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We all take for granted a winning smile but like everything in life this has got to be looked after. Proper hygiene from an early age and a careful eye on sweets and fizzy drinks will help to keep things right. Sometimes despite our best efforts we can be a victim of an accident.

The statistics are that we have a one in seven chance of damaging our front teeth. It invariably will occur when we are not expecting it. It can be a young child taking a fall from a bicycle or tripping in the playground at school .

A teenager taking that certain score during a basketball match only to encounter an elbow or an unlucky encounter with a gang of thugs.

As an adult it could be a road traffic accident or a grandparent getting a head butt from their one year old grandson. I’ve encountered all these situation.

What can we do to prevent these situations?
The most obvious situation is in sport where a protective gumshield can be made. It’s worth consulting your dentist to get a proper custom made gumshield from age eleven when all the adult teeth are in place . Prior to that age a custom shield can be made but as the baby teeth fall out and the new adult teeth appear the gumshield will start to become ill fitting. Even a cheap guard bought from the local sports shop is better than not wearing anything at all.

What are the different type of fractures?
When a tooth breaks the level of seriousness depends on where the tooth breaks . It’s a class 1 fracture if only enamel breaks and class two where enamel and dentine break. Both of these situations can be temporarily repaired by what’s known as a tip replacement. This is where a composite (tooth coloured) filling replaces the broken element of the tooth. A class 3 fracture is where the tooth breaks and the nerve is exposed. The tooth will then have to be root treated and a composite filling placed on a temporary basis as a tip replacement.
The most serious situation is where the tooth is avulsed. That means it falls out completely. In this instance the tooth should be placed in milk and a dentist contacted immediately. The quicker the tooth is placed back in the socket the better the prognosis of the tooth remaining long term. The advice is that tip replacements are the treatment of choice until age eighteen and after that a more permanent solution is found.
What are the different long term solutions to repair a broken front tooth.

VENEER
A veneer is like a false fingernail. It’s a thin layer of porcelain that is colour matched to the remaining teeth and covers over the complete front surface of a tooth. These are often used to disguise teeth that that are discoloured or heavily filled. They are often the treatment provided that gives what’s known as the Hollywood smile. They would be a good treatment for a class 1 fracture. Their lifespan would generally be regarded to last five years. The often last considerably longer if looked after.

A CROWN
A crown is made up of a complete outer surface that replaces the original enamel. They apply to both front and back teeth but I’ll cover front teeth only here. The crown type varies and different standards are available. The first type is a pjc which stands for porcelain jacket crown. Thee look great but are very fragile. The second type are like a pjc except they have a metal lining. These are called bonded crowns. These are the most commonly crowns provided. They are very strong but often the appearance can often leave a lot to be desired. They can often have a black line at the gum line and a poor translucency. The newer type of crowns use an aluminium oxide lining and have a stronger porcelain. Their appearance is great. These are procera crowns. The biggest advantage is that not as much of the outer section of the tooth has to be removed to accommodate these crowns. CAD/CAM technology is now in use where a tooth can be mapped and a crown milled from a solid ingot of porcelain matched to the patients tooth colour. The last two types of crowns tend to be expensive for both dentist and patient and aren’t commonly used.

A BRIDGE
A bridge is used to replace missing teeth. I will concentrate on a single missing front tooth. Depending on the tooth involved and the strength of the adjoining teeth a replacement plan is put in place. Typically the tooth on either side of the space is reduced to accept a crown. A bridge in this scenario would involve three units. A false tooth made up of porcelain spanned on either side by a crown. This three unit bridge is cemented into position to fill the space. This is known as a bonded crown .A different type of bridge is a Maryland bridge where the teeth on either side of the space are not ground down to accept a crown but instead has a false tooth supported by metal wings bonded to the inside aspects of the neighbouring teeth. This is also a good alternative although its lifespan wouldn’t be as long as a bonded bridge.

AN IMPLANT
An implant is an artificial root made from titanium that is used to support a single tooth or more than one tooth and is placed in bone. It’s an ideal method of replacing a single lost front tooth as it stands alone and doesn’t rely on other adjoining teeth as a bridge does. It is a treatment that relies heavily on the skill of the operator. I refer this work to trusted colleagues as not every case is suitable . It tends to be an expensive option and one that shouldn’t be entered into lightly.

A DENTURE
There are two different types of denture. A plastic denture is often the first treatment option used in the event of losing a front tooth. It’s a denture made entirely of plastic where the arch of the mouth has a plastic covering and is used to support missing teeth. Hygiene is important as patients are prone to fungal infections and denture stomatitis. These are what most people associate with dentures. On the upper arch they tend to be ok but on the lower arch they tend to be a disaster. The second type of denture is a chrome denture. The roof of the mouth has a metal frame and the remaining teeth have clasps and stops designed around them and these support the new replacement plastic teeth. These are a good long term prospect but unfortunately more expensive.

DENTAL TOURISM
This is the term given to the phenomenon of people going abroad to have many of the above treatments provided. Everyone has a choice about what we choose and where we go. You only have one set of teeth so research for yourselves exactly what’s on offer and make sure that you know what you are getting. Don’t be afraid to get a second opinion. There is a lot of inappropriate treatment being offered abroad to unsuspecting consumers.

I had a lady visit me recently who was heading out to Hungary for six crowns. The dentist doing the checkup made a disparaging remark about the poor hygiene he saw. This lady decided that she would come to me to have her teeth cleaned before she left as she didn’t want to be reprimanded a second time. I duly cleaned her teeth and had a look at each tooth as I cleaned. I asked her which teeth were to be crowned and she didn’t know. I advised her honestly that I couldn’t see where I would put one crown never mind six crowns. I advised her to get another opinion from somewhere like the dental hospital which would have nothing to gain financially. I hope she listened. She told me she had gone along to keep her friend company and ended up being seen herself. All I can say is buyer beware.