What Does Dr Crowe Do For You?

Dr Crowe is interested in you as a person and not just your teeth. Your mouth is a good indicator of your general health and you can be assured anything found giving concern will be discussed with you and a referral for help may be offered.

Your teeth are supported by bone and gums. It is very important that these are kept healthy as without this healthy support you could loose your teeth. This is why Dr Crowe prescribes treatment with the Hygienist as they concentrate on the oral prevention and health programme.

Dr Crowe works through a microscope to not only remove existing decay, but to restore the teeth so that they are easier to keep clean, help maintain your jaw relation and the structure of the teeth for the long term. Using a microscope for most dental procedures allows Dr Crowe to work extremely precisely to not only save tooth tissue but also to restore the tissues more accurately.

If you have lost teeth in the past, it does not necessarily mean that you will eventually lose them all. With the correct replacement for your missing teeth i.e. bridgework or dentures, Dr Crowe can help you maintain your teeth for the rest of your life.

There is more to a mouth than just teeth. If you suffer from jaw pain Dr Crowe may be able to help.

Restorations

Dr Crowe restorations (fillings) are all tooth coloured. During this procedure, she uses a rubber dam for optimum comfort of the patient, protection of the oral tissue, moisture control and better visual focus. Restorations can be carried out using the following materials.

The restorations done at Rookswood Dental Practice are to a standard to restore the normal tooth contour not only to fill the hole left by the removed decay. Research shows that for people who have a history of gum disease, in order to encourage the normal flow of food over the tooth surface, which is designed to keep it away from packing between the teeth thus potentially causing gum disease, discomfort and possible bad breath, we restore the natural cusps and fissures and ridges between the teeth.

The natural cusp form of a tooth as nature designed is for absorbing the main force of the bite and is a complicated fissured convex shape. It is used to guide the bite on the posterior teeth and protects the single surfaced front teeth from becoming cracked. The whole bite works together synergistically to protect its optimum function and health.

Dr. Crowe learned this precise technique of rebuilding teeth accurately into the bite at dental college and then later developed this technique further whilst training with Dr. Michael Wise and Mr. Anthony Laurie of 1, Bow Lane, London one of her current dental technicians.

Glass ionomer

These are carried out in one universal shade, the surface layer is softer than composite (see below) and will wear down normally over the next 2 years of use; then they will need a harder cover like composite to lengthen its functional life. The material leaches out fluoride to help prevent more decay and is the best material to fill the main bulk of the tooth replacing the dentine tissue for the long term. It is especially indicated in posterior (back) teeth fillings and large anterior (front) teeth restorations under composite. We use a self hardening glass ionomer (not light cured) which is hand mixed to make it as strong as possible and takes a period of up to 48 hours to fully set. The patient will have resin placed over the surface which hardens the surface of the glass ionomer many times over whilst it sets.

Presentation with pain in tooth	Discovery of problem

Tooth filled with glass ionomer restoration

Large cavity prepared for restoration	Tooth restored in glass ionomer

Composite

This material is more brittle, harder and more aesthetic than glass ionomer. These fillings are done in many tones of colours in many layers which are shade matched to the tooth. They are most attractive for front teeth but because they are light cured and contract on setting they must be applied in thin layers so it takes more time. For posterior restorations they take a lot of time to set which is why it is better to fill the bulk of the tooth with glass ionomer. Glass ionomer also bonds to the dentine better than composite thus helping prevent further decay. If the filling is done too fast with too much composite material used in one time, the tooth can fracture (the cusps are pulled in when a bulk of composite contracts on setting) or give a lot of pain post operatively. Composite is more ideal as a filling material for anterior teeth due to its better aesthetics. Composite is used on top of glass ionomer on posterior teeth when time is not a constraint. All composite restorations are carried out using a rubber dam and the gums must be healthy (i.e. not bleeding) before they can be placed or they will degrade much faster. So temporary or glass ionomer restorations are placed until adequate health of the gum is achieved to ensure a dry field to place the composite restoration. Please consult with your hygienist as prescribed by Dr Crowe to find out more.

Everyone is different – Dr Crowe is well aware of this and is quite happy to discuss what best suits your lifestyle and needs, so feel free to ask any questions.

In caring for you, we need to know what bothers or worries you and what you do and don't like.

There is no need nowadays for dentistry to be a mystery or cause you discomfort.

White restoration in composite material

White restoration finished in composite material on posterior teeth.

Preparation	Etching
Completion	After polishing

Front composite

White restoration finished in composite material on anterior tooth.

Before treatment	After treatment

The use of the rubber dam technique in dental treatment

The rubber dam system is used in most types of dental treatment at Rookswood. Its aim is to make treatment more comfortable for you.

Why do we use it?

It isolates the tooth to be treated, making access to it much easier.

It prevents contamination of the tooth cavity by saliva.

It is particularly important in root treatment where the root canal MUST be kept free of saliva.

Composite restorations need to be kept free from moisture contamination for them to adhere correctly.

When an amalgam filling is being removed it prevents amalgam falling into your mouth.

You will still be able to swallow with the rubber dam in place, making it more comfortable for you.

Gum health needs to be good if we are treating a tooth. If for any reason the gums are bleeding the rubber dam helps to prevent this affecting the tooth.

How does it work?

Each sheet of rubber dam is stamped with a template representing all the teeth in the mouth. Using a special punch, holes are made in the rubber corresponding to the area of the mouth where we are going to work.

We use a metal holder, which keeps the rubber dam held over the teeth. This is usually placed on the tooth behind the one we are working on. The holder can feel a little tight around the tooth but should not hurt. The rubber dam is then stretched over the teeth, usually from the one with the holder on, to the tooth at the middle of the arch.

Dental floss is used to ease the very thin pieces of rubber between each of the teeth.

We can then see the teeth we wish to work on. The rubber sheet is stretched over a frame, which sits outside your mouth and holds the rubber away from your tongue, allowing you to swallow normally. We can then work above it, keeping water from going in to your mouth, and keeping the tooth we are working on dry and uncontaminated.

The Rubber Dam technique should not be uncomfortable. Relax, take time to get used to it and you will find that the rubber dam makes dental treatment a much more pleasant experience even allowing some of our patients to fall asleep during the procedure.

What Does Your Dental Nurse Do For You?

Every body knows that the dental nurse’s role is to assist Dr Crowe. This is true, but she is also here to help you too.

	Rosie teaching oral hygiene

A Dental Nurse carries out many different jobs. When you arrive for your appointment, she will have prepared the surgery ready for your treatment. Everything that is required during your appointment time will be ready, and when you have gone, she will be busy tidying the surgery ready for the next patient. Your notes will have been updated while you were in the chair, and details of your next appointment will have been passed to Reception. All of this will have been put on to your computerised records to make booking appointments that little bit easier and quicker.

Dental Nurses are qualified, having passed a National Examination or NVQ, and some have a Dental Radiography Certificate as well. This means you will probably book an appointment to see her to have your x-rays taken, rather then booking in with Dr Crowe.

Treatment Room

All patients at Rookswood have their own Assigned Nurse. She will meet you at your first appointment and show you around the practice. She will go through your medical and dental history and discuss any worries or concerns you may have regarding your dental treatment. You will be able to tell her if there are any particular problems you would like to discuss and anything you tell her will be in confidence. Wherever possible, she will be with you in the surgery at every appointment you have, and if she cannot be there herself she will have passed on any relevant information to another nurse or to Dr Crowe.

If you are unclear about something or have forgotten what Dr Crowe has told you please do not hesitate to ask and your nurse will be able to explain this to you. Even after you have left the surgery, if you feel there is anything you need to discuss, contact the Practice and if she is not available to speak to you immediately, she will always contact you as soon as possible.

Please remember – if you are nervous during treatment – don’t be afraid to say so: your nurse is trained to listen to you and support you.

What does your Receptionist do for you?

The Receptionist is the first person to greet you when you arrive. She lets Dr Crowe know you are here. She can answer queries about your appointments.

Our Receptionist has been trained to answer the telephone and deal with your calls efficiently.

She is responsible for booking appointments and in making sure that they are booked that any change of appointments by yourself or the Practice are dealt with without any cause for fuss.

She will also give reminders if requested.

She deals with taking the money for appointments and treatment.

If you have any questions about your treatment, she can find out the answers for you if she does not know herself.

What happens during your examination appointment?

Dr Crowe looks at:

• The position of every tooth
• Rotations of teeth
• Any wear on the teeth
• The condition of enamel
• Any decay
• Restorations present
• Which material the teeth have been restored with
• The condition of the restorations
• Any fractures or potential fractures in the enamel of the teeth
• Any fractures or potential fractures to the cusps of the teeth
• Clinical findings in comparison with the radiographs
• The general impression of the health of the soft tissues of the mouth
• Initial sense of the jaw position, and jaw health, from the position of the teeth.

You may also have a Periodontal Assessment - a 36-point assessment of each tooth (charted by the Hygienist) - to determine the state of the tissues surrounding the teeth, gums and bone.

Aims of the Examination

We prioritise dental and oral health treatment from the information gathered above.

We give you options for your care to formulate a treatment plan with you based on your budget and the level of dental health care you wish.

The above can lead to giving you a prognosis and diagnosis for your long and short-term dental and oral health, depending on how much information you wish.

The above also gives information for the further tests needed to assess the following: your occlusion and your whole bite relation and your jaw joint health function.

Estimates and Treatment Plans

After the examination we prepare and give treatment plans and estimates for all the treatment and options we have discussed. If your treatment plan changes during the course of your treatment then we will prepare an updated plan and estimate for you. We also make sure that you know each visit, what is planned for your next appointment or appointments, as we like to work on the premise “inform before you perform, no surprises”. Dr. Crowe discusses at length your treatment options, to help you be well informed to make a choice to suit your needs. You can set the pace of your treatment, unless it is an emergency, you may take it appointment by appointment, in phases, or we may need to set up an extensive treatment plan if complex work is necessary.

We like to work so that you feel in control of your treatment with your budget. You are at the centre of the team at Rookswood. By you being at ease with your dental care plans we have found it works better, your results are more successful and you are more comfortable, confident and happy.

Radiographs

We take a radiograph where appropriate to check the following:

• Decay
• Overhangs of restorations
• Deficiencies in restorations, crowns inlays
• Areas of infection around or on the apex of the root
• Pocket depths around the tooth
• Levels of bone surrounding the tooth
• Density of bone
• Supernumerary teeth
• Un-erupted teeth
• Impacted teeth

Denar Quint Sectograph Radiographic Machine

Which Services Can We Offer You?

• Advanced restorative dentistry: Many types of crowns, bridges, veneers and implants can be designed for your ultimate needs and desires from one tooth to a full mouth reconstruction.

Bridge made by laboratory technician (Tony Laurie) to replace missing middle tooth	Bridge in mouth

• Aesthetic cosmetic dentistry: For full natural looking symmetrical smiles that are easy to keep healthy.
• Facial Pain: This is a problem that some people unfortunately experience which may be caused by dental or non-dental problems. As dentists we can investigate and rule out any dental causes to help alleviate the issue or refer you where necessary
• Occlusion: This is how the teeth come together in your bite and one of Dr. Crowes real passions is to restore wholeness, health and symmetrical balance to your bite. It incorporates precise use of procedures in for example Orthodontics Periodontics and restorative dentistry.
• Orthodontics: This is moving teeth in the mouth into spaces in the jaw to make a more aesthetic smile and healthy well functioning bite. Dr. Crowe uses her microscope to achieve this precision is key to achieving the good results for your benefit.
• Orthopaedics: This is changing the bony arch form to encourage the full natural growth potential of the jaws to allow for the spaces for the teeth to fit in to give a natural looking symmetrical smile.
• Pain-free and antiphobic dentistry: This is orientated to all patients of any age who have fears or discomfort bout receiving dentistry to alleviate their challenges so that they can enjoy the benefits of good long-term dental care.
• Periodontics: The care of the foundation of your bone and gums is essential for the success and the long term health of any of your dental treatment and reflects in your general health. Dr. Catherine Crowe is very interested in this aspect of dentistry.
• Temporo mandibular joint dysfunction treatment: This is treatment for helping people who have problems with pain, clicking, clunking, dislocating or altered patterns of opening of the jaw joints.
• Dentures: These are made to replace missing teeth and can be partial or complete and generally are made of chrome and acrylic or just acrylic. We use Stephen Oxley of John Davies laboratories, Newbury, Berkshire for our chrome dentures.

Before treatment	New chrome denture
Denture in place	After treatment