Category Archives: Treatment information

Ice cream hurts my teeth

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Does cold water make you wince?  Does ice cream hurt your front teeth?   Does cold air make you to cover your mouth with your hand…. and keep it there?

Sensitivity comes from deep within the tooth, in the dentin that lies beneath the enamel. Dentin contains tiny, water-filled tubules that connect to the nerve. When your enamel wears away and the dentin is exposed, it triggers pain. So people with damaged enamel — caused by excessive brushing, acid erosion and overly-abrasive toothpastes are more likely to have sensitive teeth. People who have their roots exposed due to recession or gum disease also experience the same sensitivity.  Whitening products, which temporarily dry out the teeth, also make it worse.


What can you do?  

1.  Brush gently with an extra soft toothbrush:  We have found that toothbrushes that are NOT extra soft/soft (or sensitive) can cause tooth abrasion over time.  Be thorough yet gentle and don’t scrub.  Please make sure plaque is removed because plaque makes acid and acid makes the teeth sensitive.

2.  Use a non abrasive toothpaste:   Generally toothpastes with extra ingredients such as tartar control are MORE abrasive.   Abrasives scratch the surface of your enamel and wear your teeth (and expose that sensitive dentin) over time.

3.  Avoid excess acidic foods:  Acidic foods can cause enamel erosion/destruction and expose sensitive dentin.  For example, sports drinks, lemons, and soft drinks are very acidic.

4.  Be aware of possible acid reflux:  Stomach acid can damage teeth if it pools while you sleep.  Do you wake up with a bad taste in your mouth?  Does your stomach bother you? Please let your dentist know if you experience these symptoms.

What can we do to help you?  

1. Prescription fluoride!   We can prescribe extra strength products such as Duraphat toothpaste and flouride gel or rinse.  The prescription strength fluoride hardens your enamel, making it more resistant to sensitivity.

2. MI paste:  This amazing paste is used after you have cleaned your teeth.  It uses an ingredient called amorphous calcium phosphate which slowly builds new enamel or repairs damaged enamel and ends sensitivity.

3.  In surgery desensitizing treatments.  We have easy paint on fluoride varnishes and treatments that can help your sensitive teeth feel better.  Your dentist or hygienist  can discuss these options with you.

Soon enough you can have your ice cream pain free!  Just don’t forget to brush!


Who needs antibiotics before a dental procedure?

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Did you know that for certain individuals it is recommended they take an antibiotic before (or immediately after) some dental procedures? This is because the mouth is full of bacteria which, if it gets into the bloodstream, can create an infection in other parts of the body.

Your immune system is normally able to fight off bacteria that enter the bloodstream, but those with heart conditions are more vulnerable to the infection it can cause. Individuals who should premedicate (which is called antibiotic prophylaxis) before a dental procedure are ones who have one of the following conditions:

  • Artificial heart valves or problems with the valves that developed during a heart transplant.
  • A history of endocarditis which is an infection in the heart.
  • Heart conditions such as palliative shunts or cyanotic congenital heart disease.

It used to be recommended that those with artificial joints also premedicate before a dental procedure, but this practice has been discontinued. It is only advised for those who also have a weakened immune system due to illnesses such as cancer.

Speak with your dentist about whether you should premedicate before a dental procedure. The procedures where antibiotic prophylaxis is recommended are the ones in which an incision is made to oral tissues. These procedures include tooth extractions, implant placement, and root canal treatment.

Laughing through your dental treatment

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Laughing gas, or nitrous oxide, has been used routinely in dentistry since 1863. It’s a safe, effective sedation option for dental patients seeking a way to control feeling overly anxious about their treatments.

Nearly 75% of adults experience mild to severe dental anxiety. Causes for dental fears are varied, and may include:

  • Previous painful experiences at a dental practice
  • Dealing with general anxiety, mood, or posttraumatic stress disorders
  • Feeling out of control or helpless
  • Having low pain threshold or fear of pain
  • Embarrassment about the look of teeth
  • Phobic about needles and/or anxious about drills
  • Sensitive gag reflex

If you do suffer fear or anxiety about dentistry, the good news is that Quirke Dental Surgeons offers sedation dentistry. One of the most common forms of sedation is nitrous oxide, often referred to as laughing gas.

Nitrous oxide is an odourless gas inhaled through a comfortable mask. Actually, most nitrous oxide machines produce a mixture of 70% nitrous oxide with 30% oxygen, which keeps the inhalation sedation at safe and effective levels.

Dental patients have reported that breathing in laughing gas creates:

  • Light-headedness
  • Tingling in arms and legs
  • Floating sensations
  • A sense of comfortable distance
  • Euphoria or giddiness
  • Tendency to giggle

In most cases, patients don’t experience side effects from nitrous oxide. A very few may temporarily experience sore throats, inflamed nasal passages, or coughing. You should not feel sleepy, nauseaus, or unpleasant in any way. If you do, please tell your dentist so they can adjust the nitrous dosage or use a different sedation option.

Wisdom teeth, what are they good for?

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Many patients come to us every year complaining of problems with wisdom teeth. Many times, the problem is as a result of an infection in the gum overlying the wisdom tooth as it breaks through the gum. This is usually relatively easy to control using antibiotics and good oral hygiene measures. And if the wisdom tooth is coming through in the correct orientation and has enough space to erupt into, control of these local and short-lived infections is often the only issue.

However, the problems really start if the wisdom tooth is not coming through at the correct angle or has insufficient space. The picture illustrates what can happen next.

2015-05-05 22.29.41


In this example, the wisdom tooth has ‘crashed’ into the back of the tooth in front. Over time this has resulted in decay on the wisdom tooth and has also seriously compromised the tooth in front to such an extent that the tooth had to be lost. This is what happens when an impacted wisdom tooth is not taken out in good time.

At Quirke Dental Surgeons, we always assess the likelyhood of wisdom teeth causing this type of problem and will recommend early extraction if we feel that the above scenario is likely to occur in the future. We can refer extraction of wisdom teeth to our visiting specialist oral surgeon if necessary for the procedure to be completed in New Ross.

Finding the best dentist with good reviews

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Most people ask their family, friends and work colleagues for advise when looking for a new dentist.

Personal recommendations like this are how most of our new patients come to us, especially as we already know that over 97.5% of our patients have rated us as excellent or very good in a very large and unique survey we carried out over several months and involving approximately 1000 patients earlier this year.

Now, we have taken the technology we used to gather this information one step further and have worked with another software company to create an in-practice, tablet-based method for patients to rate us and provide a written review. This is such a simple and straightforward method for patients to leave feedback that we are already seeing a very positive reaction to its introduction.

We are making this information available online via the testimonials page on our website, so now you can now see the reviews being left by real patients in real time.

This will help patients who have been unable to get a personal recommendation to decide who are some of the best dentists providing treatment to patients in Wexford, Waterford, Carlow and Kilkenny.

For your convenience, this is a direct link to the reviews.

Cracked tooth, what now?

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Teeth are fracturing today in record numbers and are now reputed to be the third leading cause of tooth loss. This increase is due to several factors including longer life spans (older, brittle teeth tend to crack more) and higher stress levels that may lead to increased teeth clenching and grinding.

Early diagnosis is critical — if your dentist can detect a crack while it’s small, treatment can usually save a tooth.

Yes, Cracked Tooth Syndrome is a real problem that’s often quite difficult to diagnose. The term “syndrome” refers to the association of several clinical signs (discovered by the dentist) and symptoms (reported by the patient), which often occur together. Because the signs and symptoms vary in cracked tooth syndrome, diagnosis , actually pinpointing the problem tooth (or teeth), can be difficult.

It presents itself in many phases: craze lines, cracks, fractures and sometimes vertical splits.

Craze lines are mini cracks in just the outer surface of the tooth (enamel). Although not an immediate danger to the tooth, craze lines can lead to true cracks in the enamel that actually penetrate into the dentin layer (the body of the tooth). This in turn can lead to a very serious condition called a fracture/split where the crack may extend deep into the root of the tooth.

It goes without saying that the deeper the crack extends, the worse the symptoms. The most serious condition is a fracture that exposes the nerve of the tooth, this must be assessed and treated as soon as possible if there is to be any chance of saving the tooth.

A vertical split in a tooth is not salvageable.

Cracks or impending fractures in teeth are usually too small to be seen on x-rays, so dentists must use other methods.

Sometimes crack detection requires high magnification instruments. Most endodontists (root canal specialists) use microscopes as a routine part of their practice and are very good at detecting cracks and fractures. Endodontists can also assess whether a crack has involved the nerve within a tooth and whether root canal treatment is needed to relieve the pain and symptoms.

Symptoms will vary depending on the location of the crack in a tooth and what other structures are involved. If a crack involves the outside of the tooth (periodontal structures, gums, periodontal ligament and bone) a different set of symptoms will occur than if a crack involves the inside of the tooth (the pulp chamber containing the nerve).

A sharp, intense pain of short duration during chewing and upon release of food usually indicates a crack in a “vital” tooth, in which the nerve has not been affected. If a crack reaches the nerve it will become an avenue for infection. The pulp tissue housing the nerve then becomes inflamed and sensitive to temperature changes.

The earlier a crack is detected and the more superficial it is, the simpler it will be to repair.

Cracks in teeth without a living nerve give vague symptoms and the origin of the pain is often difficult to locate until the tissues around the teeth are affected. If a crack involves the periodontal structures (the gum, periodontal ligament and bone), symptoms may include tenderness around the tooth, easily identifying what tooth is hurting.

When a crack increases and becomes a true fracture, the symptoms intensify. If located in the crown of the tooth, a piece of the tooth may cleave off and be quite sensitive to temperature change and sweet foods. If the crack is located in the root, the patient will experience pain of increasing intensity and feel it particularly if infection sets in.

So, the earlier a crack is detected and the more superficial it is, the simpler it will be to repair it. Treatment is always based on a proper diagnosis. It could be as simple as replacing the lost tooth structure, or covering the crack or fracture with appropriate restorative materials. If the nerve is involved, it might mean root canal treatment and protection of the tooth with a crown (cap). Another suggestion your dentist may have, is that you consider wearing an occlusal (bite) guard to protect your teeth from clenching and/or grinding (bruxism) which may very well be occurring subconsciously. At worst, if the tooth is not salvageable it will mean tooth loss and replacement.

This is an overview of a complex problem. Please talk to us and come and see your dentist as soon as possible. It may mean saving a tooth.

6 main reasons why I might need an extraction

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Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed.

  • A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired.
  • A crowded mouth. Sometimes dentists pull teeth to prepare the mouth for orthodontic treatment so that the remaining teeth can be properly aligned. If a tooth cannot break through the gum (erupt) because there is not enough room in the mouth for it, your dentist may recommend pulling it.
  • Related, but slightly different, are problems and repeated infections caused by impacted wisdom teeth which just do not have sufficient space at the back of the mouth or may come through at a totally incorrect angle.
  • Infection. If tooth decay or damage extends to the pulp — the centre of the tooth containing nerves and blood vessels — bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal treatment (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.
  • Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.
  • Periodontal (Gum) Disease. If periodontal disease — an infection of the tissues and bones that surround and support the teeth — have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth. This is probably the largest cause of extractions in Ireland.

Permanent teeth are only permanent if you take great care of them and the supporting gums. This does not happen by accident. It needs the ongoing co-operation of dentist, hygienist and patient to ensure that permanent teeth live up to their name.

Cerec porcelain crowns and fillings in one visit

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Cerec is our 3D scanning system that lets us make porcelain crowns and inlays (fillings) all in one visit.  For anyone techie, this is CAD-CAM dentistry at the cutting edge of technology. We have now been using Cerec for 4 years and love it more than ever. We are the only Practice in the South-East (Wexford, Waterford, Carlow, Kilkenny, Tipperary) to have access to this technology.

Cerec is great to use to replace old black amalgam fillings when one last bit of tooth has snapped off or in teeth with several cracked areas waiting to snap off. The porcelain restoration produced is bonded on to the tooth, it is strong and shiny and the closest material to original actual tooth material that there is. It sticks weak areas together and helps strengthen the tooth. It is easy to keep clean and looks good.

So what is the procedure? The tooth is numbed. To pick up the scan we have to  spray the  teeth with blue powder. We scan the opposite teeth and the way the teeth bite together first. We remove the old filling , any decay and any thin weak tooth material.  Then we scan the prepared tooth.

After this we stop working in the mouth and start working on the computer. Everybody enjoys seeing the pictures of their teeth and the designing of their new tooth. We make a 3D design and this information is sent to the milling unit in the Practice (you can watch the milling process if you like).

Lots of patients ask if this is like 3D printing and yes it is a bit – but the tooth isn’t built up layer by layer, it is cut back or sculpted from a ceramic block in the milling machine which gives a much stronger finished product. With some kinds of porcelain we use, the new tooth is ready straight away, which is great. When we make Emax restorations, the strongest porcelain we have, the 3D restoration has to be crystallised and glazed in a furnace to make it even stronger. This takes about 30 minutes longer.

The porcelain is treated with a strong etch to make it ready to bond. The tooth surface is treated also so that everything sticks as well as possible. We always want to keep the area as dry as we can for excellent bonding strength. The cement we use isn’t really cement at all, it’s a resin, made by 3M (who make the glue that holds aeroplane wings on.)

In goes the 3D porcelain restoration and then we tidy up! We have to make sure that you can bite properly, that it’s smooth and that you can floss.

Then you can enjoy your new tooth, safe in the knowledge that the procedure has added years to its lifespan.

7 reasons why a Dental Implant may be a good option for you

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. What are the advantages of dental implants over dentures and bridges?

  1. A dental implant is pretty much the next best thing to replace a missing tooth – Once dental implants are fully integrated into your jaw, they function just as well as your own natural teeth: you can eat the foods you want and speak with complete confidence. With dentures, eating hard foods such as an apple can be a problem: either the dentures come loose or patients cannot withstand the hard biting forces as this pressure causes pain as the denture pushes into the gum. Irritation and inflammation of the gums is a common problem among denture patients.
  2. Dental implants protect and keep your jaw bone healthy and as a result keep your face looking younger – Normally, the bone tissue surrounding the root of your tooth is maintained by your body’s natural renewal process. However, if you lose a tooth, you will be left with a hole where your tooth root used to be and the bone around this area will slowly begin to disappear which may change the shape of your jaw. A dental implant placed in this space is the only restorative option that can actually stimulate bone growth and production, preventing loss of valuable bone structure. In some patients where bone loss has already occurred over time, bone augmentation may be required before placing a dental implant. Bone loss is a problem for people who have dentures, and as the shape of the jaw slowly changes, the dentures need to be adjusted or re-made to fit the new shape of the jaw. This bone loss can also make a person look older, as the mouth can sag in this area.
  3. Dental implants allow you to keep your teeth where they belong – in your mouth. Unlike dentures that should be left out of your mouth for eight hours a day and might slip or fall out, Dental Implants are firmly and permanently attached in your mouth. Think about a picture hanging on a picture hook or flip flops being the equivalent of dentures  versus a picture that is bolted to the wall or laced up boots being equivalent to dental implants.
  4. Improved dental hygiene – Unlike dental bridges and dentures, which require special cleaning instructions and extra attention, dental implants just need regular brushing, flossing and hygiene appointments, just like your natural teeth.
  5. No need to drill or remove any healthy tooth structure – When replacing missing teeth with dental bridges, the teeth adjacent to the gap need to be prepared and healthy tooth structure is removed to accommodate a crown or bridge abutment to fit over the top of the tooth. In the future, if one of the supporting teeth is damaged, the entire bridge restoration will also be compromised, whereas with an implant, the restoration is independent of any of your other teeth. By replacing lost teeth with dental implants, no support is required of the adjacent teeth, and your natural teeth do not need to be prepared or altered in any way.
  6. Dental implants just look better – If placed correctly, a dental implant should blend beautifully with your surrounding natural teeth.
  7. Dental implants are a very predictable way of replacing missing teeth. Dental implants have a track record of reliable, long-term successful outcomes. They are often considered “more predictable” than other treatments to replace missing teeth, compared to dentures or dental bridges.