Phil's Take on Dentistry

There are two dental diseases: decay and gum disease.

I had the disease of decay when I was a kid. All children did before we added fluoride to the water supply. By this I mean I got more separate bits of decay per year than you can get by chance. We don’t see this form of decay any more but there are still some people who have a problem with decay. Brushing or filling teeth does not treat the imbalance that causes the problem.

Gum disease starts in your twenties. It rapidly, and in a characteristic pattern, destroys what holds your teeth in. Those of us who do not get the disease have to not smoke and get our teeth cleaned by a dentist reasonably regularly to ensure that we die before our teeth get loose. The poor folk who get periodontal disease need to go to a Periodontist and have a whole cascade of treatment to ensure they get to fifty with some teeth.
 

Be assured. I don’t miss disease. I treat appropriately and refer appropriately. This is the most important thing that a general dentist does for his patients.
 

Implants

I have restored over two hundred implants. It is a field that is costly. It is not always possible to provide the perfect looking restoration but as yet I have not done one that the patient has been unhappy with. With approximately twenty per cent of the cases that I have done I can tell that the “gum draping the crown on the implant” is not an exact match for the tooth next to it.

Often to get it to match exactly would cost thousands more in grafts of gum and bone. The dental implant specialists often do too much treatment to try to get the last little bit of aesthetics. A general practitioner with some experience and one who does not have “white tooth disease” can usually provide implant treatment as well as the specialists without going over board.

                               

 Here is a typical case where a tooth has been lost in the back of the mouth(No 1). I place an implant with "a lid." Costs can be around 2500 dollars to this stage. After waiting three months I place a connector/abutment(No 3) and finally a crown(No 4). My fees for something like this is about 4500 dollars all going well. I know anyone reading this will jump at the "all going well" bit but complications can arise.

Most of the time people want a temporary tooth especially at the front of the mouth. This can add to costs and the tempories are often cheap and NASTY.

I refer quite a few of the implant placements. I only do the easy ones which means that if I refer to a specialist the costs are going to increase.

 

 

 

 

 

Root Fillings

Do lots of these. They have a bad name. A tooth starts to hurt like hell. but once we start. it is rare that you get much more pain...except to the pocket!

Cosmetic Dentistry

This is not a specialist area of dentistry at all. I get several patients every year that ask for and get the Hollywood smile. I use skilled technicians and do the work slowly and carefully.

 

Gum Disease

 

           

 

Need a bit more size here as we are dealing with the most important thing in dentistry. Diagnosis. This bloke is twenty nine years old and has rampaging periodontal(gum) disease. He needs a periodontist quick. He was completely unaware that he had a problem. His brother and sister had the disease and were also ignorant of the problem.

You are "wired" up to get gum disease. You have two legs because of your genes and you get gum disease because of your genes. Those people who get it require a whole cascade of treatment so they can get to fifty with teeth. Those of us who escape the condition as long as we don't smoke and get our teeth cleaned regularly by a dentist we die before our teeth become loose.

 

Extractions

 

These I call the "red rose of dentistry". It is never something that you can look forward to, but it is something that can be done well. Unfortunately in recent years(last fifteen) the student dentists have not been shown or allowed to do any minor oral surgery. This means simple extractions are being referred to Oral Surgeons. I love the intellectual challenge of taking teeth out. That's right. To take teeth out requires brains, experience and skill.

The most important factor is how hard the bone is compared to how hard the teeth are. Hard bone means we often have to bring out the "heavy artillery." This adds to cost and post operative pain.

Bleeding is never an issue. I only worry about bleeding I can hear!!!!!! There are a few major complications,different on the top jaw than the bottom jaw, but they rarely cause much post operative pain.

 

Ouch!  This Costs a Fortune

 

Here is the behind the scenes look at implant treatment. This sort of work is expensive and most people are not aware of the complexity and attention to detail that is required to produce this sort of work consistently. I am lucky as I deal with fellow professionals (Dental Technicians) that have the magical ability in their fingertips to take pieces of additional silicone and produce works of art. I always include my technicians early in the planning process and so there are no nasty surprises.

 

Here is the finished work as my lab sends it to me.

 

 

 

It isn’t a Hollywood set of four perfect teeth (a bridge). Hollywood teeth are easy to produce as idealized, perfectly regular, completely opaque, white teeth are child’s play to a superior technician.  This guy has real teeth and we will provide him with a bridge that will harmonize with the rest of his mouth.

 

Let’s go back and see what is under this piece of dental work.

 

The bridge is attached to abutments by two Braden screws.

 

Figure 1 Screw Driver

 

 

Figure 2 Braden Screws

These are too small to photograph

 

Bloody hard to get the driver into the holes. Patient’s tongues get in my way.

 

 

Now we have the bridge off the “abutments.” The abutments are the things that join the teeth to the implants. These abutments have holes drilled in them to allow the Braden screws to bolt the bridge to the abutments. Below I have unscrewed one of the abutments from the implant analogue to show both the hole in the abutment that allows the Braden screw to fix the bridge to the abutment and the way the abutments is screwed into the actual implant.

 

We use the word analogue here as we are screwing into not an implant but a replica of the implant i.e. an analogue.

 

Figure 3 Abutment

 

This is all work on the smallest scale. The porcelain is joined to a metal frame. The metal frame is cast. It is made out of wax first. The wax is surrounded by a plaster looking material called investment. The wax is then melted out leaving an empty space into which molten metal is poured. Think for a minute. When metal cools it contracts, therefore changing the shape, and so the metal frame should NOT fit. It does though. I know why it does, but I do not have the ability to cast these sorts of things. I deal with artists and master tradesmen. By this stage no one will be still reading so I will let you into a secret. Dentistry is low- quality wet carpentry.

 

Below I have removed the “artificial gum” that my lab has made so we can see the implant analogue and the abutment.

 

 

Figure 4 Abutment and implant analogue

 

So what we have is three things: implant, abutment and bridge. Cost is over seven thousand dollars for the implant placement (those things that are inserted into your bone) and the making and insertion of the bridge. Well not quite seven thousand in this case as we were able to do a few things a bit cheaper than I initially thought.

 

That’s right, as we went on the cost went down. I wish it always did.