we fill the tooth in the same session.

fixed-braces-icon - dental clinics, abu dhabi We then select root canal fillings (red above) that fit precisely into the freshly prepared canals. A rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape) that is heated and then compressed into and against the walls of the root canals to seal it. Together with an adhesive cement (called sealant), the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria. When the infection is gone, the bone will heal again (right), growing back into the cavity it created during the infection.

Your tooth will then need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal for the top of the tooth. This step is of particular importance.

Already root filled teeth with problems
The prognosis for a root canal treatment depends on how thoroughly the treatment is carried out. If done quickly, without proper infection control and precision, the tooth could become reinfected. At Snö, we have the tools and expertise to guarantee thorough root canal treatments.

However, some patients might have hidden canals or small fractures in the tooth/root leading to infections. In such cases, we can spot the problem and either do a cleaning/root filling procedure, or treat the root tip using microsurgery. The absolute last resort would be to remove the problematic tooth.

At Snö we prefer to give you pain-free options. You will always get all the information pertaining to your case, including all available scientifically proven techniques, alternatives, risks and prognoses. The Snö team is available to answer any questions you may have.

Tooth loss (Periodontitis)

Slow progress
Periodontitis is an inflammatory disease affecting the tissues that surround and support the teeth. Periodontitis is generally a slow progressing problem. Left untreated, it will eventually lead to tooth loss. Symptoms, such as swelling and pain, often only appear at the last stage of the disease.

Healthy or inflamed
The root of a healthy tooth is almost entirely submerged in the bone and is connected by microscopic fibres. The gum tissue around the tooth acts a protective barrier to the root and bone. Healthy gum tissue doesn’t bleed when brushed on a regular basis.

However, if a daily routine isn’t followed, a build-up of plaque/tartar occurs. The plaque causes an inflammation in the gum tissue. An inflamed gum turns dark red, swells, bleeds easily and becomes sore. It also fails to properly protect the root and bone.

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The connection between the tooth and the body is a complex one. The tissues involved are constantly being attacked by bacteria. A normal pocket is measured by the dentist or hygienist to around 3-4mm.

Plaque
Plaque is a thin sticky layer consisting of bacteria and food debris. There is an almost constant supply of food and bacteria in the mouth. If not removed, the plaque can mineralise and create an inflammation in the gum. Mineralised plaque is called calculus.

The gingival crevice or gum pocket in a healthy individual is between 1-3mm. However, if plaque is left on the tooth, it will eventually spread down to the gum pocket. When it becomes calculus, it will show on an x-ray.

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Calculus (in this case on the back of the lower front teeth) cannot be brushed away. A dentist or hygienist has to remove it.

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Calculus/plaque left in the pocket is visible on an x-ray if left to accumulate over longer periods of time.

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A thorough charting of a patient’s periodontal status as it is always done at Snö. Regular charting is essential to monitor the development of a patient’s condition, both for treatment purposes and prophylaxis. Your dentist will provide you with this information if you move or change dentists.

A vicious circle
Bacteria thrive in calculus. Bacterial waste breaks down the tissue and bone. Gradually, the gum pockets deepen. As a result, calculus and plaque can spread deeper, making it even more difficult to remove. This, in turn, leads to further bone loss, which eventually results in loose teeth. There is also increased swelling in the gums and causing pain and discomfort. Eventually, the body will treat the affected tooth as a foreign body and reject it, leading to tooth loss.

Don’t go untreated
Bad oral hygiene, calculus, smoking, stress, age, and certain diseases are all factors that can worsen periodontitis.

Scientific studies show that a majority of people over 50 suffer from some degree of periodontitis while nearly 15 percent of this age group have severe periodontitis. In cases of people above the age of 65, 13 percent of people are left with no teeth.

If periodontitis is diagnosed and treated at an early stage, there is a very good chance of full recovery. Modern dentistry always keeps an eye out for signs of periodontitis.

Stages of periodontitis, beginning to the end…
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The gum is inflamed, bleeds a little and hurts occasionally. Bone level is unchanged. With regular cleaning and scaling of the teeth, the inflammation disappears after a couple of weeks. If the routine is not kept then the inflammation will soon return.

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The pockets have deepened and bone loss is evident. Tooth mobility increases. Calculus builds up in the deeper pocket due to poor ability to clean in pockets. Regular treatments, as well as cleaning, is essential if the tooth is to be saved. Good oral hygiene is very important.

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The tooth is now very loose an the patient will sense this in the mouth. There is an increased risk of local infections with or without fistula involvement. Prognosis is now very poor and treatment will now include surgery. In more severe cases tooth removal may be the best solution.

Prophylaxis is the foundation
During your Snö dental exam, we will measure the pocket depths. We will also occasionally take x-rays of all the teeth along with a visual inspection. Both methods help detect signs of gum disease. Together, it gives your dentist an accurate status of your gums’ condition, along with other signs like mucosa.

Treatment of periodontitis, if detected early, consists of cleaning and scaling on a regularly basis, either by a dentist or a hygienist. You will also receive oral hygiene instructions.

At Snö we use Guided Biofilm Therphy (PERIO-FLOW^®) a powerful, yet controlled jet of water, air and fine powder that not only polishes all the surfaces of a tooth, removing plaque, discolouration and soft deposits, but also reaches deep into periodontal pockets (if you have any) up to a depth of 5mm. It is far more efficient than a traditional scrape-and-polish treatment at removing the damaging biofilm that develops when dental plaque is colonised by bacteria, and can cause periodontitis and peri-implantitis. Air flow polishing is completely safe to use with dental implants, veneers, crowns and bridges.

Studies have shown that air polishing is much faster at removing stains and plaque than traditional methods. This means less time in the chair for the patient and, therefore, fewer interruptions. Teeth are cleaned in a much less abrasive manner than scraping and polishing which also causes less damage to the teeth. And its much more comfortable for the patient. Sometimes we also complement this with laser treatment – all included in the normal treatment.

For more advanced stages of periodontitis there are a variety of treatments available depending on the severity. Occasionally, your dentist might recommend using a local anaesthetic to make the treatment more comfortable.

Scientific studies have linked oral infections like periodontitis to heart attacks and strokes. Pregnant women with periodontitis have a greater risk of giving birth to premature babies.

It is not evident why or how strongly periodontitis affects other parts of the body. However, it is always important to treat an oral infection with or without symptoms, especially when treatment is readily available in modern dentistry.

If you have any questions relating to your gums, don’t hesitate to ask any member of the dental team at Snö Dental Clinic.

Warning signs

Gums bleed easily and may feel tender
The tooth feels loose
Gums between teeth change appearance
Bad breath/halitosis
Swollen gums with pus
Occasionally no symptoms

Provide good care for your body

No smoking
Good oral hygiene – even between the teeth
Regular visits to the dentist/hygienist

Caries

The environment present in the mouth, referred to as the oral environment, is tough. Teeth are exposed to strenuous activity every day but are built to resist them. The most common reason for damage to a healthy tooth is caries. So, what is caries?

Caries is caused by a chemical reaction. If you feed bacteria with carbohydrates, they will begin producing acids. In order to maintain a neutral pH in the oral environment, calcium is “borrowed” or released from the teeth, resulting in a local decalcifying of the tooth and caries is formed.

The mouth does have defence mechanisms against this chemical reaction. One of them is saliva, which flushes away acid and bacteria. Saliva also contains substances which can repair small cavities in a tooth.

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A tooth consists of a very durable layer of enamel. Below the enamel is the softer dentine and in the center of the tooth is the pulp tissue.

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When a caries lesion reaches the pulp, the tissue deteriorates and dies (necrosis), causing bacteria to continue through the root canal system. Often, but not always, this is associated with pain.

It is difficult for the acid to “dissolve” the enamel. But once a cavity is created, the process accelerates. The acid corrodes the dentine, which is softer than the enamel. If the caries reaches the pulp tissue, it deteriorates and dies, and bacteria can continue through the root canal system.

Young teeth are softer
In younger teeth, the enamel is softer, but over time substances are stored in the enamel making it stronger. That is why most caries occurs before the age of 20 years. However, in older age, the saliva production can decrease, which in turn increases the risk of caries. Fluoride (as in toothpaste) is the main reason that kids nowadays have fewer cases of caries. Fluoride strengthens the enamel and can help “heal” small lesions.

Oral hygiene is important to fight caries but diet is more important
If you do not clean your teeth twice a day, bacteria and food debris will form a layer on the surface of the teeth, called plaque. Plaque is not always visible. If you also eat a sugar-rich diet, especially over several meals a day, the plaque will become extra sticky and acidic, increasing the risk of caries formation.

The acid attack starts when you eat
The acid attack begins the moment you start eating. All carbohydrates contribute to acid formation. It is not so much what you eat but how often. Many small meals, over the day, do not give the mouth the chance to neutralise the oral environment and increases the risk of caries.

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Caries builds in areas where bacteria (and plaque) can accumulate, like in the deep grooves of the chewing surfaces, between the teeth or near the gum line. The joint between old fillings or crowns is also a weak point.

Occasionally, caries is clearly visible like in these pictures, but often an x-ray is required.

The Snö dental team is trained to discover if you are a high or low-risk caries patient. We will work together with you to prevent caries from building further. If caries occurs, the treatment approach today is a lot less invasive and focuses on preserving tooth substance.

Caries detection without X-ray
At Snö, we have invested in DiagnoCam, a technique that can be used to find and follow caries without the need for many x-rays. A laser light and a specially designed camera can see through the tooth and detect specific types of caries.

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A photograph from DiagnoCam where we can spot the caries cavity without an x-ray.

Worth thinking about (also good for other risks like periodontitis and bad breath)

Brush your teeth twice a day with fluoride toothpaste.
Clean the space between the teeth every day. You only need to clean between the teeth you want to keep:).
Rinse your mouth after meals with water. This reduces the acid attack.
No eating in-between meals (one or two intakes is normally acceptable between meals; note that it is not the amount you eat, but the frequency). No matter how good you are at cleaning, many small meals will increase the risk of caries.
Extra fluoride treatment should be used, but only when we recommend it. We will top it up by local, topical treatment when necessary. Fluoride will be layered in the enamel, thereby strengthening it.
Visit the dentist and hygienist regularly (depending on your risk assessment between 3-18 months). Listen to our recommendations. We are specialised in helping you keeping tour teeth healthy for the rest of your life. Remember that our goal is to drill as little as possible, and not to do root fillings and large restorations. The goal is to keep you caries free all your life. The best treatment is the one we never need to do.

Missing teeth

As we go through life, we risk losing teeth to caries, fractures or gum disease.

Caries
Tooth decay is treated with traditional fillings or crowns. However, if a patient has waited too long before visiting a dentist, the decay could be severe resulting in the need to extract the tooth.

Fractures
Accidents could lead to loss of teeth. While healthy teeth may be affected, teeth that are already filled or treated are most likely to be knocked out.

Gum disease (periodontitis)
Periodontitis is a slow progressing condition that can go undetected for a long time by the patient. Today, dentists are very skilled at diagnosing periodontitis in time. As it affects a great part of the population, there are many patients with untreated gum disease that will eventually lead to loss of teeth.

Several alternatives
Dentists today have many options and a lot of experience choosing the appropriate treatment to replace lost teeth. The most common treatments are implants or a bridge. In some cases a removable appliance is chosen, like a denture.

The bridge treatment requires the neighbouring teeth to be filed down. This is to allow the bridge to fit correctly. In order for the bridge to be a success, the neighbouring teeth must be solid. If they are loose or filled/repaired, the long term prognosis is not optimal. At the same time, if the neighbouring teeth are perfect, it would be a shame to file them down. If a patient is missing more teeth in a row, it can also be difficult to make an adequate bridge as the span is simply too long. Before implants were available, the only alternative was to have a partial denture made. Dentures take some getting used to as many complain it is loose in the mouth, covers the taste buds, makes chewing difficult, doesn’t look good, etc.

It is not often we do these kind of removable dentures any longer thanks to implants.

Today we can offer dental implants
In the 80s, a Swedish dentist from Gothenburg, Per Ingvar Brånemark (Nobel Biocare is still the world’s leading brand, and used by Snö) pioneered the idea of dental implants. He realised that the metal titanium is not rejected by the body, but is easily accepted as a natural part of the body. This means the titanium implant will integrate with the bone it is put in. This is called osseointegration. There are numerous people around the world with ‘new’ teeth using this method.

The bone quality is paramount
The number of implants the dentist will fit depends on the bone quality and the available bone. In a completely edentulous (lacking teeth) jaw, six implants are sufficient. On these six implants it is possible to place 12 new porcelain teeth. One implant can also used to replace one tooth. The possibilities are many.

When you lose a tooth, the bone in that cavity usually resorbs. This is because without teeth there is nothing to stimulate the bone. When you chew, the pressure stimulates the tooth and subsequently the bone. When an implant is placed we can avoid the resorption of bone. But if one waits too long before inserting an implant, there might not be enough bone left.

In cases where a lot of bone has been lost it is possible to transplant bone from another part of the body. This may seem like a lot to overcome, but when the alternative is a denture, it is worth it.

What is the prognosis?
The success rate for implants is very good. A long term study shows that more than 90 per cent of implants placed work very well. Regular visits to your dentist and hygienist will help ensure that your implants continue to work well. With time, the teeth on the implants will wear just like normal teeth and may require replacing. But in most cases, the implant will not need to be changed. If you lose an implant, it is possible to have a new one put in after a healing period.

At Snö we have a long quarantee on implant treatments, no matter what happens. Read more about implant treatments here.

Bad breath – Halitosis

We can all suffer from bad breath, or halitosis, from time to time and the reason for it varies from person to person. A common view is that bad breath stems from the stomach (digestive processes), which is rarely the case. Most often it originates from the mouth (oral cavity). People with bad breath are seldom aware of the fact that they have bad breath. When it comes from the mouth, your Snö dentist will be able to diagnose the problem and treat it.

At Snö we can quickly measure if you have bad breath or not

How do I know if I have halitosis?
A common test is to breathe into the palm of your hand. Although common, this is not a very reliable test, as people get used to their own odours. Only occasionally will you be able to detect a difference with this test. A better method is to use a piece a dental floss between your teeth at the back of the mouth. If the floss smells it would be a similar odour as your breath. Alternatively, you can lick your arm, leave the saliva to dry and then do a smell test. You can also ask your friends and colleagues to honestly tell you if you have bad breath.

What causes halitosis?
Eating foods like garlic can cause bad breath. The digested food eventually gets absorbed by the lungs and the gas molecules get released while breathing.

The most common “bad breath chemicals” produced by normal bacteria in the oral environment are volatile sulfur compounds (VSC — hydrogen sulphide, methyl mercaptan, dimethyl sulphide). Snö Dental Clinics use equipment that can measure this directly from your breath in a matter of seconds.

The mouth is always full of bacteria – this is normal. They serve an important purpose, especially in digesting food. When you eat food, debris gets stuck to your teeth and the surrounding gums. Together with bacteria, this build-up is called plaque. Left undisturbed, plaque will develop a foul odour comparable to rotten eggs. As mentioned earlier, you may not notice this yourself as you get used to your own odours. The Snö team will inform you if you have plaque causing halitosis and help you remove it.

If plaque is not treated, you will not only suffer from bad breath but also gum disease, with potential loosening of your teeth. This means that bad breath can also be linked to gum disease. The same bacteria causing bad breath also breaks down the supporting tissue and bone around teeth. With regular check-ups, the dentist will be able to detect and prevent this from happening.

If you suffer from dry mouth (xerostomia) you can easily get bad breath. While saliva helps in ‘washing’ away bacteria and food debris, it also helps prevent plaque build-up. So, the less saliva the more bacteria (as in the case with dry mouth), hence greater potential for bad breath. The causes for xerostomia can be illness, medicine use or even simply breathing primarily through the mouth instead of the nose. If you think you have xerostomia, visit your dentist.

Smoking will always give you bad breath. It will also discolour your teeth, reduce the sensitivity of your taste buds and irritate the soft tissues. Smoking will also increase the risk of gum disease (periodontitis), as well as developing cancer. Your dentist will always monitor any smoking-related illness.

Different diseases relating to the airways can also cause bad breath. As will diabetes and stomach problems. If your dentist does not see any tooth-related issues, they may refer you to a doctor for further exams.

You should look after your oral hygiene!
Good oral hygiene is mandatory to avoid odours. This becomes even more important when there is gum disease.

If you believe you have had bad breath over a long period, it can be a helpful for your dentist to write down what you eat during the week. Always inform your dentist about any medication you might be taking or if you have received or are receiving treatment by doctors. Regular visits at Snö includes cleaning with Guided Biofilm Therapy (PERIO-FLOW^®) a powerful, yet controlled jet of water, air and fine powder that not only polishes all the surfaces of a tooth, removing plaque, discolouration, and soft deposits, but also reaches deep into periodontal pockets up to a depth of 5mm.

Brush your teeth twice daily using fluoridated toothpaste. Bad breath can rise from the back of the tongue, so brushing the tongue can also help prevent bad breath. We have special tongue cleaners to use at home if the problem doesn’t go away. Use dental floss or inter-dental brushes at least once a day, ideally at nighttime. If you wear dentures, make sure to take them out at night (unless instructed otherwise).

Mouthwash has little to no effect on bad breath. They can even have a worsening effect if used improperly. There are, however, certain cases where we temporarily prescribe mouthwashes. Your dentist will give you instructions on proper brushing technique, and recommendations on toothbrushes. Instructions in the correct use of mouthwash (and the right one) can help kill bad breath-causing bacteria. You may also be instructed to chew sugar-free gum, especially if you suffer from dry mouth. The chewing will stimulate saliva production even more if the gum has a sour flavour.

Together with your dentist, we will come up with the ideal defence against halitosis.

Tooth colour

Not all teeth are white
The colour of your teeth varies. Not everyone has white teeth. In fact, many people have shades of yellow.

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The enamel protects the tooth. Underneath is the darker dentine. The reddish core consists of pulp tissue, nerves and blood vessels.

Enamel is lighter
The enamel is usually the whitest part of the tooth. It is actually a transparent substance. The dentine below it is more yellow and not as transparent as enamel. As a result, the colour of the dentine reflects through the enamel, giving the tooth a yellowish tinge. The more yellow the dentine, the more colour the tooth has, and vice-versa. This is the natural appearance of the tooth.

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When light reaches a tooth, it is reflected through the transparent enamel. The underlying dentine gives the tooth its colour. If the dentine is lighter the tooth will appear lighter and whiter.

Can you paint the teeth white?
Painting a layer of white on a tooth would make it appear unnatural due to the loss of the enamel’s natural transparency.

The colour of our teeth changes over time. Even though the enamel is hard, there are microscopic cracks that allow substances to enter the tooth. Sometimes, the gum recedes and exposes the root surface that consists of dentine and cement. This makes the tooth appear more yellow, especially in the part closer to the gum line.

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The natural colour of a tooth is created by a reflection of light travelling through the transparent enamel. The colour of the tooth is a combination of its different layers, including the dentine. If a dentist painted one tooth white it would appear white, but completely unnatural.

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At the gum line there is no enamel. If the gum recedes, the more yellow dentine becomes visible.

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Crowns made of an opaque inner core (as above to the left with gold below the ceramic material) often get a dark halo around the border towards the gum (arrows). This I because the light that should pass through the tooth and reflect doesn’t get through and hence makes the area appear darker. To the right the metal ceramic crown has been changed to a full ceramic crown with a more translucent core that reflect the light more natural (arrows).

Mimicking a natural look
A repair or replacement of a damaged tooth must mimic the layers of enamel and dentine. Certain materials like ceramics are better at mimicking a natural tooth.

Alternatives
Today, bleaching procedures help rectify yellow and discoloured teeth. Your dentist will be able to guide you on what is possible and best for your dental health.

Wisdom teeth

Archaeological findings have proven that our ancestors used to have bigger and more powerful jaws. With time, these gradually became smaller, similar to our jaws presently, appears we are developing smaller jaws, most likely due to the shift in our way of living and eating. While we now have smaller jaws and less space for teeth to grow, the size and number of teeth forming have not changed. Wisdom teeth are the last to erupt and often will not have the space needed.

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Side view: Occasionally, wisdom teeth are completely buried in the bone. In that case it is sufficient to observe the situation on a regular basis (left). Upper wisdom tooth (right) has fully erupted while the lower one hasn’t. Because there is no opposing tooth, we can expect the top tooth to over erupt. This can lead to other problems.

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Close up of partly erupted wisdom tooth in lower jaw.

This can give the patient intermittent pain, often without additional symptoms. However, it is difficult to maintain good oral health in the region. Even if the patient doesn’t experience pain, the bacteria has easy access to the crown of the tooth. Lodged food debris can lead to inflamed and swollen gums, in the area. Antibiotics or painkillers can provide relief to acute symptoms, but cannot resolve the underlying cause.

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X-rays are vital in detecting problems with wisdom teeth. In this case the patient waited too long to get a check up and there is a caries attack on the neighbouring tooth.

At Snö we have the latest low radiation 3D x-ray (cone beam) to identify and examine impacted teeth. With today’s dental techniques and anaesthetic drugs available, it is possible to remove wisdom teeth in a painless manner. Left in for too long there is an increased risk of caries and bone loss.

Things to consider
The area around the wisdom tooth is often difficult to keep clean. This can lead to gum problems caused by the increased amount of plaque and bacteria build-up. Pockets will develop and the risk of infections around the wisdom tooth increases. If bone loss occurs, it is important to have the tooth extracted.

The risk is minimal if the tooth is completely buried in the bone. It only requires regular observation using x-rays. Occasionally, a cyst could develop around the buried tooth. If the cyst grows too big, thus affecting the bone negatively, it must be removed.

Generally speaking, it is a good idea to remove wisdom teeth early, especially those that potentially can lead to problems later on. If a dentist is in doubt whether to extract or not it is imperative to keep it under close observation.

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Crowding of the front lower teeth is common with age (left). Many people (and dentists) believe this is caused by wisdom teeth that push the other teeth forward. This is untrue, and we have scientific evidence that removing wisom teeth in such circumstances is unnecessary. A removable orthodontic appliance (Inman Aligner) placed by Dr Gun, has helped this patient regain a corrected, natural smile (right).

The Snö dental team has comprehensive knowledge dealing with problematic wisdom teeth and is adept at fixing any complication related to them. Feel free to contact your dentist if you have any additional questions.

Teeth clenching

Bruxism (BRUK-siz-um) is a condition that involves grinding and forcing teeth together during the day or night. It affects many people, and while some people are aware of the damaging effects, many remain in the dark about the kind of damage this may cause to teeth.

Excessive grinding can lead to the following unpleasant side effects:

Pain in the back, spine, head, ears and muscles
Soreness in the teeth and jaw joints
Decreased ability to open or close the mouth and/or a locked jaw
Gum retraction leading to an exposed root surface of the teeth
Increased wear and sensitivity of the dentition hence greater risk for broken fillings, which could eventually lead to bone loss around the teeth

While signs of overload from bruxism are often significant and obvious, most symptoms cannot be seen by patients. Our dentists are trained to spot the early signs of bruxism and can support their findings by performing some simple muscle and ligament tests.

It is unclear why people grind their teeth. The masticatory system, including the mouth and jaws, is a complicated system that is influenced by several external and internal factors. Some trigger factors could be a poorly adjusted bite, loss of teeth leading to an imperfect bite, or damaged jaw joints. The CNS (Central Nervous System) that coordinates the masticatory system could be affected by stress or other diseases in the body, which could also be a trigger for bruxism.

Dental wear can collapse your entire bite, often without you noticing before its gone to far.

Types of Bruxism
There are two main types of bruxism: One that occurs during the day while the patient is awake, also known as awake bruxism; and one that occurs while one is asleep and unaware, or sleep bruxism. In some cases, bruxism persists throughout the day.

Abnormal Teeth Positions
The abrasive surfaces of the teeth are often in positions unrecognisable to the patient. This is likely to be a sign of grinding, especially at night, when patients are more likely to be unaware of the problem.

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This patient (23 years old) thinks this is the normal relation between the upper and lower jaw.

When the dentist slowly help the patient to guide the lower jaw forward it feels unfamiliar to the patient.

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When moving the lower jaw the dentist finds 6 “natural” slides where the upper and lower jaw “fits” to each other. This is a very common finding although the patients is not aware of the excessive wear on the teeth. We call this kind of wear attrition. Another kind of common problem that can worsen the wear is called Erosion and usually comes from digesting carbonated beverages, citrus fruits, tart candy, or stomach acid (bulimia; gastric reflux). The case on the top is such a case with chemical wear.

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Another patient with exposed cervical part of a tooth (tooth neck). The gum has receded due to overload. The root surface is darker/yellow and consists of dentine but no protecting enamel.

Long term damage to teeth
Every tooth consists of a tough layer of enamel on the outside. Underneath the enamel, there is a softer layer of dentine. When teeth grind against each other the enamel wears off, eventually leaving the dentine exposed. This speeds up damage to teeth as the softer dentine wears out much quicker than enamel. Since the enamel erosion is gradual, patients often do not register any problems until the teeth get much worse.

With time, the bite height decreases due to the gradual shortening of the teeth. This makes re-establishing a normal bite more challenging for dentists. This is why it is important to have regular check-ups to ensure good dental health.

Subsequent tension in the facial region can lead to other painful conditions such as chronic headaches and aches in the neck and shoulders. Some also believe it can lead to migraines.

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Front teeth side aspect. The lower front teeth slide on the backside of the upper front teeth. Over time the enamel is abraded and eventually missing, exposing the softer underlying dentine. The picture to the right shows an advanced stage with reduced height of the teeth causing possible problems for the TMJ (the jaw joints), muscles and ligaments.

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This patient (34 years old) has never had any symptoms, but has recently become aware of shorter front teeth. The cause is probably a combination of Bruxism (grinding) and Erosion (chemical wear) On the picture to the right is the same patient after treatment with bonded minimal invasive ceramics. It would have been much cheaper to treat and protect the teeth 10 years ago when it probably started.

The etiology is often unknown
We don’t know for sure why people grind their teeth. The face, masticatory system and the mouth is a complicated system which is affected by several factors. Trigger factors could be a poorly adjusted bite, loss of teeth leading to disharmony in the occlusion or damaged jaw joints. The CNS (Central Nervous System) which coordinates the masticatory system could be affected by stress or other diseases in the body.

Treatment
There is no cure for bruxism and treatments are mostly preventive in nature. Often, a night guard is prescribed to protect a patient’s teeth from further wear. Along with a night guard, the dentist will work with the patient to resolve the triggering factors and prevent further damage.

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A night guard has two functions. It protects the teeth from wear and it usually makes you grind less or not at all. Many patients sleep much better and cant be without it when sleeping. Others only use it when they get symptoms from the muscles, ligament and jaw joints (TMJ problem).

Calculus

One of the causes of bad breath is the prolonged build-up of tartar. It can also lead to inflammation of the gums, which can make teeth loose (called periodontitis). Some people are more susceptible to tartar than others. Your dentist will guide you regarding this matter and determine how often you will need to get your teeth cleaned.

Tartar usually builds up above the gum line – supragingival. This is much easier to remove and can usually be done over a single visit to your dentist. Some patients might require more than one visit, depending on the amount of tartar found. Tartar can also build up under the gum line – subgingival. Routine x-rays will pick this up and your dentist will recommend an appropriate treatment.

Treatment
Using a probe, your dentist will assess the root surfaces of your teeth for irregularities and how tightly the gum adheres. The most common way to remove tartar a treatment called depuration. It involves scraping off the tartar with a specialised tool.

A newer, often more effective and gentler treatment that we provide at Snö is the Guided Biofilm Therapy (PERIO-FLOW^®). It is a powerful, yet controlled, jet of water, air and fine powder that not only polishes all the surfaces of a tooth, removing plaque, discolouration and soft deposits, but also reaches deep into periodontal pockets up to a depth of 5mm. It is far more efficient than the traditional scrape-and-polish treatment at removing the damaging biofilm that develops when dental plaque is colonised by bacteria causing periodontitis and peri-implantitis. Even deeper, sub-gingival air polishing can be carried out using a PERIO-FLOW^® extension nozzle. The air flow polishing procedure is completely safe to use with dental implants, veneers, crowns and bridges.

Studies have shown that air polishing is much faster at removing stains and plaque than traditional methods. This means less time in the chair for you and fewer interruptions. Teeth are cleaned in a much less abrasive manner, which results in less damage to your teeth. This can also be complemented with laser treatment. When needed, all this is included in the normal treatment at no extra cost

For more advanced stages of periodontitis there are a variety of treatments available, depending on the severity.

If your teeth are particularly sensitive, your dentist might use a local anaesthetic.

After treatment
Most patients will have sore gums after depuration. The teeth might also become more sensitive to cold for a few days. This is due to the removal of the calculus and cleaning of the wound from the inflammation.

It is important to follow our instructions for good oral hygiene. This will ensure you have healthy gums after the treatment, especially since healing under the gums often takes months. When the gum is healthy, future cleanings become much less painful. If a patient has deep gum pockets before the treatment, it is likely the sensitivity will carry on for longer. In such cases, your dentist will recommend fluoride treatment to help protect the exposed root surfaces.

In cases where patients have deep gum pockets, the dentist will monitor the condition and suggest appropriate treatments. Remember to brush your teeth thoroughly and floss between the teeth.

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During a routine check-up, the dentist or hygienist diagnoses the calculus and possible inflammation and bone loss (from the back of the lower front teeth). The other picture shows the work of removing plaque almost complete (the arrows show where a final PERIO-FLOW^®air polishing, as explained above, will finalize the treatment).

The signs are the same as with periodontitis

Warning signs

Gums bleed easily and may feel tender
The tooth feels loose
Gums between teeth change appearance
Bad breath (halitosis)
Swollen gums with pus
Occasionally no symptoms

Things to remember

No smoking
Good oral hygiene – even between the teeth
Regular visits to the dentist/hygienist

If you have any questions related to your teeth, gums or health, do not hesitate to ask any member of the dental team at Snö Dental Clinic.

Bleeding gums

Tough environment in your mouth
Your mouth’s environment is varied and tough. It plays host to many microscopic living organisms – namely bacteria. These bacteria can be neutral, helpful or harmful. For instance, out of the oral environment and in the bloodstream, the same bacteria can be very harmful.

The inside of your body is closer than you might think
Our teeth are attached to the surrounding bone via small flexible rubberlike fibres called the periodontal ligament (PDL). The fibres function as shock absorbers and reduce the risk of the bite force damaging the teeth. To protect this ligament, the body has a special barrier that we call the gums.

A front tooth, side aspect. The gums surround the tooth and protect it from bacterial invasions.

The gums are a part of our defense system
The gum surrounding the tooth contains a 1-3mm deep pocket. If you probe into the pocket, you can feel the bone (please don’t try this-at home; it is painful!). In and around this pocket, millions of bacteria gather. To protect the body against the bacteria and bacterial debris bombarding it 24/7, the gum contains many blood vessels, supplying the area with defence cells.

Balance or unbalance
When your gums are fresh, there is a balance between the attacking bacteria and the body’s defence. However, if an unbalance occurs (for instance, if your oral hygiene is compromised) the bacteria could attack and affect the gums, causing damage. Your body will attempt to heal the damaged gums. Defence mechanisms are activated through the blood stream. The body rapidly creates new blood vessels in order to transport more defence cells to the area. These blood vessels are fragile. You will not notice the increased blood supply initially, but flossing could lead to bleeding due to the fragile blood vessels rupturing. When you see blood on the dental floss, you might think you have done something wrong and may stop. However, you should continue flossing as the body needs help removing the bacteria. Occasionally, cleaning may fail and bacteria will enter the blood stream. In a healthy body this is not a problem but if your immune system is compromised, for any reason, the consequences can be severe.

Restorations will be affected
All the filling materials we use are sensitive to liquid. In an inflamed environment, with gums prone to bleeding, it is difficult to create the dryness needed for predictable results.

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Gums bleeding (left) during flossing is a sign of inflammation, most probably caused by bacterial infection. Healthy gums rarely bleed when flossed (right).

What you can do before you visit your dentist
Our dentists strongly recommend brushing and flossing twice daily. You may experience soreness and slight bleeding for the first couple of days, especially if you have never flossed before. You may miss up to 25 percent of the bacteria if you do not floss. This will affect your breath negatively too. In the beginning, flossing will take some getting used to, but it will quickly become a natural part of your daily routine.

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The patient was not aware of the inflammation between the teeth. When the amalgams (top) were removed, the gums showed up inflamed and bleeding (middle). After replacing the old amalgam with ceramic onlays, the gum is healthy again.

A chronic bleeding gum can be one of the most common mouth diseases (periodontitis) that could lead to loss of teeth.