About Dr Jose Lage

Dr Lage has a special interest in Implant Dentistry, Mercury free Dentistry, Root Canal Treatments (Endodontics), and Cosmetic Dentistry (crowns, bridges, veneers, teeth whitening). He is very calm and very good with children and nervous patients. Jose speaks English, Portuguese and Spanish and is trying to improve his Italian and French.

Dental implants cost UK – what you need to know

Many people are in the unenviable situation of wanting to replace missing teeth, this can often be through tooth loss caused by dental decay or by trauma. Whatever the cause, the problem still remains, how do you replace those missing teeth and what is the cost?

In this article we will take a look at a few other questions relating to dental implants and then take a detailed analysis of the cost.

How Successful Are Dental Implants?

The first dental implant was based into a human in 1965 by Professor Branemark, since then a huge body of knowledge has built up around this growing market. Success rates are usually around 98% for dental implants, sometimes as high as 99.2%.

Factors which can affect the success rate of dental implants

There are a variety of factors which affect the success rate of dental implants, however we found the following to be good guide:

  • Smoking. Smoking has a dramatic effect on the oral pathology. It kills off good bacteria as well as bad and can also dry out the mouth significantly. This altering of the bacteria in conjunction with a dry environment can mean that healing doesn’t happen as fast as it should. It also leaves any implant placement site more open to infection and further problems. Very often smokers will not be considered for dental implants for this reason.
  • Dental hygiene. After the implant is placed they can be susceptible to many of the same problems that natural teeth are susceptible to. Gum disease can still happen around implants and if not kept under control can turn into the more severe peri-implantitis. It is a difficult to treat infection of the bone around the implant, it can lead to further bone loss, tooth loss around the implant site and also loss of the implant itself. A good dentist will always ensure that your dental hygiene is at a good place prior to placing the dental implants.
  • Food & Drink. Eating a balanced diet is important for maintaining overall body health and ensuring the healing process stays optimal. Also, eating a diet high in sugar can increase the chances of tooth decay in surrounding teeth and subsequent gum disease which can then affect the implant itself. After surgery it will also be important to stick to a relatively soft food diet for a few months to give the implant time to integrate into the bone.
  • Bone quality and quantity. If there is not enough bone or the bone is not good enough quality to place the dental implant then implants can become compromised. Very often a dentist would use bone augmentation procedures to build up this bone and therefore support the implants better. Bone grafting or sinus lift are examples of this.
  • Dental implant protocols. Lastly but by no means least are the protocols that are used. It may be tempting to cut corners to have cheap dental implants such as cutting out some stages. It has however been shown that if an implant is placed and then an adequate amount of time is left to the implant heal before it is restored gives a higher percentage chance of success, the protocol that your dentist uses for the dental implant surgery is of prime importance when looking at longevity. If these stages are missed out, which may be tempting if the patient is travelling overseas for cheaper dental implants, then problems may be more likely to develop.

What are the benefits of having dental implants?

If you have missing teeth you have a few options to replace them, each of them have a different cost upfront and in the long-term and each have a different set of features, benefits and disadvantages.

bone loss around the tooth extraction site
The teeth either side of a dental extraction site can begin to collapse if they are not supported

The benefits of a dental implant treatment are that they can support the bone around where the tooth was lost, after a tooth has been extracted the bone where the root was begins to collapse, as this collapsing happens bone quantity is lost.

Over time this can also mean that gum levels are reduced in that area, not only does this have a cosmetic affect but it can also mean that implants become more difficult to place as years go on due to the volume of bone, so it is advisable to have implants placed as soon as possible after a tooth has been extracted to prevent this bone resorption.

Bone resorption around the tooth extraction site

Can I have cheap dental implants?

As with anything in life it’s always possible to look for lower cost options, however is important to understand the difference between lower cost and cheap.

Many people may be tempted to seek cheaper alternatives to UK prices by travelling overseas. This comes with a wide array of problems such as:

  • Is the person placing the implant a suitably qualified professional? In the United Kingdom dentists are required to register with the General Dental Council, this council regulates the dental profession to ensure that patients remain protected. Is this same protection in place overseas?
  • What happens about all of the appointments? Dental implants are often a more complex treatment and require a few visits to the dentist, are all of the costs of these visits included in your dental implant price? Be prepared for additional trips abroad if not.
  • What happens about follow-up and post operative care? Whilst dental implants have a high success rate there may be complications post implant placement or post-restoration. Are you prepared to travel overseas to have these complications resolved? One would want to know that all travel, including flights and hotels are included in any costing.
  • What are cross infection control policies like in other countries? In the UK there are strict policies governing cross infection control and how this is the. Government legislation lays this out to ensure you remain safe. What are the cross infection control policies and requirements in other countries?
  • Will language be a barrier? Whilst some of the team may speak English it would be good to have the entire team being fluent in English, this then allows the patient to communicate effectively and adequately with the dental team throughout the dental implant procedure. The last thing anyone wants is to be unable to communicate any problem.

The cost of dental implants in the UK

Let’s take some time to look at more detail at the dental implants cost UK, what makes up that cost and how you may be able to have a cheaper alternative.

The cost of the dental implant is made up of a series of different factors, including but not limited to:

  1. The titanium dental implant itself – This will be a precision made implant component manufactured to tolerances down to 1000th of a millimetre. Of course the number of implants fitted with also affect the cost.
  2. A trans-mucosal element – This is an element of the restoration which connects the final bridge or denture through to the dental implants itself. This element is also often made from titanium although can be custom-made by a dental laboratory.
  3. The final restoration – This is usually either a crown, bridge or denture. This will often be made by a high-quality dental laboratory taking a few weeks to manufacture.
  4. The connecting screw – There is then often a screw which connects the final restoration via the trans-mucosal element into the implant. A screw may seem insignificant however in order to prevent them loostening they are also manufactured to extremely high tolerances and often made of gold. This gives a small amount of flexibility into the screw so that it can be tightened without breaking.
  5. The planning stages – After you have decided that you want to go ahead with dental implants and have received your full treatment plan (this is usually after a few hours with your implant dentist discussing the options) the planning stages will begin, this can often involve a CT scan, dental impressions or multiple x-rays. This all follows a dental implant initial consultation, very often dentists do this for free.
  6. Treatment planning – This stage involves detailed communication between the dentist (who will be restoring the final implant with the crown, bridge or dentures), the implant surgeon (the person placing the dental implant) and the dental laboratory (the person making the crown, bridge or denture). The liaising and planning between these 3 people can either be done via analogue techniques using conventional models and mockups of how you will look, or can be done digitally using CADCAM design software.
  7. The dental team – There is then also the cost of the dental team, not only is there the implant surgeon and the dentist but they will also have a team of nurses and hygienists as well as reception staff, all there to look after the patient and ensure they are well cared for.
  8. The facilities – The facilities in which dental implants are placed will be upmost important, they should be convenient as well as well maintained.
  9. Training and development – No one wants someone dealing surgically in their mouth without adequate training and skills, these take time to develop and perfect over the years which often makes the cost of dental implants in the UK more expensive than travelling overseas.
  10. Additional implant procedures – Sometimes there isn’t enough bone and additional procedures such as bone grafting or sinus lift may be required, these all add additional costs although you should be made aware of them at the initial treatment planning stages

The cost of a dental implant is therefore:

  • Implant components, including the implant, transmucosal element and screw. £200-300
  • CT scans are approximately £150.
  • placement of the dental implants itself £1200.
  • The dental implant transmucosal element and screw including final crown £750.

Total – £2300/ replacement tooth

However, if more than a single tooth needed to be replaced the price may come down, here’s an example.

Let’s say there were 4 missing teeth in a row and these were going to be replaced with implants:

  • Implant components, including the implant, transmucosal element and screw. £200-300 X 2 (only 2 implants would probably be used) – total £600
  • CT scans are approximately £150.
  • Placement of the dental implants itself £1200 X 2. Total £2400
  • The dental implant transmucosal element and screw including final implant bridge £750 X 2 (for the teeth over the implants.) + £598 X 2 (for the teeth in between the implants). Total £2696

Grand total – £5846 = £1461/ replacement tooth

It’s worth bearing in mind that very often interest-free finance can be arranged.

To replace a single missing tooth could therefore be as low as £46.20 per month, that’s less than a cup of coffee per day!*

Dental implant alternatives

There are few alternatives to dental implants worth looking at

Alternatives to dental implants include:

  • Dental bridges. These are attached to the teeth either side of the gap and can only be used if there are existing teeth on which to support the bridge.
  • Dentures. Very often dentures are the very reason that people go with dental implants in the first place, they simply want a fixed a more stable full set of false teeth. However, modern dentures can often be made extremely lifelike, fitting well and therefore stable.

If you would like to book a free consultation to discuss dental implants and to find out how our dental practice in Croydon can help, please visit our dental implants page and click the free consultation button.

* Subject to status. Conditions apply. Representative example. Treatment cost £2700 with a £500 deposit. Cash price of goods/amount of credit £2200; 60 monthly payments of £46.20; Total amount repayable £2772.25; Representative 9.9% APR variable.

Wisdom Teeth Removal – All You Need to Know

wisdom tooth removalThe third molars, or the wisdom teeth, are the last ones to erupt among the permanent teeth. Since they erupt, if they do erupt, at a mature age, normally between 17 and 25, they are often called “wisdom” teeth. Of course, there is no real connection between the eruption of wisdom teeth and intelligence. If you haven’t got your wisdom teeth, or have less than four of them, you do not have to go to a neurophysician.  But you may need to see your dentist if you still haven’t got some or all of your wisdom teeth by your 25th birthday.

Impacted Wisdom Teeth

the position of wisdom teeth

Wisdom teeth behave rather like elderly people. They are the last teeth to erupt in each jaw. And they may erupt partially or may not erupt at all. Teeth which do not erupt properly or remain below the gum are called “impacted” teeth. Most of the problems associated with wisdom teeth are associated with their impaction. Some of them include.

  • Pain– This is the first and the least bothersome effect.
  • Pericoronitis – Neglect can lead to gum injury under pressure of chewing and may result in infection in the gum tissue. This condition is called pericoronitis.
  • Damage to adjacent teeth– Impacted wisdom teeth can damage the growth and alignment of adjacent teeth. Also, the infection may be transferred to neighboring gums and teeth.
  • Cysts and Other Swelling –Cysts and swellings, if they form around an impacted tooth, require removal of the affected wisdom tooth fluid/pus-filled sacs.
  • Damage to the bone
  • Malocclusion – Not only can impacted wisdom teeth interfere with the correct alignment of neighboring teeth, but they can also make their realignment difficult. Therefore, if your dentist feels that there is a lack of space in your jaws for proper orthodontic treatment of all the teeth, he or she may decide to remove your wisdom teeth.

Extraction of Wisdom Teeth; Is it the Only Option?

In view of the reasons listed above dentists normally advise the extraction of an impacted wisdom tooth which is found to be a source of one more of these above problems. Some dentists even advise an unconditional removal all wisdom teeth whether they get impacted or not. The removal of a tooth is much easier when it has not yet grown large roots. For this reason, the American Dental Association (ADA) recommends that individuals between ages 16 and 19 should have their wisdom teeth assessed to determine if extraction would be useful as a preventive step.

Very often this is done by your dentist or oral surgeon.

The logic supporting this approach is:

  • The impacted tooth is a likely source problem in the future even if not now. this means there is lower risk of complications.
  • Even symptom-free wisdom teeth can harbor infection which can appear or spread later.
  • Wisdom teeth promote the chances of acquiring gum disease and tooth cavities (caries).
  • Extraction of a wisdom tooth at later ages will definitely be more difficult when it has become more firmly rooted.

Is the Extraction of Wisdom Teeth Risky – What Are the Complications?

Extraction of wisdom teeth normally does not result in any long-term complications. However, in some rare cases, one or more of the following issues may come up:

  • Dry socket– If the blood clot formed after surgery is removed a condition known as dry socket may result, this is effectively an empty tooth socket where the clot fails to form, it is usually very painful. However, this condition arises rarely.
  • Infection of extraction sites– Normally your dentist will advise antibiotics to prevent any follow-up infection. But in case of non-compliance infection may result.
  • Sinus damage– There is a possibility sinus damage in case of extraction upper wisdom teeth. However, your dentist is well aware of this and will take the necessary precautions during the procedure. You have nothing to worry about if the procedure is performed by a qualified and experienced dentist.
  • Weakening of the jawbone– This is a remote possibility.
  • Damage to nerves– Damage to nerves in the vicinity of the wisdom teeth can result in the reduction, or even loss of sensation in the lower lip, tongue or the chin region.

The procedure of Wisdom Tooth Removal

wisdom tooth removal procedure

  • Anesthesia– It is a normal practice to give anesthesia to avoid pain during the procedure. It can be one of three types depending on the pain threshold level.
    • Local anesthesia. Anesthetic injections are given in the region around the tooth with a very fine and sharp needle. To avoid the pain of injection you may even be applied with a numbing liquid. You will remain fully awake during the surgery but will not feel any pain. It is possible that you do feel some pressure.
    • Sedation– An intravenous injection may be given in your arm to sedate you. Sedation will make you unconscious. Additionally, a local anesthesia may be used to numb your gums.
    • General anesthesia. This will be needed only in very special cases. General anesthesia (GA) makes you totally unconscious.  Under GA, your body functions like blood pressure,  breathing rate, temperature, and fluids are closely monitored by the team.
  • Incision– A cut is made in the top of the gum to expose the tooth and the underlying bone.
  • Bone Removal – Any bone which is impeding access to the tooth is removed.
  • Tooth Sectioning – The tooth may be divided into sections if the dentist finds it easier to remove the tooth in parts.

Wisdom teeth removal recovery time

Full recovery after having a wisdom tooth removed is usually a few weeks. You should, however, begin to notice that the bruising and swelling and immediate pain reduces after 24 hours. If you continue to feel pain then use an ice pack on your cheek.

After 48 hours you could consider a salt water mouthwash to gently swirl around your mouth, please avoid excessive and violent washing of your mouth as this could dislodge the clot.

Time off work after having a wisdom tooth removed

Depending on the job you have it is normally advised to have 48 hours off, this just gives the initial healing phase time to begin. When you go back to work avoid rushing around and increasing your blood pressure too much, also avoid stimulants such as caffeine as this again may increase your heart rate and blood pressure which could dislodge the clot.


How to find a holistic dentist UK

how to find a holistic dentist UKWhen one uses the term holistic dentist it can conjure up all sorts of visions about weird and wacky treatment options. That’s definitely not how we view the term holistic dentist!

‘Holistic’ is not the same as ‘alternative’ and so our vision of holistic dentistry is as follows:

  • Seeing all people as a whole without classifying patients into groups, everyone is different and an individual.
  • Identifying the habits and things people do that impact their oral health and helping with these habits etc for example, smoking.
  • Explaining the links between dental health and overall health and helping patients with both.
  • Taking a minimally invasive approach to all treatments and helping patients solve dental problems at home, wherever possible.
  • Using ethically sourced materials.
  • Using Continu cleaning materials, these are biologically safe and we have even sprayed them into our mouths to prove it!
  • Conserving energy by switching off unnecessary lights and keeping air-conditioning to a minimum.
  • Separating and recycling waste.
  • Purchasing UK locally sourced, organic vegetables from farmers markets.

Our view is that we should then take these values, ideas and beliefs into our regular dental treatment.

How does a holistic dentist deal with gum disease?

Being a holistic dentist means understanding the whole body. Gum disease can progress painlessly on the whole and yet it can affect your whole body, here’s how:

holistic dentist treating gum disease

Unfortunately, there really aren’t any home remedies to treat gum disease.

Holistic dental hygiene

The core of holistic dental hygiene is to ensure that you look after your teeth properly, here’s how:

  • Clean your teeth twice per day with the fluoride containing toothpaste. Fluoride helps the outer layer of your tooth remineralisation and stay hard meaning it can counteract the effects of acid and tooth decay.
  • Make sure you brush for 2 min each time.
  • Use of fluoride mouthwash after meals and never immediately after brushing.
  • Cean in between your teeth with an interental brush or floss.

There is of course no reason why you can’t use an environmentally friendly toothbrush which can be disposed of naturally. The only thing we would say is to ensure that the bristles are not too abrasive as they may cause damage to your gums.

Getting rid of dental pain the natural way

The most important point to remember is that if you’re in pain there is going to be an underlying cause. You may have a crack in your tooth, you may have erosion causing the more sensitive dentine to be exposed or you may have dental disease. We can therefore only recommend temporary relief whilst you are waiting to see your dentist.

Natural remedies for pain relief include

  • An ice pack or cold compress applied to your cheek. This can constrict the blood vessels and dumb down the nerve endings resulting in a mild numbing effect.
  • Rubbing clove oil onto the affected site. So long as you have no open wounds in your mouth then clove oil has been shown to be antiseptic and also provide a mild knowing effect. Simply dab a cotton ball into the clove oil and rub on the affected part.
  • Teabags. Cold used teabags contain tannin, tannin has been shown to help reduce blood flow if you have an open wound in your mouth.

Natural remedies for toothache.

If you have toothache it’s important to know what the cause is, simply using natural home remedies may reduce the pain in the short term but if the cause isn’t treated then the pain can come back worse than it did before.

Common causes of toothache include:

  • A dental cavity. If this is deep then the underlying nerve can sense feelings of hot and cold and cause pain.
  • Gum disease. The information from the gum disease can cause pain around the tooth margin. Anti-inflammatory treatments work well here.
  • Tooth abscess. This is an infection in the root of the tooth and pain can often be severe.
  • Cracked tooth. If the tooth is cracked then as you eat it can flex causing sudden pain which is not there usually.
  • Tooth erosion. Erosion of the tooth, particularly around the gum line can cause pain and sensitivity.

Natural remedies are therefore only good for removing pain in the short term, you will need to visit a dentist to find out what the cause of the pain is and ensure it is treated to prevent further painful episodes.

Natural treatments, solutions and remedies to take can include:

  1. Rinsing with salt water. This can help loosen food particles as well as the salt being a natural disinfectant. Salt water can also help in the reduction of inflammation and promote faster healing to any wounds in your mouth.
  2. Cold compress. This is particularly good if you have an injury or the toothache is caused by trauma. A cold compress will constrict the blood vessels which tends to make the pain feel less severe. It can also wok well to reduce swelling which exacerbates to take pain. The cold compressed should be applied over the area of pain against your cheek (on the outside of your mouth). Use a bag of frozen peas or crushed ice, moulded to the shape of your face and wrap in a soft tea towel to prevent the ice from touching your skin.
  3. Clove oil. Clove oil has been used in dentistry for many years in the form of eugenol. This is a natural antiseptic and can help to take. You should apply the clove oil using a cotton wall bud onto the area which is causing the pain in your mouth. If the taste is too strong you may wish to dilute it with some vegetable oil.
  4. Use tea bags. Teabags, particularly peppermint tea it seems can often reduce pain. Regular tea contains tannin which has been shown to reduce bleeding which may also be of use. Allow the teabag to cool but still be warm then place the teabag over the tooth which is causing the pain.

Finding an holistic dentist

The best way to find and holistic dentist near you is to search on Google, once you have found a few dental practices then check out their website. Look for their environmental policies on their about us page, check to see if they use amalgam and ask about their ethical standards. Everything should be transparent and on their website for you to view.

Natureza Dental Practice is an holistic dentist in Croydon, Surrey. “Natureza” means ‘nature’ or ‘environment’ in Portuguese, Portugal which is where the owners of the practice originate. They therefore named their practice after their philosophy of being a holistic and natural dentist.


Amalgam fillings, everything you need to know.

Many people know us as a mercury free dental practice, we get asked many times about amalgam fillings and their use within dentistry, we thought the best way to go through many of these things is to create a blog post.

What is an amalgam filling?

A filling is simply your dentist replacing decayed tooth structure with a new material. In days gone by the best material to use to replace this decayed structure was amalgam.

Amalgam consists of silver, tin, copper and approximately 50% by weight of mercury.

Why are dentists still using mercury in fillings?

As a simple to use, manageable, malleable and long-lasting filling material amalgam fits all of the criteria. However, in our opinion, with more health conscious individuals it does not fit the criteria of being the healthiest option for a patient, the dentist or the environment.

How safe is a dental amalgam?

A dental filling releases low levels of mercury, particularly during removal. The information on this website is available to help you understand the potential toxicity or safety of dental amalgam fillings.

The UK Department of Health advises all dentists not to remove or replace amalgam fillings in pregnant women.

Here you can find several documents that can be accessed directly by clicking on the buttons and research articles that you can find online.

How difficult is it to have mercury dental fillings removed?

The actual technique of getting amalgam fillings removed is quite simple, however the safe and holistic way to remove them is to use extensive suction, filters and special burs.

Can an amalgam filling be replaced?

Yes, however it is best removed under very tight control procedures, including, but not limited to:

  1. High-quality ventilation during the removal procedure.
  2. Filters in place to cover your nose and eyes to protect you from daybreak and mercury vapours.
  3. Rubber dam* in place around the tooth to ensure we catch any daybreak and stop it going into your mouth.
  4. High-volume suction to ensure that the mercury vapour is kept to a minimum.
  5. Safe storage of anything which goes into the dental suction chamber.
  6. Continuous water irrigation to keep your feeling cool as it has been shown that more vapour is released with heat.
  7. Specially designed burs which efficiently remove the amalgam was keeping the heat low.

*This is controversial for some people as they believe that the amalgam vapour built up behind the rubber dam, however studies have also shown that treatment with a rubber dam reduces the overall exposure to amalgam during the whole procedure

Why is mercury in dental amalgams?

Mercury was historically used in dental amalgams as it was very pliable at low temperatures meaning that the metal did not need to be heated in order to be placed into the dental cavity, you can imagine how painful it might be having molten metal poured in!

Should I get my silver fillings removed?

The general advice is that if your silver amalgam fillings are working well, not breaking down and the tooth structure around them is sound then leave them as they are. If, however the fillings are beginning to break down then they could either be removed and replaced or, if the breakdown is severe, a dental crown placed over the top.

Why don’t dentists make a silver filling that has no mercury?

Indeed there are many materials which have no mercury including:

  1. Dental composite.
  2. Gold.
  3. Ceramic.

Composite tends to be the cheapest option, is most aesthetic and is amongst one of the easiest materials for the dentist to use. In dental terms it is a relatively modern material which is why amalgam was used historically.

Gold fillings and ceramic inlays have also been used in latter years, gold is falling out of favour due to its cost but ceramic inlays are still used frequently.

Are Composite Resin fillings better than Amalgam fillings?

As with many questions, it depends on who you ask. In our opinion composite resin fillings are indeed better than amalgam fillings for the following reasons:

  • They look better and blend in with the natural teeth.
  • They are simple and easy to repair if they break. Composite can be treated so that it bonds to itself, this means a dentist can easily add more if some chips off.
  • They bond to the tooth structure, this means that your dentist may not need to remove additional tooth structure (After removing the tooth decay) in order to create an undercut that the amalgam would sit in. Composite resin fillings are therefore less destructive on the whole.
  • In very small quantities composite resins can also release fluoride which have a positive effect on the re-mineralisation of your enamel as it is attacked throughout the day.

There has however been research which shows that amalgam has a slightly lower wear rate compared to composite, this could mean that in time composite fillings may need to be replaced more frequently as they wear. In our opinion this slight disadvantage is far outweighed by all of the other advantages of composite resin.

Do holistic dentists help people get healthier? If so, how?

All dentistry can be considered holistic. Links have been found between dental disease and heart disease, diabetes and even erectile dysfunction. The same bacteria has been found in heart disease as is present in those people with gingivitis. The same is true for many other conditions. Looking after your mouth is a very good holistic way to begin looking after your whole body.

Periodontal disease and dental implant failure

Periodontal disease and dental implant failurePeriodontal disease and dental implant failure

One of the concerns with anyone that has dental implants is, how successful will they be? This is clearly a question which needs answering, working on the assumption that a dental implant has been placed into a sufficient amount of bone then the biggest reason that an implant files is lack of post-placement care.

A dental implant integrates entirely with the body and needs to be looked after much the same as a natural tooth.

How do dental implants fail

Typical reasons for failure of dental implants include:

  • Poor surgical decisions. This can involve placement of implants in insufficient quality or quantity of bone & poor design of the final restoration.
  • Abusing your oral environment. Studies show that smoking can inhibit healing, smoking restricts blood vessels which can mean that the implant placement doesn’t heal as well. Alcohol has also been shown to increase risk of post operative complications, including general infections and wound complications.
  • Dental decay. If you already have tooth decay on other teeth when you may be more susceptible to developing gingivitis and/or periodontitis around the implant area.
  • Overloading the dental implant. If you have a poor/heavy bite and/or grind heavily you may overload the dental implant and support structures. Extreme contact sports can also affect the success rate.
  • Overall poor oral hygiene. Implant failure is also exacerbated by bad oral health, implants succeed much better in a healthy environment.

Risk factors of periodontal disease and peri-implantitis

Risk factors for periodontal disease include:

  • Age – Indicators are that 70% of people over the age of 65 have periodontitis.
  • Smoking – Smoking affects your body’s ability to heal and alter is the bacteria levels in your mouth.
  • Genetics – Some people are just more prone to developing periodontal disease and peri-implantitis
  • Stress – Stress can lead to a general reduction in overall body health meaning your ability to heal is reduced. Stress can also mean you grind your teeth more.
  • Bruxism – Teeth grinding
  • Poor diet – A poor diet can also affect your body’s ability to heal itself leaving you more inclined to gum disease which then leads onto periodontal disease

The early warning signs

One of the earliest warning signs of periodontal or periimplant disease is gum disease or gingivitis. Periodontal and periimplant disease are the progression of gum disease which hasn’t been treated. Gum disease is an infection of the gum whereas periodontal or periimplant disease are an infection of the surrounding support structures around either the tooth or the implant.

Therefore the early warning signs include:

  • Puffy or red gums around the tooth or implant
  • Bleeding upon mild brushing around the gum or implant
  • Persistent bad breath.
  • Gums that are receding making the teeth look along.

Whether the signs appear around a natural tooth dental implant it’s important that the early warning signs are treated. If you end up with periodontal disease you can end up with tooth loss… Tooth replacement can then be quite expensive! The same can be said if you have gum disease around a dental implant, ultimately this could lead to failure of the implant and bone loss.

If the dental implants fails is it worth getting another?

Complete failure and loss of the dental implant happens in less than 3% of cases so it is fortunately quite rare. You should always have a discussion with your dentist about the reason the implant failed, if the reason can be clearly identified and resolved i.e. smoking, poor oral hygiene, teeth grinding etc then yes, it is probably worth having another dental implant.

If the reason for the implant failure persists then it may be wise to look for alternative ways to replace the missing tooth/teeth.

Is it possible to completely cure peri-implantitis?

Research published in 1994 using techniques modified from the periodontal arena have shown that the best way to treat peri-implant problems is to

“…arrest the progression of disease and to achieve a maintainable site for the patient’s implant”

The study goes on to say that

“Bone regeneration is possible in selected peri-implant bony defects when appropriate surgical techniques are used, implant surface preparation is achieved, and the cause is eradicated.”

It therefore is possible to treat periodontal disease and dental implant failure with skilful dental and surgical techniques.

What is the best type of dental filling?

What is the best type of dental filling?

As with many things in dentistry and in life the real answer to this question is, it depends. The best type of dental filling depends upon:

  1. The clinical situation.
  2. Your views about the different materials.
  3. Your budget.

In some instances your dentist will prefer to design a dental filling to protect any remaining tooth structure. If this is the case they may turn of filling into what is known as an overlay. An overlay covers any remaining tooth cusps and can protect them from the bite.

Very often this type of dental filling/overlay is made out of porcelain.

Because porcelain is made by a dental technician they can be more expensive than other types of dental filling.

Gold fillings can also be made, once again these are made by a dental technician so have increased cost which added to the cost of the gold can make them quite an expensive alternative.

Composite resin can also be used. These type of composite fillings Are what are known as white fillings. Tooth colored composite fillings are also often used if you want old amalgam fillings replaced. 

Amalgam fillings are not used as much as they used to be. This type of filling material is often associated with mercury poisoning and general health problems. For this reason amalgam fillings are often replaced. There is much written about the science behind amalgam filling replacement, However even the American Dental Association still recommend the use of amalgam.

Glass ionomer can also be used as a white filling, this type of filling material will release fluoride slowly.

Common questions asked about dental fillings.

What is the difference between root canal and teeth filling?

Very simply a dental filling is only in the enamel and dentine of your tooth. The dentist will remove any decayed area and replace it with the dental filling. Root canal is when the nerve of the tooth is removed, this is a much more involved procedure and is often done by a specialist known as and endodontic.

Is it possible to develop a cavity under a filling?

Yes. Good oral health is key to preventing this although fillings, inlays or onlays can leak over the years allowing bacteria and therefore decay to take hold. Unfortunately there is often nothing that can be done about this and the filling simply needs to be replaced. You may find you have the early warning signs of this if you have sudden onset of tooth sensitivity in an area where you have a dental filling.

Can you eat with a temporary filling?

Yes. We do however recommend sticking to food which is not too sticky or chewy. If the temporary filling is towards the front of your mouth then you may also want to avoid food which can sustain for example curry, red wine or lots of tea. The composite material does have a tendency to stain.

How long does it take a dental filling to harden?

Most tooth colored fillings are cured using a high-intensity light in the dental practice, this ensures they have a primary hardening immediately. They do however continue to harden for a little while after although the bulk of this is done within 10 min.

What do fillings on front teeth look like?

A good filling on a front teeth will not look like a filling at all! A good dental filling will blend in so that you don’t even know it exists. This of course will only happen with a tooth coloured filling.

Is a dental filling a very painful process?

No. You will always have a local anaesthetic to numb the area. Also it is recommended that you ask your dentist for a topical anaesthetic first. A topical anaesthetic gel, applied on the end of a little cotton will bud will numb your gum, will numb the area prior to having a dental injection. This means that you can have the injection with no sensation or feeling at all. This should ensure that the whole dental filling procedure is relatively pain-free.

You may experience some mild discomfort as the truth numbness wears off, particularly around where the dental injection was given. This however should be mild discomfort at worst and will clear up after a couple of days

Can a permanent tooth filling stay for a lifetime?

Yes it is possible for tooth filling to last a lifetime however it is not usual. composite fillings tend to last 7 to 10 years whilst metal fillings tend to last 8 to 10 years although they can last up to 20 years. The most common reason that are filling needs to be replaced is due to decay which has managed to creep in around the edge of the filling where it meets the tooth. This can happen with any type of filling regardless of the material.

Are Composite Resin fillings better than Amalgam fillings?

Composite fillings don’t last quite as long as amalgam fillings generally however they are more aesthetic, more biocompatible and for this reason generally more accepted by patients.

Mercury Fillings

With a mercury filling in place

Mercury Filling After

After the mercury filling has been removed and replaced with a composite filling

Do amalgam fillings leak mercury

Amalgam fillings do not generally leak mercury once they are fitted. The critical times for mercury to escape from a filling is whilst the filling is being placed or especially during removal. This is why dental practice which specialises in amalgam filling removal will always use specialist equipment to ensure that any free mercury vapour is extracted away with a dedicated protocol for Mercury replacement.

Tooth extraction – your questions answered

Tooth extraction – your questions answeredTooth extraction-your questions answered

So many people have many questions about tooth extractions, in this blog post we seek to answer some of those most common concerns.

Is it safe to exercise after tooth extraction? Why or why not?

After you have had a tooth extracted it’s best to avoid strenuous exercise for at least 24 hours. After you have had a tooth extracted it will naturally bleed, this bleeding is controlled by your body via a blood clot. If you exercise rigourously then you will increase your heart rate and blood pressure, this could dislodge the blood clot which could start the bleeding again. You may then find you need to wait awhile before exercising in order to stop the bleeding.

How long does it take to heal after a tooth extraction?

You should find that bleeding stops quite quickly, typically within a few hours. The healing process has begun!

You will find it takes a few months for the wounds to heal over completely, however you should notice that any discomfort is gone within a week or so.

Is it okay if I leave food in my tooth extraction hole?

No. We recommend avoiding chewing food for 24 hours after a tooth extraction in order to avoid this. Stick to more liquid diets such as soup for this period. After 24 hours it is usually safe to rinse your mouth out with mouthwash to dislodge any food which is caught in the extraction hole.

Once the extraction site starts to heal you can gently brush the area with a soft toothbrush in order to remove food from the hole. If you leave food here it will begin to decay which could lead to gum disease, not to mention smelly breath!

How soon after a tooth extraction can a bridge be placed?

Your dentist will usually want to wait about six months after the tooth has been extracted before placing a bridge. This is to give the socket full time to heal. When you have a tooth removed there is a hole, what happens is that the bone surrounding the hole falls in to fill it. This can result in an overall loss of bone height in this area.

If bridges are placed to early this bone loss process may not have finished, the result is that the bridge can touch the gum when it is placed but as the resorption process continues the gum will tend to move away from the underside of the bridge creating a gap.

This is one reason why many dentists prefer dental implants as these can be placed into the hole where the tooth was and prevent this bone resorption.

Is it OK to eat spicy food after a tooth extraction?

Whether the food is spicy or not will make no difference at all. We do however recommend that you stick to a more liquid and soft diet for at least 24 hours after a tooth has been extracted, this gives very blood clot time to form.

Can you drink after a tooth extraction?

Yes, but we recommend avoiding rinsing out or spitting forcefully for at least 24 hours. Try not to swill the drink around your mouth and just drink carefully. After 24 hours a salt water mouthwash gently swilled around your mouth can help.

How painful is it to have a tooth extraction?

Your dentist will always give you a local anaesthetic for the tooth extraction, this means the actual process is virtually painless. As the anaesthetic wears off you may find some discomfort which can usually be eased with over-the-counter painkillers.

If the pain continues you should go back to your dentist as they may be able to offer you stronger options.

If you have pain Immediately after teeth extraction and once the local anesthetic has worn off you may find that an ice pack held against the outside of your cheek can help to reduce any existing pain.

Can you get dry socket with stitches? How can it be prevented?

A dry socket happens when there is partial or complete loss of the blood clot. The blood clot helps to protect the underlying bone and nerves from the oral environment, so losing the blog clot exposes them and can be extremely painful.

To prevent a dry socket it’s best to avoid anything which could dislodge the blood clot, this includes excessive exercise, rinsing your mouth out and spitting, eating solid foods… These should all be avoided for at least 24 hours.

Why have I still got pain weeks after tooth extraction?

If you still have pain many weeks after the tooth has been extracted they could be a variety of causes. If the pain is severe you could have a dry socket, you may also have a sequestra, this is a small tooth or bone fragment which has been left behind in the socket. The body will naturally expel the sequestra but it can feel rather painful. If you can see small bony pieces in the socket then please visit your dentist again.

What could a throbbing pain after tooth extraction mean?

You would normally find that pain or discomfort after a tooth extraction is described as throbbing. The throbbing is actually the beat of your heart which you are more able to notice through the extraction site. Over the counter painkillers should take care of this and the pain should begin to ease after 24 hours.

What’s the difference between a surgical extraction and simple extraction?

Simple extractions are when a regular tooth sticks out from the gum, a surgical extraction is more complex as the tooth is usually still underneath the gum and not exposed. This requires a level of surgical exposure i.e. the removal of the gum and/or the bone. These types of extraction can be performed by either a dentist or oral surgeon.

Dental crowns versus dental veneers – Which should you choose and why?

Dental crowns versus dental veneersPeople often wonder whether they should choose dental crowns or dental veneers, the choice is often not particularly simple and sometimes there may not be a choice at all!

Let’s begin by explaining what crowns and veneers are.

What is a dental crown?

What is a dental Crown?dental crown is used to replace damaged tooth structure. They are used when there is significant loss of healthy tooth structure due to decay or trauma. The dentist will remove any damaged tooth structure and possibly a small amount of healthy tooth structure in order to facilitate placement of the Crown and maintain good oral health afterwards. The remaining tooth is then prepared to a stump, the dentist then takes an impression of the stump and surrounding teeth.

This dental impression is then used to replicate your mouth, on top of this replica a crown is then manufactured.

Once the crown is manufactured it is returned to the dental practice to be fitted. Whilst the crown is being made you will be fitted with a temporary crown.

Dental crowns can also be used for cosmetic dentistry, a crown will be selected if there are drastic cosmetic improvements to be made to existing teeth.

Dental crowns can be made from a combination of materials including:

  • Feldspar/quartz.
  • Lithium disilicate.
  • Zirconium dioxide (zirconia).
  • Cobalt chrome base with feldspar quartz ceramic layered on top.
  • Gold alloy base with feldspar quartz ceramic layered on top.
  • Titanium base with feldspar quartz ceramic layered on top.

There are a variety of reasons why a dentist may choose one type of dental crown over another including cost, strength and cosmetic appearance.

Is a ceramic dental crown better than metal or stainless steel?

As with many things in dentistry the answer depends upon your clinical situation. A metal free crown made from feldspar/Quartz, lithium disilicate or zirconium dioxide tend to let light pass through in a more natural way. Zirconia crowns also have extremely high strength making them almost as strong as a metal crown in many instances.

Metal free crowns of therefore generally the treatment of choice wherever possible.

Which metal used in a metal dental crown?

The metal is usually an alloy, these are usually split into three categories:

  • Precious
  • semiprecious
  • nonprecious

Precious metal crowns typically contain:

  • 48% gold
  • 40% palladium
  • 4% zinc
  • 4% 10
  • 4% indium

Semi precious metal crowns typically contain:

  • 79% palladium
  • 8% tin
  • 5% cobalt
  • 5% gallium
  • 2% gold

Nonprecious metal crowns typically contain:

  • 54% nickel
  • 22% chromium
  • 9% molybdenum
  • 4% iron
  • 4% niobium
  • 4% tantalum

Data courtesy of www.animated-teeth.com/dental_crowns/t-dental-crown-gold.htm

What is a dental veneer?

A dental veneer is used In exactly the same way as a dental crowns, to replace damaged tooth structure. However, they are used when the damage is minimal, if the damage exceeds a certain amount then a dental crown may be required.

Dental veneers can also be used in cosmetic dentistry and provide a more minimally invasive approach and using dental crowns as they are a very thin layer of ceramic. Although dental crowns may be necessitated if the amount of cosmetic change is drastic.What is dental veneer?

Dental veneers are made in much the same way as dental crowns and usually fit over the front surface of the tooth, they can be made from the following materials:

  • Dental composite.
  • Feldspar/Quartz.
  • Lithium disilicate.

There are a number of reasons why a dentist may choose one type of dental veneer over another including ease of repair/fitting, cost and cosmetic appearance.

Whilst your permanent ceramic dental veneer is being made by a dental laboratory your dentist will usually fit a temporary veneer.

What are the advantages and disadvantages of porcelain veneers?


  • Can help to restore broken down or chipped teeth.
  • Can help to brighten a particularly dark smile which can’t be whitened with teeth whitening
  • Can help to reshape teeth.
  • Are a more minimal approach then using a full dental Crown.


  • Any treatment of the tooth should be carefully considered. There maybe minimal removal of healthy tooth tissue but it is still removal nonetheless.
  • Can be prone to fracture in certain circumstances.

Is it a bad idea to veneer healthy teeth?

Generally speaking most dentist will prefer not to veneer healthy teeth, preferring to keep teeth as untreated and natural as possible. However, there is always a balance. Sometimes the distress that an unsightly tooth causes a patient means that the risks of veneer are outweighed and it is decided to veneer natural teeth.

Should I get dental veneers or dental bonding?

Generally speaking both dental veneers and dental bonding (Often called composite veneers) are used in similar situations. However, dental bonding with a composite material can often be offered for more minor correction of unsightly or decayed teeth. Dental bonding using a composite resin is also a more minimal approach to treatment and will usually be considered prior to dental veneers as veneers require more tooth structure to be removed, although not as much as dental crowns..

Your options for cosmetic dentistry explained

Cosmetic options in Croydon explained

Your options for cosmetic dentistry explained

As you may know, one of the things our Croydon Dentist is passionate about with cosmetic dentistry  is what is known as ‘Minimally Invasive Dentistry’ – this means we do the absolute smallest amount of treatment possible to achieve the desired result.

In years gone by the only way to restore broken down, discoloured or misaligned teeth was to either have train track braces (which many people didn’t like the look of) or to have dental veneers (which can, in some circumstances, remove otherwise healthy tooth tissue). However modern advances in 3 key areas have changed this dramatically.

  1. Our ability to move crooked and misplaced teeth in to the perfect alignment with modern orthodontic techniques that are almost invisible
  2. Modern advances in Teeth Whitening & bleaching techniques to reduce the dark and/or yellow colour on teeth
  3. Advances in materials for dental bonding to restore broken tips and make minor changes to the shape of teeth

This philosophy is known as ‘Align, Bleach, Bond’ for obvious reasons, and so this blog is written in that order to reflect our conservative and minimal approach.

Ways to straighten crooked teeth


Orthodontics can straighten crooked teeth with a variety of techniques.

  1. Lingual orthodontics – these fit on the tongue side of your teeth so are not visible in everyday use. Not everyone is suitable for lingual orthodontics due to the amount of space required, especially on the top teeth.
  2. Lifestyle orthodontics – these include things like Damon braces which can use clear brackets which are virtually imperceptible.
  3. Almost invisible orthodontics – treatments such as Invisalign have revolutionised the way orthodontic braces are used. Invisalign uses clear aligners rather than brackets and wires to straighten teeth.

What do the different orthodontic braces look like?

Lingual orthodontics

Lingual orthodontics

Lingual orthodontics-notice how the braces cannot be seen from the front

Lifestyle orthodontics

Damon braces

Notice the difference between the lifestyle Damon braces on the front top teeth and the regular train track braces

Almost invisible orthodontics

Invisalign braces

Notice how these braces are completely clear and virtually imperceptible when they are in place

Using veneers or bonding to straighten crooked teeth

Sometimes it can be more advantageous to use dental veneers or bonding to straighten crooked teeth, typically these would be used when:

  • The patient requires a more rapid result, veneers and bonding can usually be done in a few weeks compared to many months for orthodontics.
  • The basic shape and/or colour of the teeth is not desirable. If the teeth would require covering with bonding or veneers in order to alter the basic shape or colour then it may be decided to change the alignment of the teeth at the same time with that veneer or bonding, thereby eliminating the need to have orthodontics.

Many times however, orthodontics and veneers or bonding are used in conjunction with one another. Teeth can be moved to an ideal position and then veneered or bonded to restore the colour and/or shape.

How to whitening dark teeth

The quickest, simplest, easiest and most cost-effective way to white and dark teeth is to have teeth whitening. Teeth whitening is one of the few treatments which almost everyone can have, making it an extremely popular choice for whiter teeth.

If your teeth are particularly dark then you may not be able to whiten them to the desired colour, if this is the case then dental veneers and/or dental crowns may be preferred as they can cover up the dark tooth.

How to rebuild a broken tooth

  • Dental bonding – this can restore broken down teeth, particularly chipped teeth. Dental bonding using a composite resin is applied to your teeth directly by the dentist.
  • Dental veneers – these can be build more severely broken down teeth and tend to last longer than dental bonding as they are made from a stronger material. Dental veneers are made by a highly skilled dental technician.
  • Dental crowns – for the most severely broken down teeth dental crowns may be required. Dental veneers only cover the front surface of your tooth whereas dental crowns, the whole surface. Dental crowns made by a highly skilled dental technician.

Which type of cosmetic dental treatment is right for me?

This is a great question. Many times a cosmetic dentist, such as ours in Croydon, Surrey will use a combination of techniques to achieve the desired result.

The best thing to do is to tell your dentist the outcomes you are looking for, rather than the treatment that you want. The dentist will then have a clear understanding of what you want to achieve and can then give you a range of options.


What is cosmetic dentistry and what treatments does it include?

What is cosmetic dentistry and what treatments does it include?

Cosmetic dentistry is often considered a standalone aspects of dentistry however, it possible for all dentistry to be cosmetic and for everything to look good as well as keep your teeth healthy and in great condition.

What follows is an overview of treatment is normally assigned to the category of cosmetic dentistry, we’ve listed them by dental problem rather than by specific treatment, this allows you to find the best cosmetic solution for you.

How can I straighten crooked teeth?

Straightening crooked teeth can be done with a variety of different treatments depending upon the level of correction required, timeframe and cost.

  1. Dental bonding
    1. Timeframe: immediate, dental bonding can be applied in the dental chair whilst you wait.
    2. Level of correction: usually only suitable for a couple of teeth at a time, mild correctional changes only can be made.
    3. Cost: Low – from £99/tooth
  2. Dental veneers
    1. Timeframe: usually 2 or 3 weeks from start to finish.
    2. Level of correction: dental veneers can treat fairly extensive crooked teeth, but because the teeth are not moved bodily this is still limited.
    3. Cost: medium/high Depending on the number of teeth to be corrected – from £598/tooth
  3. Orthodontics
    1. Timeframe: anywhere from six months to one year
    2. Level of correction: Orthodontics give the highest level of correction and can be achieved with orthodontics as the teeth are moved bodily from their crooked or misaligned position to their new position.
    3. Cost: medium/high. Treatments typically start from £1650

How can I whiten dark teeth?

Whitening dark teeth can also be achieved with a variety of treatments, depending upon the amount of whitening required.

  1. Air abrasion and/or polishing
    1. Regular dental hygiene appointment can remove surface stains of teeth quite quickly, particularly good for smokers stains.
    2. Cost: from £50 per appointment
  2. Teeth whitening
    1. Teeth whitening can whiten teeth to your desired colour, usually in a couple of weeks.
    2. Cost: from £259 per arch (top or bottom)
  3. Dental bonding
    1. Bonding can lighten a single tooth if that tooth has become dark, perhaps due to an underlying problem with the tooth, decay or root canal treatment. This is often only possible if the tooth is set back from the other teeth as the bonding will form a liar over the surface of the tooth.
    2. Cost: Low – from £99/tooth
  4. Dental veneers
    1. Dental veneers can lighten extremely dark teeth which cannot be lightened adequately with teeth whitening.
    2. Cost: from £598/tooth

How can I replace missing teeth?

Missing teeth are unsightly and can affect confidence, they can also be a trap for food which can lead to dental decay. Adjacent teeth can also drift into the gap meaning that, over time, your bite can be affected.

The options to replace missing teeth will depend upon the convenience, cost and number of teeth to be replaced.

  1. Dentures
    1. Convenience: usually the least convenient option as the teeth are not fixed permanently and the dentures can become loose overtime requiring continuous maintenance. Dentures can have a tendency to fracture if not maintained although repair is usually quite simple.
    2. Cost: usually the cheapest option with acrylic dentures starting from £400
    3. Number of teeth: Dentures can be used to replace a single missing tooth right way through to replacing all missing teeth.
  2. Dental implants
    1. Convenience: the treatment can take up to one year to complete but once done, so long as the dental implants are looked after they can be an exceptionally good way to replace missing teeth as they support the teeth either side and can help to prevent further bone loss.
    2. Cost: From £949 per implant to have a dental implant placed and then from £629 per tooth to have the implant restored with a crown. Pricing can be a little complex due to the number of variables.
    3. Number of teeth: It is not always required to have one implant her tooth which need replacing, for example often six teeth could be replaced with two dental implants. Implants can replace anything from a single missing tooth up to a full mouth.
  3. Dental bridges
    1. Convenience: treatment usually takes approximately 2 weeks and once done, so long as the bridge is maintained can last many years.
    2. Cost: from £498 per tooth
    3. Number of teeth: bridges require standing teeth as this is where the new. It will be attached. Therefore in order to have a classic dental bridge (without implants) you need to have existing teeth either side of the gap. To replace a single missing tooth is easy with a dental bridge. In order to replace multiple missing teeth it’s usually only possible to replace three standing teeth in a row, a healthy tooth needs to be at each end of these three teeth. If this is not the case then either a denture or dental implant may be required.