British Society for Restorative Dentistry

Restorative dentistry in its broadest sense involves the restoration of oral and dental tissues for patients. It includes the following dental disciplines:

• operative dentistry which involves the filling of teeth;
• periodontology which is the prevention and treatment of gum disease;
• endodontics which includes root canal treatment;
• prosthodontics which is the replacement of teeth.

The vast majority of restorative dentistry is provided in general dental practice. Many dentists work for the National Health Service with some only working on a private basis or a combination.

There are also registered specialists in restorative dentistry. These include the high street specialist who could be a periodontist, endodontist or prothodontist most of whom practice privately. In Britain there are also hospital specialists in restorative dentistry who are consultants in restorative dentistry. To become a specialist an appropriate period of postgraduate training must be undertaken. The General Dental Council holds the lists of all the specialists in dentistry in this country.

Dental Care Professionals include dental nurses, dental therapists, hygienists and dental technicians - they are all important members of the dental team and all have a role in the provision of restorative dentistry for patients under the direction of a dentist.

Lists of dentists can be found in various directories and on search websites. Most Primary Care Trusts have good websites with details of dentists in your area. For those living in England, NHS Direct Online (www.nhsonline.nhs.uk) can be useful and holds lists of dentists by postcode.

As dentistry can be provided both under the NHS and privately and under some insurance schemes it is important that you establish with your dentist under what terms you are being treated under before you start treatment. There are certain groups of patients who are exempt from NHS dental fees such as children under the age of 18 years and those in full time education under the age of 19 years. Other groups include those on Income Support and certain types of benefits. However you will need to check this with your dentist or Primary Care Trust first.

There are special groups of patients who may be eligible for dental care within the community dental service. These include children with advanced dental disease, the elderly and those requiring special care dentistry for example those with learning difficulties.

You will need a referral from a healthcare worker which will usually be your general dentist. The referral may be to a high street specialist such as an endodontist, periodontist or prosthodontist or to a consultant in restorative dentistry in hospital. This maybe for an opinion, help with a specific item of treatment or a course of dental treatment. Simply because you are referred for treatment is no guarantee that you will receive it.

Patients who are provided with specialist hospital treatment are a very small and specific group who are accepted under strict criteria. This may include those with congenital dental disease, those who have suffered severe dental trauma and those requiring oral rehabilitation as a direct result of cancer. There are also certain medical conditions which may exclude dental treatment within general dental practice.

Implants are "screw in teeth". Modern implants are made of Titanium metal which osseointegrates ("fuses") with bone. There must be adequate bone in which to place an implant, though grafting (adding bone) can sometimes be carried out to increase the amount of bone available. To have implants patients need to have healthy mouths free of dental disease and need to be generally fit and healthy. There is a much higher failure rate of implants in those who smoke. Surgery is necessary to place implants, though often they can be inserted under local anaesthetic. In this country we do not normally provide implants until patients have stopped growing.

The surgeons who place and restore implants need special training. There will be many stages involved in the provision of implants and it is important that they are carefully planned and executed. The implants can be used to anchor single teeth, bridges or dentures. In the dental literature good success rates have been recorded for implants and the future looks promising. However there are other ways of replacing missing teeth (which indeed may be more appropriate) and it is important that you discuss these with your dentist before embarking on a course of treatment.

Implants are generally not available under the NHS. Those dentists outside NHS hospitals who provide implants will do so on a private basis. The costs can be high and you must establish these before treatment. Within NHS hospitals there is an extreemely limited budget for the provision of implants. These will generally be dental teaching hospitals and strict criteria will be applied to referred patients. The high priority groups of patients will depend on the individual hopsital. Though often they will be those patients: who have not developed teeth; have lost teeth through trauma; are unable to wear complete dentures. Sometimes they will be provided for those who have lost teeth through oral cancer, though because of the effects of radiotherapy on bone they may not be appropropriate.

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If you are registered with an NHS dentist or are a regular private patient you should be able to obtain advice or treatment as approriate from your dentist. Alternatively there are emergency dental clinics and NHS dental walk in centres run in various hospitals. Primary Care Trusts should be able to advise on these.

The General Dental Council is the regulating body for dental professionals in the United Kingdom. All practicing dentists are registered with the GDC, who also hold the specialists lists. Their website is at www.gdc-uk.org

The British Dental Association is the professional association and trade union for dentists in the United Kingdom. The majority of dentists are members. Their website is at www.bda-dentistry.org.uk

NHS Direct Online is a website providing health information and advice for people in England. Their website is at www.nhsonline.nhs.uk