Practice News

our service

March 2020

I am delighted to announce that our extended contact activity has just been confirmed. Should you wish to make an appointment for yourself or someone else, kindly get in touch with us at your convenience. -Conrad Costa

 

GDPR

May 2018

We have updated our privacy policy in accordance with GDPR legislation. Our website does not track you, nor do we collect any information about you whilst you browse our website. We do not covertly make you mine Bitcoin on our behalf nor do we drop any cookies or sell you adverts. We value our own privacy very much and therefore have a lot of respect for your online privacy.

Patient satisfaction Survey

August 2016

Our patient satisfaction survey, which had been ongoing since April, is now closed. We would like to thank all those who participated. We would nonetheless welcome your feedback (whether written, verbal or by email) at any time. Our Friends and Family Test remains ongoing.

New Practice manager

January 2016

We would like to extend a warm welcome to Ms Angelique van Woerkom, who joins us at Castle and Costa as our new Practice Manager. Angelique has many years of experience as a Dental Care Professional and had worked for us frequently as a locum. She is familiar with our working system and is very eager to learn and help us improve our service.

New Associate Dental Surgeon

August 2015

We are pleased to welcome Dr Gavin Gill to our practice as our new associate dental surgeon, following the retirement of Dr Gillian Fellows. Dr Gill has many years of experience in general practice and in teaching hopsitals and will prove to be an asset to our team.

CQC inspection and report

June 2015

We are delighted to announce that Castle and Costa Dental Surgeons have passed their CQC inspection. Following a visit by two inspectors, we were given a clean bill of health - as well as a few suggestions - which we have taken on board. For more information, visit our Resources page.

Dementia Awareness training

November 2014

We extend our congratulations to our dental care professionals and dentists after they were awarded an NVQ level II in dementia awareness training. This will enable us to engage with our patient base better and to improve our understanding of their condition.

Conrad and audrey Costa

March 2013

We are pleased to announce that following the sad demise of Mr Castle, Conrad and Audrey Costa have recently taken over the running of the practice and will strive to maintain and improve the good standard of care that Castle and Costa have been delivering to the non-ambulatory for the past years.

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Root Canal Treatment

Sometimes, due to extensive decay or physical injury, the pulp of a tooth (the living structure on the inside of a tooth that houses nerve fibres and blood vessels) may eventually get colonised by bacteria and get inflamed and infected. Most of the time this is a painful process, and since the tooth has a very limited capacity to heal, early intervention is recommended.

The healthy tooth

 

How does decay or injury affect the pulp?
Since the pulp is sheltered in the deepest layer of a tooth, it is only when a big cavity is allowed to progress unchecked that decay (colonies of bacteria and bacterial toxins) gets very close to the pulp. Bacteria and their toxins irritate the pulp, which gets inflamed.

A decayed tooth. The area of bacterial destruction is often much bigger than the cavity suggests, and the pulp may become irritated and inflamed

Following this, the pulp goes necrotic and a chronic infection sets in. Such an infection may be asymptomatic for a period of time, but may spontaneously flare up and cause a spreading infection of the tissues of the mouth and face, and feel tender to bite on.

When the pulp goes necrotic (dead), it is colonised by bacteria, and may lead to an abscess and a spreading infection in the jaws

Likewise, when a cavity is very close to but not actually touching the pulp of a tooth, bacterial toxins may already have irritated the pulp beyond the capacity of the tooth to heal, even though a dentist may have attempted to fill the tooth before it would have started giving symptoms. The dentist will usually place a particular base or lining to the filling in the hope that it would help the tooth recover from the injury, but in some cases, this wouldn't be enough to stop the tooth from giving symptoms and requiring root canal treatment in future.

Physical injury, usually to front teeth, may result in necrosis or irreversible inflammation of the pulp for two reasons: the injury might result in a fracture of the affected tooth that goes through the pulp, thus exposing it to the bacteria that are naturally present in the mouth, following which the pulp gets infected. Otherwise the injury might displace the tooth, albeit transiently, resulting in severance of the blood vessels that supply the pulp. The pulp thus dies (goes necrotic) and in turn gets infected by bacteria that travel via the gingival crevice (margin between gum and tooth).

What does a necrotic (infected) tooth feel or look like?
Even though some necrotic teeth do not give any symptoms and may be chance findings on a check-up or show up on a routine X-ray, most commonly affected teeth will start off giving non-specific symptoms of chronic inflammation, namely feeling sensitive to temperature change. As the inflammation gets irreversible (beyond the healing capacity of the tooth) the tooth will feel intensely sensitive to hot and cold stimuli, and this persists for a few moments even after the stimuli are removed. At later stages pain might be sharp and stabbing in nature, and might even keep the patient awake at night. Following this, a latent period might set in as the nerve fibres die off and a chronic infection at the tip of the roots gets established. Such a tooth would not have spontaneously healed; rather it would still require definite treatment to eradicate the infection. Teeth giving symptoms may have big fillings, fractures, or untreated cavities.

Teeth which have had knocks on them rendering them necrotic may even turn dark as blood products on the inside decompose and discolour. If an abscess forms following a chronic infection, a necrotic tooth may feel tender to bite on, and on occasions, pockets of pus might be released via a sinus that looks like a raised spot on the gum beside the tooth. Sometimes an infection from a necrotic tooth may spread to the tissues of the mouth and the face which may be uncomfortable, or in worst cases life-threatening.

What does Root Canal Treatment involve, and how does it help save a necrotic tooth?
Once infected, a necrotic tooth will not get better on its own, and the problem cannot be rectified with a simple filling. The aim of root canal treatment is to remove the dead pulp which is a source of chronic infection, as an alternative to having the whole tooth removed (extracted).

Under local anaesthetic if required, the pulp chamber is cleaned following the removal of all decay

The procedure is done under local anaesthetic, and after drilling into the tooth in the same way a filling is carried out, the dentist proceeds to disinfect the canals where the pulp was using both mechanical instruments and chemical disinfectants until the infection is eradicated. Usually, the process is done over two or more visits, as the dentist may leave some disinfectant in the root canals for a while, to help the tissues heal. On the last visit, the root canals are filled again using a special filler, and a filling is placed on the tooth to restore normal function and appearance.

Filling the tooth will involve filling the pulp chamber first. Crowning the tooth is usually advisable following a period of healing

Sometimes, as the resulting cavity would be extensive following treatment, the dentist might suggest crowning a tooth to give it some extra structural support and prevent breakage. In certain complex cases, such as very slender curved roots, atypical canal shapes or failed previous root canal treatment, your dentist might suggest that the treatment be done at a specialist, which might guarantee a better success rate attributed to the use of specialist equipment such as microscopes. It is up to the patient whether or not to accept to be referred.

We regret that due to safety concerns and the lack of appropriate portable equipment, we are unable to carry out root-canal therapy on a domiciliary basis, but we would be happy to refer any patients requiring such treatment appropriately.