Frequently Asked Questions and my answers

If you have a question that has not been addressed below, please ask it in the text box at the bottom of this page and I will answer it online and if appropriate put it on the website anonymously for others to benefit from as soon as possible.

Q. Will treatment take a long time?

A.

Full mouth rehabilitations can take from several months up to 2 years to complete, especially if long periods of healing and stabilisation are required between stages. Even if treatments required are extensive, we will ensure that we fit into your diary as unobtrusively as possible. We will work in the most time and cost effective way possible, reducing time you spend travelling to and from the practice. However high quality dentistry is time consuming and cutting corners is false economy. An estimate of time required will be given to you at the start of the treatment after thorough planning.

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Q. Is treatment painful?

A.

Nobody will pretend that dental treatment is their favourite pastime! Extensive treatment will entail some discomfort after local anaesthetic has worn off and we provide suitable medication for each case as appropriate. However, we would like to assure you that our proceedures are pain-free and we take great care to ensure that treatment and aftercare is of the highest possible quality. It is exceptionally rare for patients to report discomfort that has really been a problem for them. Please refer to our testimonials for our patient experiences.

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Q. How much will it cost?

A.

If I could, I'd be delighted to provide all of the treatment and teaching I do for absolutely nothing. Dentistry gives me the same satisfaction as a hobby. Unfortunately, for all of us, modern dentistry is costly to provide to the standards I insist upon and that my patients would expect if they knew what I know.

There is a vast variation in the quality of dental treatment both in this country and abroad and as with anything, you do get what you pay for. The personalised care we provide, the experience of my team, the quality of my work, the type of work we do and our location means that we do cater to the upper end of the market in our profession. Of course I would like to make treatment as affordable as possible since it's heartbreaking for someone to decline treatment based on what may be perceived as a substantial investment. I'm able to arrange payment plans that allow spreading payments for up to 5 years to ensure that the dental care you require is readily affordable.

A realistic estimate is provided for your proposed course of treatment. If settled in advance the fees are set and treatment can normally be completed without further costs being incurred. I'm also one of the very few practices that provides a five-year guarantee on technical work.

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Q. How much does a given item of treatment (crown, implant, filling) cost?

A.

Every patient is different and the fee scale provided on this website can only be a guide. Some case are really very straightforward to treat, others are considerably more challenging and fees will necessarily reflect this. Therefore, the fee for a crown may be very different for two different patients or even for two different teeth within the same patient's mouth. A customised treatment plan and estimate are therefore provided for every patient.

Occasionally it will be very difficult to give an estimate until previous dental work has been removed. For example, a crown may need to be replaced due to decay in the tooth underneath. Upon removal it maybe discovered that the decay is quite limited and can easily be removed, the tooth re-shaped and a new crown made straight away. However if the decay has been there for a while, it may extend well into the tooth, exposing the nerve, going under the gumline and seriously compromising the prognosis of the tooth long-term. The tooth may require minor gum surgery to expose a healthy edge, a temporary crown, a root canal treatment, posts, a new structural core bonded to the underlying tooth, a provisional crown to refine the tooth shape up to the new gum line while it matures and finally a new impression and final crown. The difference between these two treatments may run to £1,500 for a single tooth. Multiply that to say 20 crowns around the mouth and there is potentially a £30,000 difference between a straightforward treatment plan and more complicated one for what appears to be the same tooth on x-ray before the crown is removed. An alternative may be to even remove the tooth and place a dental implant to support the new crown which may be more predictable long-term and may be of a comparable cost to the more complex scenario.

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Q. Can I replace all of my amalgam (silver) fillings with white ones?

A.

The current view is that there is no medical, dental, or toxicity related reason to replace old amalgam fillings. Each time a filling is replaced some damage is done to the tooth.  This may result in some cases where the fillings are very large in the need for further treatment. Often amalgam fillings do a good job over many years with no detrimental effects. However, modern white (tooth coloured) materials will bond to the tooth and look more natural. They would be the treatment of choice if a replacement were necessary. It is also acceptable to change amalgam fillings for aesthetically superior white fillings for cosmetic reasons. The patient should be made aware that elective removal will cause some damage to the tooth and may result in some cases where fillings are very large for the need for further treatment such as root canal procedures or a crown being required. It is also much more technically demanding to carry out an excellent white filling to ensure a good bond and optimisation of the properties of the materials. Often each tooth will take 1 to 2 hours if properly done. A rushed or poorly executed white filling is often inferior to a good amalgam.

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Q. What if something doesn't go to plan or goes wrong?

A.

I put it right. No medical or dental procedure can be guaranteed to be perfect every time by the very nature of medicine and dentistry. My planning and experience will allow me to draw your attention to any likely problems at the start of treatment and you will be made aware of these before we embark on treatment. I am fully equipped to deal with most eventualities that may crop up unexpectedly, though I would hope to predict them at the start.

In a rare event that something goes wrong due to an error on my part, I will assume full responsibility, inform you immediately and rectify the problem at my own expense.

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Q. How long does a filling/crown/implant/veneer last?

A.

Due to the huge variability in patients’ bite dynamics, wear and tear, oral hygiene, diet, decay and gum disease susceptibility, variability in customised work, variability in the damage sustained by the repaired tooth to start with etc there is no real answer to this. All dental work is likely to deteriorate over time to some extent just as any other item subject to wear and tear in a hostile environment. No dental treatment can be guaranteed indefinitely, even implants which seem to have a very long life as far as we can see. Our 5 year guarantee does seem to be a reasonable assurance against obvious shortcomings in treatment quality, but it is not possible to guarantee any dental treatment beyond this. However, we are happy to say that most of our work does seem to be standing the test of time and our success rates are easily comparable with what may reasonably be expected of modern dental work.

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Q. Does whitening damage my teeth?

A.

Whitening using proprietary peroxide-containing materials has been carried out for several decades. There is no evidence that the materials currently used at the concentrations we use have any detrimental effect on the structure of the teeth. The most common side-effect of whitening is normally that of temporary and reversible sensitivity which can be minimised by reducing the concentration, frequency and duration of whitening. There is no evidence to suggest that modern whitening is damaging to the nerves of the teeth.

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Q. I want my final crowns to be white but have been advised against this - why?

A.

Natural teeth are not white! Even teeth that have been whitened or bleached are not white. The beauty of a tooth comes from its gradations of colour, shape, texture and transparency as well as more subtle interactions with light such as opalescence and even fluorescence. Making teeth white is unnatural and is often regretted by the patient who has insisted on it after crowns or veneers are fitted. We understand that you would like your teeth to look healthy and bright. Our ceramists are very knowledgeable about the materials they work with and the way their crowns or veneers look in the mouth. Please allow us to help guide you to the most appropriate result!

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Q. My teeth and dental work keep breaking / wearing away – why?

A.

It is helpful to consider the teeth as the working end of a system that includes the teeth, gums, jaws, jaw joints (the temporomandibular joints) and the muscles and nervous system (conscious and subconscious) that controls them. This system is known as the masticatory system.

Some people do sometimes have a conflict between the way their teeth meet and the way their jaws naturally move leading to interferences developing between the biting surfaces of the teeth that are then ground or broken away by conscious or subconscious clenching and grinding habits.

Interestingly there is little evidence to suggest that the way we bite or chew leads to jaw problems or headaches or that dentistry can solve pain from the muscles and joints that drive this system. There is more to it than simply that.

There are certainly protocols that must be followed to diagnose the nature of such problems and ensure that all of the above structures are healthy and stable prior to building a new mouthful of teeth or implants to work within the system.

Accordingly, patients who feel that their bites are not correct or who are continually breaking dental work may need to go through a sometimes protracted period of observational treatment where the bite is stabilised and provisional crowns are used over extended periods to ensure that there is good masticatory system stability before the final bite scheme is designed and built by the laboratory.

This may delay treatment but this is preferable to rushing into treatment when the masticatory system is not stable.

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