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SURGICAL EXTRACTIONS (WISDOM TOOTH) INR   0 INR  0
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SURGICAL EXTRACTIONS (WISDOM TOOTH)

The pain, swelling and discomfort that follows wisdom tooth extraction is a normal part of the healing process. How long is wisdom teeth recovery time? When will you be back to chewing crunchy carrots and apples with ease? Getting Your Teeth Pulled The wisdom teeth, also known as the third molars, are the final set of molars to erupt. Not everyone keeps these teeth, nor are they necessary for having a healthy, beautiful smile. In fact, they can cause harm if they do not come in properly. When these molars come in, usually between the ages of 16 and 20, there may not be enough room left for them to erupt. As a result, they can emerge at an angle, they may crowd the mouth and sometimes they don't fully emerge. This can lead to future oral health problems like infections and pain. The American Dental Association recommends that people have their mouth checked before age 20 to see how the wisdom teeth are erupting and for wisdom teethimpaction while the roots are still developing. If necessary, a dentist or an oral surgeon can remove the final molars in a single outpatient procedure. Tooth extraction is a form of major surgery. While in general anesthesia or local anesthesia options are used to make wisdom teeth removal a more comfortable procedure, pain and discomfort are a part of the process, especially after the anesthesia wears off. After your teeth are pulled, wisdom teeth recovery time begins. Taking Care of Yourself After Surgery After getting your wisdom teeth pulled, you are likely to experience pain and swelling. There may be some bleeding. While your mouth heals, you have to be careful not to dislodge the blood clot or harm your healing gums. You should not consume solid foods, alcohol, coffee, soda or hot beverages in the first few days following your procedure. You shouldn't even brush your teeth for the first day of recovery. According to the offices of practicing oral surgeon Dr. Joseph Arzadon of Arlington, Virginia, typical wisdom teeth recovery time is three to four days, although it can be as long as one week. The length of recovery depends a lot on how badly the wisdom teeth were impacted and how they were erupting. There are plenty of things you can do to make the recovery time easier. Plan on taking it easy for a few days; you can resume your normal activities after the first day in most cases, but for about a week you don't want to do anything that could dislodge the blood clot from where your teeth were removed. For the pain, you can take a prescription pain killer given to you by your oral surgeon or recommended over-the-counter pain relievers. To help with the swelling, place an ice pack over your jaw. The cold helps to reduce the inflammation and ease any discomfort. Your dentist or oral surgeon should instruct you on how to take care of your mouth for the recovery period. You may be told to avoid brushing, spitting, flossing and rinsing for 24 hours. After that, you can gently brush your teeth. Rinse your mouth with salt water frequently to help keep it clean and prevent an infection. Stock up on apple sauce, yogurt, cottage cheese and other soft foods. You want to eat a soft-food diet for the first day or more and then slowly move to semi-soft foods when you are ready. The recovery period can take several days and in some cases there may still be swelling and discomfort for a week or more. Use ice packs, enjoy soft foods and keep your mouth clean with simple salt water. If you notice any unusual symptoms like pus discharge, severe pain or a fever, call your oral surgeon right away. While complications such as an infection are rare, they are possible.

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ORTHODONTIC CLEAR ALIGNERS INR   0 INR  0
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ORTHODONTIC CLEAR ALIGNERS

When consumers think about orthodontics, braces are the first thing to come to mind. However, orthodontics is more than just braces. Orthodontists are concerned with the position of the teeth, what has caused them to arrive at their current position, and what future movement may be needed so that a patient’s bite is fully functional. Your cosmetic dentist may have some orthodontic options available to straighten your teeth, ranging from conventional braces (with wires and brackets) to invisible braces (clear orthodontic aligners). Each method ranges in price and treatment length, and will vary by patient. Ask your cosmetic dentist about which treatment is right for you. CLEAR ORTHODONTICS ALIGNERS Clear orthodontic aligners can straighten a dental patient’s teeth without the wires and brackets of traditional braces. The aligners consist of a sequence of clear, removable trays that fit over the teeth to straighten them. Each tray must be worn by the patient for a specified amount of time—usually around 20 hours a day for two weeks–before the patient can progress to the next tray. In most situations, the aligners can straighten teeth in anywhere from six to 18 months. Clear orthodontic aligners are suitable for patients with mild or moderate crowding, or minor spacing issues. They may not be appropriate for patients with severe crowding or spacing. While the aligners can correct a mild malocclusion, patients with severe underbites, overbites or crossbites may require more advanced orthodontic treatment. Unlike traditional braces, the trays can be removed for brushing, flossing, and eating. Because the trays are clear, patients can undergo this type of orthodontic treatment without the usual discomfort associated with regular braces. Although treatment prices for aligners are normally set by the individual dentist or orthodontist, they can be more expensive than braces. If a patient fails to wear the trays properly, or loses them, additional costs may be incurred if new trays or impressions of a patient’s teeth are needed.

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ORTHODONTICS TREATMENT INR   0 INR  0
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ORTHODONTICS TREATMENT

Orthodontics Overview Straight teeth and a correct bite reduce the risk of future dental issues and help you to smile more confidently. With straight teeth, you have a better chance of preventing plaque buildup, which often leads to gum disease. You’ll also be able to chew food properly and speak better. Dental Associates offers many orthodontic treatment options, including traditional metal braces, clear ceramic braces, Invisalign trays, lingual archwires, removable appliances, or even partial treatments. We’ll help you to decide which orthodontic treatment is best for you based on the severity of your bite, the degree of dental misalignment and your hopes regarding treatment times and the final results. Whatever orthodontic treatment we determine is best for your individual case, your braces will straighten your teeth, help you bite and chew correctly, improve your appearance, improve your oral health and help you feel better about yourself! Braces for a Misaligned Bite Braces correct a bad bite, also called malocclusion. Types of misaligned bites can be a crossbite, overjet, open bites and other bite issues. Bad bites and crooked teeth are often interrelated, and braces can fix both simultaneously. Even if your teeth appear straight, it’s possible that your jaws may not be properly aligned. In this case, an orthodontist may recommend treatment to prevent future problems such as premature tooth loss, extra wear to tooth enamel, speech and chewing problems, and more severe jaw problems. Jaw or tooth alignment issues can be inherited or caused by an injury, losing baby teeth prematurely or too late, or by thumb sucking. The kind of orthodontic treatment you’ll have depends on what you need to get corrected, what you prefer and what your orthodontist recommends. Below are some of the most common orthodontic treatment options. Traditional metal braces are an orthodontic treatment optionTraditional Metal Braces Traditional braces consist of standard metal brackets. This is the most common type of braces, and they have become much sleeker and more comfortable with recent advancements in technology. With metal braces, you also have the option of adding colored elastic bands to make your braces vibrant, colorful and uniquely yours! Learn more about traditional braces and colorful braces bands. Clear Braces Not all braces brackets have to be metal. If you want your braces to be less noticeable, clear braces may be for you. Clear braces function in the same way as traditional metal braces, but the brackets are made with translucent materials. Learn more about clear braces on our traditional braces page. Invisalign clear braces are an orthodontic treatment optionInvisible Braces Invisalign braces are a clear set of custom-fitted removable trays made with a pliable material that fits snuggly to your teeth. Each new set of Invisalign aligners applies a slight adjustment to your teeth. Since they’re removable, you can take them out while eating, drinking, brushing and flossing, so you can easily maintain good oral health habits. You can also remove them for special occasions. Learn more about Invisalign clear braces. Partial Orthodontic Treatment Not everyone needs a full set of braces. Depending on the case, sometimes just one, two or a few teeth need to be realigned for aesthetic purposes, or to prepare for other dental work such as dental implants, restorations, or periodontics. In these types of cases, an orthodontist may recommend partial orthodontic treatment, also called limited treatment. Because this treatment corrects a more isolated area of the mouth, it usually requires less treatment time and also less hardware. Two-Phase Orthodontic Treatment for Young Children To create a healthy smile for a lifetime, a child’s teeth need to be straight and their jaws need to be aligned properly. It’s beneficial to have an orthodontist examine your child while they still have some of their baby teeth. By age seven, typically enough permanent teeth have emerged to evaluate relationships developing between the teeth, the jaw, and bite patterns for a pediatric dentist to make sure everything in the mouth will continue to develop as it should. If a pediatric dentist or orthodontist determines that early treatment is necessary, it often occurs in two phases. The first phase will begin right away while baby teeth are still present, and the second phase will occur when your child gets older at the time deemed appropriate by your child’s growth and development. At Dental Associates, you’ll experience the benefit of having your child’s orthodontist right down the hall from their pediatric dentist. Your child will receive the most coordinated pediatric dentistry and orthodontic care, all in the same clinic. Early treatment will help prevent larger oral issues later, and thus prevent more invasive orthodontic procedures when the child gets older. Early prevention and intervention makes orthodontic work as a teenager much more comfortable and successful.

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PERIODONTAL (GUM) INR   0 INR  0
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PERIODONTAL (GUM)

Periodontal (gum) disease can be a very aggressive infection: Left untreated, it can destroy the vital periodontal structures that protect teeth and maintain their attachment to the jaw. The end result—tooth loss—harms both your health and appearance. Controlling gum disease and ultimately restoring health and appearance to damaged gums and tooth-supporting bone requires aggressive treatment—sometimes even surgical measures. Periodontal (gum) surgery treats moderate to advanced disease. Infection Control: An Important First Step Gum disease is primarily caused by bacterial plaque, a thin film of food remnants and bacteria that builds up on tooth surfaces when oral hygiene is inadequate or inefficient. As the gums become infected by the bacteria, the body responds with inflammation, a defensive mechanism aimed at isolating the bacteria and destroying it. But as the war between body and infection rages, the inflammation becomes chronic and damages the surrounding gum and bone tissues. This causes gum attachment and supporting bone to be lost from the teeth, creating spaces between the gums and teeth known as periodontal pockets. The progression of periodontal disease becomes a vicious cycle: As the pockets deepen, dental hygiene becomes less effective. The only way to stop gum disease is to remove bacterial plaque and calculus (hardened plaque deposits) from all tooth surfaces—including from the roots that lie beneath the gum line. Dentists use special hand instruments (or ultrasonic equipment) called scalers to manually remove calculus. If you need a deeper cleaning of the root surfaces, your general dentist may refer you to a periodontist (gum specialist) for a manual plaque-removal technique known as root planing or debridement. If the tissues don’t appear to be responding as desired, then antibiotic treatment to reduce bacterial levels might be introduced. Splinting teeth together, or bite adjustment—where a tiny bit of tooth enamel is removed to reduce forces received by a particular tooth—may also be included to help stabilize loose teeth. Of equal importance is a necessary change in behavior and lifestyle on the part of the patient. The disease develops and advances primarily because of a lack of effective hygiene, so the patient must therefore renew and maintain a daily habit of brushing and flossing, and a routine of regular dental visits for cleanings and checkups (at least twice a year and maybe more with advanced gum disease). He or she should also consider stopping tobacco use and other habits that harm oral health. Surgical Techniques If the infection has caused deep periodontal pockets (5 mm or more) or has settled beyond the reach of manual scalers, then gum surgery may be needed to access, clean and repair the diseased areas. Flap surgery is one type of procedure used to access the deeper pockets of infection and clean them. The surgeon, usually a periodontist, creates a three-sided flap in the gum tissue, with one side still attached to the blood supply. The resulting opening resembles the flap of an envelope. Opening the flap, the surgeon can then access deep periodontal pockets to perform plaque removal, as well as repair receded gum tissue or lost bone. When finished, the surgeon then sutures the flap closed with self-dissolving stitches. Regenerative techniques may also be needed to re-grow lost tissue and bone. These involve the use of various grafting procedures to obtain tissue from the roof of the patient’s mouth or another source and attach it where needed. Once in place, the graft acts as a scaffold for new gum tissue to grow upon and develop. These micro-surgical techniques require meticulous skill (and some level of art) not only to place the grafting material so it is most conducive to growth, but also to fashion it cosmetically to achieve the most attractive result. These and similar procedures are usually performed with local anesthesia, sometimes supplemented with other sedation methods. Special cleaning instructions will be given to protect the site from further infection, and any minor discomfort after the procedure can usually be managed with anti-inflammatory medication (like ibuprofen) for a few days. Treating Disease Today, Preventing It in the Future Gum disease treatment, including surgery, isn’t a cure—the prospect for reoccurrence is always there. Proper hygiene and maintenance by both you and your dentist is essential for preventing this. Gum surgery is performed to regenerate lost bone and to help create an environment around the teeth and gums that makes it easier to clean and maintain them. Gum surgery, then, should be considered as part of an overall strategy to stop periodontal (gum) disease’s unchecked advance so that healing can take place. This will allow you to keep your natural teeth for as long as possible—maybe even for life.

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SKIN DISEASES & DISORDERS INR   0 INR  0
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SKIN DISEASES & DISORDERS

Care for conditions from acne to wrinkles. Did you know that your skin is the largest organ of your body? It is, in terms of both weight—between 6 and 9 pounds—and surface area—about 2 square yards. Your skin separates the inside of your body from the outside world. It protects you from bacteria and viruses, and regulates your body temperature. Conditions that irritate, clog, or inflame your skin can cause symptoms such as redness, swelling, burning, and itching. Allergies, irritants, your genetic makeup, and certain diseases and immune system problems can cause dermatitis, hives, and other skin conditions. Many skin problems, such as acne, also affect your appearance. Your skin can also develop several kinds of cancers. Here are the key facts about some of the most common skin problems: Acne—A disease that affects the skin's oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make a substance called sebum. The pores connect to the glands by a canal called a follicle. When the follicle of a skin gland clogs up, a pimple grows. Acne is the most common skin disease; an estimated 80 percent of all people have acne at some point. Early treatment is the best way to prevent scars. Your doctor may suggest over-the-counter (OTC) or prescription drugs. A child's face with Eczema Eczema—Also known as atopic dermatitis, this is a long-term skin disease. The most common symptoms are dry and itchy skin, rashes on the face, inside the elbows, behind the knees, and on the hands and feet. Currently, there is no single test to diagnose eczema, so doctors rely on information about you and your family. Hives—Red and sometimes itchy bumps on your skin. An allergic reaction to a drug or food usually causes them. People who have other allergies are more likely to get hives than other people. Other causes include infections and stress. Hives are very common. They usually go away on their own, but if you have a serious case, you might need medical help. Impetigo—A skin infection caused by bacteria. Usually the cause is staphylococcal (staph), but sometimes streptococcus (strep) can cause it, too. It is most common in children between the ages of 2 and 6. It usually starts when bacteria get into a break in the skin, such as a cut, scratch, or insect bite. Symptoms start with red or pimple-like sores surrounded by red skin. These sores usually occur on your face, arms, and legs. The sores fill with pus, then break open after a few days and form a thick crust. You can treat impetigo with antibiotics. A Photo of Melanoma Melanoma—A severe and potentially life-threatening skin cancer. The "ABCD's" of what to watch for with the moles on your skin: Asymmetry: the shape of one half does not match the other Border: the edges are ragged, blurred, or irregular Color: the color is uneven and may include shades of black, brown, and tan Diameter: there is a change in size, usually an increase People with melanoma may have surgery, chemotherapy, biological therapy, radiation therapy, or a combination of those. To Find Out More Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. Melanoma, a more serious type of skin cancer, is less common. The number of cases of skin cancer has been increasing. Exposure to the sun is a major factor. In 2006, over 30 million people visited health-care providers for skin rashes. Moles—Growths on the skin. They happen when cells in the skin, called melanocytes, grow in a cluster with tissue surrounding them. Most people have between 10 and 40 moles. A person may develop new moles from time to time, usually until about age 40. About one out of every 10 people has at least one unusual (or atypical) mole that looks different from an ordinary mole. They may be more likely than ordinary moles to develop into melanoma, a type of skin cancer. Because of this, you should have a health care professional check your moles if they look unusual, grow larger, change in color or outline, or in any other way. A Photo of an arm with Psoriasis Psoriasis—A skin disease that causes scaling and swelling. Most psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. But they can show up on other areas, as well. Psoriasis can be hard to diagnose because it can look like other skin diseases. The doctor might need to look at a small skin sample under a microscope. Treatment depends on how serious the disease is, the size of the psoriasis patches, the type of psoriasis, and how the patient reacts to certain treatments. Rashes (basic dermatitis)—Dry and itchy skin; Rashes on the face, inside the elbows, behind the knees, and on the hands and feet. Your doctor will help you develop a good skin care routine, learn to avoid things that lead to flares, and treat symptoms when they occur. A Photo of a mans face with Rosacea Rosacea— Frequent redness (flushing) of the face; small red lines under the skin; inflamed eyes/eyelids, a swollen nose, and thicker skin. Your physician can usually diagnose rosacea with a thorough medical history and physical exam. There is no cure for rosacea, but it can be treated and controlled. Skin Cancer—Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands, and arms. Another type of skin cancer, melanoma, is more dangerous but less common. Wrinkles—Your skin changes as you age. You might notice wrinkles, age spots, and dryness. Sunlight is a major cause of skin aging. (See "Skin and Sun—Not a Good Mix"). Cigarette smoking also contributes to wrinkles. The wrinkling increases with the number of cigarettes and years a person has smoked. Many products claim to revitalize aging skin or reduce wrinkles, but the Food and Drug Administration has approved only a few for sun-damaged or aging skin. Various treatments soothe dry skin and reduce the appearance of age spots.

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DENTAL HYGIENE INR   0 INR  0
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DENTAL HYGIENE

Dental Hygiene Hygiene Appointments To ensure that your teeth are clean and your dental hygiene is adequate, we suggest that you attend a professional hygiene appointment at Dental O So Gentle every 6 months. By doing so we can ensure that you retain optimal oral health. Oral diseases, including decay, periodontitis and gingivitis, are all asymptomatic in their early stages. That’s why we recommend that you maintain biannual hygiene appointments; prevention is always better than cure. Your hygiene appointment will usually involve: A comprehensive assessment of your teeth, gum and soft tissue. A thorough teeth cleaning and polish. A full evaluation of possible cosmetic smile enhancements. An application of fluoride as a decay preventing agent. Any recommendations required for dental treatments, such as fillings/restorations, implants, crowns and root canal treatments. This will constitute your treatment plan, if necessary. Why do I need a professional hygiene and exam appointment? You might think that as long as you brush your teeth, your oral health will be fine. While brushing you teeth is very important, a dental hygiene appointment ensures that your mouth is healthy in its entirety. A healthy mouth is vital for a healthy body. By ensuring your mouth is healthy you can decrease the risk of tooth decay and gum disease. In fact, gum disease has been identified as a risk factor in heart disease. How can I care for my teeth and gums? There are a few ways in which you can care for your oral health. Brush your teeth and floss every day – this will prevent decay, periodontal disease and plaque build-up. It is also advisable to brush after eating sweet foods. Fluoride – always use a toothpaste that contains fluoride. If you’re not sure which toothpaste is best, have a chat with your Dental O So Gentle dentist. Avoid smoking – smoking not only causes staining on your teeth, but it can also cause oral diseases. Visit the dentist – we recommend that you make a professional hygiene and exam appointment at either our Perth City or Beldon dental clinic twice a year. Protect your teeth – always wear a mouth-guard when playing sport and refrain from using your teeth as a tool, e.g. to open packets, rip tape etc.

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ROOT CANAL INR   0 INR  0
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ROOT CANAL

Root canal treatment is a treatment for repairing and, ultimately, saving a tooth once the nerve has become irreversibly damaged by decay or a fracture, and is infected. If treatment is not received, then the tissue surrounding the tooth could possibly become infected and an abscess may form. Root canal treatment is when the nerve and pulp (the centre of the tooth where the nerves and blood vessels are contained) are removed and the inside of the tooth is cleaned and sealed. Whilst it might seem extreme, the nerve has to be removed due to the multiplication of bacteria within the pulp chamber. How do I know if I might need a Root Canal Treatment? You might need a root canal treatment if you experience the following: Severe toothache during chewing or whenever there is pressure placed on the tooth. Prolonged sensitivity to hot and cold temperatures. (Especially once the stimulus is removed.) Tooth discolouration (darkening). Swelling and tenderness in the gums. Bad tastes in the surrounding area. A gum boil – a persistent or recurring pimple on the gums. Throbbing pain at night. Pain during running. Pain requiring relief by swishing cold water over the tooth. What happens during a root canal treatment? A root canal treatment will require at least one visit, and potentially more, to the dentist. The first step of the procedure is the taking of an x-ray. This will help determine the shape of the root canals and check if there are any signs of infection in the surrounding bone. Your dentist will then numb the area using a local anaesthesia. To keep the area dry and free of saliva during the treatment, a rubber dam (or separator) will be placed around the tooth. An access hole is made into the tooth, so that bacteria and decayed nerve tissue and debris removed. The tooth is then cleaned out using root canal files in our automated rotary system. Once cleaned thoroughly, the tooth is then sealed. A tooth that requires a root canal treatment is often one with a large filling or extensive decay, therefore making it weak. A crown is often required and placed on the tooth to protect it. This will help prevent breakages and restore it to full function. If any additional dental work is required, your dentist will discuss it with you. What should I expect after a root canal treatment? For the first few days after a root canal treatment, your tooth may feel sensitive. This is due to natural tissue inflammation, which can also be caused by pain or infection present prior to the procedure. This discomfort usually subsides after a few days, and it can be controlled using over-the-counter pain medications. What if the discomfort doesn’t go away? If you’re still experiencing uncomfortable pain after the treatment, you may need to schedule a five minute appointment with Dental O So Gentle in order to receive a minor occlusal adjustment. What can and I can’t I do after a root canal treatment? It is advisable that you minimise chewing on the tooth under repair, until the treatment is completed and the tooth is crowned. You can and should brush/floss as you do normally. If your tooth flares up and is too painful to touch, please call your dentist. This can happen occasionally due to the complicated nature of the root canal treatment. Either further canal cleaning or an occlusal adjustment may be needed.

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Root Canal INR   0 INR  0
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Root Canal

Root canal treatment is a treatment for repairing and, ultimately, saving a tooth once the nerve has become irreversibly damaged by decay or a fracture, and is infected. If treatment is not received, then the tissue surrounding the tooth could possibly become infected and an abscess may form. Root canal treatment is when the nerve and pulp (the centre of the tooth where the nerves and blood vessels are contained) are removed and the inside of the tooth is cleaned and sealed. Whilst it might seem extreme, the nerve has to be removed due to the multiplication of bacteria within the pulp chamber. How do I know if I might need a Root Canal Treatment? You might need a root canal treatment if you experience the following: Severe toothache during chewing or whenever there is pressure placed on the tooth. Prolonged sensitivity to hot and cold temperatures. (Especially once the stimulus is removed.) Tooth discolouration (darkening). Swelling and tenderness in the gums. Bad tastes in the surrounding area. A gum boil – a persistent or recurring pimple on the gums. Throbbing pain at night. Pain during running. Pain requiring relief by swishing cold water over the tooth. What happens during a root canal treatment? A root canal treatment will require at least one visit, and potentially more, to the dentist. The first step of the procedure is the taking of an x-ray. This will help determine the shape of the root canals and check if there are any signs of infection in the surrounding bone. Your dentist will then numb the area using a local anaesthesia. To keep the area dry and free of saliva during the treatment, a rubber dam (or separator) will be placed around the tooth. An access hole is made into the tooth, so that bacteria and decayed nerve tissue and debris removed. The tooth is then cleaned out using root canal files in our automated rotary system. Once cleaned thoroughly, the tooth is then sealed. A tooth that requires a root canal treatment is often one with a large filling or extensive decay, therefore making it weak. A crown is often required and placed on the tooth to protect it. This will help prevent breakages and restore it to full function. If any additional dental work is required, your dentist will discuss it with you. What should I expect after a root canal treatment? For the first few days after a root canal treatment, your tooth may feel sensitive. This is due to natural tissue inflammation, which can also be caused by pain or infection present prior to the procedure. This discomfort usually subsides after a few days, and it can be controlled using over-the-counter pain medications. What if the discomfort doesn’t go away? If you’re still experiencing uncomfortable pain after the treatment, you may need to schedule a five minute appointment with Dental O So Gentle in order to receive a minor occlusal adjustment. What can and I can’t I do after a root canal treatment? It is advisable that you minimise chewing on the tooth under repair, until the treatment is completed and the tooth is crowned. You can and should brush/floss as you do normally. If your tooth flares up and is too painful to touch, please call your dentist. This can happen occasionally due to the complicated nature of the root canal treatment. Either further canal cleaning or an occlusal adjustment may be needed.

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