ABOUT OUR TREATMENTS
WHAT ARE PERIODONTAL DISEASES?
Periodontal diseases are diseases that affect the gums and bone supporting our teeth. The main cause for gum problems is the accumulation of bacteria (Plaque) on the roots of the teeth, which lead to inflammation of the gums, and in turn, to the destruction of the supporting bone.
WHAT IS A PERIODONTAL POCKET?
A periodontal pocket is a pathological space that forms between the gum and the tooth due to the accumulation of localised plaque. When healthy, this space is called the gingival groove and will have up to 3 millimetres of probing depth; exceeding this value, it will be considered as a periodontal pocket. The larger the pocket, the greater the bone loss.
HOW ARE PERIODONTAL DISEASES TREATED?
The treatment of periodontal diseases is performed in different phases. First of all, the bacteria on the surface of the roots of the teeth, and outside and inside the gums must be eliminated as best as possible. After completing this phase, a period of healing will follow, to assess how the gums respond. In more complicated cases, periodontal surgery may be required.
IF I BLEED FROM THE GUMS, IS THERE CAUSE FOR ALARM?
Bleeding gums should be seen as a warning sign since this only happens when they are inflamed. When the treatment begins and the bacteria are eliminated, this will cause a decrease in inflammation, and in turn, the gingival bleeding will also decrease, and should disappear when the treatment is completed.
IS PERIODONTITIS CONTAGIOUS?
Although Periodontitis is an infection caused by bacteria, it is supposedly not contagious.
I SUFFER FROM PERIODONTITIS, CAN I HAVE AN ORTHODONTIC FIXTURE FITTED?
One should never perform orthodontic treatment with a case of untreated periodontitis. After correct and complete treatment for Periodontitis, an orthodontic fixture can be placed. However, while the Patient is using a fixture, it is important that he/she receives regular follow-up to ensure that their gums remain stable.
WHY DO I HAVE TO PERFORM SURGERY TO TREAT PERIODONTITIS?
Periodontitis has varying degrees of severity. When the periodontal pockets are very deep, the initial phase of treatment may not be sufficient to disinfect them completely. For this reason, in cases of Severe Periodontitis, it is often necessary to have surgery to treat and eliminate the pockets and therefore be able to stabilise the periodontal situation.
WILL I BE IN PAIN AFTER SURGERY?
Nowadays, with the quality and efficacy of analgesics and anti-inflammatory drugs, the probability of effectively feeling pain is quite low. Obviously, there may be some discomfort associated with the surgery, but it will always be short-lived.
SURGERY AND IMPLANTS
I LOST BONE DUE TO PERIODONTAL PROBLEMS, CAN I HAVE IMPLANTS FITTED?
Although periodontal problems are accompanied by bone loss around the teeth, it’s not always a compromise. If necessary (for example, to place implants), a bone graft can be used to make up for any deficiencies in the amount of bone.
WHY IS IMPLANT PLACEMENT MORE ADVANTAGEOUS THAN PLACING BRIDGES?
Implants can be used to replace one or more missing teeth. Its great advantage in relation to bridges on teeth is the absence of tooth wear caused by the bridge. In the case of intact teeth, wearing them down can weaken them.
WHAT IS THE WAITING TIME BETWEEN TOOTH EXTRACTION AND IMPLANT PLACEMENT?
Bone type and stability allowing, it is possible to extract the tooth and place the implant immediately. However, if the necessary conditions are not met after tooth extraction, a period of healing between 3 and 6 months should be allowed before implant placement.
CAN I PLACE THE CROWN IMMEDIATELY AFTER THE IMPLANT?
In many cases it is possible to place the crown immediately after the implant. However, depending on the quantity and quality of existing bone, it may be necessary to have bone graft surgery before or during implant placement. In this case, the immediate placement of the crown is not recommended before the end of the healing period.
HOW CAN I ORGANISE MY LIFE AFTER THE SURGICAL PROCEDURE? WILL I HAVE TO REQUEST MEDICAL LEAVE OF ABSENCE?
Discomfort after surgery depends on its extent and complexity. As a general rule, Patients will take pre-medication, and after surgery, they must strictly comply with the indications given to them. Sometimes, for the sake of discomfort and not pain, a period of rest at home may be indicated. However, it is not often that this type of surgery interferes with the patient's normal day-to-day life.
WHAT HYGIENIC ORAL CARE SHOULD I HAVE AFTER PLACING IMPLANTS?
Although the implants are artificial structures, they are surrounded by bone and gum. In the same way that the accumulation of bacteria can cause problems in teeth and supporting structures, the bacteria around the implants can also affect these structures. From the moment an implant is placed and its exterior is exposed to the oral environment, strict oral hygiene will always be required around the implant, to minimise the probability of infection. In the first 15 days, this will consist in the use of a specific mouthwash, and from then on, proper brushing.
CAN I REPLACE ALL MY MISSING TEETH IN ONE DAY? HOW LONG DOES IT TAKE UNTIL I CAN GET FINAL RESTORATIONS?
It is possible to place all missing teeth in a single day or in the first 24 hours after implant surgery, but only provisional teeth (prostheses or temporary crowns). To restore function and aesthetics, the therapy phase with provisional restorations is fundamental for the success of the final crowns. The latter should only be placed after a specified period of healing, which varies according to the condition of the underlying bone.
HOW LONG DOES AN IMPLANT LAST?
Scientific studies show that implants can potentially last for more than 30 years in the case of optimal maintenance. In order for the implants to last as long as possible, strict oral hygiene must always be performed, as well as frequent visits to the Dentist so that he or she can evaluate your clinical situation and provide professional care of the surrounding tissues on an ongoing basis.
WHAT IS THE AVERAGE DURATION OF SURGERY?
The duration of surgery depends on the number of implants or teeth that require surgery. In more extensive surgeries, there is always an interval for recovery.
CAN I HAVE IMPLANT PLACEMENT SURGERY UNDER GENERAL ANESTHESIA?
Implants are, as a general rule, placed under local anaesthesia. The surgery is painless and associated with minimal or no discomfort, aside from any potential discomfort you may experience during anaesthesia. However, more anxious patients or patients with special preferences can undergo implant placement surgery under sedation or general anaesthesia.
IS IMPLANT PLACEMENT SURGERY PAINFUL?
Implant placement surgery is not associated with pain. In general, the discomfort reported by patients is minimal and circumscribed to anaesthesia.
I HAVE OSTEOPOROSIS, CAN I PERFORM IMPLANT PLACEMENT SURGERY?
Osteoporosis does not preclude the placement of implants. The time period from implant placement to prosthesis placement may have to be increased because the bone is not of good quality. Even if you have osteoporosis, this problem rarely affects the jaw. However, if you are taking bisphosphonates, you should always notify your Clinician.
I HAVE DIABETES, CAN I PERFORM IMPLANT PLACEMENT SURGERY?
Diabetes does not preclude the placement of implants. However, it is essential that the diabetes is adequately controlled before advancing to surgery.
I HAVE HEART PROBLEMS: CAN I PERFORM IMPLANT PLACEMENT SURGERY?
Patients with heart problems can have implants placed with maximum safety as long as these issues are properly controlled. The operating rooms are equipped with devices to monitor them throughout the surgery. It is certainly advisable for our Clinician to make contact with your cardiologist before the surgery.
DO IMPLANTS TRIGGER ALARMS WHEN PASSING SECURITY CONTROLS AT AIRPORTS?
Although the implants are made of titanium (metal), this does not cause the alarm to go off when passing airport security checks.
WHAT IS A ROOT CANAL (ENDODONTIC TREATMENT OR ROOT CANAL TREATMENT)?
Every year, millions of teeth are treated and saved with endodontic treatment, also known as root canal or root canal treatment. Endodontic treatment treats the inside of the tooth, and becomes necessary when the nervous tissue inside the tooth is inflamed or infected (by deep cavities, trauma, fracture, among other causes). If pulp inflammation is not treated it can lead to an infection in the bone, an abscess and/or pain. During root canal, the nerve tissue is removed from the inside of the disinfected tooth, and the tooth is filled with a biocompatible material so that it can continue to be used.
CAN A DEVITALISED TOOTH HAVE CAVITIES?
Yes, a devitalised tooth can develop a cavity. A cavity requires dental structure (whether the tooth is vital or not), plaque and depends on the susceptibility of the host.
WHY DO I NEED TO DEVITALISE (ENDODONTIC TREATMENT) MY TOOTH?
Endodontic treatment becomes necessary when the nervous tissue inside the tooth is inflamed or infected (by deep cavities, trauma, fracture, among other causes). If the inflammation or infection is not treated, it can lead to an infection in the bone, an abscess or cause pain.
IS DEVITALISING A TOOTH A PAINFUL PROCESS?
No! Nowadays, we have at our disposal a variety of potent and very effective local anaesthetics, so the patient remains completely comfortable throughout the procedure. If the Patient feels worried or anxious about the treatment, he or she should inform the Alcoforado Clinic team as there are a variety of solutions to combat states of anxiety and fear, namely conscious sedation with nitrous oxide, sleeping pills and in more severe cases, deep sedation.
DO DEVITALISED TEETH WITH ENDODONTIC TREATMENT GET WEAKER?
No, endodontic treatment does not weaken the teeth. However, the loss of dental structure due to cavities (which led to the need for endodontic treatment) makes them more fragile, so the strengthening of the tooth after endodontic treatment is often recommended.
WHAT IS THE SPECIALTY OF PROSTHODONTICS?
Prosthodontics is a specialty that treats dental and facial problems that involve the restitution of lost teeth and bone structures. Prosthodontics is the area of Dentistry where function and aesthetics are returned to the oral cavity through the use of fixed or removable prostheses supported by implants or by the gum itself.
WHAT IS A CROWN?
A crown is a “cover” that is placed over a destroyed tooth. Crowns are used to protect, cover and restore the shape of teeth when direct restorations cannot do this effectively. The crown completely covers the tooth.
WHAT MATERIALS ARE CROWNS MADE OF?
Crowns can be made of various materials: metal, metal-ceramic, ceramic, composite and acrylic.
Nowadays, ceramic crowns are the most common material, as they provide good resistance and better aesthetics. Several types of ceramics are also available.
WHAT TYPES OF CROWNS ARE THERE?
There are crowns on teeth and crowns on implants.
Crowns on teeth: crowns that are cemented/adhered onto teeth;
Crowns on implants: crowns placed over implants - which can be cemented or screwed.
WHAT IS THE DIFFERENCE BETWEEN CERAMIC AND ZIRCONIA CROWNS?
Ceramic crowns are most commonly used in aesthetic areas, such as in front teeth and where too much resistance is not required. Zirconia crowns are recognised for their excellent hardness, strength and biocompatibility properties. They are most commonly used in the rehabilitation of posterior teeth that require less aesthetics and are subject to larger resistance force.
HOW MANY APPOINTMENTS DO YOU NEED FOR A CROWN?
Usually, 2 appointments are required.
At the 1st appointment, the tooth is prepared with a drill, leaving it with the appropriate shape to receive the crown. Only the amount of dental structure required for this purpose is removed. Moulds are made and sent to the laboratory. The moulds can be conventional, through a paste placed in trays, or digital, through an oral scan performed with the help of an intra-oral scanner. At this appointment, a temporary crown is placed on the tooth, while waiting for the final crown to be made.
At the 2nd Appointment, the temporary crown is removed and the final ceramic crown, sent from the laboratory to the clinic, is verified in position. If all is well, the crown is cemented on the tooth. Usually, 1 to 2 weeks are required between the 1st and 2nd appointments.
WHY DO I NEED A CROWN?
There are several factors that lead the Patient to place a crown, namely:
— Protection of a weakened tooth that is likely to fracture;
— Restoration of a fractured tooth or a tooth with elevated natural wear;
— Covering a tooth with an extensive restoration and with little dental structure remaining;
— Covering a tooth with that has an abnormal shape or is severely discoloured;
— Covering of a devitalised tooth;
— A tooth that will be the pillar of a fixed bridge;
HOW DO I MAINTAIN THE CROWNS?
The teeth restored with crowns should be cared for as much as the remaining dentition. This requires proper oral hygiene: use of dental floss/brushing and cleaning the teeth with the correct technique at least 2 times a day. Do not forget maintenance appointments at the dental office at least 2 times a year.
WHAT IS A PROSTHESIS?
Dental prostheses aim to replace missing teeth in the oral cavity. For this purpose, there are partial, total and fixed protheses as well as removable protheses.
WHAT ARE REMOVABLE PROSTHESES?
Removable prostheses replace missing teeth, can be removed and replaced in the mouth, and can be directly supported on the gums or existing teeth. A partial removable prosthesis made taking into account healthy teeth in the oral cavity, while the total removable prosthesis is totally supported on the gum.
WHAT ARE FIXED PROSTHESES?
Fixed prostheses include crowns, bridges or prostheses supported by implants, which are more aesthetic, comfortable and stabilise masticatory function. They can only be manipulated or removed by oral health professionals.
WHAT ARE CERAMIC VENEERS?
Veneers are thin ceramic “covers” that are adhered to the teeth. They serve to correct the shape, size, position (within certain limits) and the colour of teeth. Unlike crowns, which fully cover the teeth, veneers are a partial cover. In this case, they cover the aesthetic part, which faces outwards. Veneers are also known as “contact lenses”, “covers” and “ceramic laminates”.
DO I NEED TO WEAR DOWN MY TEETH IN ORDER TO PLACE VENEERS?
Most of the time, nominal dental wear is required. It is a conservative and minimally invasive procedure. In some cases, it is possible to place veneers without wearing down the tooth.
HOW MANY APPOINTMENTS DO YOU NEED TO PLACE CERAMIC VENEERS?
Usually, 2 appointments are required. The 1st Appointment consists of micro dental preparation and the making of moulds (conventional or digital) to send to the laboratory. At this appointment, a temporary veneer is placed, while waiting for the final ceramic veneer. In case dental preparation is not required or tooth wear is minimal, the provisional veneer is not required. At the 2nd Appointment, the ceramic veneer is adhered to the tooth. Normally, the time between the 1st and the 2nd appointment is 1 or 2 weeks.
CAN I PLACE DENTAL VENEERS?
In general, there are no absolute contraindications to the placement of dental veneers.
Each case must be evaluated individually and carefully. There may be situations in which other types of treatments may be more suitable.
HOW DO I MAINTAIN THE VENEERS?
The teeth restored with ceramic veneers should be cared for like the remaining dentition. This requires proper oral hygiene: use of dental floss/brushing and cleaning the teeth with the correct technique at least 2 times a day. Do not forget maintenance appointments at the dental office at least 2 times a year.
WHAT IS DENTISTRY?
Dentistry is the specialty of Dental Medicine that focuses on the prevention, diagnosis and treatment of infectious diseases, such as cavities. It is dedicated to restoration of lost dental structure caused mainly by dental cavities or trauma.
WHAT ARE CAVITIES?
A cavity is an infectious disease caused by bacteria. It manifests in the demineralisation of the tooth, caused by acids resulting from bacterial digestion.
WHY DO SOME CAVITIES CAUSE PAIN AND OTHERS DO NOT?
Cavity lesions always start in the outermost layer of the tooth (enamel), where there is no innervation. If the cavity is not treated, it progresses to the middle layer (dentin) which is innervated. The gradual progression of a cavity will lead it to penetrate the innermost layer of the tooth (pulp), where the nerve is found, causing pain.
ARE THERE TEETH AT HIGHER RISK OF DEVELOPING CAVITIES?
The most sensitive period for developing cavities is during dental eruption, until eruption is complete. The teeth most easily affected by cavities are the premolars and molars, due to their complex anatomy and greater difficulty in cleaning them correctly.
WHAT FACTORS CAN PROMOTE THE APPEARANCE OF CAVITIES?
There are several factors to take into account, such as frequent intake of carbohydrates throughout the day (especially in sugary foods and drinks), poor oral hygiene, certain diseases that affect the structure of the teeth, and medication that can decrease normal saliva production, among others.
WHAT IS THE TREATMENT FOR A DENTAL CAVITY?
After anaesthesia of the tooth, the dentist removes the entire dental structure affected by the cavity with the aid of rotary instruments. By using proper materials, a restoration is placed on the tooth in order to protect the innermost layers of the tooth, restoring the tooth's original anatomy and function.
WHAT IS A RESTORATION?
Restoration is the process of reconstructing and treating a decayed or fractured tooth in order to restore its aesthetics and function. There are several materials available to restore teeth, the most commonly used of which are composite resins and ceramics. It is up to your dentist to advise you on which type of restoration is suitable for treating your tooth.
CAN TEETH WITH RESTORATIONS BECOME DECAYED AGAIN?
Yes. The restorations placed on teeth accumulate bacteria along the edges, which can initiate new cavities. The hygiene of these teeth must be done with care to prolong the life of the restoration and the tooth.
HOW SHOULD I MAINTAIN MY RESTORATIONS?
The performed dental treatments are regularly controlled during appointments with the Oral Hygienist or Dentist. By looking at x-rays, it is possible to check the condition of old restorations and detect new cavities.
HOW LONG DOES A TOOTH RESTORATION LAST?
The answer to this question is not exact since the lifetime of restorations depends on several factors. Oral hygiene habits and diet, the quality of restoration materials, and the location and extent of the restoration on each tooth will directly influence its durability.
HOW CAN A DENTAL FRACTURE OCCUR?
A dental fracture can result from: dental trauma, which can be caused in situations such as falls or sports; structurally fragile and compromised teeth; and tooth clenching or grinding (bruxism); among others.
WHAT SHOULD I DO IN CASE OF A TOOTH FRACTURE?
Depending on the extent of the fracture, the tooth may or may not be recovered. At the appointment, through oral inspection and x-rays, the dentist will provide a prognosis for the tooth. If the tooth fracture is superficial, it is possible to recover the tooth through a restoration or crown. If the fracture is too extensive, the tooth may not be viable and, in these cases, it will have to be extracted.
WHAT IS A DIASTEMA?
A diastema is a large additional gap between teeth that can occur in different regions of the oral cavity, but often appears between the upper central teeth.
PREVENTION AND ORAL HYGIENE
WHAT IS BACTERIAL PLAQUE AND WHAT CAUSES IT?
Bacterial plaque is a sticky, colourless film (biofilm) that naturally accumulates on the surface of the teeth and along the gums. The sugars present in food and drinks combine with the bacteria present in the plaque and release acids that attack the enamel and lead to its deterioration, causing cavities. Bacteria in plaque can also contribute to gum disease (gingivitis and later periodontitis).
Regular and correct brushing, as well as the use of dental floss and/or interdental brushes are the most effective tools for cleaning plaque. When plaque is not removed daily, it accumulates and hardens, turning into tartar.
WHAT IS DENTAL TARTAR?
Dental tartar is a hard deposit formed by residual bacterial plaque that reacts with the minerals present in saliva and accumulates between the teeth and along the gums. Tartar can only be removed by an oral hygienist or a dentist. Tartar cannot be removed only by brushing your teeth. Due to its very rough surface, it helps accumulate more plaque.
WHAT IS A SCALING?
Scaling is a professional disinfection performed by an oral hygienist. The aim is to remove plaque and tartar by cleaning and polishing dental surfaces. This treatment can help prevent gum disease.
Scaling is performed with specific equipment, to produce an ultrasonic vibration that fragments tartar, separating it from the tooth surface.
DO I HAVE TO MAKE ORAL HYGIENE APPOINTMENTS FROM TIME TO TIME?
Oral Hygiene appointments should generally be performed every 6 months so that there can be regular plaque control and hygiene. However, these intervals should always be evaluated by a professional and customised according to the needs of each patient.
WHAT IS A PROFESSIONAL POLISHING?
Professional polishing removes stains, smoothens the roughest surfaces, eliminates small imperfections and leaves teeth shiny. In addition to the aesthetic purpose, the main objective is to prevent the accumulation of plaque.
WHAT IS THE DIFFERENCE BETWEEN DENTAL BLEACHING PERFORMED AT HOME OR AT A DENTAL OFFICE?
In-office bleaching is performed in a single session while outpatient bleaching is performed at home until the ideal colour is achieved.
DOES DENTAL BLEACHING WORK?
Dental bleaching does work. There are several types of bleaching that should be selected for each person. Previous restorations are not affected by bleaching.
CAN PREGNANT WOMEN GO TO THE DENTIST?
Yes, pregnant women can go to the dentist. However, intervention should be restricted to minimally invasive treatments, provided that this does not pose a risk of infection. A persistent infection is more harmful to the foetus than dental treatment. X-rays are not recommended during pregnancy. Whenever possible, dental treatment should be performed during the 2nd trimester of pregnancy.
I'M AFRAID TO GO TO THE DENTIST: WHAT CAN I DO?
First off, at the Alcoforado Clinic, we pay the utmost attention to the well-being and comfort of all our Patients. We have a variety of powerful and effective local anaesthetics, so treatments and surgeries can be performed without any pain. If anxiety persists, we have means to combat it, such as conscious sedation, sleeping pills and in the most severe cases of anxiety, light, moderate or deep sedation.
RECOGNISED FOR ITS PROFOUND KNOWLEDGE IN PERIODONTOLOGY, THE ALCOFORADO CLINIC ENSURES THE PREVENTION, TREATMENT AND MAINTENANCE OF GUM HEALTH AND OTHER TISSUES THAT SUPPORT THE TEETH.