Comprehensive head and neck cancer examination and risk assessment [059]
Bethel (Vol 26) 🎹🎵 Disneyland Park (Vol 26) 🎹🎵
Automated Tx planning 0 Diagnostic 1 Preventative (PSR/cariogram) 2 Periodontics 3 Oral Surgery 4 Endodontics 5 Restorative including LA 6 Prosthodontics 8 Orthodontics Botox and Fillers
Patient information
Procedural information: Suggested codes Comparison fees ADA codes
0 Diagnostic:
1 Preventative:
5 Restorative:
6 Prosthodontics:
4 Endodontics:
3 Oral surgery:
Oral medicine:
2 Periodontics:
8 Orthodontics:
O/E:
R/v Med Hx/FSH:
R/v Rx:
Self Mx/OHI:
OHI (
)
N/v:
Procedural information
0 Diagnostic
Consult
• Visual inspection and manual palpation of EO H&N structures and IO soft tissues. Includes detailed Pt risk assessment
• Comprehensive exam involves recording current status of your oral health, and should be done on a regular basis. This may require interpretation of information acquired from additional Dx procedures reported and itemized separately
$52.50 Bupa
• Consultation involves seeking advice and discussing treatment, and may involve the dentist getting appropriate information to inform their advice
$56 Bupa
• Periodic exam is an evaluation of oral health that is done between regular recurrent exams. This may require interpretation of information acquired through additional Dx procedures reported and itemized separately
$49 Bupa
• Oral examination involves limited exam of oral structures, which may be for a specific problem. This may require interpretation of information acquired through additional Dx procedures reported and itemized separately
$43 Bupa
• Provision of Tx required after hours
• Travel from usual place of practice to provide Tx
• Provision of medication/medicament involves An the actual supply, prescription or administration of appropriate medications and medicaments required for dental Tx's
• Non-invasive test for screening oral mucosa for oral Ca, and may include adjunctive Dx devices
• Letter includes details of the Pt's condition and reason for referral
• Consultation by referral involves consultation w/ Pt referred by dental or medical practitioner for opinion or Mx w/ specific dental disorder, and may involve a returning report from the consultant
$85 Bupa (extended, 30 min+)
• Will be signed and dated by the referring dentist
• Oral surgery referrals are probably the most common type made
$110 Bupa
$58 Bupa
Comprehensive oral examination (1 per year) [011 NO GAP]
$52.50 Bupa
88011 $54.05 CDBS
Consultation [014, 015 NO GAP]
$56 Bupa
$72 Bupa - Extended (30 minutes or more)
Periodic oral examination (2 per year) [012 NO GAP]
$49 Bupa
88012 $44.90 CDBS
Oral Examination - Limited [013 NO GAP]
$43 Bupa
88013 $28.20 CDBS
After-hours callout [915]
$105 Bupa
Travel to provide services [916]
$65 Bupa
Provision of medication/medicament [927]
(NIL COVER BY BUPA)
Oral mucosal screening [054]
(NIL COVER BY BUPA)
Oral hygiene instruction [141🆓]
NOT COVERED BY BUPA
Dietary analysis and advice [131🆓]
NOT COVERED BY BUPA
• Letter includes details of the Pt's condition and reason for referral
• Consultation by referral involves consultation w/ Pt referred by dental or medical practitioner for opinion or Mx w/ specific dental disorder, and may involve a returning report from the consultant
Consult by referral [017, 016]
$85 Bupa (extended, 30 min+)
$72 Bupa
• Oral surgery referrals are probably the most common type made
Treatment under general anesthesia/sedation [949]
$130 Bupa
Sedation - IV - per 30 minutes or part thereof [942]
$110 Bupa
88942 $137.50 CDBS
IV cannulation and establishment of infusion [928]
$105 Bupa
Relative Analgesia - inhalation of nitrous oxide and oxygen mixture - per 30 inutes or part thereof [943]
$58 Bupa
88943 $68.75 CDBS
Low level laser therapy - per appointment [945]
$52 Bupa
X-ray🖼
Panoramic radiograph - per exposure [037]
$119 Bupa
• PA focuses on the Root
Intraoral B/W or PA radiograph - per exposure [022 PA or BW NO GAP]
$38 Bupa
88022 $31.25 CDBS
Computed Tomography of the skull or parts thereof [039]
$148 Bupa
Pantographic tracing [967]
$145 Bupa
Radiograph of temporomandibular joint - per exposure [035]
$110 Bupa
Cone Beam Computed Tomography - scan acquisition - per appointment [026]
$102 Bupa
Lateral, antero-posterior, postero-anterior or submento-vertex radiograph of the skull - per exposure [033]
$92 Bupa
Cephalometric radiograph - lateral, antero-posterior, postero-anterior or submento-vertex - per exposure [036]
$91 Bupa
Cephalometric analysis - excluding radiographs [081]
$70 Bupa
Cone Beam Volumetric Tomography analysis and/or interpretation - orofacial structures [091🆓]
$66 Bupa
Intraoral radiograph - occlusal, maxillary, mandibular - per exposure [88025]
88025 $63.15 CDBS
Cone Beam Volumetric Tomography analysis and/or interpretation - temporomandibular joints only [090🆓]
$56 Bupa
Extraoral radiograph - maxillary, mandibular - per exposure [031]
$52 Bupa
Hand-wrist radiograph for skeletal age assessment [038]
$52 Bupa
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary and mandibular dentition (both arches) [089🆓]
$51 Bupa
Tooth-jaw size prediction analysis [082]
$47 Bupa
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (single arch) [088🆓]
$41 Bupa
Cone Beam Volumetric Tomography analysis and/or interpretation - small field of view (less than 1 complete dental arch) [087🆓]
$36 Bupa
Impressions
• Impressions are a negative imprint of teeth and soft tissues, taken w/ alginate or PVS, from which an original reproduction (cast or model) can be fabricated
• It is made by placing a material into a stock or custom tray which roughly fits over the teeth
• The material is liquid or semi-solid when mixed and placed in mouth, and sets to become elastic usually in a few minutes
• Alginate impressions are made by adding water to powdered alginate, and has a mixing time between 45-60 seconds, slower w/ cold water
• Alginate impressions must be stored correctly in a damp tissue, in a sealed polythene bag
• Alginate is used when less accuracy is required
• PVS is used to make accurate dental impressions w/ excellent reproducibility
• The repair/modification option for Impression is specifically taking impression where required for repair or modification of dental appliance
Alginate:
• Diagnostic cast/study model is a cast model of a person's teeth, that a dental professional uses as a guide in the application of corrective or restorative dentistry
• Identification involves marking dental appliance w/ Pt's name or other form of enduring Pt ID
• Diagnostic wax up is where planned restorations are developed in wax on a diagnostic cast to determine optimal clinical and lab procedures needed to achieve desired aesthetics and function
• Individually made tray is where a Tray is custom made from a model of the teeth or supporting gums of either jaw, made for the application of medicament to oral health structures
• It is made by placing a material into a stock or custom tray which roughly fits over the teeth
• The material is liquid or semi-solid when mixed and placed in mouth, and sets to become elastic usually in a few minutes
• Alginate impressions are made by adding water to powdered alginate, and has a mixing time between 45-60 seconds, slower w/ cold water
• Alginate impressions must be stored correctly in a damp tissue, in a sealed polythene bag
• Alginate is used when less accuracy is required
• PVS is used to make accurate dental impressions w/ excellent reproducibility
• The repair/modification option for Impression is specifically taking impression where required for repair or modification of dental appliance
Alginate:
• Diagnostic cast/study model is a cast model of a person's teeth, that a dental professional uses as a guide in the application of corrective or restorative dentistry
Diagnostic model - per model [071]
$57 Bupa
Identification [777]
$42 Bupa
• Diagnostic wax up is where planned restorations are developed in wax on a diagnostic cast to determine optimal clinical and lab procedures needed to achieve desired aesthetics and function
Diagnostic Modelling - physical - per tooth [074]
$8 Bupa
Diagnostic Modelling - digital - per tooth [075]
$8 Bupa
Intra-oral evaluation of diagnostic modelling - per tooth or tooth replacement [076]
$8 Bupa
Individually made tray - medicament [926]
(NIL COVER BY BUPA)
Photographs
• Dental photography provides a static, in-depth look at a Pt's smile or oral condition, for both the dentist and the Pt
• D-SLR cameras are perfect for dental photography
In orthodontics we usually do at least 4 extraoral photographs, i.e.
1) Frontal lips relaxed
2) Frontal smiling
3) Profile R side relaxed
4) 3/4 profile 45 degree smiling
In orthodontics we usually do at least 5 intraoral photographs, i.e.:
1) Frontal in occlusion
2) R buccal in occlusion
3) L buccal in occlusion
4) Upper occlusal (using mirrors)
5) Lower occlusal (using mirrors)
• D-SLR cameras are perfect for dental photography
Photographic records - intraoral - per appointment [072]
$28.50 Bupa
Photographic records - extraoral - per appointment [073]
$28 Bupa
1) Frontal lips relaxed
2) Frontal smiling
3) Profile R side relaxed
4) 3/4 profile 45 degree smiling
In orthodontics we usually do at least 5 intraoral photographs, i.e.:
1) Frontal in occlusion
2) R buccal in occlusion
3) L buccal in occlusion
4) Upper occlusal (using mirrors)
5) Lower occlusal (using mirrors)
Biopsy
Biopsy of tissue [051]
$115 Bupa
Procedures to derive biologically active components from a collection of blood [057]
$63 Bupa
Histopathological examination of tissue [052]
$53 Bupa
Cytological investigation [053]
$53 Bupa
Blood collection [055]
$53 Bupa
Hematological examination [056]
$53 Bupa
1 Preventative
Scale and clean S/C 🦷✨
• For Removal of calculus, if Plaque is not removed regularly by brushing and flossing, it hardens to create calculus; which cannot be removed w/ a toothbrush, only a dental professional can remove it during an oral cleaning
$93 Bupa (1st visit)
• Between your teeth
• Underneath your gums
Sometimes we will also use an Ultrasonic device:
E.g. of before (presence of Calculus) and after:
Scaling:
Removal of calculus [114 NO GAP, 115 NO GAP]
$93 Bupa (1st visit)
88144 $92.05 CDBS
$93 Bupa (subsequent visit)
88115 $59.85 CDBS
Risks of Scaling include:
• Infection of gums resulting in bacteremia
• Pain or discomfort
• Tooth sensitivity
• Bleeding
• Space betwen teeth
• Discomfort in the jaws
• Fever
We will use Metal picks to remove hard calculus from: • Infection of gums resulting in bacteremia
• Pain or discomfort
• Tooth sensitivity
• Bleeding
• Space betwen teeth
• Discomfort in the jaws
• Fever
• Between your teeth
• Underneath your gums
Sometimes we will also use an Ultrasonic device:
E.g. of before (presence of Calculus) and after:
Scaling:
Tooth polishing/prophylaxis 🦷✨
• For removal of plaque and/or stain, involves Removal of dental plaque and/or stain from the surfaces of all teeth and/or implants. This item is included in procedures described by items 114 and 115 (Removal of calculus), 250 (Active NSPT) and 251 (SPT)
$54.50 Bupa
• Enamel micro-abrasion is the use of 37% phosphoric acid and pumice, or 6% hydrochloric acid and silica, applied to the altered enamel surface w/ mechanica presure from a rubber cup
• Done to smooth surfaces of teeth and restoration
• Used to remove extrinsinc stains, dental plaque acumulation, increase aesthetics, and reduce corrosion of metallic restorations
Removal of plaque and/or stain [111 NO GAP]
$54.50 Bupa
88111 $55.20 CDBS
Enamel micro-abrasion - per tooth [116]
$74 Bupa
• Used to remove extrinsinc stains, dental plaque acumulation, increase aesthetics, and reduce corrosion of metallic restorations
Recontouring and polishing of pre-existing restoration
• Old, corroded amalgams w/ ditched margins on teeth that are caries free can be refurbshed by recontouring w/ steel burs and polishing, to restore a satisfactory surface finish and marginal adaptation
• We can do the same for composite and other restorations too
Recontouring and polishing of pre-existing restoration - per appointment [113]
$14 Bupa
• We can do the same for composite and other restorations too
Fissure Sealant
• Fissure sealants involve Sealing of non-carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number
$45 Bupa
Fissure and/or tooth surface sealing - per tooth [161🆓, 88162]
$45 Bupa
88161 $47.25 CDBS
Subsequent services - 88162 $23.65 CDBS
Resin Infiltration - per tooth [163🆓]
$45 Bupa
Indications of Fissure sealants include:
• Pits and fisures of deciduous teeth, when there is increased risk of experiencing caries
• Pits and fissures of permanent teeth, when there is increased risk of expereincing caries
• Incipient carious lesions (non-cavitated) of pits and fissures
• Pits and fissures of teeth in young Pt's w/ medical, physical or intellectual disabilities, mostly when systemic health could be jeopardized by dental disease or need for dental Tx
• Pits and fisures of deciduous teeth, when there is increased risk of experiencing caries
• Pits and fissures of permanent teeth, when there is increased risk of expereincing caries
• Incipient carious lesions (non-cavitated) of pits and fissures
• Pits and fissures of teeth in young Pt's w/ medical, physical or intellectual disabilities, mostly when systemic health could be jeopardized by dental disease or need for dental Tx
Fluoride treatment
• Application of cariostatic agent is Procedure to promote caries resistance, involving prolonged application of a concentrated fluoride or remienralization and/or cariostatic agent
• For topical application of remineralizing agent, involves non-fluoride topical remineralizing agents containing calcium and/or phosphate to control dental caries. Not to be used as an intrinsic part of the restoration
$28.50 Bupa
• Concentrated remineralization involves procedure to promote caries resistance in specific situation. Not to be used as an intrinsic part of teh restoration
• Fluoride varnish is a highly concentrated fluoride applied to the tooth's surface
• Fluoride varnish recommended for prevention of root caries, administered at least twice a year
• For Fluoride tray, Thin ribbon of fluoride gel is placed into both the upper and lower fluoride tray
Application of cariostatic agent - per tooth [123]
$40 Bupa
Topical application of remineralizing agent - 1 Tx [121 NO GAP]
$28.50 Bupa
88121 $35.45 CDBS
Risks of Fluoride Tx include:
• White specks on mature teeth
• Staining and pitting on teeth
• Problems w/ bone homeostasis
• V dense bones that aren't v strong
• White specks on mature teeth
• Staining and pitting on teeth
• Problems w/ bone homeostasis
• V dense bones that aren't v strong
• Concentrated remineralization involves procedure to promote caries resistance in specific situation. Not to be used as an intrinsic part of teh restoration
Topical remineralization agents, home application - per arch [122]
$157 Bupa - though No benefit on most products
• Fluoride varnish recommended for prevention of root caries, administered at least twice a year
• For Fluoride tray, Thin ribbon of fluoride gel is placed into both the upper and lower fluoride tray
Bleaching
• Home bleaching involves going to the dentist, getting a set of trays for your teeth, and then applying bleach into those trays to whiten your teeth; the bleach is usually carbamide peroxide, and has variable [] levels. This procedure describes the complete course of Tx per arch. For provision of the tray and medicaments see items 926 and 927
• External bleaching Can only be used in mild cases of tooth staining. External bleaching is the clinical course of Tx carried out exclusively in the surgery
• External bleaching involves modification of tooth using chemical and/or physical methods applied externally
• Internal bleaching is whitening a tooth from the inside out, 1st a root canal is performed to remove any infected pulp, then safe sodium perborate paste is placed deep inside of the tooth, which reacts w/ stains and dissolves their particles
• Material reacts w/ stains and dissolves their particles, making the tooth appear whiter
Bleaching, home application [119]
$200 Bupa - though No benefit on most products
Bleaching, external - per tooth [118]
$65 Bupa - though No benefit on most products
Risks of teeth whitening include:
• Tooth sensitivity
• Irritated gums
• Tooth sensitivity
• Irritated gums
• Internal bleaching is whitening a tooth from the inside out, 1st a root canal is performed to remove any infected pulp, then safe sodium perborate paste is placed deep inside of the tooth, which reacts w/ stains and dissolves their particles
Bleaching, internal - per application [117]
$110 Bupa
• Material reacts w/ stains and dissolves their particles, making the tooth appear whiter
Mouthguard and Occlusal splints
Occlusal appliance - e.g. splint [965📝]
$458 Bupa
Bi-maxillary mouthguard - indirect [153 NO GAP]
$220 Bupa
• Mouthguards are a thick, often spongy shield that fits over your teeth and gums
• Contact sports a mouthguard is recommended include football, basketball, baseball and hockey
• Whereas a mouthguard protects your teeth, an occlusal splint (aka nightguard) holds your teeth together to prevent harmful movement as you sleep
• Triple laminated mouthguard, involves triple layer coverage of the dentition
Provision of a mouthguard - indirect (triple laminated, dual laminated, or single laminated) [151 NO GAP]
$197 Bupa
• Single laminated provisional junior mouthguard is Made of flexible material which protects your teeth from impact during sporting activities
• Hard acrylic splints fit the jaw and cover the biting surfaces of teeth
• Splint resin involves a resin appliance attached to the teeth for stabilizing mobile or displcaed teeth. This item includes subsequent removal of the splint
• Clear thermo-elastic splints resist breaking and still allows the splint to maintain its original shape
• Splint metal involves Cast metal appliance bonded to teeth to stbailize mobile or displaced teeth
Repair/addition - occlusal appliance [972]
$157 Bupa
Splinting and stabilization - direct - per tooth [981🆓]
$75 Bupa
• Occlusal splint (aka night guard, bite splint) are custom fabricated hard acrylic/plastic device that fits over the occlusal and incisal surfaces of upper teeth, designed to immobilize and stabilize mobile loose teeth, and guides the jaw into a neutral position which relieves some pressure on the jaw joint, and very effectively protects teeth against destructive forces of grinding
Physical therapy for TMJ and associated structures - per appointment [971]
$40 Bupa
Types of Occlusal splints include:
• Stabilization splint (aka Michigan splint), is a hard acrylic splint that provides a temporary and removable ideal occlusion, which thus reduces abnormal muscle activity and produces neuromuscular balance. The splint needs to be adjusted over several visits as the masticatory muscles relax, and a consistent jaw relationship is reached. It is used for masticatory myalgia and TMJ arthralgia, especially if the pain is worse upon wakening
• Anterior repositioning splint, induces a therapeutic mandibular position, forward to the MICP. It places a Pt's mandible and TMJ into an anterior position to reduce a TMJ click that occurs on opening and closing of the jaw. It is useful for disk interference disorders, sometimes in Pt's w/ joint sounds, intermittent or chronic locking of the joint, and inflammatory disorders e.g. retrodiscitis
• Pivoting splint, is a hard acrylic appliance that covers 1 arch and usually provides a single posterior contact in each quadrant, usually as far posteriorly as possible. Thus, condyles are pulled downward upon clenching on the pivot, thus relieving traumatic load and giving the disk freedom to resume a normal position. It is used to unload the articular surface of the joint caused by decrease in inter-articular pressure, Tx joint sounds, and to Tx Sx's related to degenerative joint diseases
• Soft or resilient splint, fabricated from resilient material and usually adapted to upper teeth. Goals include to achieve even and simultaneous contact w/ opposing teeth. They should be replaced after 4-6 mo as they lose their resilience w/ passage of time. It is used to reduce Sx's of TMD (joint dysfunction and myalgia), protective device for persons likely to receive trauma to dental arches (athletic splint), prevent bruxism and clenching, and to relieve extremely sensitive posterior teeth due to chronic or repeated sinusitis
• Anterior bite plane, is a hard acrylic appliance worn over upper teeth that provides contact w/ only lower anterior teeth. It disengages the posterior teeth and thus eliminates their influence in mastication. Used to Tx muscle disorders related to orthopedic instability or acute change in occlusion condition, and parafunctional activity associated w/ unfavorable posterior contacts but only for short periods. If used over a long time unopposed mandibular teeth can supraerupt
• Posterior bite plane, usually fabricated for the lower teeth and involves areas of hard acrylic located over posterior teeth and connected by a cast metal lingual bar. It achieves major alterations in vertical dimension and mandibular repositioning. It is used for severe loss of vertical dimension, and when major changes in anterior positioning of the mandible are needed. It can cause potential supraeruption of unopposed teeth, and intrusion of occluded teeth. Thus long term use is discouraged
• Stabilization splint (aka Michigan splint), is a hard acrylic splint that provides a temporary and removable ideal occlusion, which thus reduces abnormal muscle activity and produces neuromuscular balance. The splint needs to be adjusted over several visits as the masticatory muscles relax, and a consistent jaw relationship is reached. It is used for masticatory myalgia and TMJ arthralgia, especially if the pain is worse upon wakening
• Anterior repositioning splint, induces a therapeutic mandibular position, forward to the MICP. It places a Pt's mandible and TMJ into an anterior position to reduce a TMJ click that occurs on opening and closing of the jaw. It is useful for disk interference disorders, sometimes in Pt's w/ joint sounds, intermittent or chronic locking of the joint, and inflammatory disorders e.g. retrodiscitis
• Pivoting splint, is a hard acrylic appliance that covers 1 arch and usually provides a single posterior contact in each quadrant, usually as far posteriorly as possible. Thus, condyles are pulled downward upon clenching on the pivot, thus relieving traumatic load and giving the disk freedom to resume a normal position. It is used to unload the articular surface of the joint caused by decrease in inter-articular pressure, Tx joint sounds, and to Tx Sx's related to degenerative joint diseases
• Soft or resilient splint, fabricated from resilient material and usually adapted to upper teeth. Goals include to achieve even and simultaneous contact w/ opposing teeth. They should be replaced after 4-6 mo as they lose their resilience w/ passage of time. It is used to reduce Sx's of TMD (joint dysfunction and myalgia), protective device for persons likely to receive trauma to dental arches (athletic splint), prevent bruxism and clenching, and to relieve extremely sensitive posterior teeth due to chronic or repeated sinusitis
• Anterior bite plane, is a hard acrylic appliance worn over upper teeth that provides contact w/ only lower anterior teeth. It disengages the posterior teeth and thus eliminates their influence in mastication. Used to Tx muscle disorders related to orthopedic instability or acute change in occlusion condition, and parafunctional activity associated w/ unfavorable posterior contacts but only for short periods. If used over a long time unopposed mandibular teeth can supraerupt
• Posterior bite plane, usually fabricated for the lower teeth and involves areas of hard acrylic located over posterior teeth and connected by a cast metal lingual bar. It achieves major alterations in vertical dimension and mandibular repositioning. It is used for severe loss of vertical dimension, and when major changes in anterior positioning of the mandible are needed. It can cause potential supraeruption of unopposed teeth, and intrusion of occluded teeth. Thus long term use is discouraged
&ull; Resin appliance attached to teeth for stabilizing mobile or displaced teth; may also be used to stabilize a fractured jaw. Item includes subsequent removal of teh splint
Splint resin - indirect [772]
$270 Bupa
Registration and mounting of dental models for occlusal analysis [964]
$84 Bupa
Splint metal - indirect [773]
$300 Bupa
Characterization of denture base [775]
$51 Bupa
Adjustment of pre-existing occlusal appliance e.g. splint - per appointment [966]
$70 Bupa
Desensitizing
• All desensitizing undertaken at a single appointment
Desensitizing procedure - per appointment [165🆓]
$35 Bupa
5 Restorative
Caries activity screening test
• For Caries activity screening test, it is Test to semi quantitatively screen the dental plaque for a specific group of caries inducing S mutans
Microbiological screening test [048]
$41.50 Bupa
Culture examination and identification [042]
$41 Bupa
Bacteriological examination [041]
$35 Bupa
Antibiotic sensitivity test [043]
$24 Bupa
Collection of specimen for pathology examination [044]
$24 Bupa
Saliva Screening Test [047]
$20 Bupa
Composite Filling/restoration 🦷✨
You will be given an Anesthetic to block pain >> We will give you an Anaesthetic for the Anaesthetic too!
We will use a Drill to remove caries
• Composite resin is a plastic used to repair damaged tooth
• Adhesive restoration involves restoration using an adhesive technique and a tooth-colored material
We will use a White plastic to fill the hole
• Adhesive restoration direct involves Indirect non-metallic restoration
$226 Bupa (5 surface posterior)
Shade and restore:
$55 Bupa
• Pin retention is use of a pin to aid the retention and support of restorations in a tooth
$30 Bupa
• Restoration of incisal corner is used in conjunction w/ items describing restorations of anterior teeth that are formed in such a way as to restore anatomical or functional shape of incisal corner
• Cusp capping is used in conjunction w/ items describing restorations of posterior teeth, formed in such a manner as to restore the anatomical or functional height of a cusp
• Bonding of tooth fragment involves Reattachment of fractured tooth fragments, so can provide good and long-lasting aesthetics, because the tooth's original anatomic form, color and surface texture are maintained
$133 Bupa
We will use a Drill to remove caries
• Composite resin is a plastic used to repair damaged tooth
• Adhesive restoration involves restoration using an adhesive technique and a tooth-colored material
We will use a White plastic to fill the hole
• Adhesive restoration direct involves Indirect non-metallic restoration
Adhesive restoration direct [525, 524, 523, 522, 521; 535, 534, 533, 532, 531]
$226 Bupa (5 surface posterior)
88525 $231.35 CDBS
$211 Bupa (4 surface posterior)
88524 $196.90 CDBS
$200 Bupa (3 surface posterior)
88523 $170.35 CDBS
$165 Bupa (2 surface posterior)
88522 $143.80 CDBS
$132.50 Bupa (1 surface posterior)
88521 $118.45 CDBS
$224 Bupa (5 surface anterior)
88535 $248.55 CDBS
$188 Bupa (4 surface anterior)
88534 $215.20 CDBS
$170 Bupa (3 surface anterior)
88533 $190.95 CDBS
$148 Bupa (2 surface anterior)
88532 $158.85 CDBS
$123 Bupa (1 surface anterior)
88531 $126.50 CDBS
Risks of a filling include:
• Anesthetic complications, like allergic reactions, injury to nerves and blood vessels
• Development of a cavity around the filling
• Expansion and shrinkage of the filling, that can damage the filling and the tooth
• Injury to the mouth
• Need for more extensive procedures like a crown, or root canal
• Damage to other teeth during the procedure
• Sensitivity to hot and cold in the affected tooth
• For provisional (temp) restoration, Often used during complex restorative dental procedures to serve as temporary prosthetic replacements while Pt's wait for a permanent restoration. This item should be used only where the provisional (intermediate) restoration is not an intrinsic part of Tx. It does not include provisional/temporary sealing of access cavity during endodontic Tx or during construction of indirect restorations• Anesthetic complications, like allergic reactions, injury to nerves and blood vessels
• Development of a cavity around the filling
• Expansion and shrinkage of the filling, that can damage the filling and the tooth
• Injury to the mouth
• Need for more extensive procedures like a crown, or root canal
• Damage to other teeth during the procedure
• Sensitivity to hot and cold in the affected tooth
Provisional/interim restoration - per tooth [572🛣]
$55 Bupa
88572 $50.05 CDBS
Pin retention - per pin [575🆓]
$30 Bupa
88575 $28.75 CDBS
Adaptation of new restoration to existing removable prosthesis - per tooth [571]
$30 Bupa
Restoration of incisal corner - per corner [578🆓]
$27 Bupa
Cusp capping - per cusp [577🆓]
$27 Bupa
• Bonding of tooth fragment involves Reattachment of fractured tooth fragments, so can provide good and long-lasting aesthetics, because the tooth's original anatomic form, color and surface texture are maintained
Bonding of tooth fragment [579]
$133 Bupa
88579 CDBS $99.40
Odontoplasty/enameloplasty
• Odontoplasty (aka enameloplasty) involves removing tooth enamel, using a sanding disk or fine diamond bur to eliminate enamel from a tooth to alter its shape
Odontoplasty - per tooth [171]
$23.50 Bupa
Amalgam Filling 🦷🥈
• Amalgam tattoo is a grey, blue or black area of discoloration on the mucous membranes of the mouth, typically on the gums of the lower jaw
• It is common, painless, and benign, but can be mistaken for melanoma
$210 Bupa (5 surf)
• It is common, painless, and benign, but can be mistaken for melanoma
Metallic restor direct [515, 514, 513, 512, 511]
$210 Bupa (5 surf)
88515 $203.65 CDBS
$184 Bupa (4 surf)
88514 $178.40 CDBS
$166 Bupa (3 surf)
88513 $156.50 CDBS
$137 Bupa (2 surf)
88512 $131.15 CDBS
$121 Bupa (1 surf)
88511 $106.95 CDBS
6 Prosthodontics
New Denture
• Denture are removable, false teeth made of acrylic used to replace missing teeth, supported by surrounding soft and hard tissue
• RPD's (partial dentures) are used when some natural teeth remain
• Cobalt-Chrome (CoCr) cast metal framework involves provision of framework for a Pt removable dental prosthesis made w/ a cast metal on which to replace teeth where some natural teeth remain. Other components of the denture e.g. teeth, rests, retainers and immediate tooth replacements should be appropriately itemized
$1,170 Bupa (Maxillary)
• Full dentures are used when all teeth are missing
$2,000 Bupa (maxillary and mandibular)
• Denture base is a part of the dneture which rests on the foundation tissues and to which teeth are attached
• Denture resin base involves Provision of resin base for a Pt removable dental prosthesis where some natural teeth remain. Other components of the denture like teeth, rests, retainers and immediate tooth replacements should be itemized separately
$530 Bupa (maxillary)
$840 Bupa (complete maxillary and mandibular)
• You should clean dentures at least once a day, and after eating if you need to
• Always clean dentures over a bowl of water or a folded towl in case you drop them
• Brush your dentures 1st removing any bits of food, using a non-abrasive denture cleaner, not toothpaste; but be careful not to scrub too hard. Brush all surfaces including the surface that fits against your gums
• Soak your dentures every day in a denture-cleaning solution, that helps remove any plaque or stubborn stains
• Do not use very hot water to soak your dentures or it can weaken the dentures
• Don't keep your dentures in overnight unless there are specific reasons for you to keep them in
Options:
• Acrylic dentures have good appearance, cost effective, easily modifiable (can add more teeth in future if needed), but limited stability/retention
• Metal (chrome cobalt) is much stronger, thinner and smaller than plastic ones, so will be less bulky. It offers stability, retention, and equal distribution of masticatory forces
• Implant retained fixed pros has an expense, and requires very good periodontium
• Gold crowns for dentures have gold which is an ideal alternative for those with cobalt or chromium allergies, but is more expensive
• In metal dentures the clasps are made from Cobalt chrome, and are cast as part of the actual metal framework. They are more expensive than acrylic dentures
• Metal palate or plate involves A reinforcing cast metal section added to a resin denture base. Other denture components should be itemized separately
• Resilient lining involves Provision of a resilient tissue-bearing surface for a removable prosthesis. Item may be used w/ provision of new, or maintenace of pre-existing prostheses. Associated services should be itemized separately
. We use Definitive relining/Molloplast
• Wrought bar is where Wrought wire metal clasps provide retention for partial dentures
• Wrought bar involves a wrought bar joining sections of a partial prosthesis
• • Tooth/teeth (partial denture) involves each tooth added to the base of a new partial denture, where the # of teeth should be indicated
$44 Bupa
• Immediate tooth replacement is Provision w/in a denture to allow immediate replacement of an extracted tooth
$43 Bupa
$41 Bupa
• Occlusal rests serve to support the position of a partial denture and resist movement toward the tissue
• Surgical guide for an immediate denture, is a Surgical stent that is a guide for recontouring tissues after extraction
• For Precision or magnetic denture attachment, involves A preformed device w/in a prosthesis that connects to a precision or magnetic component on a tooth or implant. For the tooth component see #645, for implant component see item #661
• Flexible dentures are made of a thin thermoplastic like nylon, which provides excellent aesthetics and comfort, and also adapt to constant movement
• Precision attachment denture is a kind of RPD that contains precision attachments to lock denture onto th enatural teeth; magnetic attachment is where the magnets are placed in the denture
• Suck down temp denture is Used as a temporary measure to cover a missing tooth for aesthetic reasons, which look like a clear mouthguard w/ a denture tooth in it
• Metal backing involves Extension of the casting of a cast metal partial denture to provide backing for the denture tooth
• Retainer/clasp is where combination of several RPD compoents that engage an abutment tooth extra-coronally for support, stabiulity, and retention of the partial denture
• Implant supported dentures are the middle ground between a conventional denture that uses adhesive and more expensive full-arch dental implants, so more affordable, but significantly improving ability to chew and smile
• Custom impression trays help to accommodate a variety of dental arch sizes, and helps the making of a high quality impression
• Inlay for denture tooth involves Provision of an inlay in a denture tooth
• RPD's (partial dentures) are used when some natural teeth remain
• Cobalt-Chrome (CoCr) cast metal framework involves provision of framework for a Pt removable dental prosthesis made w/ a cast metal on which to replace teeth where some natural teeth remain. Other components of the denture e.g. teeth, rests, retainers and immediate tooth replacements should be appropriately itemized
Partial Denture - CoCr Cast Metal Framework [727📝🛡️, 728📝🛡️]
$1,170 Bupa (Maxillary)
$1,170 Bupa (Mandibular)
Definitive Full/Complete denture [719🆓🛡️, 711🆓🛡️, 712🆓🛡️]
$2,000 Bupa (maxillary and mandibular)
$1,000 Bupa (maxillary)
$1,000 Bupa (mandibular)
Warranty on prostheses:
• 12 mo warranty on technical faults, and 2 years on clinical errors
• No warranty provided on immediate dentures of # of any kid
• No warranty on biological faults including # abutment tooth for RPD; resorption of ridge due to biological conditions; xerostomia in case of retention for complete dentures
• Covered technical faults include Debonding of acrylic teeth; Debonding of porcelain/composite; Porosity in metal components; Porosity in acrylic
• Warranty conditions require 6 mo recalls over at least 2 years (starting from date of insert), if recall is missed by 1 week for any reason, warranty expires imemdiately
• Pt must maintain high standard of OH and a caries risk <20% at each recall
• 12 mo warranty on technical faults, and 2 years on clinical errors
• No warranty provided on immediate dentures of # of any kid
• No warranty on biological faults including # abutment tooth for RPD; resorption of ridge due to biological conditions; xerostomia in case of retention for complete dentures
• Covered technical faults include Debonding of acrylic teeth; Debonding of porcelain/composite; Porosity in metal components; Porosity in acrylic
• Warranty conditions require 6 mo recalls over at least 2 years (starting from date of insert), if recall is missed by 1 week for any reason, warranty expires imemdiately
• Pt must maintain high standard of OH and a caries risk <20% at each recall
Risks of dentures include:
• Pain
• Dentures that don't fit well or are uncomfortable
• Loose teeth
• Bleeding gums
• Swelling
• Ulcers
• Gum abscess
• Soreness or carcks in the corner of your mouth
• Bad breath
• Pain
• Dentures that don't fit well or are uncomfortable
• Loose teeth
• Bleeding gums
• Swelling
• Ulcers
• Gum abscess
• Soreness or carcks in the corner of your mouth
• Bad breath
• Denture base is a part of the dneture which rests on the foundation tissues and to which teeth are attached
• Denture resin base involves Provision of resin base for a Pt removable dental prosthesis where some natural teeth remain. Other components of the denture like teeth, rests, retainers and immediate tooth replacements should be itemized separately
Partial denture - Definitive Acrylic resin base [721🆓📝, 722📝]
$530 Bupa (maxillary)
88721 $448.05 CDBS
$530 Bupa (mandibular)
88722 $448.05 CDBS
Warranty is specifically excluded for code 721 and 722 unless technical faults are evident. Faults NOT covered include:
• Inadequate adjustment by the Pt e.g. bending clasps
• Inappropriate use of denture e.g. framework has been bent or biting denture into positionr ather than using fingers to place denture
• Immediate denture #'s
• Chipping of acrylic teeth
• Aesthetic conerns e.g. Pt does not like appearance of teh complete denture or RPD after given approval at try-in appointment
• Provisional denture is a temporary denture, used for a short time, until a more definite prosthetic dental treatment can be provided. This item should be used only where a provisional denture is not an intrinsic part of items 711, 712, 719; 721, 722. Other components of denture e.g. teeth, rests, retainers and immediate tooth replacements should be apporpirately itemized• Inadequate adjustment by the Pt e.g. bending clasps
• Inappropriate use of denture e.g. framework has been bent or biting denture into positionr ather than using fingers to place denture
• Immediate denture #'s
• Chipping of acrylic teeth
• Aesthetic conerns e.g. Pt does not like appearance of teh complete denture or RPD after given approval at try-in appointment
Provisional/Interim/Immediate Acrylic denture [715, 713, 714, 723, 724]
$840 Bupa (complete maxillary and mandibular)
$420 Bupa (complete maxillary)
$420 Bupa (complete mandibular)
$230 Bupa (partial maxillary)
88723 $336 CDBS
$230 Bupa (partial mandibular)
88724 $336 CDBS
• Always clean dentures over a bowl of water or a folded towl in case you drop them
• Brush your dentures 1st removing any bits of food, using a non-abrasive denture cleaner, not toothpaste; but be careful not to scrub too hard. Brush all surfaces including the surface that fits against your gums
• Soak your dentures every day in a denture-cleaning solution, that helps remove any plaque or stubborn stains
• Do not use very hot water to soak your dentures or it can weaken the dentures
• Don't keep your dentures in overnight unless there are specific reasons for you to keep them in
Options:
• Acrylic dentures have good appearance, cost effective, easily modifiable (can add more teeth in future if needed), but limited stability/retention
• Metal (chrome cobalt) is much stronger, thinner and smaller than plastic ones, so will be less bulky. It offers stability, retention, and equal distribution of masticatory forces
• Implant retained fixed pros has an expense, and requires very good periodontium
• Gold crowns for dentures have gold which is an ideal alternative for those with cobalt or chromium allergies, but is more expensive
• In metal dentures the clasps are made from Cobalt chrome, and are cast as part of the actual metal framework. They are more expensive than acrylic dentures
• Metal palate or plate involves A reinforcing cast metal section added to a resin denture base. Other denture components should be itemized separately
Metal palate or plate [716🛣]
$330 Bupa
• Resilient lining involves Provision of a resilient tissue-bearing surface for a removable prosthesis. Item may be used w/ provision of new, or maintenace of pre-existing prostheses. Associated services should be itemized separately
. We use Definitive relining/Molloplast
Resilient lining [737🆓]
$215 Bupa
• Wrought bar involves a wrought bar joining sections of a partial prosthesis
Wrought bar [738🆓]
$131 Bupa
• • Tooth/teeth (partial denture) involves each tooth added to the base of a new partial denture, where the # of teeth should be indicated
Tooth/teeth (for new - partial denture) [733]
$44 Bupa
88733 $37.10 CDBS
Immediate tooth replacement - (post extractions) for Partial dentures - per extracted tooth [736🆓]
$43 Bupa
88736 $9.30 CDBS
Retainer for Partial denture - per tooth [731🆓]
$41 Bupa
88731 $45.20 CDBS
Occlusal Rest - for Partial denture - Per Rest [732🆓]
$39 Bupa
• Surgical guide for an immediate denture, is a Surgical stent that is a guide for recontouring tissues after extraction
Surgical guide for an immediate denture [779]
$220 Bupa
Precision or Magnetic Denture Attachment, inc Locator type [735🛡️]
$156 Bupa
• Flexible dentures are made of a thin thermoplastic like nylon, which provides excellent aesthetics and comfort, and also adapt to constant movement
• Precision attachment denture is a kind of RPD that contains precision attachments to lock denture onto th enatural teeth; magnetic attachment is where the magnets are placed in the denture
• Suck down temp denture is Used as a temporary measure to cover a missing tooth for aesthetic reasons, which look like a clear mouthguard w/ a denture tooth in it
• Metal backing involves Extension of the casting of a cast metal partial denture to provide backing for the denture tooth
Metal backing (for addition of teeth, ONLY cast metal) for Partial denture teeth - per backing [739]
$55 Bupa
• Implant supported dentures are the middle ground between a conventional denture that uses adhesive and more expensive full-arch dental implants, so more affordable, but significantly improving ability to chew and smile
• Custom impression trays help to accommodate a variety of dental arch sizes, and helps the making of a high quality impression
• Inlay for denture tooth involves Provision of an inlay in a denture tooth
Inlay for denture tooth [778]
(NIL coverage for Bupa)
Denture aftercare
• Remodelling involves Replacement of the resin base of a denture, w/ or w/o rearrangement of the teeth, to improve its accuracy and fit, this procedure requiring multiple appointments
$425 Bupa (complete)
• Relining is resurfacing/roughening the tissue/inside side of a denture, and an adhesive is placed on the acrylic, the soft reline material is placed into th denture and seated in the mouth to cure, to fill spaces that exist between the current denture contour, and the altered tissue contour, so essentially a refit
• Relining for processed, involves Replacement of the tissue fitting surface of a denture to improve its accuracy and fit, a procedure requiring multiple appointments
• Relining for direct involves Addition to the tissue fitting surface of a denture to improve its accuracy and fit, using a self or light cured material. The procedure requires multiple appointments
$415 Bupa (Complete - Processed)
• Repair or addition to metal casting involves the cast metal frame of a denture, a complex procedure requiring the dismantling of the denture. Other complementary services should be appropriately itemized
• Denture clasp/retainer is a combination of several RPD components that engage an abutment tooth extra-coronally for support, stability, and retention of the partial denture
• You may be able to add additional teeth to acrylic partial dentures, the technician just needs to add more acrylic to the denture to chemically bond the new tooth
• for Add tooth to partial denture to replace extracted teeth, If the tooth is an immediate replacement, #736 is applicable
$172 Bupa
• Repairing broken base of a denture involves Repair, insertion and adjustment of a broken resin denture base
$155 Bupa (complete)
• Replacing/adding clasp to denture involves Repair, insertion and adjustment of a denture involving replacement or addition of a new clasp or clasps
$155 Bupa
• Replacing/adding new tooth on denture involves Repair, insertion and adjustment of a denture involving replacment w/ or addition of a new tooth or teeth to a previously existing denture
$153 Bupa
• Reattaching pre-existing clasp to denture, is where involves Repair, insertion and adjustment of a denture involving reattachment of a pre-existing clasp
$135 Bupa
• Reattaching existing tooth on denture involves Repair, insertion and adjustment of a denture involving reattachemnt of a pre-existing denture tooth or teeth
• Tissue conditioning involves provisional/temporary lining of tissue fitting surface of a denture w/ conditioning material
• Cleaning and polishing of pre-existing denture is this not associated w/ any other item of maintenance or repair of denture
• Impressions are helpful for the repair or modification of a dental appliance
$59.50 Bupa
• Adjustment of a denture does not apply to routine adjustments following the insertion of a new denture or the maintenance or repair of an existing denture
$51 Bupa (after 3 mo post denture delivery)
• Denture base modification involves Structural addition to a denture base to enhance aeshtetics or function
Remodelling - denture [745🆓, 746🆓]
$425 Bupa (complete)
$398.50 Bupa (partial)
• Relining for processed, involves Replacement of the tissue fitting surface of a denture to improve its accuracy and fit, a procedure requiring multiple appointments
• Relining for direct involves Addition to the tissue fitting surface of a denture to improve its accuracy and fit, using a self or light cured material. The procedure requires multiple appointments
Relining - denture [743🆓, 744🆓, 751, 752]
$415 Bupa (Complete - Processed)
$385 Bupa (Partial - Processed)
$187 Bupa (Complete - Direct)
$160 Bupa (Partial - Direct)
Repair or addition to metal casting [769🆓]
$195 Bupa
• You may be able to add additional teeth to acrylic partial dentures, the technician just needs to add more acrylic to the denture to chemically bond the new tooth
• for Add tooth to partial denture to replace extracted teeth, If the tooth is an immediate replacement, #736 is applicable
Add tooth to partial denture to replace an extracted or decoronated teeth - per denture tooth [768🆓]
$172 Bupa
88768 $156.50 CDBS
Repairing broken base of a denture [763🆓, 764🛣]
$155 Bupa (complete)
$155 Bupa (partial)
88764 $147.95 CDBS
Replacing/adding clasp to denture - per retainer (clasp) [762🛣]
$155 Bupa
88762 $154.60
Replacing/adding a new tooth on denture - per denture tooth (Indirect) [765🆓]
$153 Bupa
88765 $154.60 CDBS
Reattaching existing tooth on denture - per tooth [88766]
88766 $147.95 CDBS
Re-attaching pre-existing clasp to denture [761🛣]
$135 Bupa
88761 $147.95 CDBS
Reattaching existing tooth on denture - per denture tooth (chairside) [766🆓]
$134 Bupa
Tissue conditioning (temporary) preparatory to impressions - per application [771🆓]
$90 Bupa
Cleaning and polishing exist denture [753🛣]
$64.50 Bupa
Impression - dental appliance repair/modification [776🆓]
$59.50 Bupa
88776 $47.25 CDBS
• Adjustment of a denture does not apply to routine adjustments following the insertion of a new denture or the maintenance or repair of an existing denture
Adjustment of (pre-existing) denture [741🆓]
$51 Bupa (after 3 mo post denture delivery)
No charge (up to 3 mo post denture delivery per r/v appointment)
88741 $53.90 CDBS
• Denture base modification involves Structural addition to a denture base to enhance aeshtetics or function
Denture base modification (e.g. Bite blocks added to existing dentures, chairside) [754]
$362 Bupa
Maintenance of overdenture attachment - per attachment [755]
$155 Bupa
Composite Inlay/Onlay
• Composite inlays are a special type of filling that can be used to treat medium and deep decay, and other damage
• Inlays incorporate the pits and fissures of a tooth, so only filling the area between the cusps
• Onlays will cover 1 or more cusps of the tooth
• Dental overlay is dental filling material made from composite resin used to overlay the tooth
• Indirect restoration is where Fabrication occurs outside the mouth
• Indirect Tooth-colored restoration involves indirect non-metallic restoration
• Tooth colored restor indirect involves Direct restoration using adhesive technique and tooth-colored material
5 surf $930 Bupa
• Porcelain inlays are a strong alternative to a filling, custom made outside yoru mouth and then bonded to your tooth
• Inlays incorporate the pits and fissures of a tooth, so only filling the area between the cusps
• Onlays will cover 1 or more cusps of the tooth
• Dental overlay is dental filling material made from composite resin used to overlay the tooth
• Indirect restoration is where Fabrication occurs outside the mouth
• Indirect Tooth-colored restoration involves indirect non-metallic restoration
• Tooth colored restor indirect involves Direct restoration using adhesive technique and tooth-colored material
Tooth colored restor indirect [555, 554, 553, 552, 551]
5 surf $930 Bupa
4 surf $895 Bupa
3 surf $840 Bupa
2 surf $705 Bupa
1 surf $375 Bupa
Recementing of inlay/onlay [596🆓]
$110 Bupa
Removal inlay/onlay [595]
$110 Bupa
Overlays - Per Tooth [734]
$53 Bupa
Gold Inlay
• Gold inlays are an alloy of gold, coper and other metals and as such as very strong, and so the longest lasting of any filling, 10-20 years at least
$1,100 Bupa (5 surf)
Metallic restor indirect [541, 542, 543, 544, 545]
$1,100 Bupa (5 surf)
$1,000 Bupa (4 surf)
$700 Bupa (3 surf)
$545 Bupa (2 surf)
$425 Bupa (1 surf)
Veneer
• Veneer are restorations a layer of material added over the front surface of the tooth to correct discoloration, minor misalignment, chips or cracks, protecting the tooth's surface from damage
• Indirect veneer involves attachment of a tooth-colored veneer to the surface of a tooth, where veneer is constructed indirectly. Where the restoration of the tooth at the same visit is required prior to placement of the crown, the use of #627 is applicable
$255 Bupa (anterior tooth)
• They involve wafer-thin, custom-made tooth-colored shells bonded to front surface of tooth
• A thin surface of the original tooth needs to be removed to make space for the veneer so it does damage your tooth
• Indirect veneer involves attachment of a tooth-colored veneer to the surface of a tooth, where veneer is constructed indirectly. Where the restoration of the tooth at the same visit is required prior to placement of the crown, the use of #627 is applicable
Tooth-colored - Veneer - Indirect [556]
$850 Bupa
Indications of Veneers include:
• Stained or darkened teeth
• Hypocalcification
• Multiple diastemas
• Peg laterals
• Chipped teeth
• Lingual positioned teeth
• Malposed teeth not requiring orthodontics
• Stained or darkened teeth
• Hypocalcification
• Multiple diastemas
• Peg laterals
• Chipped teeth
• Lingual positioned teeth
• Malposed teeth not requiring orthodontics
Risks of Veneers include:
• Jaw pain
• Misalignment of bite
• Veneer cracking or falling off
• Temperature sensitivity of the tooth
• Exposed veneer margins
• Veneers remaing white whilst the surrounding teeth discolor
• Direct veneer involves Direct bonding of a veneer of adhesive tooth-colored material to the surface of a tooth
• Jaw pain
• Misalignment of bite
• Veneer cracking or falling off
• Temperature sensitivity of the tooth
• Exposed veneer margins
• Veneers remaing white whilst the surrounding teeth discolor
Adhesive restoration - veneer - direct [526, 536]
$255 Bupa (anterior tooth)
$265 Bupa (posterior tooth)
• A thin surface of the original tooth needs to be removed to make space for the veneer so it does damage your tooth
Crown Stainless Steel SSC
• Stainless steep crowns are metal caps used to repair a decayed baby back tooth, and prevent it from decaying further, used to cap teeth w/ large or deep cavities
• Full indirect metallic crown invovles Artificail crown constructed w/ cast or milled metals, restoring a natural tooth
• Full metal crowns are entirely cast in a metal alloy
• Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down
• Preformed crowns are recommended by specialists in children's dentistry for Mx of molars
• Full indirect metallic crown invovles Artificail crown constructed w/ cast or milled metals, restoring a natural tooth
Full crown - metallic - indirect - e.g. Gold Alloy [618📝🛡]
$1,390 Bupa
• Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down
• Preformed crowns are recommended by specialists in children's dentistry for Mx of molars
Crown Non-metallic
• Crowns are a type of restoration which completely caps or encircles a tooth
• Non-metallic crowns are highly aesthetic restorations made entirely of ceramic or porcelain
• Lithium disilicate (E-max) is more translucent than Monolithic Zirconia, which creates a more lifelike crown that requires no stain, although zirconia is stronger
• Metal bonded crown (aka PFM, VMK, veneered full crown) have a metal base bonded to a veneer made from porcelain, which combines durability, aesthetics, and value for money
• Preliminary restoration for crown involves Direct restoration of the remains of a tooth to provide a base for an intended indirect crown, placed at the same visit as the crown preparation. Pins and/or posts used should be itemized separately
• Recementing crown or veneer involves Recementing a previously cemented crown/veneer
• Temporary/Provisional crown is a short-term crown used in dentistry, serves until a final restoration can be inserted. This item should be used only where a provisional crown is not an intrinsic part of another service. It should not be used for a provisional restoration between appointments during crown construction
• Removal of crown is removal of a currently cemented definitive crown that may subsequently be reinserted
• Emax is a type of all-ceramic crown made from lithium disilicate material, which has excellent strength and appealing aesthetics
• E-Max crowns are more translucent than Zirconia crowns, allowing more light to pass through, which makes the look as natural as possible, and ideal for front teeth as they are naturally less opaque
• Whereas all porcelain or PFM crowns last 5-15 years, metal crowns for 20+ years, gold and zirconia crowns can last a lifetime
• Non-metallic crowns are highly aesthetic restorations made entirely of ceramic or porcelain
• Lithium disilicate (E-max) is more translucent than Monolithic Zirconia, which creates a more lifelike crown that requires no stain, although zirconia is stronger
• Metal bonded crown (aka PFM, VMK, veneered full crown) have a metal base bonded to a veneer made from porcelain, which combines durability, aesthetics, and value for money
Full metal-ceramic crown - veneered - indirect [615📝🛡]
$1,560 Bupa
Full crown - ceramic - Zirconia or Lithium disilicate (E-max) - indirect [613📝🛡]
$1,552 Bupa
Indications of Crowns include:
• Fractured/cracked tooth
• Endodontic Tx
• Broken restoration
• Active caries
• Large restoration
• Change vertical dimension
• RPD abutment
• Aesthetics
• Fractured/cracked tooth
• Endodontic Tx
• Broken restoration
• Active caries
• Large restoration
• Change vertical dimension
• RPD abutment
• Aesthetics
Warranty on permanent indirect fixed:
• No warranty on temporary fixed items
• 12 mo warranty on technical faults (covered by dental lab), and 2 years on clinical errors
• Covered tehcnical faults include Incorrect shade (taken by lab), Chipping of porcelain
• Not covered faults include Inadequate occlusal adjustment resulting in breakage; Shade incorrect although Pt confirmed shade during try in
• Warranty conditions include 6 mo recalls over at least 2 years (starting from date of insert), if recall is missed by 1 week for any reason, warranty expires immediately
• Pt must maintain high standard of OH and a caries risk of <20% at each recall
Warranty exclusions include:
• Pt Dx w/ bruxism
• Pt's w/ oral habits e.g. wire striping, chewing or biting on ice cubes or other hand items
• Pt w/ molar guidance
• Pt w/ unprotected anterior guidance
• Pt w/ TMD and not being Tx w/ a splint
• Pt w/ TMD and not wearing their splint
• External trauma or forces to fixed or removable denture
• Pt w/ untreated periodontitis
• Pt's w/ active caries and uncompleted operative Tx, and/or RCT and/or oral surgery Tx
• Pt's not following POI after insert of fixed, removable or hybrid denture
• Biological faults including Unanticipated complications from RCT under crown
• Change in shade of abutment teeth resulting in change in perceived color of crown
• No warranty on temporary fixed items
• 12 mo warranty on technical faults (covered by dental lab), and 2 years on clinical errors
• Covered tehcnical faults include Incorrect shade (taken by lab), Chipping of porcelain
• Not covered faults include Inadequate occlusal adjustment resulting in breakage; Shade incorrect although Pt confirmed shade during try in
• Warranty conditions include 6 mo recalls over at least 2 years (starting from date of insert), if recall is missed by 1 week for any reason, warranty expires immediately
• Pt must maintain high standard of OH and a caries risk of <20% at each recall
Warranty exclusions include:
• Pt Dx w/ bruxism
• Pt's w/ oral habits e.g. wire striping, chewing or biting on ice cubes or other hand items
• Pt w/ molar guidance
• Pt w/ unprotected anterior guidance
• Pt w/ TMD and not being Tx w/ a splint
• Pt w/ TMD and not wearing their splint
• External trauma or forces to fixed or removable denture
• Pt w/ untreated periodontitis
• Pt's w/ active caries and uncompleted operative Tx, and/or RCT and/or oral surgery Tx
• Pt's not following POI after insert of fixed, removable or hybrid denture
• Biological faults including Unanticipated complications from RCT under crown
• Change in shade of abutment teeth resulting in change in perceived color of crown
Risks of Crowns include:
• Discomfort and sensitivity
• Chiped crown
• Loose crown
• Crown falls off
• Allergic reaction
• Exposed crown margin
• Preformed tooth-colored crown involves Placing a preformed tooth-colored crown as a coronal restoration for a tooth. This includes ?composite strip crown
• Discomfort and sensitivity
• Chiped crown
• Loose crown
• Crown falls off
• Allergic reaction
• Exposed crown margin
Crown - tooth-colored - preformed [588]
$300 Bupa
Repair of crown or bridge - indirect - per crown or pontic [658]
$195 Bupa
Core - preliminary restoration for crown - direct [627]
$165 Bupa
Repair of crown, bridge or veneer - direct - per crown, pontic or veneer [659]
$143 Bupa
Recementing crown or veneer [651🆓]
$118 Bupa, post warranty period
Full crown - polymeric material - indirect [611]
$660 Bupa
Provisional crown - per tooth [631]
$150 Bupa
Removal of cemented root canal post or post crown [452]
$130 Bupa
Removal of crown [655]
$80 Bupa, post warranty period
• E-Max crowns are more translucent than Zirconia crowns, allowing more light to pass through, which makes the look as natural as possible, and ideal for front teeth as they are naturally less opaque
• Whereas all porcelain or PFM crowns last 5-15 years, metal crowns for 20+ years, gold and zirconia crowns can last a lifetime
Crown Gold
• Gold crowns are rarer due to increased demands for more aesthetic materials
• Preformed metallic crown w/ tooth preparation involves Placing a preformed metallic crown as a coronal restoration of a tooth. Where the restoration of the tooth at the same visit is required prior to the placement of the crown, use of #627 is applicable
$170 Bupa (w/ significant tooth preparation)
• Preformed metallic crown w/ tooth preparation involves Placing a preformed metallic crown as a coronal restoration of a tooth. Where the restoration of the tooth at the same visit is required prior to the placement of the crown, use of #627 is applicable
Crown - metallic - preformed [586, 587]
$170 Bupa (w/ significant tooth preparation)
88586 $263.80 CDBS
$150 Bupa (minimal tooth preparation)
88587 $156.50 CDBS
Fixed bridge Pontic and Bridge Abutment/Retainer
• A dental bridge is a false tooth (called a pontic), held in place by the abutment teeth on either side of the gap
• Direct bridge pontic is The direct attachment of a replacement tooth to the adjoining abutment tooth/teeth. The pontic and attachment may utilize reinforcing materials. Attaching restorations, or retainers should be appropriately itemized. The pontic will need to be attached to 2 crowns on either side, on the abutment teeth
$935 Bupa (Indirect)
Direct - $200 Bupa
• Indirect bridge pontic is The indirect provisin of an artificial replacement tooth joined to a retainer(s) on an abutment tooth or osseointegrated implant
• Conventional bridges involve numerous porcelain teeth joined together to bridge a gap caused by a missing tooth or teeth
• Tooth shaped crowns are made in the lab to cover a tooth or teeth either side of a gap
• Bridges can be PFM (porcelain fused to metal) or all-ceramic
• Hybrid implant bridge are bridges supported by 4-6 implants
• Recementing bridge or splint involves Recementing a previously cemented bridge or splint
• Rebonding of bridge or splint involves rebonding of an enamel bonded bridge or splint that requires retreatment of the fitting surface
• Provisional bridge pontic involves Placement of a fixed provisional bridge pontic supported by teeth or implants designed to last until the definitive bridge can be constructed and inserted. Provisional restoration of abutments are itemized seprately as #631. Provisional implant abutments are itemized separately as #633. Item should be used only where a provisional bridge is not an intrinsic part of the Tx being provided. It should not be used for a provisional bridge between appointments during bridge construction
• Removal of bridge or splint involves The removal of all, or part, of a currently cemented definitive bridge or splint that may subsequently be reinserted
• Direct bridge pontic is The direct attachment of a replacement tooth to the adjoining abutment tooth/teeth. The pontic and attachment may utilize reinforcing materials. Attaching restorations, or retainers should be appropriately itemized. The pontic will need to be attached to 2 crowns on either side, on the abutment teeth
Types of bridges:
• Traditional bridges, where the bridge has a pontic in the middle, and crown on both sides. It doesn't prevent jawbone degeneration. The adjacent teeth become permanently damaged due to the need for crowning
• Cantilever bridges, where the missing teeth are at the end of the jaw and there is only 1 adjacent teeth. These are rarely used because they are known to cause damage to the rest tooth
• Maryland bonded bridge, where there is a middle false tooth, and on both sides of the tooth there is a wing-like structure hwich is fixed to the back of adjacent teeth. These however are not suitable in areas where the biting pressure is high like molars
• Implant-supported bridge, used when there is more than 1 missing tooth. The bridge is not supported by crown or wings but w/ the help of implants. It is more expensive, but it's the only process which helps in regenerating jawbone
• Traditional bridges, where the bridge has a pontic in the middle, and crown on both sides. It doesn't prevent jawbone degeneration. The adjacent teeth become permanently damaged due to the need for crowning
• Cantilever bridges, where the missing teeth are at the end of the jaw and there is only 1 adjacent teeth. These are rarely used because they are known to cause damage to the rest tooth
• Maryland bonded bridge, where there is a middle false tooth, and on both sides of the tooth there is a wing-like structure hwich is fixed to the back of adjacent teeth. These however are not suitable in areas where the biting pressure is high like molars
• Implant-supported bridge, used when there is more than 1 missing tooth. The bridge is not supported by crown or wings but w/ the help of implants. It is more expensive, but it's the only process which helps in regenerating jawbone
Bridge pontic - Per pontic [642📝, 643📝🛡]
$935 Bupa (Indirect)
$350 Bupa (Direct)
Semi-fixed attachment [644]
$250 Bupa
Precision or magnetic attachment [645]
$250 Bupa
Bonded retainer - per tooth [648, 649]
Direct - $200 Bupa
Indirect, e.g. Resin bonded bridge, Retainer for bonded fixture - $260 Bupa
• Conventional bridges involve numerous porcelain teeth joined together to bridge a gap caused by a missing tooth or teeth
• Tooth shaped crowns are made in the lab to cover a tooth or teeth either side of a gap
• Bridges can be PFM (porcelain fused to metal) or all-ceramic
• Hybrid implant bridge are bridges supported by 4-6 implants
• Recementing bridge or splint involves Recementing a previously cemented bridge or splint
Recementing bridge or splint - per abutment [652🆓]
$122 Bupa, post warranty period
Provisional implant abutment - per abutment [633]
$170 Bupa
Provisional implant restoration - per implant abutment [633]
$160 Bupa
Rebonding res-bonded bridge or splint where retreatment of bridge surface is required [653]
$140 Bupa, post warranty period
Provisional bridge pontic - per pontic [632]
$140 Bupa
Removal of bridge or splint [656]
$100 Bupa, post warranty period
Bridge Maryland Wing
• Maryland bridge is similar to a conventional bridge, in that a prosthetic tooth is attached to teeth on either side to replace teeth, the wings on either side are bonded to the back of adjacent teeth, eliminating the need to drill away any of the adjacent tooth's natural enamel
• The wings are attached using composite resin
• The wings are attached using composite resin
Implant Crown
• Dental implants are used to replace a missing tooth, but unlike dentures which are false teeth you can easily remove, implants are titanium screws that replace a single tooth
• Custom abutments are abutments accurately milled to fit the crest of their tissue capturing positon of implant and shape of surrounding tum tissue, and so recommended for use in the aesthetic zone
• 1-stage endosseous implant is a type of endosteal implant meant to mimic natural root of a tooth by using a vertical column of bone to anchor the dental implant hardware
• In private practice the cost is $1.5k for insertion surgery, and $3k for pros crown placement (inc lab costs), for a total of $4.5k
Fixed - $1,800 Bupa
Non-metallic - $1,580 Bupa
• Diagnostic template incorporate radiopaque markers as reference marks for preferred implant placement whre template is not used a surgical guide
Insertion of the 1st stage of 2-stage maxillofacial endosseous implant - per implant [685]
$2,000 Bupa
• 1-stage endosseous implant is a type of endosteal implant meant to mimic natural root of a tooth by using a vertical column of bone to anchor the dental implant hardware
Insertion of 1 Stage Endosseous Implant - per implant [688]
$1,560 Bupa
Indications of an implant include:
• Partial edentulous Pt's who have intermediate gaps or free-end edentulism (Kennedy class 1)
• When a Pt is not satisfied w/ the existing unstable and nonretentive conventional complete dental prosthesis
• To preserve existing RPD's
• Partial edentulous Pt's who have intermediate gaps or free-end edentulism (Kennedy class 1)
• When a Pt is not satisfied w/ the existing unstable and nonretentive conventional complete dental prosthesis
• To preserve existing RPD's
Risks of an implant include:
• Infection at implant site
• Injury or damage to surrounding structures, like other teeth, blood vessels
• Nerve damage, which can cause pain, numbness, tingling in oral or facial structures
• Sinus problems, when implants in the upper jaw protrude into the sinus
• 2-stage implant is where you have 2 surgeries which allows for a higher success rate• Infection at implant site
• Injury or damage to surrounding structures, like other teeth, blood vessels
• Nerve damage, which can cause pain, numbness, tingling in oral or facial structures
• Sinus problems, when implants in the upper jaw protrude into the sinus
• In private practice the cost is $1.5k for insertion surgery, and $3k for pros crown placement (inc lab costs), for a total of $4.5k
Insertion of 1st Stage of 2 stage endosseous implant - per implant [684]
$1,560 Bupa
2nd stage surgery of 2-stage endosseous implant - per implant [691]
$320 Bupa
Insertion of a 1-stage maxillofacial endosseous implant - per implant [686]
$2,000 Bupa
Prosthesis with metal frame attached to implants - fixed - per arch [666, 667]
Fixed - $1,800 Bupa
Removable - $1,750 Bupa
Prosthesis with resin base attacheed to implants - removable - per arch [665]
$1,650 Bupa
Full crown attached to osseointegrated implant - indirect [671, 672, 673]
Non-metallic - $1,580 Bupa
Veneered - $1,580 Bupa
Metallic - $1,580 Bupa
Maxillary sinus augmentation - Lateral wall approach - per sinus [247]
$800 Bupa
Fitting of implant abutment - per abutment [661]
$730 Bupa
Insertion of a mini-implant - per implant [687]
$625 Bupa
Surgical implant guide [679]
$350 Bupa
Maxillary sinus augmentation - Trans-alveolar technique - per sinus [246]
$270 Bupa
Repair or replacement of the ceramic component of an implant metal-ceramic or all ceramic crown or bridge - per prosthetic tooth [694]
$195 Bupa
Closure of the screw access chamber [692]
$123 Bupa
Implant prosthetic screw replacement [668]
$115 Bupa
Cleaning and polishing of an implant prosthesis [695]
$65 Bupa
Remodelling of a fixed implant prosthesis [693]
$398 Bupa
Diagnostic template [678]
$310 Bupa
Removal of impalnt and/or retention device [663]
$265 Bupa
Fitting of bar for denture - per tooth or implant [664]
$250 Bupa
Surgery involving the maxillary antrum [393]
$210 Bupa
Removal and reattachemnt of prosthesis fixed to implant(s) - per implant [669]
$197 Bupa
Removal of fractured abutment screw [696]
$150 Bupa
4 Endodontics
Pulp testing
• Pulp testing is a non-invasive test to determine clinical status of the pulp, including application of external stimulation to pulp to determine its response. Other teeth generally tested for comparison
Pulp testing - per appointment [061🆓]
$26.50 Bupa
Occlusal adjustment
• Minor occlusal/bite adjustment is procedure performed to remove tiny interferences that keep teeth from coming together properly
Minor occlusal adjustment - per visit [961🆓]
$33 Bupa
Clinical occlusal analysis, including muscle and joint palpation [963]
$61 Bupa
Pulp capping
• Direct pulp capping is where Protective dressing is placed directly over an exposed pulp
$32 Bupa
Direct pulp capping [411🆓]
$32 Bupa
88411 $35.75 CDBS
Indications of pulp capping include:
• Small (<1mm^2) pulpal exposure has occured due to trauma or mechanical exposure during caries removal
• Nil pain prior to Tx
• Should be possible to stop bleeding from the exposure
• Tooth should be restorable w/ immediate well sealed restoration
• Nil periradicular pathology
• Small (<1mm^2) pulpal exposure has occured due to trauma or mechanical exposure during caries removal
• Nil pain prior to Tx
• Should be possible to stop bleeding from the exposure
• Tooth should be restorable w/ immediate well sealed restoration
• Nil periradicular pathology
Root Canal Treatment (RCT)
• Post and root cap involves Post and capping fitted to the root of a tooth. The post provides an anchor in the root canal of the tooth and the capping may provide support for an overdenture. It may incorporate a precision or magnetic attachment that should be itemized separately
• Indirect post and core for crown involves Post and core fabricated accurately to the dimension of the prepared root canal(s) and the desired coronal anatomy to provide an anchor foundation for an artificial crown
• RCT involves drilling a hole into a decayed toth and removing the soft center known as the dental pulp where the root nerves are, and replacing this with a filling
• The purpose is to eliminate infection and protect the decontaminated tooth from future microbial invasion
• Obturation of the canal involves effectively blocking the inside of the tooth, from the rest of the body
$254 (1st canal)
• CMP (chemo-mech prep) involves removal of pulp or necrotic debris from a canal
$237 Bupa (1st canal)
$170.50 Bupa
• Immediate sealing of perforation by biologically proven materials involve MTA or bioceramic material, offers the best surface for osseous repair
• Extirpation/pulpectomy of pulp or debridement of root canal involves removing the pulp from inside the tooth as part of an RCT procedure. This is an emergency or palliative procedure distinct from scheduled endodontic Tx visits. Temporization other than closure of access cavity should be itemized separately
$158 Bupa
• Direct post involves insertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration
$152 Bupa
• Incomplete endo therapy is where Decay is removed and there is not enough tooth to hold a proper filling for the long term, so a decision is made that the tooth is not suitable for restoration. Temporization is itemized separately
$142 Bupa
• Additional visit for irrigation involves Additional debridement irrigation and short-term dressing required where evidence of infection or inflammation persists following prior opening of the root canal and removal of its contents
$109 Bupa
• Exploration/negotiation of calcified canal is where a Calcified tooth means a tooth's normal dental pulp chamber is compromised due to a reduction in size or obliterated due to trauma, disease, decay or age
• Apical seal is surgical method of debriding and filling the apical end of the root canal of a tooth, w/ the procedure possibly including apicectomy and PA curettage
• Apicectomy involves Removal of the tip of the root of the tooth, known as the apex, performed if infection or cysts persist after RCT or if dentist is unable to seal the root tip w/ a normal root filling
• Removal of root filling involves that from a previously obturated canal to enable endodontic retreatment
• Removal or bypass of fractured endo instrument is where A wide range of instruments have been reported to # w/in the root canal system
Post and root cap - Indirect [629]
$362 Bupa
Post and core for crown - Indirect [625📝]
$340 Bupa
• The purpose is to eliminate infection and protect the decontaminated tooth from future microbial invasion
• Obturation of the canal involves effectively blocking the inside of the tooth, from the rest of the body
Root canal obturation [417🛣, 418🛣]
$254 (1st canal)
88417 $214.05 CDBS
$95 (per additional canal)
88418 $100.10 CDBS
Complete chemo-mechanical preparation [415🆓, 416🆓]
$237 Bupa (1st canal)
88415 $219.75 CDBS
$95 Bupa (per additional canal)
88416 $104.70 CDBS
Indications of a root canal treatment include:
• Severe toothache pain on chewing or application of pressure
• Prolonged sensitivity to hot or cold, after temperature has been removed
• Darkening of the tooth
• Swelling and tenderness in nearby gums
• Persistent or recurring pimple on the gums, called an abscess
• Chipped or cracked tooth
• Tooth mobility
• Severe toothache pain on chewing or application of pressure
• Prolonged sensitivity to hot or cold, after temperature has been removed
• Darkening of the tooth
• Swelling and tenderness in nearby gums
• Persistent or recurring pimple on the gums, called an abscess
• Chipped or cracked tooth
• Tooth mobility
Risks of a root canal treatment include:
• The fine metal files that clean the canal can break and remain in the tooth, so the tooth may need to be removed
• There is a risk of creating a hole in the side of the tooth during the cleaning process, or the tooth otherwise #, requiring exo
• Severe or persistent, sensitivity or pain
• Infection
• Treatment doesn't work requiring further treatment or extraction
• Resorbable root canal filling involves Placement of resorbable root canal filling material in a primary tooth
• The fine metal files that clean the canal can break and remain in the tooth, so the tooth may need to be removed
• There is a risk of creating a hole in the side of the tooth during the cleaning process, or the tooth otherwise #, requiring exo
• Severe or persistent, sensitivity or pain
• Infection
• Treatment doesn't work requiring further treatment or extraction
Resorbable root canal filling - primary tooth [421]
$170.50 Bupa
88421 $122.50 CDBS
Sealing of perforation [436]
$160 Bupa
Extirpation of pulp or debridement of root canal [419🛣]
$158 Bupa
88419 $141.50 CDBS
Post - direct [597]
$152 Bupa
88597 $90.45 CDBS
Incomplete endodontic therapy (tooth unsuitable for further Tx) [412]
$142 Bupa
88412 $122.50 CDBS
Additional visit for irrigation and/or dressing [455🛣]
$109 Bupa
88455 $108.45 CDBS
Interim therapeutic root filling - per tooth [88458]
88458 $144.65 CDBS
Exploration and/or negotiation of calcified canal - per canal and appointment [445]
$95 Bupa
• Apical seal is surgical method of debriding and filling the apical end of the root canal of a tooth, w/ the procedure possibly including apicectomy and PA curettage
Apical Seal - Per Canal [434]
$248 Bupa
Apicectomy - Per Root [432]
$222 Bupa
Hemisection [438]
$178.50 Bupa
Surgical treatment and repair of external root resorption - per tooth [437]
$160 Bupa
Restoration root capping - direct [598]
$132.50 Bupa
Obturation of resorption defect or perforation (non-surgical) [457]
$110 Bupa
Removal of root filling - per canal [451🛣]
$90 Bupa
• Removal or bypass of fractured endo instrument is where A wide range of instruments have been reported to # w/in the root canal system
Removal or bypassing fractured endo instrument [453]
$130 Bupa
Pulpotomy
• Pulpotomy is dental procedure where pulp of tooth is the crown is removed and the pulp in the root canal is left intact, mainly performed on children and is used to Tx decay that has extended to the pulp
$90 Bupa
Pulpotomy [414🆓]
$90 Bupa
88414 $78.05 CDBS
Indications of a pulpotomy include:
• Vital tooth
• Healthy periodontium
• Only coronal involvment
• Extraction contraindicated
• Absence of infection/abscess, fistula, spontaneous pain, involvement of pulp floor, and inter-radicular bone loss
• Vital tooth
• Healthy periodontium
• Only coronal involvment
• Extraction contraindicated
• Absence of infection/abscess, fistula, spontaneous pain, involvement of pulp floor, and inter-radicular bone loss
3 Oral Surgery
Drainage
• For drainage of abscess or cyst, Cyst is a sac enclosed by distinct abnormal cells; an abscess is pus-filled infection
$75 Bupa
Drainage of abscess (or cyst) [392]
$75 Bupa
88392 $99.40 CDBS
Tooth extraction/exo 👋🦷
• Tooth extraction is the removal of a tooth from its socket in the bone
• Surgical removal of a tooth or fragment is where an incision and the raising of a mucoperiosteal flap are required, but where removal of bone or sectioning of the tooth is not necessary to remove the tooth
$309 Bupa (w/ bone and tooth)
• Sectional removal of a tooth or part(s) thereof, involves The removal of a tooth or part(s) thereof in sections; Bone removal may be necessary
$170 Bupa
• Periapical curettage involves Removal of tooth fragments, pieces of dead bone, or debris from a tooth socket by using a curette
• Removal of a tooth or part(s) thereof is A procedure consisting of the removal of a tooth or part(s) thereof
$137 Bupa
• Exploratory periradicular surgery involves Exploratory curettage to look for root fractures
• Control of post-op hemorrhage involves Control of reactionary or secondary post-operative hemorrhage
• Surgical removal of a tooth or fragment is where an incision and the raising of a mucoperiosteal flap are required, but where removal of bone or sectioning of the tooth is not necessary to remove the tooth
Surgical removal of tooth/fragment [324🆓, 322🆓]
$309 Bupa (w/ bone and tooth)
88324 $335.90 CDBS
$222 Bupa (no bone)
88322 $218.65 CDBS
Surgical removal of a tooth or tooth fragment requiring removal of bone - 1st tooth extracted on a day [88323]
88323 $249.70 CDBS
Additional extraction requiring surgical removal of a tooth or tooth fragment [88326]
88326 $178.90 CDBS
Sectional removal of a tooth or part(s) thereof [314🆓]
$170 Bupa
88314 $172.20 CDBS
Additional extraction requiring removal of a tooth or part(s) thereof, or sectional removal of a tooth [88316]
88316 $84.95 CDBS
Periapical Curettage - Per Root [431]
$165 Bupa
Removal of a tooth or part(s) thereof [311🆓]
$137 Bupa
88311 $134.75 CDBS
Indications of an extraction include:
• Caries reaching far under the gingiva or into the root
• Severe loosening due to periodontitis
• Orthodontic lack of space
• Longitudinal dental #
• Root canal preparation involved root wall being drilled through accidentally
• Relocated or excess teeth
• Severe tipping of teeth
• Retained deciduous teeth
• Teeth in the line of a # of the mandible or maxilla
• Caries reaching far under the gingiva or into the root
• Severe loosening due to periodontitis
• Orthodontic lack of space
• Longitudinal dental #
• Root canal preparation involved root wall being drilled through accidentally
• Relocated or excess teeth
• Severe tipping of teeth
• Retained deciduous teeth
• Teeth in the line of a # of the mandible or maxilla
Risks of an extraction include:
• Tooth abscess
• Misalignment of teeth
• Dry socket
• Nerve damage
• Jaw fracture
• Need for surgical extraction
• Excessive bleeding
• Sinus communication
• Tooth abscess
• Misalignment of teeth
• Dry socket
• Nerve damage
• Jaw fracture
• Need for surgical extraction
• Excessive bleeding
• Sinus communication
Post-operative care not otherwise included [986🆓]
$50 Bupa
• Exploratory periradicular surgery involves Exploratory curettage to look for root fractures
Exploratory Periradicular Surgery [433]
$165 Bupa
Surgical removal of foreign body [378]
$160 Bupa
Control of reactionary or 2o post-operative hemorrhage [399]
$35 Bupa
Removal of tumor, cyst, scar
Surgery to salivary gland [376]
$230 Bupa
Removal of tumor/cyst/scar - involving muscle, bone or other deep tissue [373]
$215 Bupa
Surgery to salivary duct [375]
$198 Bupa
Removal of tumor/cyst/scar - cutaneous, subcutaneous or in mucous membrane [371]
$153 Bupa
Marsupialisation of cyst [379]
$150 Bupa
Fibrous tuberosity reduction
• Fibrous tuberosity reduction involves reducing excessive soft tissue from the maxillary tuberosities
Reduction of Fibrous Tuberosity [337]
$165 Bupa
Recontour tissue - per appointment [987]
$55 Bupa
Hyperplastic tissue removal
• Repair of skin and subcut tissue or mucous membrane involves Surgical cleaning and repair of facial sin wound in the region of the mouth or jaws, or prepiar of oral mucous membrane, where the wounds involve the subcut tissues
$181 Bupa
• Hyperplastic lesions occur on gingival CT which develops as a result of chronic irritation
• Removal or repair of soft tissue (not elsewhere defined) is General item to describes urgical procedures for removal or repair of soft tissues not necessarily following trauma, which cannot be described by another item. Details of the procedure should be specified
Repair of skin and subcutaneous tissue or mucous membrane [351]
$181 Bupa
88351 $164.15 CDBS
Removal of hyperplastic tissue [341]
$165 Bupa
Repair of soft tissue [377]
$90 Bupa
Removal of muscle attachment [343]
$273 Bupa
Vestibuloplasty
• Vestibuloplasty is pre-prosthetic surgery, often performed before placement of dental appliance like dentures, designed to deepen the vestibule of your mouth, the area between your cheeks and teeth
Vestibuloplasty [344]
$561 Bupa
Skin or mucosal graft [345]
$561 Bupa
Frenectomy
• Frenectomy is Removal of the frenum from the mouth, a small muscular attachment that connects 2 pieces of oral tissue
Surgical intervention of a frenum - Frenectomy [391🆓]
$225 Bupa
Alveolectomy
• Alveolectomy aims to remove some or all of the alveolar bone that surrounds a tooth and change the shape and surface of the jawbone to prepare it for subsequent procedures
Alveolectomy - per segment [331]
$245 Bupa
Ostectomy - per jaw [332]
$245 Bupa
Mandible - relocation following dislocation [361]
$100 Bupa
Flabby ridge reduction
• Reduction of Flabby ridge (aka displaceable ridge), which is mobile soft tissue present on the superficial aspect of the alveolar ridge
Reduction of flabby ridge - per segment [338]
$165 Bupa
Palliative care
• Palliative care is interim care to relieve pain, infection, bleeding or other problems not associated w/ other Tx
$62 Bupa
Palliative care - per appointment [911🆓]
$62 Bupa
88911 $70.15 CDBS
2 Periodontics
Clinical periodontal analysis
• For Clinical periodontal analysis and record, involves Detailed exam performed to assess and Mx periodontal disease, by recording a Pt's periodontal condition
$37 Bupa
Clinical periodontal analysis and record [221🆓]
$37 Bupa
88221 $54.35 CDBS
Non-surgical periodontal therapy 🦷
• NSPT involves Scaling and root planing followed by oral therapy as required
• Supportive periodontal therapy (SPT) is a broader term and focuses on Pt's previously Tx for periodontal disease. This include sprocedures described in items 111, 114, 115 and 222. Items e.g. 113 (Recontouring and polishing of pre-existing restorations), 131 (Dietary analysis and advice) and 142 (Tobacco counselling) may be itemized separately
• Tx acute perio infection is where Acute situation w/ an infection involves swelling and even pus. It may include establishing drainage and removal of calculus from the affected tooth/teeth or implant
$88 Bupa
• For Root planing and subgingival curettage, Root planing involves removal of dental plaque and calculus, and then smoothing or planing the exposed surfaces of the roots, removing cementum or dentin impregnated w/ calculus
• For periodontal debridement, involves Thorough mechanical removal of biofilm and calculus from periodontally diseased root surfaces
Active non-surgical periodontal therapy - per quadrant [250]
$280 Bupa
Supportive periodontal therapy - per appointment [251]
$165 Bupa
Treatment of acute periodontal infection - per visit [213🆓]
$88 Bupa
88213 $71.50 CDBS
Periodontal Debridement - per tooth [222🆓]
$61.50 Bupa
Non-surgical treatment of peri-implant disease - per implant [223🆓]
$44 Bupa
• For periodontal debridement, involves Thorough mechanical removal of biofilm and calculus from periodontally diseased root surfaces
Guided tissue regeneration (GTR)
• GTR is surgical technqiue in whch membrane is adapted over bony defect, tooth root or implant
Guided tissue regeneration - per tooth or implant (size 13x25) [236🆓]
$575.50 Bupa
Guided tissue regeneration - membrane removal [237]
$255 Bupa
Root resection
Osseous surgery - per tooth or implant [242]
$455 Bupa
Root resection - per root [241🆓]
$220 Bupa
Osseous graft
Osseous graft - per tooth or implant (0.25g) [243🆓]
$606.50 Bupa
Osseous graft - block [244🆓]
$800 Bupa
Crown lengthening 🦷
Transplantation of tooth or tooth bud [388]
$391 Bupa
Surgical exposure of unerupted tooth - per tooth [381]
$225 Bupa
Surgical exposure and attachment of device for orthodontic traction [382]
$225 Bupa
Periodontal flap surgery for crown lengthening - per tooth [238]
$210 Bupa
Replantation and splinting of a tooth - per avulsed or intentionally removed tooth [387]
$165 Bupa
88387 $395.65 CDBS
Splinting of displaced tooth/teeth - per displaced tooth [386]
$160 Bupa
88386 $202.05 CDBS
Periodontal surgery involving 1 tooth [245]
$150 Bupa
Repositioning of displaced tooth/teeth - per tooth [384]
$110 Bupa
88384 $195.85 CDBS
Surgical repositioning of unerupted tooth - per tooth [385]
$300 Bupa
Gingivectomy
• Gingivectomy involves cutting away part of the gingiva, the oldest surgical approach in periodontal therapy and is usually done for improvement of aesthetics or prognosis of teeth. This procedure includes peridontal debridement of the tooth
Gingivectomy - per tooth [231]
$146 Bupa
Periodontal flap surgery
• Periodontal flap surgery involves shifting the gum to allow a good view of and direct access to the surface to be smoothed down. The procedure includes periodontal debridement of the tooth
Periodontal flap surgery - per tooth [232]
$256.50 Bupa
Surgical Treatment of peri-implant disease - per implant [233]
$250 Bupa
Gingival graft - per tooth, implant or extraction socket [235]
$682.50 Bupa
Gingival xenograft, per tooth [239]
$400 Bupa
8 Orthodontics
Aligners/Invisalign
• Sequential plastic aligners or Invisalign Tx involves sequential set of clear aligner trays, w/ each set moving the teeth closer to their desired position. For retention appliances, see items 811 and 845
• Bonding of attachment should not be used to describe bracket attachment req by partial or full arch banding
• Removal of enamel from interdental surfaces of teeth to reduce width
Indications of Clear aligners include:
• Mild crowded and malaligned problems, 1-5mm
• Spacing problems, 1-5mm
• Deep overbite, Class 2 div 2 cases
• Narrow arches that can be expanded w/o tipping the teeth too much
• Absolute intrusion, of 1-2 teeth
• Lower incisor exo for severe crowding cases
• Tip molar distally
• Mild crowded and malaligned problems, 1-5mm
• Spacing problems, 1-5mm
• Deep overbite, Class 2 div 2 cases
• Narrow arches that can be expanded w/o tipping the teeth too much
• Absolute intrusion, of 1-2 teeth
• Lower incisor exo for severe crowding cases
• Tip molar distally
Sequential plastic aligners - per arch (vacuum formed appliance) [825❌]
(As negotiated with member, e.g. $123.50)
Bonding of attachment for application of orthodontic force [862]
$181 Bupa
Enamel stripping - per appointment [982]
$45 Bupa
Retainers
• Retainers are designed to help teeth retain their new position after previous braces/aligners moved them, because teeth move thorughout life, so that teeth won't move again
• Passive removable appliance is Device attached to teeth but can be removed by metal clasp or by other means, to maintain the position of teeth
• Passive fixed appliance is Passive device bonded to 1 or more teeth, and used to prevent movement of teeth in relation to each other
• Bonded retainer is fixed/bonded to teeth and is not removable, it is fixed to inside of teeth so completely discrete; your teeth will stay in their new positions and will not be able to move back to where they were before. In the case of a bonded bridge, the number of pontics should be itemized separately
• Passive removable appliance is Device attached to teeth but can be removed by metal clasp or by other means, to maintain the position of teeth
Passive removable appliance - per arch [811]
$243 Bupa
• Passive fixed appliance is Passive device bonded to 1 or more teeth, and used to prevent movement of teeth in relation to each other
• Bonded retainer is fixed/bonded to teeth and is not removable, it is fixed to inside of teeth so completely discrete; your teeth will stay in their new positions and will not be able to move back to where they were before. In the case of a bonded bridge, the number of pontics should be itemized separately
Fixed appliances
Course of orthodontic treatment [881]
(As negotiated with member)
Course of orthodontic treatment with orthognathic surgery [882]
(As negotiated with member)
Full arch banding - per arch [831❌]
(As negotiated with member, e.g. $1,909.30)
Partial banding - per arch [829❌]
$660 Bupa
Fixed palatal or lingual arch appliance [841❌]
$430 Bupa
Orthodontic adjustment [871]
$150 Bupa
Passive appliance - fixed [872❌, 873❌, 874❌]
$106 Bupa (Re-attachment of)
$140 Bupa (Repair of)
$70 Bupa (Removal of)
Removal of banding - per arch [833❌]
$90 Bupa
Partial banding for inter-maxillary elastics (vertical and/or cross elastics) [842]
$515 Bupa
Relining - removable appliance - processed [878]
$250 Bupa
Repair of removable appliance [875]
$155 Bupa (Resin base)
$155 Bupa (Clasp, spring or tooth)
Addition to removable appliance - clasp, spring or tooth [877]
$155 Bupa
Metal band [574❌]
$90 Bupa
88574 $42.15 CDBS
Expansion appliances
• Expansion appliances are used to correct upper jaws that are too narrow, and so the cause of problems like teth crowding and bite misalignment
• It works by appliyng pressure to the soft cartilage in the jaw which gradually widens the palate
• For functional orthopedic appliance, Twin block is made up of 2 removable plates that clip onto the upper and lower teeth, to correct Class 2 malocclusions; Bionators are removable appliances designed to correct overbites by promoting lower jaw growth
• URA/LRA w/ 3 way expander, is an Upper and lower removable appliance, where the 3-way expander features 3 independently expanding sections in 1 housing, for transverse as well as sagittal anterior development
• Mandibular space maintainer helps to "hold space" for permanent teeth
• Mandibular space maintainer (Band and loop) is Used in majority of Pt's requiring single tooth space maintenance; preserves proximal dimensions, but is nonfunctional
• For prefabricated myofunctional orthopedic appliance, it can be used out of a packet and fit into a Pt w/o taking an impression, used to correct malocclusion by addressing soft tissue problems
• Maxillary expansion appliance is an Orthodontic technique used to widen your upper jaw when it is too narrow
• It works by appliyng pressure to the soft cartilage in the jaw which gradually widens the palate
• For functional orthopedic appliance, Twin block is made up of 2 removable plates that clip onto the upper and lower teeth, to correct Class 2 malocclusions; Bionators are removable appliances designed to correct overbites by promoting lower jaw growth
Functional orthopedic appliance - custom fabrication (e.g. Twin block, Bionator) [823]
$1,550 Bupa
Expansion appliance - fixed - per arch (esp Maxillary) [843]
$950 Bupa
Active removable appliance - per arch [821✅ e.g. URA/LRA]
$750 Bupa (e.g. 2 or 3 way expander, +/- additional components)
• Mandibular space maintainer (Band and loop) is Used in majority of Pt's requiring single tooth space maintenance; preserves proximal dimensions, but is nonfunctional
Types of Space maintainers include:
• Nance appliance, used for loss of multiple primary teeth bilaterally, used only in the upper arch
• Lower lingual holding arch, used for loss of multiple primary teeth bilaterally, used only in lower arch. Should not be used w/ primary dentition
• Band and loop, used for loss of single primary tooth unilaterally, or multiple tooth loss (requires 2 band and loop appliances). Used in both lower and upper arches
• Distal shoe, used for loss of primary 2nd molars prior to eruption of permanent D's (unilateral). Used in both upper and lower arches
• URA/LRA single spring, is where Force is applied by a removable appliance is mediated by a spring, which can only make point contact w/ the tooth• Nance appliance, used for loss of multiple primary teeth bilaterally, used only in the upper arch
• Lower lingual holding arch, used for loss of multiple primary teeth bilaterally, used only in lower arch. Should not be used w/ primary dentition
• Band and loop, used for loss of single primary tooth unilaterally, or multiple tooth loss (requires 2 band and loop appliances). Used in both lower and upper arches
• Distal shoe, used for loss of primary 2nd molars prior to eruption of permanent D's (unilateral). Used in both upper and lower arches
Functional orthopedic appliance - prefabricated [824]
$400 Bupa
• For prefabricated myofunctional orthopedic appliance, it can be used out of a packet and fit into a Pt w/o taking an impression, used to correct malocclusion by addressing soft tissue problems
• Maxillary expansion appliance is an Orthodontic technique used to widen your upper jaw when it is too narrow
Sagittal movement appliance [844]
$900 Bupa
Snoring appliances
• Snoring or sleep apnea mouth guard work like an orthodontic retainer, supporting the jaw in a forward position to help maintain an open upper airway
Mandibular advancement appliance for diagnosed snoring and obstructive sleep apnea [984]
$1,360 Bupa - though This item is not payable via HICAPS or HealthPoint - account should be issued to member to submit to Bupa. Benefit only payable w/ referral letter from customer's Respiratory Physician or Specialist Physician confirming a hospital study has been undertaken and an Oral Sleep Apnea Device is required; or w/ copy of sleep study confirming customer's need for the device
Repair/addition - snoring or sleep apnea device [985]
$155 Bupa
Thumb sucking appliance
Extraoral appliance [851]
$650 Bupa
Passive appliance - fixed (inc Habit deterring appliance, Mandibular space maintainer inc LHA, Band and loop) [845✅ ]
$360 Bupa
Minor tooth guidance - fixed [846]
$230 Bupa
Obturator
• Palatal obturator is a prosthesis which totally occludes an opening e.g. an opening in the roof of the mouth
O/E
Staining/Discoloration
• Superficial staining can be addressed with prophy/polishing or bleaching
• Deep discoloration can be addressed with veneers
• Deep discoloration can be addressed with veneers
Caries
Watch
Caries 🦷🥵
Periodontitis/pocketing 🦴🥵
Gingivitis and periodontitis:
• Periodontitis may require root planing and curettage
Depth of bone:
• Periodontitis may require root planing and curettage
Depth of bone:
Xerostomia/dry mouth/Salivary Flow/Character 👅🥵
Dry mouth can be caused by:
• Psychoactive medication (antidepressants, opiates, antipsychotics)
• Blood pressure medication (antihypertensives, diuretics)
• Asthma medication (bronchodilators)
• Reflux medication (proton-pump inhibitors)
• Allergy medication (antihistamines)
• Cancer medication (antineoplastics)
• Psychoactive medication (antidepressants, opiates, antipsychotics)
• Blood pressure medication (antihypertensives, diuretics)
• Asthma medication (bronchodilators)
• Reflux medication (proton-pump inhibitors)
• Allergy medication (antihistamines)
• Cancer medication (antineoplastics)
Stenson Ducts/Papilla
Wharton Ducts
Parotid Glands
Submandibular Glands
Attrition levels, Erosion, Abrasion/Abfraction 🦷🥵
• Dental attrition is a type of tooth wear caused by tooth to tooth contact, resulting in loss of tooth tissue, usually starting at the incisal/occlusal surface
• Attrition can be treated with a restoration
• Dental erosion is loss of the surface of your teeth due to acids you eat or drink, or acids coming up from your stomach
• Dental abrasion is the non-carious, mechanical wears of tooth from interaction w/ objects other than tooth-to-tooth contact, most commonly affecting the premolars and canines, usually along the cervical margins
• Abfraction is loss of tooth structure where the tooth and gum come together, wedge-shaped or V-shaped, unrelated to cavities, bacteria or infection
• Abfractino is caused by stress and pressure applied to teeth through bitingm chewing, clenching teeth, and most commonly, teeth grinding, so is greatest in stress near the gum line, where the enamle and cementum of teeth meet
• Attrition can be treated with a restoration
• Dental erosion is loss of the surface of your teeth due to acids you eat or drink, or acids coming up from your stomach
• Dental abrasion is the non-carious, mechanical wears of tooth from interaction w/ objects other than tooth-to-tooth contact, most commonly affecting the premolars and canines, usually along the cervical margins
• Abfraction is loss of tooth structure where the tooth and gum come together, wedge-shaped or V-shaped, unrelated to cavities, bacteria or infection
• Abfractino is caused by stress and pressure applied to teeth through bitingm chewing, clenching teeth, and most commonly, teeth grinding, so is greatest in stress near the gum line, where the enamle and cementum of teeth meet
Crowding
Crowding is where there isn't enough space for all the teeth to fit normally in the jaw
Missing tooth ❌🦷
Missing teeth can cause:
Bone in jaw to shrink
Neighboring teeth to grow into the gap, causing crooked teeth
Gums to recede, creating pockets where bacteria can grow
What we can do about it:
Dentures, that fits into spaces where missing teeth are
Bridges, which is a tooth mounted to teeth on either side
Implants, which feels more like a natural, real tooth, fused to the jaw. Best long-term solution but expensive
TMJ disorders
TMJ noises
Clicking/popping
• Jaw popping is a clicking sound from the jaw each time it is engaged, which can be followed by sensations of pain • Can sometimes arise from overextending the jaw, e.g. when yawning or eating • Can be cause by Arthritis, Injury to the jaw, Myofascial pain syndrome, Malocclusion, Infection, TumorsCrepitation
• Grinding/grating sound usually indicative of degenerative changes in TMJ • Usually due to tear in disc or posterior attachment which produces bone ot bone contact of mandibular condyle w/ joint socket in base of skullTMJ deviation
• Hypermobility can result in excessive anterior movement of the jaw, away from the affected side. There are usulaly some clicking sounds, and there may or may not be pain• Mandible often deviates toward the affected side during opening because of muscle spasm or mechanical locking by a displaced meniscus
Grinding 🦷
Grinding causes:
• Occlusal splint can help w/ grinding
• Occlusal splint can help w/ grinding
Impacted teeth/Unerupted/Exfoliated 🛑🦷
When a tooth is impacted it means it has been blocked from erupting through the gum
• Impacted tooth may require removal
• Impacted tooth may require removal
Tooth pain🦷🥵
Tooth pain can be caused by:
• Caries
• Traumatized tooth, or high bite
• Dentin sensitivity
• Cracked tooth syndrome
• Reversible pulpitis
• Irreversible pulpitis
• Pulp necrosis
• Apical periodontitis
• Lateral periodontal abscess
• Pericorinitis
• Myofascial pain
• Maxillary sinusitis
• Bruxism
• Post-op sensitivity
• ANUG
• Dry socket
• TMJ pain
• Impacted food
Tender to percussion (TTP) specifically duplicates Sx's of pain upon mastication. It helps to indicate inflammation in the PDL, which can be due to:
• Trauma
• Occlusal prematurities
• Periodontal disease
• Extension of pulpal disease into the periradicular area
For results to the cold test:
• No response, means that the tooth is Non-vital
• >10 seconds of lingering pain, means there is irreversible pulpitis, because it indicates a hyperactive nerve that continues firing after the cold stimuli is removed. A 2012 systematic review however by Mejare et al (2012) in IEJ showed that there is insufficient evidence to assess accuracy of hypersensibility to cold stimulation to determine reversible vs irreversible pulpitis
For radiating pain:
• Tooth abscess can radiate to the jawbone, neck or ear
• TMJ pain can radiate to the teeth, and is accompanied by facial pain or headache
• Ear pain
• Sinuses
• Impacted teeth don't break through the gumline, and can cause pain that can radiate up to the ear, or 1 side of the nose
• Occasional heart problems
• Caries
• Traumatized tooth, or high bite
• Dentin sensitivity
• Cracked tooth syndrome
• Reversible pulpitis
• Irreversible pulpitis
• Pulp necrosis
• Apical periodontitis
• Lateral periodontal abscess
• Pericorinitis
• Myofascial pain
• Maxillary sinusitis
• Bruxism
• Post-op sensitivity
• ANUG
• Dry socket
• TMJ pain
• Impacted food
Tender to percussion (TTP) specifically duplicates Sx's of pain upon mastication. It helps to indicate inflammation in the PDL, which can be due to:
• Trauma
• Occlusal prematurities
• Periodontal disease
• Extension of pulpal disease into the periradicular area
For results to the cold test:
• No response, means that the tooth is Non-vital
• >10 seconds of lingering pain, means there is irreversible pulpitis, because it indicates a hyperactive nerve that continues firing after the cold stimuli is removed. A 2012 systematic review however by Mejare et al (2012) in IEJ showed that there is insufficient evidence to assess accuracy of hypersensibility to cold stimulation to determine reversible vs irreversible pulpitis
For radiating pain:
• Tooth abscess can radiate to the jawbone, neck or ear
• TMJ pain can radiate to the teeth, and is accompanied by facial pain or headache
• Ear pain
• Sinuses
• Impacted teeth don't break through the gumline, and can cause pain that can radiate up to the ear, or 1 side of the nose
• Occasional heart problems
Occlusal Plane
• Occlusal palne should curve higher in the back, as it extends outwards, from incisal edges of anterior teeth, to occlusal surfaces of posterior teeth
• Requires complex orthodontic procedures to treat
• Requires complex orthodontic procedures to treat
Tooth fracture
• Tooth fracture may require filling, or even bonding of that broken fragment
Loose tooth
• Loose tooth may require splinting to stabilize tooth
Tooth abscess
• Tooth abscess is an abscess that can occur in different regiosn of a tooth
• It may require a root canal treatment
• It may require a root canal treatment
R/v medical Hx
Allergies
🚨Asthma🤧
• Asthma can impact dental caries susceptibility, due to changes in salivary composition, or as side effects of medicines used to control asthma• Asthma medication also relaxes the sphincter just above the tummy, which can cause dental erosion from the acid
• Using an inhaler can irritate the back roof of the mouth, causing mouth ulcers and thrush
• Asthma attacks can be induced by stressful situations, and this includes going to the dentist, so always eremember to bring your inhaler to your dental appointment in case of an asthma attack
🚨Environmental allergy/Hay fever/Other allergies
🚨Allergic to Food/Other products
🚨Allergic to Drugs and Medications including Reactions to LA's
Adrenaline
• Adrenaline is added to LA to temporarily narrow your vessels, which keeps anesthetic in the area for longer• Pt's w/ heart conditions may be more concerned, w/ the American Heart Association recommending any Pt w/ heart disease a maximum of about 2 cartridges of dental anesthetic (whereas a normal person can receive up to 11 cartridges of anesthetic)
Penicillin
• Penicillin prescribed for treating bacterial infections• Allergy can cause hives, rashing and itching, or in severe reactions anaphylaxis
• Avoid penicillin drugs (amoxicillin, ampicillin, amoxicillin-clavulanate, dicloxacillin, nafcillin, piperacillin-tazobactam as well as drugs in cephalosporin class closely related to penicillins
• Tetracyclines (e.g. doxycycline), quinolones (e.g. cpirofloxacin), macrolides (e.g. clarithromycin), aminoglycosides (eg. gentamicin) and glycopeptides (e.g. vancomycin) are all unrelated to penicillins and safe to use in penicillin allergic Pt's
🚨Allergic to Latex
• Natural rubber latex contains protein that can cause allergic reactions• Schedule 1st thing in morning to lessen exposure ot air borne latex particles
• All operative staff to wear non-latex gloves, and non latex masks
🚨Previous Anaphylatic Reaction
Vitals
🚨High blood pressure
• High blood pressure is >140/90 mmHg• Causes increased risk of numerous heart diseases, brain diseases, metabolic syndrome, dementia, kidney disease, erectile dysfunction, diabetes
• It's harder for Pt's w/ hypertension to lower their blood pressure w/ medication when they have gum disease
Low blood pressure
• Low blood pressure can cause diziness when standing up after sitting in the dental chair for an extended period of time, causing dizziness or even faintingHigh pulse rate
• If your heart rate increases when you've had anesthetic, it's perfectly normal, because it usually contains adrenaline which is added to temporarily narrow blood vessels, keeping the anesthetic in the area being worked on for longerLow pulse rate
• A slow heart rate can be normal and healthyAbnormal pulse rhythm
• Improvement in oral hygiene has been associated w/ decreased risk of cardiovascular events• The risk of AF has been found to be lower in subjects receiving dental scaling
Low and High respiration rate
• Dysfunctional breathing can impact sleep, and therefore affect your general health• Dysfunctional breathing results in a lower carbon dioxide level, which makes the body more acidic and prone to dental problems
• Dysfunctional breathing can result in narrower upper and lower jaws resulting in crowding of teeth
Stomach or digestive condition
• For Pt's w/ GERD or heratburn, acids in your stomach can reach your mouth, and the acids can erode tooth enamel
• Pt's w/ IBD including Crohn's disease and UC, can have signs in mouth including Mouth sores, Infection, BLeeding gums, Swollen gums. Medications taken can also cause gingivitis, dry mouth, or inflamed tongue
• Pt's w/ IBD including Crohn's disease and UC, can have signs in mouth including Mouth sores, Infection, BLeeding gums, Swollen gums. Medications taken can also cause gingivitis, dry mouth, or inflamed tongue
Headache
• Simple cavities and infections can trigger headache pain
• The headache type usually associated w/ dental problems are tension headaches, caused by muscle strains that build up in the mouth and jaw
• Tension headaches are a diffuse, mild to moderate pain in your head that's often described like a tight band around your head
• Migraine headaches are described as throbbing or pulsing and uslaly begin on 1 side of the head
• Migraines are linked with tooth pain includin gTMJ, teeth grinding and toothches
• The headache type usually associated w/ dental problems are tension headaches, caused by muscle strains that build up in the mouth and jaw
• Tension headaches are a diffuse, mild to moderate pain in your head that's often described like a tight band around your head
• Migraine headaches are described as throbbing or pulsing and uslaly begin on 1 side of the head
• Migraines are linked with tooth pain includin gTMJ, teeth grinding and toothches
Psychiatric condition
• The link betwen poor dental and mental health can be a vicious cycle w/ persistent pain and inflammation in the mouth leading to further anxiety, depression and poor self-esteem
• Dental diseases can lead to those w/ severe mental illness being almost 3x more likely to lose all their teeth, through general neglect, damaged gums through over-vigorous brushing, or attriton of teeth due to excessive grinding
• Early signs of eating disorders are often spotted by dentists as damage is caused to tooth enamel through purging
• Depression can cause increased risk of dangerous dental behaviors, and poor nutrition
• Medication used for depression can cause drug induced dry mouth
• Dental diseases can lead to those w/ severe mental illness being almost 3x more likely to lose all their teeth, through general neglect, damaged gums through over-vigorous brushing, or attriton of teeth due to excessive grinding
• Early signs of eating disorders are often spotted by dentists as damage is caused to tooth enamel through purging
🚨Extremely anxious Pt, Depression and anxiety
• Depression can cause neglected oral hygiene, and avoidance of necessary dental care• Depression can cause increased risk of dangerous dental behaviors, and poor nutrition
• Medication used for depression can cause drug induced dry mouth
Respiratory/other lung disorders/disease 👃
• Increased caries risk, defects with teeth surface (enamel)
• Increased risk of gingivitis and periodontal disease, more calculus
• Higher likelihood of teeth positioning problems
• Oral yeast infection (candidiasis)
• Dry mouth (xerostomia)
• If you had a poroblem w/ a heart valve then antibiotic prophylaxis before dental procedure is strongly advised
• Risk of transmission of tuberculosis in detnal settings is low
• Infection occurs through inhalation of mycobacteria which then travels to alveoli of lungs, only people w/ active disease can spread infectious, a person w/ latent TB is not infectious
• Higher likelihood of teeth positioning problems
• Oral yeast infection (candidiasis)
• Dry mouth (xerostomia)
Bronchitis
Rheumatic fever
• The serious side effect of rheumatic fever is that the heart valves can be affected, so dental treatment is a particular risk to such people because bacteria may be introduced into the blood during dental treatment, that can lodge on a previously damaged heart valve and cause deterioration in cardiac function• If you had a poroblem w/ a heart valve then antibiotic prophylaxis before dental procedure is strongly advised
🚨Tuberculosis
• Risk of transmission of tuberculosis in detnal settings is low
• Infection occurs through inhalation of mycobacteria which then travels to alveoli of lungs, only people w/ active disease can spread infectious, a person w/ latent TB is not infectious
🚨Pregnancy/Breast feeding/Baby due
Effect of pregnancy on teeth:
• Gums can bleed more due to pregnancy because of hormonal changes
• Pregnancy hormones can make gums more sensitive to dental plaque
• Gum disease durin gpregnancy is linked to increased risk of premature birth and low birth weight
• Conditions like diabetes can increase risk of gum problems during pregnancy
• Frequent vomiting can weaken teeth and make them more at risk of decay and erosion (wearing away)
• Calcium is particularly important in your diet whilst you are pregnant and breastfeeding, helping to build the teeth and bones of the developing child
• Cravings for sugary foods can cause tooth decay
• Gums can bleed more due to pregnancy because of hormonal changes
• Pregnancy hormones can make gums more sensitive to dental plaque
• Gum disease durin gpregnancy is linked to increased risk of premature birth and low birth weight
• Conditions like diabetes can increase risk of gum problems during pregnancy
• Frequent vomiting can weaken teeth and make them more at risk of decay and erosion (wearing away)
• Calcium is particularly important in your diet whilst you are pregnant and breastfeeding, helping to build the teeth and bones of the developing child
• Cravings for sugary foods can cause tooth decay
Osteoporosis 🦴
Effects of osteoporosis on teeth:
• Osteoporosis medication (antiresorptive agents) help strengthen bones, but can cause a rare but serious condition cause osteonecrosis of the jaw that can severely damage the jawbone
• Bone loss in jaw and bone around teeth
• Tooth loss
• Loose or ill-fitting dentures because of bone loss
• Gum disease
• Osteoporosis medication (antiresorptive agents) help strengthen bones, but can cause a rare but serious condition cause osteonecrosis of the jaw that can severely damage the jawbone
• Bone loss in jaw and bone around teeth
• Tooth loss
• Loose or ill-fitting dentures because of bone loss
• Gum disease
🚨Mobility Impaired
• Pt's w/ mobility impairments and even difficulties with dexterity may require special facilities or services to access quality dental care, they may have problems getting into the surgery, and even into the detnal chair
• Dental practices should offer facilities for wheelchair users, including access and ground-floor surgeries
• Carer and family members should support a physically disabled persn to effectively manage their oral health at home on a daily basis
• Electric totohbrushes may help for those w/ mobility problems
• Dental practices should offer facilities for wheelchair users, including access and ground-floor surgeries
• Carer and family members should support a physically disabled persn to effectively manage their oral health at home on a daily basis
• Electric totohbrushes may help for those w/ mobility problems
🚨Diabetes Type 1 or 2
• High blood sugar can cause problems w/ eyes, nerves, kidneys, heart and other parts of the body
• Untreated diabetes can result in dry mouth, so higher risk of cavities, inflamed and bleeding gums
• Untreated diabetes can also cause problems tasting food
• Can cause delayed wound healing
• Can be more susceptible to infections inside the mouth
• For kids w/ diabetes teeth may erupt at an age earlier than typical
• Untreated diabetes can result in dry mouth, so higher risk of cavities, inflamed and bleeding gums
• Untreated diabetes can also cause problems tasting food
• Can cause delayed wound healing
• Can be more susceptible to infections inside the mouth
• For kids w/ diabetes teeth may erupt at an age earlier than typical
🚨Heart conditions/Pacemaker
• Gum disease is associted w/ increased risk of developing heart disease
• Poor dental health increases the risk of bacteiral infection in the blood stream which can affect the heart valves, particularly important if you have artificial heart valves
• Tooth loss patterns are connected to coronary artery disease
• Take care of MI a medical emergency in the dental office
• Risk of problems from anitbiotics usually exceeds benefits from preventive antibiotics, attracting blood products that may lead to clots
• Pt's w/ certian heart conditions receive single dose of antibiotic about 1 hour prior to certain dental Tx, but only in v specific cases, including prosthetic cardiac valve or prosthetic material used in valve repair; cardiac valve disease and have had cardiac transplant; had bacterial endocarditis before
• Newer cardiac devices are better shielded and may be less susceptible to interference
• Piezoelectric dental scalers may be safer than magnetostrictive models
• Electorsurgery devices have the highest potential for electromagnetic interference
• Poor dental health increases the risk of bacteiral infection in the blood stream which can affect the heart valves, particularly important if you have artificial heart valves
• Tooth loss patterns are connected to coronary artery disease
🚨Myocardial infarction
• More than 60 days should elapse after a MI before elective non-cardiac procedures like elective dental care• Take care of MI a medical emergency in the dental office
Heart valve disorder
• Currently antibiotic prophylaxis against infective endocarditis is generally not recommended for Pt's w/ an aortic valve or mitral valve prolapse undergoing dental procedure - but there's been contention as to whether they should receive antibiotic prophylaxis llike other high risk Pt's• Risk of problems from anitbiotics usually exceeds benefits from preventive antibiotics, attracting blood products that may lead to clots
• Pt's w/ certian heart conditions receive single dose of antibiotic about 1 hour prior to certain dental Tx, but only in v specific cases, including prosthetic cardiac valve or prosthetic material used in valve repair; cardiac valve disease and have had cardiac transplant; had bacterial endocarditis before
🚨Cardiac Pacemaker
• Some electronic dental devices may cause interference w/ implanted ardiac devices• Newer cardiac devices are better shielded and may be less susceptible to interference
• Piezoelectric dental scalers may be safer than magnetostrictive models
• Electorsurgery devices have the highest potential for electromagnetic interference
Kidney or thyroid disease
• Kidney disease is where kidneys are damaged and no longer perform proper function removing waste and extra water from bloodstream
• Kidney disease can cause dry mouth, bad breath, increase in plaque and gum disease
• Pt's w/ hypothyroidism may have lack of hemostasis and are at increased risk for infection, and so also delayed healing time • Pt's w/ hypothyroidism are also at risk for heart disease
• Elevated levels of thyroid hormones can cause Pt's to be extremely sensitive to sympathomimetic drugs like epinephrine, used in local anesthetic and retraction cords
• Increased levels of anxiety and stress in dental office can trigger thyroid storm in Pt's w/ hyperthyroidism, and is often life threatening
• Cardiac events have been linked to thyroid disease, so taking the Pt's blood pressure and pulse at the start and end of dental procedure is recommended
• Kidney disease can cause dry mouth, bad breath, increase in plaque and gum disease
• Pt's w/ hypothyroidism may have lack of hemostasis and are at increased risk for infection, and so also delayed healing time • Pt's w/ hypothyroidism are also at risk for heart disease
• Elevated levels of thyroid hormones can cause Pt's to be extremely sensitive to sympathomimetic drugs like epinephrine, used in local anesthetic and retraction cords
• Increased levels of anxiety and stress in dental office can trigger thyroid storm in Pt's w/ hyperthyroidism, and is often life threatening
• Cardiac events have been linked to thyroid disease, so taking the Pt's blood pressure and pulse at the start and end of dental procedure is recommended
🚨Stroke
• Dentists should assess risk of Pt's risk of complications before providing dental care, and so therefore timing of stroke, and type and magnitude of dental procedure
• Avoid concurrent use of drugs like Metronidazline and tetracycline that interact w/ warfarin which can increase the INR
• Short stress-free appointments scheduled in the morning to reduce risk for complications
• Avoid placing a retraction cord impregnated w/ epinephrine
&bul; LA should have limited amount of epinephrine (vasoconstrictor)
• Avoid concurrent use of drugs like Metronidazline and tetracycline that interact w/ warfarin which can increase the INR
• Short stress-free appointments scheduled in the morning to reduce risk for complications
• Avoid placing a retraction cord impregnated w/ epinephrine
&bul; LA should have limited amount of epinephrine (vasoconstrictor)
Masseter
Temporalis
Neuromotor Mastication (CN5)
Neuromotor Facial Expression (CN7)
Neuromotor Palatal Elevation (CN9, 10)
Neuromotor Tongue Movement (CN12)
Neurosensory testing CN5-1 extraoral
Neurosensory testing CN5-2 extraoral
Neurosensory testing CN5-3 extraoral
🚨Cancer, Chemotherapy, Radiotherapy/Radiation therapy
• Cancer Pt's may have numerous out of pocket costs for dental work and dental rehabilitation to replace teeth that have been removed or damaged during and after treatment
• This is the case not only for head and neck cancers, but anyone underogingundergoing cancer treatment
• Radiotherapy can damage saliva glands reducing salivary flow, significantly increasing dental disease
• Chemotherapy and radiotherapy can cause changes ind ental growth and development in children
• Bisphosphonates can cause a rare but serious side effect osteonecrosis of the jaw
• This is the case not only for head and neck cancers, but anyone underogingundergoing cancer treatment
• Radiotherapy can damage saliva glands reducing salivary flow, significantly increasing dental disease
Leukemia
• Cancer Pt's are at high risk for dental and plications due to cancer treatment, or side effects of cancer treatment• Chemotherapy and radiotherapy can cause changes ind ental growth and development in children
• Bisphosphonates can cause a rare but serious side effect osteonecrosis of the jaw
Communication barriers
🚨Vision Impaired
• Feel comfortable and become familiarised w/ the layout of the office• Seek necessary assitance for filling out of paper work
• You will be offered appropriate oral health education
🚨Hearing Impaired
• Auditory challenges can result in pronounced dental fear and anxiety• Request for a sign language interpreter as desired
• We will help to understand your concerns and symptoms, secure informed consent, ensure effective treatment, especially for more invasive procedures
🚨Speech Impaired
• Speech difficulties in children can be caused by dental issues• Tongue tie may cause trouble eating, speaking and swallowing
• Malocclusion can cause disordered speech including lisps and inability to properly produce strident sounds
• Orofacial myofunctional disorders is where the tongue falls into an abnormal position and can affect speech development making certain sounds difficult to produce
• Premature tooth loss can negatively impact your child's speech
• Improper jaw structure can cause teeth to become crammed together leaving less room for the tongue to move around, and can also cause a poor bite pattern, impacting speech
• Poor tooth appearance can cause a Pt to refrain from oepning their mouth wide enough causing them to mumble or speak incorrectly
🚨Translator Required
• Translators require not only experienc ein language but in the fiel dof dentistry itself🚨Epilepsy/Seizures
• Pt's w/ epilepsy may have additional anxieties about going to the dentist related to having seizures, particularly where it is not well controlled or had a bad experinece in the past
• Let us know the nature/frequency/pattern of seizures, seizure triggers, medications to avoid drug interactions (e.g. w/ some antifungal and antibiotics, which can therefore jeopardise seizure control), and epilepsy management plan if you have one
• Let us know the nature/frequency/pattern of seizures, seizure triggers, medications to avoid drug interactions (e.g. w/ some antifungal and antibiotics, which can therefore jeopardise seizure control), and epilepsy management plan if you have one
Infectious disease
🚨Hepatitis B/C or other Liver disease
• Hepatitis B is preventable through vaccination• There is no vaccine for hepatitis C
• Dentists and all staff should apply standard precautions for all Pt's
• Dental sedation should onyl be performed by specialists for Pt's w/ significant liver disease as small doses can lead to coma
🚨HIV/AIDS/contagious diseases
• Dental problems e.g. sore bleeding gums, herpes sores in the mouth, fungal and candida/yeast infections may be the 1st signs of AIDS• Many people fear HIV may be transmitted during treatment, but universal precautions are taken between each and every Pt to prevent transmission of HIV and other infectious diseases
🚨CJD
• CJD is an invariably fatal human prior disease• Dental work on Pt's w/ exposure to higher-infectivity tissues shoudl be performed at facility familiar w/ CJD specific infection prevention and control procedures
🚨Bleeding disorders/Anticoagulants
Excessive bleeding/bruising
• Can get heavy bleeding from dental workAnemia
• Pt's can be prescribed special antimicrobial rinse to prevent gum disease, or antibiotic drugs to reduce risks of related infection• Pt's w/ severe anemia may require oxygen during treatment to compensate for anemia's hindrance on amount of oxygen in your bloodstream
• Pt's w/ Fanconi anemia, a genetic condition, raises the risk of oral cancer and these Pt's must consistently visit the dentist for oral cancer screening
🚨Anticoagulant Therapy/Blood thinners
• For older medications (warfarin, antiplatelet agents) as well as newer direct acting oral anticoagulants, it isn't necessary to alter anticoagulation or antiplatelet therapy prior to dental intervention• Use local measures to control bleeding
• Modification to medication regime prior to dental surgery should be done in consultation and on advice of Pt's Dr
R/v Medication/Rx currently taking (prescribed or OTC)
Vitamins
Vitamin A
• Vitamin A is important in keeping your gums healthy, and also building tooth enamel• Most foods w/ vitamin A are orange, e.g. sweet potatoes, carrots
Vitamin B
• Vitamin B is a complex of 8 vitaminsVitamin B1 (thiamine)
• Useful for fighting off tongue inflammation• Helps retain the natural, healthy pink color in gums
Vitamin B2 (riboflavin)
• Vitamin B2 deficiency can cause glossitis, angular cheilitis, pain, mouth sores• Found in foods like pasta, bagels, spinach and almonds
Vitamin B3 (niacin)
• Vitamin B3 deficiency can cause bad breath and canker sores• Poultry, meat and fish are good sources of vitamin B3
Vitamin B6 (pyridoxine)
• Vitamin B6 deficiency can cause a sore, burning mouth, or smooth tongueVitamin B9 (folic acid)
• Folic acid can reduce inflammation in the gums, and make them more resilient to dental plaque and anaerobic bacteria, leading causes of gum disease, tooth decay and bad breathVitamin B12 (cyanocobalamin)
• Vitamin B12 deficiency can cause glossitis, glossodynia, recurrent ulcers, cheilitis, dysgeusia, lingual paresthesia, burning sensatinos, and pruritisVitamin B5 (Pantothenic acid)
• Vitamin B5 is thought to have a significant effect on the psychological process, relating to control teeth grindingVitamin B7 (Biotin)
Vitamin C
• Vitamin C strengthens your gums and soft tissue in your mouth• It can protect against gingivitis, the early stage of gum disease
• It can prevent your teeth from loosening
• Vitamin C can be found in citrus fruits, potatoes, and leafy greens
Vitamin D
• Vitamin D affects bone mineral density, and along w/ immunomodulatory effects can affect periodontal disease• Vitamin D deficeincy is linked w/ low bone density, pathologic #, and poor bone healing after dental surgery
Vitamin E
• Vitamin E is linked to prevention of periodontal disease, and works by reducing inflammation and serving as an antioxidantVitamin K
• Vitamin K helps your body produce osteocalcin, a protein that supports bone strengthMinerals️
Calcium
• Calcium plays a role in making jaw bones healthy and strong, to hold teeth in placePhosphorus
• Phosphorus supports calcium in building strong bones and teethMagnesium
Sodium
Potassium
Chloride
Sulfur
Coffee and tea ☕
• 400mg of caffeine/day (4 cups of brewed coffee, or 2 energy drinks) appears to be safe for most healthy adults
• Coffee/tea stains teeth
• Sugar added to coffee/tea causes caries
• Coffee/tea stains teeth
• Sugar added to coffee/tea causes caries
Drinking/Alcohol 🥃
Effects of alcohol on teeth:
Tannins in wine can stain teeth
Alcohol dries the mouth
Can be acidic
Can stain teeth
Chewing ice damages teeth
Sugar in alcohol can cause cavities
Increased risk of gum disease
Increased risk of mouth sores
Increased risk for oral cancer
Tannins in wine can stain teeth
Alcohol dries the mouth
Can be acidic
Can stain teeth
Chewing ice damages teeth
Sugar in alcohol can cause cavities
Increased risk of gum disease
Increased risk of mouth sores
Increased risk for oral cancer
Social or illicit drugs
• Many heroin users exhibit multiple carious teeth, due to drug induced xerostomia, poor diet and lack of oral hygiene
• Grinding is asociated w/ both methamphetamine and ecstasy
• Ecstasy users jaw clenching and teeth grinding may lead to severe dental attrition
• Cocaine presents a potentialy life threatening situation in the dental practice, as the combination of cocaine use and an LA w/ vasoconstrictor may exacerbate a sympathetic response and the development of a hypertensive crisis or cardiac dysrhythmia
• Heroin and opiate users often complain analgesics don't work
• NSAID's should be used to Mx discomfort as narcotis may cause relapse in recovering Pt's
• Current or past IV drug usage carries possibility of transmitting hepatitis and HIV
• Grinding is asociated w/ both methamphetamine and ecstasy
• Ecstasy users jaw clenching and teeth grinding may lead to severe dental attrition
• Cocaine presents a potentialy life threatening situation in the dental practice, as the combination of cocaine use and an LA w/ vasoconstrictor may exacerbate a sympathetic response and the development of a hypertensive crisis or cardiac dysrhythmia
• Heroin and opiate users often complain analgesics don't work
• NSAID's should be used to Mx discomfort as narcotis may cause relapse in recovering Pt's
• Current or past IV drug usage carries possibility of transmitting hepatitis and HIV
Smoking 🚬
Effects of smoking on teeth:
Bad breath
Tooth discoloration
Inflammation of salivary gland openings
Buildup of tartar on teeth
Increased loss of bone in jaw
Increased risk of white patches in mouth
Increased risk of gum disease, and therefore tooth loss
Delayed healing
Lower success rate of dental implants
Risk of developing oral cancer
Know your triggers, what makes you want to smoke
Find methods that help you quit:
Going cold turkey
Gradually cutting down
NRT (nicotine replacement therapy)
Prescription medications for Withdrawal symptoms
My QuitBuddy phone app
Support service Quitline 137 848 Mon-Fri 8am-8pm
Bad breath
Tooth discoloration
Inflammation of salivary gland openings
Buildup of tartar on teeth
Increased loss of bone in jaw
Increased risk of white patches in mouth
Increased risk of gum disease, and therefore tooth loss
Delayed healing
Lower success rate of dental implants
Risk of developing oral cancer
Know your triggers, what makes you want to smoke
Find methods that help you quit:
Going cold turkey
Gradually cutting down
NRT (nicotine replacement therapy)
Prescription medications for Withdrawal symptoms
My QuitBuddy phone app
Support service Quitline 137 848 Mon-Fri 8am-8pm
Pain medication/Chronic pain
• Maintaining dental hygiene now can save more pain down the line
• Because serious dental issues are common in Pt's using medications for acute and chronic pain, regular trips to the dentist are necessary to catch problems before they become more serious
• Pain medication can often cause dry mouth, which make tooth decay and gum disease more likely
• Pt's w/ chronic pain often avoid potential pain triggers, so it's often in the latter stages of decay when the tooth needs to be removed, when things get addressed
• Because serious dental issues are common in Pt's using medications for acute and chronic pain, regular trips to the dentist are necessary to catch problems before they become more serious
• Pain medication can often cause dry mouth, which make tooth decay and gum disease more likely
• Pt's w/ chronic pain often avoid potential pain triggers, so it's often in the latter stages of decay when the tooth needs to be removed, when things get addressed
Beta blockers
• When an ordinary Pt takes adrenaline, it doesn't affect blood pressure much because it has both alpha adrenergic (vasoconstriction) and beta adrenergic (vasodilation) effects. However, if a Pt on non-selective beta blocker takes a systemic dose of adrenaline, the beta blocker prevents vasodilation, leaving unopposed alpha vasoconstriction, which can cause a substantial hypertensive reaction
• In most people this hypertensive reaction only causes a headache and discomfort, but for a small number e.g. a vascular abnormality in the brain, this can cause a stroke
• The effects w/ cardioselective beta blockers should be less, e.g. acebutolol, atenolol, betaxolol, bisoprolol, esmolol and metoprolol
• In most people this hypertensive reaction only causes a headache and discomfort, but for a small number e.g. a vascular abnormality in the brain, this can cause a stroke
• The effects w/ cardioselective beta blockers should be less, e.g. acebutolol, atenolol, betaxolol, bisoprolol, esmolol and metoprolol
Oral contraceptives
• Oral contraceptives are hormones that prevent fertility, as either a combination of estrogen and progesterone, or progesterone alone
• Although levels are now lower, historically the level of hormones in pills could be harmful to your gums and oral health, which can cause higher blood flow to your gums, causing sensitivity and greater susceptibility to plaque and bacteria
• 2x more likely to develop a dry socket after wisdom tooth removal, although there may be additional variables like smoking, the extraction site, complexity of procedure, and age
• TMD is related to birth control, which is pain and stiffness int he TMJ joint and surrounding areas, because synthetic hormones can lead to deficiency in natural estrogen, which causes more inflammation
• Canker sores may be triggered by hormonal shifts during menstruation
• Hormones can cause swollen salivary glands, which may inhibit the flow of saliva and cause dry mouth
• Injectable progesterone contraceptives may contribute to periodontal disease and gingivitis
• Although levels are now lower, historically the level of hormones in pills could be harmful to your gums and oral health, which can cause higher blood flow to your gums, causing sensitivity and greater susceptibility to plaque and bacteria
• 2x more likely to develop a dry socket after wisdom tooth removal, although there may be additional variables like smoking, the extraction site, complexity of procedure, and age
• TMD is related to birth control, which is pain and stiffness int he TMJ joint and surrounding areas, because synthetic hormones can lead to deficiency in natural estrogen, which causes more inflammation
• Canker sores may be triggered by hormonal shifts during menstruation
• Hormones can cause swollen salivary glands, which may inhibit the flow of saliva and cause dry mouth
• Injectable progesterone contraceptives may contribute to periodontal disease and gingivitis
Diuretics
Diuretics can cause dry mouth (xerostomia), and so in turn can in turn cause dental caries, periodontal diseases, and mucosal lesion formation
🚨Drug Induced +/- Immunosupression
• For Pt's assess the preventative/prophylactic regimes that may be necessary to carry out range of dental Tx
• There may be increased risks of complications as a result of dental Tx, because of significantly reduced ability to cope w/ dental Tx
• Adrenal crisis is a rare event in dentistry, so most routine dental procedures can be performed w/o steroid cover
• There may be increased risks of complications as a result of dental Tx, because of significantly reduced ability to cope w/ dental Tx
🚨Steroid therapy
• Pt's on long-term systemic steroids may need to take "steroid cover (supplemental glucocorticoids) when undergoing certain types of stressful treatment including dental procedures• Adrenal crisis is a rare event in dentistry, so most routine dental procedures can be performed w/o steroid cover
🚨Antibiotic Cover before dental care
• Antibiotic prophylaxis is used in dentistry for Pt's at risk of infective endocarditis or prosthetic joint infection, to eliminate or reduce transient bacteremia caused by invasive dental procedures
• Conditions for which prophylaxis is still recommended include prosthetic heart valves and rheumatic heart disease in Pt's at high risk of endocarditis
• Most experts no longer recomend antibiotic prophylaxis for dental procedures in Pt's w/ prosthetic joints
• Conditions for which prophylaxis is still recommended include prosthetic heart valves and rheumatic heart disease in Pt's at high risk of endocarditis
• Most experts no longer recomend antibiotic prophylaxis for dental procedures in Pt's w/ prosthetic joints
🚨Rx that can cause MRONJ including bisphosphonates
• MRONJ is medication-related osteonecrosis of jaw
• MRONJ is an area of exposed bone in the maxillofacial region that has persisted for more than 8 weeks, in a Pt receiving bisphosphonates, denosumab or antiangiogenic therapy for cancer, where there is no history of radiation therapy to jaws or obvious metastatic disease tothe jaws
• Pt's w/ established MRONJ should avoid elective dentoalveolar oral surgery as this may result in additional areas of exposed necrotic bone
• There is improved outcome of MRONJ if anti-resorptive therapy is ceased
• MRONJ is an area of exposed bone in the maxillofacial region that has persisted for more than 8 weeks, in a Pt receiving bisphosphonates, denosumab or antiangiogenic therapy for cancer, where there is no history of radiation therapy to jaws or obvious metastatic disease tothe jaws
• Pt's w/ established MRONJ should avoid elective dentoalveolar oral surgery as this may result in additional areas of exposed necrotic bone
• There is improved outcome of MRONJ if anti-resorptive therapy is ceased
Self Mx
Brushing 🦷🖌
Brush 2x a day (Morning, Night)
Brush using an Electric toothbrush
or use Special technique
Spit afterwards, Do NOT rinse
Brush using an Electric toothbrush
or use Special technique
Spit afterwards, Do NOT rinse
Flossing 🦷🧵
Floss Once a day
Flossing has Exclusive access to places your brush cannot
How to Floss:
![]()
![]()
Flossing has Exclusive access to places your brush cannot
How to Floss:
Flossette
Pikster
Water
• 4-6 cups per day
Dietary Advice🌮
• 4-6 cups per day
Mouth rinse 👄💧
Unless if the dentist asks you don’t need to use a mouth rinse
You can use it for Bad breath if you like though
You can use it for Bad breath if you like though
GC Tooth Mousse Plus
GC Tooth Mousse
No fluoride formulationAccess to medical care
Medical practitioner
Medical practitioners diagnose physical and mental illnesses, disorders and injuries, and prescribe medications and treatment to promote or restore good healthMedicare
Medicare is Australia's universal health insurance scheme guaranteeing all Australians and some overseas visitors to access a range of health and hospital services at low or no costConcession card
Concession and health care cards is mainly to provide access to the PBS pharmacy scheme, and certain Medicare services, at a cheaper ratePrivate health insurance
Provides financial cover for part or even all of the cost of various health treatments and servicesN/v
3-day food diary
Fill it out ✏️ for 3 typical days :
2 weekdays
1 weekend
Bring it in next time you’re here
2 weekdays
1 weekend
Bring it in next time you’re here
OPG
• MBS #57963 covers OPG (orthopantomography) images if there are Sx's of impacted teeth, caries, periodontal pathology, or PA pathology
Tx decision tree
1️⃣ Regular check up, x-rays, scale and cleans, fluoride treatments (approx $201.05)
2️⃣ Filling ($89.05 - $918.75)
3️⃣ Crown ($1,277.20+)
4️⃣ Endo ($825.75 - $2,557.80)
5️⃣ Extraction ($176.30 - $1,303.60)
+
• Denture ($779.10 - $2,453.60)
• Implant ($1,826.80 - $2,682.90)
= Total $955.40 - $3,986.50
2️⃣ Filling ($89.05 - $918.75)
3️⃣ Crown ($1,277.20+)
4️⃣ Endo ($825.75 - $2,557.80)
5️⃣ Extraction ($176.30 - $1,303.60)
+
• Denture ($779.10 - $2,453.60)
• Implant ($1,826.80 - $2,682.90)
= Total $955.40 - $3,986.50
🚨= Add alert
🆓 = QLD Health Covered
🛣 = QLD Health Conditional
❌ = Out of scope
✅ = Within scope
📝 = Checklist sign-off required
🛡️ = Warrantee
General warrantee:
• 1 year warranty for general dentistry procedures, inc acrylic dentures
• 2 year warranty for prosthetic services, inc implants
• Warranty periods only apply if you follow regular OH and scheduled maintenance check ups
• New or replacement dentures can only be done every 5 years
• We usually offer a discount fee of around 30%
• Further 10% discount applies to students, staff, and eligible concession card holders
• You cannot claim any reimbursement of funds from Medicare, any private health care fund, or DVA
• Prosthetic services (e..g crowns, dentures, implants) requires a deposit of 50% to be paid prior to Tx commencing, usually covering the lab expenses. The full balance must be paid on completion of the Tx i.e. insertion of the crown, denture, or implant
• When your appointment is finished, you should be Rebooked, Referred or have a Recall appointment booked
• You will get an SMS reminder a day before your appointment
• When you arrive at reception please notify staff so they can inform your dentist that you have arrived
• If you cancel w/o 24 hours' notice this may result in a cancellation fee of $25 being applied to your account
• Failure to attend 3 or more appointments may result in your Tx being suspended and you will be referred back
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