Holbrook Dental Practice, 1 Howard Street, Fishergate, Fulford Road, York YO10 4BQ

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FAQs

Frequently Asked Questions

Useful info

Basically, the crown needs to be cemented back in place (if viable) as soon as possible. We recommend you contact the practice immediately to obtain further advice and an appointment. When a crown is loose or comes out, several things may take place all to the detriment of the tooth, so the sooner the status quo is re-established the better. Some of the things that may happen are:

  • Teeth on either side or opposing the crown may move making it difficult or impossible to re-seat the crown
  • The tooth may be sensitive and feel painful without the crown.
  • The tooth may look unsightly, making you less willing to smile.
  • The gum may overgrow, meaning the crown won’t seat without having to adjust the gum margins around the tooth.
  • A loose crown may get decay under it making the problem worse.

Some crowns come off cleanly and are really simple to clean up and re-cement.
Some crowns are placed with a stronger adhesive and may need to be cleaned by a laboratory.
Some crowns have cores and/or posts to anchor them and these can be broken too!
So the sooner we see you the better.

Implant placement is a minor surgical procedure, which is normally carried out under local anaesthetic (i.e. after being numbed up). We go through an detailed preparatory procedure prior to implant placement, in order to keep the risk of infection to a minimum. This will involve placing a sterile drape on top of your clothes and your dentist & nurse will wear sterile gowns, hats, etc. (as seen on TV!).

What To Expect On The Day Of Your Surgery

  1. The procedure is likely to take up to two hours. This includes preparation and recovery time with the actual procedure lasting about 45-60 minutes.
  2. Please ensure that you have eaten as normal. There is no need to come in on an empty stomach.
  3. It is advisable to bring a companion along, as you may feel tired after the procedure. You can still drive, use public transport, etc. if you need to.
  4. Ladies, please do not wear any makeup. Gentlemen, if you do not normally keep a beard, please shave.
  5. You will not experience any pain during the procedure but will feel movement, pressure and vibration from instruments. You are likely to be numb for several hours following the procedure.
  6. I will give you painkillers and antibiotics (if necessary) prior to the procedure, so that you will have some pain relief in your system when the numbness wears off.
  7. I will place several stitches in your mouth following the procedure. The stitches I use are not dissolvable, due to which, I will need to review you 1-2 weeks after the procedure to remove them. The stitches can sometimes feel a little prickly in your mouth.
  8. You will have a swelling following surgery. This will be most noticeable on day 2 following surgery, which is normal. Ice application (discussed below) is very effective in minimizing the swelling.
  9. People who bruise easily will have a noticeable bruise for up to 2 weeks following surgery.

What To Do When You Get Home

  1. If possible, do not schedule any important appointments on the day and go straight home after the procedure.
  2. Apply an ice pack on the side of your face for as long as you can. Frozen peas in a zip-lock plastic bag works very well.
  3. Pain relief – you can take the following if necessary:
    1. Paracetamol – 2 x 500mg tabs every 6 hours
    2. Ibuprofen – 2 x 200mg tabs every 8 hours
  4. Mouthwash – I would like you to rinse gently using 0.2% Chlorhexidine Mouthwash every 6-8 hours. Additionally, you can use a warm salt water mouthwash for gentle rinsing if you wish.
  5. Toothbrushing – Brush your mouth as normal but avoid the surgical site for 24 hours. Following this, start brushing the site gently. It is normal for your gums to bleed a little following toothbrushing.

What To Avoid

  1. Avoid strenuous exercise for 2-3 days after the surgery.
  2. Diet – Avoid food that is very hot (as you may not be able to sense temperature well for a few days). Also avoid food with sharp or hard bits (crisps, seeds, nuts, crusty bread, etc.). Food such as rice, pasta, chicken, fish, etc. are all acceptable.
  3. Avoid vigorous rinsing / spitting, as this may dislodge the stitches.
  4. Please do not smoke.
  5. Avoid alcohol for 48 hours after the procedure.

If you have any concerns, please contact us at the practice immediately. In the unlikely event of an out-of-hours emergency, please contact your GP or local A&E department.

If your gum(s) are swollen, we recommend rinsing with Corsodyl mouthwash or hot salt mouthwashes and contact the practice for further advice. Gums can be swollen for various reasons:

  • Gum disease, which will cause the gums to bleed readily and feels sore. Cleaning them thoroughly along and under the gum margins and between the teeth can often make them feel better. They will probably bleed as the gums are telling you they have been exposed to plaque bacteria for too long.
  • Infections can present as a swollen gum and can sometimes just be localised or sometimes affect your cheek, lips or face. If infection is present, the cause needs to be determined and attended to. Infections can be caused by partially grown teeth like wisdom teeth, gum disease, infected roots or trauma. Sometimes antibiotics are needed initially to control the problem.

Our Hygienist, Jacqueline Taylor is a specially trained member of the team who helps our patients in all aspects of gum disease and oral health. Gum disease (periodontal disease) is the cause of more tooth loss than any other dental problem and is a ‘silent killer’. Only meticulous checking for the problem at your examination and then careful cleaning of the teeth will prevent you from losing teeth.

The bacteria, which form in the mouth and stick tenaciously to the teeth like ‘ivy to a wall’, cause both tooth decay and gum disease and only by keeping your mouth scrupulously clean will you avoid these problems. Jacqueline’s major contribution to the health of our patients is down to regular, personal advice and removal of the bacteria and their waste products.

Your visits with Jacqueline are adjusted to serve your needs and most of our patients see her every 4-6 months, once a healthy base line has been established. During your visit Jacqueline will:

  • check your medical history
  • check how your gums are: bleeding or build up of deposits of bacteria
  • remove any hard or soft deposits (plaque & tartar) from your teeth
  • adjust your cleaning regime for home care if needed and give advice on which products to use.

We allocate 30min per patient to allow time for your treatment.

We recommend you contact the practice immediately to obtain further advice and an appointment. In the meantime, avoid eating where the broken tooth is and avoid hard, chewy or sticky foods, which may break the tooth further. Broken teeth can sometimes just be tiny enamel fragments or whole corners of the teeth. Depending on how much and where the break is will determine how much discomfort you are in, how un-aesthetic the tooth looks and how quickly you will need to be seen. The more information you can give us over the phone the better the chance we can attempt to repair your tooth when you come in.

We recommend you contact the practice immediately to obtain further advice, and if required, an appointment with the Dentist.

If a child (or adult) has an adult front tooth knocked out, we recommend you contact the Practice as soon as possible as TIME IS OF THE ESSENCE when a tooth has been knocked out. A tooth that has been knocked out has the best chance for survival if it is replaced back into its correct place as soon as possible and within the first hour. If you cannot get the child to a dentist, please try and pop it back in yourself. Immediately after the trauma the area feels quite numb and you can fairly comfortably push the tooth back in… remember it is better to be firm yet gentle and save the tooth than not to attempt to put it back in!

  • The tooth is attached by tiny fibres between the root and bone so don’t clean or scrub the root as this will remove part of the attachment so the tooth won’t take.
  • Gently rinse the tooth, pick off any large bits of dirt or similar and quickly replace.
  • Gently keep the tooth in place by biting together or pushing gently on the tooth till a dentist can ‘splint’ the tooth in place.
  • If you cannot replace the tooth, store the tooth in saline (consider using eye wash solution) or store at body temperature inside the mouth (in the cheek).

Recent research sadly suggests that teeth, which have been knocked out all the way have a poor long term prognosis, BUT replacing the tooth is still important as it allows us to plan how to manage the loss long term. If a child loses a front tooth early, it is really difficult to manage the gap well while they are growing. It is better to have the tooth re-implanted and then the child, parent, dentist & specialist can plan carefully how to manage the problem.

If the front tooth is loosened it is equally important to get this checked out. Sometimes the tooth is simply shaken in its foundation and not much is needed. Other times, the root may have broken and various treatment options will need to be considered: Can the tooth be saved? Is the break in such a place the tooth will never recover? Splinting of the teeth may be needed and only an examination & x-rays will tell the Dentist what can be done.

If the tooth has chipped or broken, the treatment will depend on how and where your tooth has broken. Small enamel chips can be smoothed over if necessary, bigger corners will probably need a temporary dressing initially until final treatment can be agreed and carried out. If the nerve is exposed, urgent treatment is needed to avoid pain. Often root canal treatment will be needed. Repeated broken fillings can be a sign of bite and teeth grinding problems.

These could be possible symptoms of clenching and grinding, and can be, in most cases, alleviated with treatment at the Practice.

We have chosen to operate as a predominantly private practice so that we have no outside constraints on how we provide your dentistry. We will advise what treatment is required and support you to decide how we provide it and when. All the costs associated with any treatment plan will be advised to you in advance as we fully appreciate this can sometimes be an important part of the decision making process in respect of any suggested treatment.

Private charges are set by us and are greater than the cost of similar treatment (if available) on the NHS. The main reason is that we do not receive any funding from the Government towards the cost of the treatment. Prices are also affected by the level of experience we can offer. When thinking about our fees, it may be appropriate to consider those charged by other professionals such as solicitors or accountants.

We can accept payment in instalments as your treatment progresses or you can choose to pay 50% at the beginning and the balance on completion. Please see out Fees & Payment plans page for further information.

Please ring us!

Please ring and speak to Reception so we can let your dentist know, often they would be grateful for the extra time! More seriously, your appointment has been tailored to the procedure you are having done and so depending on what that is and how late you are running will affect whether we can still see you and carry out something meaningful. Reception will be able to help you figure all this out so that hopefully we will still be able to see you.

Please ring us! We ask that you give us 2 working days notice in order that we might reallocate the surgery time to another patient. If less than 2 working days notice is given and we are unable to fill the appointment space, you may still be charged the appointment fee. Our policy is not to charge on the first occasion an appointment is missed or cancelled at short notice as we fully appreciate that sometimes the unexpected does happen to detract from even the best laid plans. If, however, further appointments are missed or cancelled late then our policy is to initially charge 50% of the planned appointment fee, increasing to 100% if 3 or more appointments are missed or cancelled in a 2 year period.

If you contact us as soon as you realise that you are going to, or have missed your appointment and you are able to reschedule your appointment for the same day, no fee will be levied.

Equally, should something happen in the practice that results in us needing to reschedule your appointment with less than 2 working days notice, then you will be moved back one stage in the above process i.e. 100% fee to 50% fee or 50% fee to no fee due. We think this is a fair system for all concerned.

Parking immediately outside the practice is restricted to 10 minutes on Howard Street or 1 hour on Fishergate. However, there is unrestricted parking within a short walk of the Practice and a secure car park near by. Please refer to the Contact Us page for more details.

Caring for my teeth

Your teeth vary in shape and size depending on their position within your mouth. These differences allow the teeth to do many different jobs. Teeth help us to chew and digest food. They help us to talk and to pronounce different sounds clearly. Finally, teeth help to give our face its shape. A healthy smile can be a great asset and because this is so important, it makes sense to give your teeth the best care possible. New research has shown that a lack of teeth can diminish our cognitive abilities.

Tooth decay can be painful and lead to fillings, crowns, etc. If tooth decay is not treated, the nerve of the tooth can become infected, causing an abscess. This may then need root canal treatment or even an extraction. It is very important that you keep up with a good daily routine to keep your teeth and gums healthy at home.

Gum disease is the largest cause of tooth loss in adults. Gum disease is a preventable condition and can be treated and kept under control with regular cleaning sessions and check-ups, preventing further problems. If teeth are lost, it may be necessary to fill the gaps with bridges, dentures or implants.

It is easy to get your mouth clean and healthy; and keep it that way. A simple routine of brushing twice a day with a fluoride toothpaste and cleaning between the teeth, good eating habits, avoid having sugary foods and sugary drinks, and regular dental check-ups can help prevent most dental problems. Although most people brush regularly, many don’t clean between their teeth and some people don’t have regular dental check-ups. A few small changes in your daily routine can make a big difference in the long run. Your Dentist or Dental Hygienist can remove any build-up on your teeth and treat any gum disease that has already appeared. However, daily dental care is up to you and the main weapons are your toothbrush and interdental cleaning aids.

Plaque is a thin, sticky bio-film of bacteria that constantly forms on your teeth. It starts forming within hours of brushing your teeth and is the main cause of tooth decay and gum disease. It is important to keen the level of plaque in your mouth as low as possible.

When you eat foods containing sugars and starches, the bacteria in plaque produce acids, which attack tooth enamel. The stickiness of the plaque keeps these acids in contact with teeth. After constant acid attack, the tooth enamel breaks down forming a hole or cavity.

If plaque is not removed by brushing, it can harden into something called calculus (another name for it is ‘tartar’). As calculus forms near the gum line, the plaque underneath releases poisons causing the gums to become irritated and inflamed. The gums begin to pull away from the teeth and the gaps become infected. If gum disease is not treated, the bone supporting the teeth is destroyed and healthy teeth can become loose and fall out. Gum disease is the biggest cause of tooth loss in adults and can lead to a need for dentures, bridges or implants.

It is important to remove plaque and food debris from around your teeth, as this will stop your gums from swelling and becoming infected. If you leave plaque on your teeth, it can harden into tartar, which can only be removed by the Dentist or Hygienist. It is important to keep your regular appointments so that your teeth can have a thorough clean if they need it, especially as gum disease often is symptom free until it is quite advanced.

Gum disease will usually show itself as red, swollen gums that bleed when brushed or flossed. Many people are alarmed when they notice their gums are bleeding and then brush more gently. Conversely, it is important that you continue to clean regularly and firmly in order to fight the condition.

Your Dentist or Dental Hygienist will be able to recommend a toothbrush suitable for you. However, adults should choose a small to medium size brush with soft to medium multi-tufted, round-ended nylon bristles or ‘filaments’. The head should be small enough to reach into all parts of the mouth, especially the back of the mouth where it can be difficult to reach. Children need to use smaller brushes but with the same type of filaments.
You can buy more specialised toothbrushes. For instance, people with sensitive teeth can now use softer bristled brushes. There are also smaller headed toothbrushes for those people with crooked or irregular teeth.

Some people find it difficult to hold a toothbrush, for example because they have a physical disability. There are  toothbrushes which have large handles and angled heads to make them easier to use, also special handles exist to “bulk up” the handle.
An electric brush often has a rotating or vibrating head, which provides a large amount of cleaning action with very little movement needed from the user, although you do need to position the brush correctly.

Worn-out toothbrushes cannot clean your teeth properly and may damage your gums. It is important to change your toothbrush every two to three months or sooner if the filaments become worn. When bristles become splayed, they do not clean properly.

You must clean between your teeth with dental floss, interdental brushes or tape. Dental tape is taller than floss and many people find it easier and more efficient to use. Flossing removes plaque and food particles from between your teeth and under the gum line, areas a toothbrush can’t reach. You should clean between your teeth at least once a day with floss or interdental brushes (e.g. TePe brushes).

TePe brushes were developed with the support of dental professionals in Sweden and from throughout the world and are probably the most effective and comfortable way of cleaning in between your teeth. The ergonomic brush handle was developed to give a comfortable and firm grip when being used. The brushes are made from high grade filaments and are selected for their cleaning and durability properties. All TePe interdental brush sizes have plastic coated wire allowing for gentle and safe cleaning.

  • Most people will require two or more sizes to clean their mouth effectively as each space is slightly different
  • Slide the brush at right angles very gently between your teeth
  • Use the full length of the interdental brush
  • Do not push too hard
  • Curve the brush for the hard to reach gaps between your back teeth

Aftercare

How long your crown lasts depends on how well you look after it, how well it has been made & the quality of underlying tooth. The crown itself cannot decay, but decay can start where the edge of the crown joins the tooth. Therefore, to prevent decay affecting the crown, it is important to keep this area just as clean as you would your natural teeth. Brush for two minutes twice a day with a fluoride toothpaste and clean in between your teeth with interdental brushes or floss.

You will be fitted with a temporary crown between the preparation appointment and the fit appointment, and this temporary is not as strong. Please avoid sticky or hard foods and also use your floss down towards your gums. Pulling on the floss away from your gums may dislodge the temporary crown. To avoid the temporary crown from dis-colouring, it is advised to avoid eating food with added colouring (e.g. curries, etc.)

If your temporary crown comes out, please contact your Dentist as soon as possible to have it re-cemented, both for your own comfort, to protect the tooth and to keep the space in your mouth for your final permanent crown.

After a filling it is important to be careful when eating until the numbness has worn completely off. Avoid testing the numbness by biting the numb lip or cheek as you are likely to damage your lip or cheek. This can be serious with young children as they are not used to being numb and we advise parents to watch their children closely for this.

With silver fillings (also known as amalgams), you should avoid chewing on the side with the new filling(s) for the first hour; they do not gain their full strength even though they are “hard”. With composite (tooth coloured fillings), you may eat on them as soon as the numbness has completely worn off. They are hardened to full strength as they are placed. We strongly recommend you are gentle on the side where any filling has been placed for the first 24 hours.

For a few days after the procedure, you may experience some sensitivity to hot or cold foods and chewing, this is normal. If this sensitivity does not go away or gets worse, please call the Practice so that the clinician can check the new filling and take care of any problems. Just as important, if after the anaesthesia wears off, your “bite” does not feel “just right” or it feels that you may be hitting your new filling when you bite, please call the Practice so that the clinician can simply and easily adjust your new filling. A filling that is hitting “high” will not wear itself in and will cause your tooth to be very sensitive and sore.

After root canal treatment, it is important to be careful when eating until the numbness has worn off. The root canalled tooth will have a temporary filling material that can be dislodged if you eat hard gritty foods so we suggest you eat carefully on the temporary filling. You may experience jaw pain and muscle soreness as root canal treatments can be lengthy procedures, which tend to aggravate jaw and muscle pain. A root canal treated tooth can feel tender for one week and feel different for a while after. If you notice any swelling or if any pain gets worse please contact the Practice for advice and help. Sometimes, if this happens we may need to see you to help drain any infection or prescribe you antibiotics.

Once the root canal treatment has been completed, we will be monitoring the tooth to check it heals fully. This is done with x-rays from time to time. Often, after root canal treatment, crowns are needed (particularly on back teeth) to protect the remainder of the tooth from breaking. The scientific literature suggests that up to 60% of molars may fracture after root canal treatment if they are not crowned. If the tooth fractures or splits before a crown has been placed, the tooth may not be salvageable and may need to be extracted. To avoid this, your clinician will therefore advise a crown be placed soon after your root canal is completed when we feel confident any infection has cleared up.

Following these few simple rules should help your tooth socket to heal comfortably and uneventfully….

DO:

  • Take painkillers if required, but avoid those containing aspirin.
  • Eat and drink sensibly during the first few hours, on the other side of the mouth.
  • Apply pressure to the socket, by biting on gauze or a rolled up cotton handkerchief, for 10-15 minutes if the socket “oozes” or bleeding persists.
  • Try to keep the area clean during healing particularly if stitches are present.
  • Contact the Practice if you are in anyway concerned.

DON’T:

  • Rinse out for the first 24 hours.
  • Consume alcohol during the first 24 hours.
  • Worry if swelling or bruising develops around the area, particularly after a difficult extraction. This tends to improve after the first 2-3 days.

What To Do When You Get Home

  1. If possible, do not schedule any important appointments on the day and go straight home after the procedure.
  2. Apply an ice pack on the side of your face for as long as you can. Frozen peas in a zip-lock plastic bag works very well.
  3. Pain relief – you can take the following if necessary:
    1. Paracetamol – 2 x 500mg tabs every 6 hours
    2. Ibuprofen – 2 x 200mg tabs every 8 hours
  4. Mouthwash – I would like you to rinse gently using 0.2% Chlorhexidine Mouthwash every 6-8 hours. Additionally, you can use a warm salt water mouthwash for gentle rinsing if you wish.
  5. Toothbrushing – Brush your mouth as normal but avoid the surgical site for 24 hours. Following this, start brushing the site gently. It is normal for your gums to bleed a little following toothbrushing.

What To Avoid

  1. Avoid strenuous exercise for 2-3 days after the surgery.
  2. Diet – Avoid food that is very hot (as you may not be able to sense temperature well for a few days). Also avoid food with sharp or hard bits (crisps, seeds, nuts, crusty bread, etc.). Food such as rice, pasta, chicken, fish, etc. are all acceptable.
  3. Avoid vigorous rinsing / spitting, as this may dislodge the stitches.
  4. Please do not smoke.
  5. Avoid alcohol for 48 hours after the procedure.

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