The Gentle Dental Practice

Hygenist

My name is Anita and I am the Dental Hygienist at the practice. I have been a member of the team for six happy years and below I have briefly summarised what my role is and how this can help you.

The role of the hygenist
My role plays a very important part in the maintenance and prevention programme we provide for our patients. My aim is to clean your teeth and to advise you on the best methods of effective plaque removal to help prevent dental decay and gum disease.

My aims are:

• To explain the role of plaque in tooth decay and gum disease.
• To remove tartar and staining (where possible) with hand instruments and an ultrasonic scaler (if necessary)
• To demonstrate the required tooth brushing techniques and recommended oral hygiene products such as interdental brushes, dental floss etc.
• To motivate and encourage
• To monitor your progress

Cosmetics - Smile with Confidence

There are many different aspects of dental care available in today's modern society. A pleasing smile can achieve amazing amounts of confidence. Gaps, discoloured fillings, and crooked teeth no longer have to be accepted, knowing the options gives you the choice to smile with confidence.

Crowns and Bridges

Crowns are used to rebuild heavily restored teeth to their full function, and bridges replace missing teeth. With the use of modern techniques they can conform to your natural teeth leaving people none the wiser!

Veneers

When teeth are severely discoloured, misshapen, fractured or have spaces between them, a veneer could correct this. A thin covering of porcelain (just like a false finger nail) is bonded to the tooth surface and the aesthetic solution you have been looking for can be achieved.

White Fillings

Unsightly silver fillings or old and discoloured white fillings can now be replaced with new modern materials which will conform perfectly to your natural teeth.

Teeth Whitening - find out more here

This is a process that can lighten your teeth. Tested safe chemicals are used in a custom fitted tray, this holds a bleaching gel against the tooth or teeth of the surfaces to be lightened.

Five important facts about tooth whitening:

It is safe
Successful in at least 90% of patients
Lightness can last up to five years
Quick results
Easy to use

Implants - What are Dental Implants?

Dental Implants are a replacement for missing teeth. They comprise of a titanium post which is implanted into the bone and acts like the roots of the teeth. After they have been fitted and have healed into place, dentures or crowns may be attached to them. Dentures are attached by the use of magnets, resulting in a far more solid fit, giving you the confidence to smile and eat without worry. Crowns are fitted onto the implants, giving the appearance and function of natural teeth.

Why replace missing teeth?

The loss of back teeth may cause your mouth to sink and face look prematurely older. Front teeth help to form certain sounds and therefore the loss of these teeth could affect your speech. Your facial appearance, dental health and the correct functioning of your mouth are excellent reasons to replace missing teeth.

Osteo-Ti Implants

We have conducted extensive research into many of the Implant systems on the market and concluded that Osteo Ti Implants offer the best solution for our patients. Their up to date technology, ongoing research and patient and practice support allows us to deliver the implant service our patients deserve. Click here to visit the Osteo-Ti website.

Relevant Links

The Association of Dental Implantology

Inhalation sedation - Laughing Gas

Nasal Sedation (Relative Analgesia) at The gentle Dental Practice.

You can be helped to feel relaxed by ‘relative analgesia’ sometimes known as inhalation sedation. This means breathing in a mixture of nitrous oxide and oxygen (‘laughing gas’) which quickly leads to a pleasant, relaxed feeling. The dentist puts you at ease at the same time, by talking softly and suggesting what you feel. You remain conscious all the time, although you may be a little drowsy, and any treatment given causes you no discomfort. You breathe in the mixture through a nosepiece, which is very comfortable. You can’t overdose on the gas, as the mixture quickly leaves the body if you breathe in one or two breaths of ordinary air. There are no after-effects either, and you can drive a car after about 15 minutes. Many dentists use this safe and effective technique.

How do I know if it's for me?
If you exhibit any of the following characteristics, "Nasal Sedation Dentistry" may help you:

• Fear Stress and Anxiety about going to the Dentist
• People who desire a beautiful and natural smile and have fear and anxiety associated with dentistry
• Fear of needles
• You are hard to get numb
• Dental Phobia
• A history of bad dental experiences
• Painful or sensitive teeth
• Afraid to go to the Dentist
• You are troubled with a bad gag reflex
• Difficulty controlling movement from conditions such as Cerebral Palsy or Parkinson's disease
• You need complex treatment requiring long dental appointments
• People who have limited time to complete their required treatment and want to accomplish a lot in a single appointment. Treatment requiring multiple visits can often be accomplished in a single visit.

What is nitrous oxide?
Nitrous oxide is a popular anaesthetic agent used by dentists. Its safety has been well-established; it is effective, and the anaesthetic effect wears off quickly so there is no extended recovery time. It can be used for both children and adults.

Nitrous oxide has a very calming, comforting effect, even though the patient remains in control. Some dental experts have called it the "ideal anaesthetic" because it takes effect quickly (in less than 5 minutes) and because there is a very rapid recovery time (about 5 to 10 minutes). Nitrous oxide is mixed with oxygen so that you will have an ample supply of oxygen at the same time.

In addition to the sedative effect of nitrous oxide, it helps control discomfort associated with some procedures. The level of sedation can be easily adjusted for the best possible effect for each individual patient.

The effects of nitrous oxide
Nitrous oxide kills pain and it induces a pleasurable feeling. After 5 minutes or so of breathing in the gas, you should feel a euphoric feeling spread throughout your body. It really kind of feels like a 'happy drunk' feeling. Some people find that there are auditory or visual effects as well. You will feel a bit light headed and often people get 'the giggles' (hence the name laughing gas!). As an interesting aside, nitrous oxide was one of the drugs of choice for young people in the late1700s and early 1800s, when "laughing gas demonstrations" were a popular source of entertainment and enjoyment!

Depending on the concentration and length of administration of laughing gas, four levels of sedation can be experienced (after an initial feeling of light-headedness):
1 a tingling sensation, especially in the arms and legs, or a feeling of vibration, quickly followed by
2 warm sensations, and
3 a feeling of well-being, euphoria and/or floating ("drift"). During heavier sedation, hearing may dissolve into a constant, electronic-like throbbing.
4 At a deeper level of sedation again, sleepiness, difficulty to keep one's eyes open or speak ("dream") can occur.

During relative analgesia, you should be maintained within the first three stages. If you've had bad experiences with laughing gas in the past, it is highly likely that these were due to improper administration and too high a concentration of N2O.

It's been observed that N2O depresses almost all forms of sensation - especially hearing, touch and pain, and that it seems to disinhibit some emotional centres in the brain. The ability to concentrate or perform intelligent acts is only minimally affected, as is memory.

How is it administered?
The equipment used for delivering "happy gas" is quite simple. It consists of a supply of compressed gases and an apparatus which delivers the gases to the patient. By turning some knobs and flipping on/off switches, the administrator can produce the desired mix of N2O-O2 in the desired quantities. Flowmeters and pressure gauges allow the administrator to keep an eye on the flow of gases.

The desired N2O-O2 mix is fed through a tube to which a nasal hood or cannula is attached. This hood is put over your nose. All you have to do now is breathe normally through your nose - bingo!

In modern machines there is a sort of "double mask" where the outside mask is connected to a vacuum machine to suck away the waste gas - you wouldn't want your dentist to get a face full of N2O... The white inside mask, which is placed over your nose, comes in lots of yummy scents - vanilla, strawberry, and mint!

The twin tubes running to the mask are for "gas in" and "gas out". The "gas out" line is attached to the vacuum machine, while the "gas in" line is attached to the RA (short for relative analgesia) machine. The inner mask is attached to the "line in", you breathe out through a one-way valve in the inner mask, and the exhaust gas is collected inside the outer grey mask (pictured to your right) and sucked into the vacuum machine.

The white inner mask (sticking out) comes in vanilla, strawberry and mint

The grey "outer mask" ensures that your dentist doesn't leave work with a headache

What are the advantages?

• Happy gas works very rapidly - it reaches the brain within 20 seconds, and relaxation and pain-killing properties develop after 2 or 3 minutes.
• The depth of sedation can be altered from moment to moment, allowing the person who administers the gas to increase or decrease the depth of sedation. Other sedation techniques don't allow for this. For example, with IV sedation, it's easy to deepen the level of sedation, but difficult to lessen it. Whereas with gas, the effects are almost instant.
• Other sedation techniques have a fixed duration of action (because the effects of pills or intravenous drugs last for a specific time span), whereas gas can be given for the exact time span it's needed for. It can also be switched off when not needed and then switched on again (though to avoid a roller-coaster effect, you shouldn't do this too abruptly).
• There's no "hangover" effect - the gas is eliminated from the body within 3 to 5 minutes after the gas supply is stopped. You can safely drive home and don't need an escort.
• With nitrous oxide, it's easy to give incremental doses until the desired action is obtained (this is called "titration"). So the administrator has virtually absolute control over the action of the drug, preventing the possibility of accidental overdoses. While giving incremental doses is possible with IV sedation, it's not possible with oral sedation (as a result, oral sedation can be a bit of a hit-and-miss affair).
• Unlike IV sedation, no injection is required. In cases of very severe needle phobia, getting laughing gas first can help you feel relaxed enough to allow the needle required for IV sedation to be inserted in your arm or hand. The very deep state of sedation achievable through IV sedation may then allow you to accept local anaesthetic.
• Inhalation sedation is very safe. It has very few side effects and the drugs used have no ill effects on the heart, lungs, liver, kidneys, or brain.
• For certain procedures, especially those involving soft tissues (e. g. deep cleaning), inhalation sedation may be used instead of local anaesthesia. N2O acts as a painkiller; however, its pain-relieving effects vary a lot from person to person and can't be relied upon. So if you're determined to give the needle a miss, you and your dentist will have to try and see what happens...
• Inhalation sedation has been found to be very effective in eliminating or at least minimizing severe gagging.

When should I not use it?
There aren't any major contraindications to RA, except for emphysema and some exotic chest problems. It hasn't been proven to be safe during the first trimester of pregnancy, so you can't use it then. Because you have to breathe it in through your nose, it's not suitable for people who have a cold or some other condition which prevents them from breathing through their nose. M.S. is another contraindication.

You can't be allergic to N2O. It's also safe to use if you suffer from epilepsy, liver disease, heart disease, diabetes, or cerebrovascular disease. It is also used quite successfully in many people with respiratory disease - but it depends on the exact nature of the disease, so check with us here at the Gentle Dental Practice.

Tony Gold.