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Treatment of Chronic Conditions

Treatment of Chronic conditions

Many people do not enjoy a perfectly healthy mouth, despite having  large amount of leisure time and money.  Many patients are not aware of the dental problems occurring in their mouths. Even with a history of regular dental treatments, how many people ask themselves: “Are my teeth as good as they were 10 or 20 years ago”?

Chronic dental disease/problems develop over a period of time, and if not recognized and correctly treated, this may lead to further deteriotion and ultimately the mouth will look “tired”, “aged” or even with tooth lost.

“I was born with week teeth!”

This notion was used by the patient or offered by some dental professionals as an excuse of failing to maintain the teeth for life. Very few people are born with ‘weak teeth’.

“God did not give you bad teeth at the back and good teeth in the front”

Often we hear people say: “I was born with weak teeth, dental fillings on my back teeth keep falling off.” 

If that is the case, maybe you want to ask yourself: “Are my front teeth any good?”  If the answer is yes, then you may want to think differently.

What went wrong?

Nature provides each one of us a good set of teeth from the beginning, and what went wrong?

Reasons are several:

Lack of understanding and basic knowledge:

Most dental problems are chronic. The public should be made aware of what cause their chronic dental problems. The incidents for these chronic problems are more prevalent than most thought. It is estimated that 50% of the public are not aware that they are having some form of ongoing chronic dental disease in their mouth, and only realize and seek treatment when they become painful and infected.

Untreated decays or failed dental fillings

The healthy teeth are covered with enamel, a hard calcium crystal. If food is allowed to accumulate between the teeth or not removed from the grooves on the tooth surfaces, oral bacteria will turn them into acid. The acid will then attack the calcium and cause the enamel to break down, decay then set in. Brushing and flossing will reduce and minimize the chance of the breakdown. Fluoride in our diet and drinking water will strengthen the enamel crystal and hence reduce the risk of decay.

Sometimes decay does occur and a cavity develops. Small decays can occasionally be monitored and using fluoride to try to remineralize the enamel. This has to be checked with utmost vigilance. The patient is to be advised of the possibility of future restorative intervention if this conservative treatment fails. Otherwise the small cavity will become a large one with severe consequences.

The small cavities if not detected and treated can progress into huge cavities without patient realizing. It is only when eventually the decay has progressed and invaded the pulp, severe pain sets in to alert the patient to seek dental emergency treatment.

At this stage, the treatment to this tooth will become more involved and therefore more costly treatments such as root canal therapy and crown may be required to salvage the tooth.

In some cases, if the cost has become a problem, unfortunately, removal of the tooth will be the only answer to this condition.

It is, therefore, imperative to have small cavities treated as soon as they are detected.

Maintenance of oral conditions:

Your teeth are protected by enamel and subject to all form of chewing forces. Your gum provides the support to your teeth.  Tooth decay and gingivitis will occur if plaque is not removed thoroughly and frequently. Brushing and flossing each day will provide some protection. Regular “maintenance”, i.e. “check up” and “scale and clean” appointment with the dentist is essential to ensure your mouth is disease free and healthy.

This will ensure that any decays or gingivitis (gum disease) are detected or treated early to avoid becoming chronic dental problems in the future.

Chronic untreated small decay will progress into large cavities, pain and infection will result.

Chronic untreated gingivitis will turn into periodontitis resulting in bone loss, teeth will become loose and eventually will be lost.


Most people can relate to this topic. The sugar from our diet will turn into acid in our mouth, and the acid in turn will break down the enamel of the teeth. High sugar in the diet will cause massive tooth decay if the teeth are not brushed regularly and thoroughly after each meal. If the affected enamels are not treated, a slow chronic decay condition results. When this decay progressed to the pulp, acute painful tooth ache will either require extensive treatment, (root canal therapy), or the tooth may have to be lost.

Premature loss of tooth or teeth:

Due to previous dental experiences, some tooth or teeth in the mouth may have been extracted in the past. There could be the lack of facilities, financial restrain or simply ignorance in general dental knowledge when this decision was made. The loss of the tooth may be a good idea at the time, i.e. pain relief, but if the missing tooth or teeth are left untreated, over period of time, major problems may result.

Early loss of tooth/teeth for whatever reason, if not replaced promptly, may show no apparent ill effect in the beginning. The long term chronic problems developed can be

  • Tilting of the adjacent tooth/teeth
  • Over eruption of the opposing tooth/teeth
  • Gum recession and causing hot and cold sensitivity
  • Develop facial dissymmetry
  • More sensitivity if and when treatments are required at a later date.

Like many issues in the medical field, some people are more susceptible than the others in responding to this premature loss of teeth. For those who are vulnerable, major movement of the remaining teeth will occur. This movement usually does not show much signs nor symptoms but eventually will turn into a chronic dental condition.

The end results could manifest in

  • Food trap
  • Uncharacteristic decay pattern
  • Uneven wear and fracturing of the teeth
  • Spacing of the remaining teeth that cause cosmetic concerns
  • Night grinding (Bruxism). 

Treatment of this condition is obviously to prevent all the possible dental pathology associated with the premature lost of teeth by replacing them as soon as practical.  Dental prosthesis such as partial dentures, bridges and more recently, implants are prescribed to deal with the missing teeth.

Bruxism (Night Grinding):

One of the most destructive conditions which can cause massive damage to the teeth is called Bruxism. The teeth grinding while asleep will destroy the enamel biting surfaces of the teeth. The tell tale signs are the biting edge of the front teeth looks flat and the teeth look short.

The chronic nocturnal grinding nature of this condition if unchecked will, in severe cases, reduce the affected teeth to gum level.

The causes of bruxism are several. The most commonly acknowledged are interferences/imbalance of the teeth in occlusion (the bite) is out that triggers the grinding, and together with the stress in life that while sleeping, the clinched jaw will propagate the teeth destruction process.

Treatment of this condition is, if detected early, (with a minimal loss of tooth tissue), to wear a night guard or splint during sleep can protect and minimize the damage caused by the clinching and grinding forces.

In the more advanced situations, extensive procedures will be sorted to restore the lost oral hard tissue. The worn teeth are to be “built up” by various dental materials. Crowns are sometimes necessary and the treatment can become extremely expensive. Alternately, an overlay denture may be a cheaper alternative to a rather difficult situation.

Chronic Gingivitis

The health of the gum has not been perceived an important dental issue by most people. Thinking “no holes” in the teeth is a main objective to show in good dental health.  In fact healthy gum is the foundation for healthy teeth in the mouth.

Cleaning the teeth by brushing should also include brushing the gum.

Plaque is formed constantly in the mouth and therefore one needs to seek professional cleaning periodically to maintain healthy gum despite of your own daily home brushing. If the plaque is formed along the gum margin and hardened, (tartar), ordinary brushing will not remove it. It can only be removed thoroughly by the dental professionals.

The tartar formed around the gum will harbor food and bacteria that will cause inflammatory response from the body. The gum will become swollen and bleed easily during brushing. This is now called a chronic gingivitis which will continue to worsen if scale and clean is not carried out soon. This will ultimately lead to potential loss of bone that holds the teeth in the jaw. If this is not treated and allowed to advance, teeth will become mobile and eventually fall out. This is a domino effect.   

Treatment of this condition requires the patient to regularly visit dental professionals to remove all tartar build ups.  Depending on the seriousness of the condition, frequent visits at the beginning is important to make sure that the gums are in healthy condition again, this can then be  followed by Active Dental Maintenance (examination, scale and clean) with dental professionals every six months.

At Bondi Dental, patients who participate in our Active Dental Maintenance Program have not known to develop gingivitis because of the detailed and thorough cleaning they receive.

To prevent chronic dental problems:

Treatment of chronic dental conditions requires time and incurs costs.  It is therefore paramount that you be vigilant in monitoring the health of your teeth.  The key point is to make sure that all potential chronic issues are identified and addressed.

Treatment of chronic dental problems at Bondi Dental

Treatment of chronic dental problems requires a professional dentist to have the experience and knowledge to provide accurate diagnosis and good clinical skills in treatment.

At Bondi Dental, our Principal Dentist, Dr. Andrew Sih has over 30 years of experience in all aspects of dentistry.  He will be able to promptly address and identify your problems and provide you with the right treatments to restore your oral health.

If you suffer from any of the above conditions, call Bondi Dental and make an appointment with Dr. Andrew Sih at (02) 9365 3988 now.