Dental Services

Home
The Staff
Hicaps
Dental Services
Dental Charges
Contact Details
Contents
Contents

 

 

 

     

Preventive dentistry is the heart and soul of any dental practise. It means checking, cleaning and fluoriding teeth. This is what the Health Funds recognise as the long term cheapest solution to dental problems. Basically people who take the trouble to maintain their teeth every 6 to 12 months don't get much go wrong with their teeth. That is why the Health Funds encourage their clients to have it done and pay a rebate of up to 100% in the case of Medibank. The other Health Funds pay rebates of about 80% for this type of work. Quite simply it works and works well, not to mention saving a great deal of trauma on the way.
For those who don't have health insurance, such a visit will cost about $185 for adults or about $120 for children. We are happy to take teenage Medicare Vouchers which cover high school kids. It is amazing how under utilized this service is.
There is a special category in Preventive Dentistry called periodontal disease, which occurs due to a combination bad oral hygiene and a raft of chronic flesh destroying infections. The condition seems to be closely associated with Diabeties type 2. For people who are unfortunate enough to have this condition, their preventive visits need to be more frequent and are more expensive. Most adult teeth are lost due to this condition which is characterized by bad breath, painful bleeding gums and loose wobbly teeth. Usually by the time we see it, the treatment consists of regular and scrupulous scaling and cleaning. It is a condition that can be slowed down and made more comfortable, but never stopped. It is akin to having a chronic infection under your finger nails which eats away at the supporting structure until the nail is finally removed or torn off. And when I say chronic infection it usually goes acute at some time or other and there is no other treatment than to extract the infected (pus ridden) and painful culprits. And that is the sad fact of periodontal disease, it is a one way ticket to nowhere; so don't let it get that far!

Diagnostics: in other words X-rays. We take small high resolution films in the practise for about $40 per film on average. Mostly however we refer our X-Ray work down to Castlereagh Radiology which is just behind Coles supermarket in Katoomba; who have an OPG machine which takes full mouth X-Rays.
Castlereagh Radiology run and excellent service and take excellent OPG's and cephlametric Xrays, and what is more they are normally happy to bulk bill. God Bless them! Like the story of amalgam, there seems to be a great deal of misinformation as to the level of radiation which is received. An OPG will give about as much radiation as you would receive from 20 minutes in the sun. So if you are an out doors person, delete one hole from your next round of golf or something similar. The usefulness of the X-Ray is very great. Often, it simplifies an otherwise impossibly vexatious problem. Moreover, we can refer back to the X-Rays at a later date.
Thanks to Castlereagh Radiology we have no financial incentive to gather or not to gather the information that we might judge to be necessary.

Restorative dentistry: Froma Dental Clinic no longer uses amalgam restoratives because of the controversy about their mercury content. Besides that, the new generations of composite, compomer and glass ionomer restoratives are actually overall better than the amalgam. Generally speaking we are fortunate to have a choice of the best dental restoratives made in the world. Currently we use products made from such places as Germany, Japan and the United States, and believe it or not Liechtenstein which is the home of Ivoclar products.
There seems to be a lot of public concern about amalgam and many people have heard the word "composite resin". For those who are interested, amalgam is blamed for just about everything except global warming by some sections of the community. There is a grain of truth in that mercury is an ingredient in the mixing of amalgam. However there is a chemical reaction that takes place which converts a Silver /Tin alloy plus Mercury into a new and completely different alloy metal called an amalgam. This is a metallurgical fact. In the old amalgams that were around for the 80-90 odd years from the late 1800's until the 1980's, there was a phase of the amalgam called "gamma 2" which was mercury rich and tended to leach out, particularly in the first few days after the restoration was done. Long experience and literally billions of these restorations made people's lives better and NOT worse. Besides there were no alternatives that would economically stand up to the extra-ordinary stresses that are placed on a restorative and that includes the "composite resins" that were available until about the mid 1990"s . All that has changed now thanks to science and commercial competition.

The new generation of COMPOSITE resins are usually tough enough to take the extra- ordinary loads of occlusion (chewing) There are several sorts:

bullet

Those which are cured with a curing light but which need to be bonded in with a bonding agent; These products are very cosmetic at the front and reach their full strength almost immediately.At the back, we normally use a different type with a higher "filler" content. They are very tough, but not all that decay resistant. They nearly all need to be used in conjunction with a lining agent.

bullet

Those which are chemically cured which have a setting and curing time (like a pour of cement in this case setting about 5-10 minutes and curing time of up to 12 hours). These products go by the brand names Ketac Molar and Fuji 9. They have the wonderful advantage that they are very resistant to recurrent decay and can be placed very easily, also there is no worry about sections which may not have cured correctly. They also nearly always need to be used in conjuinction with a lining agent.

bullet

Glass ionomer is another chemical category of restorative which is VERY decay resistant but is not very strong. It is therefore used to advantage in areas of high decay and low load, such as down near the gum part of a deep filling. When used in conjunction with a posterior composite resin this is called a sandwich technique, The combination of glass ionomer and composite resin makes for a very effective restoration, combining decay resistance and occlusal toughness. In fact it gives the best result that is currently attainable with current dental resin technology.

The dentist will choose what is best for the particular case and situation. Restorations are usually done under very gentle and effective local anaesthesia so that we can sort out the problems properly without causing pain and trauma. An average cost for a restoration is currently about $200. Please note that these restorations nearly always need to be lined with an appropriate cement to prevent post operative problems. Amalgams were far more forgiving in this respect.

Crown and bridge work: the ingredients normally used are gold and porcelain and treatment is normally done over two visits The first visit is to prepare the teeth, and make a mould of the teeth involved; and the second visit is normally two weeks later to issue the crowns or bridges or veneers. Dr Maxwell has had extensive experience in this field. When a tooth is badly broken down, there comes a stage where you can no longer patch it with a simple restoration, and a restoration needs to be constructed in the laboratory.
Lava crowns: In the last few years there has been a wonderful breakthrough in crown aesthetics. These are fully porcelain crowns that are indistinguishable from natural teeth. The construction method is similar to porcelain fused to metal, excepty it is cad/cam computer technology. Thus the normal protocol is two visits with a differnet laboratory practise. The current cost is $1,500 per tooth.
This type of work is designed to last a very long time. The wonderful advantage of gold is that it doesn't break or corrode and with a glass ionomer cement it also isn't very prone to recurrent decay. These gold restorations (often faced with porcelain) can be joined together to make bridgework, and thereby replace missing teeth. They are great for restoring cosmetic disasters and function for the long term. The disadvantage is that for unblemished teeth, there may be a lot of cutting involved. The current cost per unit is about $1200, so don't be misled by thinking that one tooth is being replaced when a bridge needs 3 or 4 units: to achieve this the cost is on a per unit basis.
For damaged and deeply stained front teeth there is the comparatively new technology of porcelain veneers. The cosmetic improvement is usually is astonishing and the trauma is minimal. Basically a very thin replica of the tooth is made in porcelain. It looks like a piece of egg shell when it comes back from the laboratory. This is then bonded to the front of the tooth using special flowable composite resins and bonding agents. It gives a very long term and very cosmetic result. The current cost is currently about $1100 per tooth.

Oral surgery: this means the removal of teeth. This can be simple or difficult and is again always done under gentle and effective local anaesthesia. So getting a tooth removed or extracted doesn't hurt! However "pulling a tooth" is not how it is actually done because a tooth must be teased out with careful and controlled force. Actually most people don't want to know the details other than that it doesn't hurt; you feel some pushing and shoving and you usually hear a few crackles and crunches and then the process is over.
The average cost of a tooth extraction is about $280, however when a tooth breaks and the roots need to be chased out then the cost may increase dramatically. Suitable analgesics are always provided post operatively as part of the service. It is important to take the given pain relief as some analgesics such as aspirin are powerful anti clotting agents which promote relentless bleeding.

Endodontics: this means taking the nerve out of a tooth and finally root filling it. This is normally done over 3 visits and is an intricate and painstaking business. It doesn't hurt but some minor discomfort is involved.

There has been a great leap forward in technology, with the introduction of 'rotary endodontics'.  This technology has greatly improved the mechanical preparation of teeth, and therefore the chance of success. Basically drills and high technology NiTi files are used instead of little hand files. Nothing is perfect however.

The success of the procedure is directly proportional to how sick the tooth is to start off with; i.e. when you have an infected tooth at the back, then the chances of success gets lower and lower until it is hopeless. Teeth at the front normally are quite effectively treated by the method of root canal therapy. Basically, no root canal therapies are attempted in this practise unless we think the chances of success are quite high. We just don't like facing people who have been through the whole procedure and who are finally resolved to have their tooth extracted who say "well why didn't you pull the bloody thing out in the first place" most teeth can be replaced and some are just NOT worth the hassle.

A Root Canal Therapy normally costs in the vicinity of $550 for a front tooth to $1000 for a back tooth. This price usually does not include the restoration on top of the root filling and is charged separately.

Pulpotomy: in this practise we have had a wonderful success rate with an abbreviated form of the above treatment called a pulpotomy. Usually the client presents with a very deep and very painful decay in a rear tooth which is not infected. The large part of the nerve is removed and dressed and is left for about a week. The tooth is then restored with a permanent restorative. Thus these visits normally cost about $250 each. The relief and comfort later is usually dramatic, and our success rate has been enviable.

Dentures: we have had extensive experience in this area of dentistry.
Dr Maxwell particularly likes making cast metal partial dentures because of their comfort and reliability. To this extent he has used the same casting laboratory for over 30 years. Make no mistake, dentures are hard to make and need time to wear in. Lower full dentures are far and away the biggest problem when it comes to getting used to them, particularly if you have not had them before or if you have allowed your skeletal system to collapse because of old and ill fitting dentures. That is the wonderful advantage of cast metal partials and keeping your teeth, their fit and quality far exceeds anything that can be made in acrylic and so they fit like a dream.
The cost of a cast partial denture is currently around $1100 and a full set around $1100 for a top or lower and $2,000 for full on full.

Orthodontics: Dr Maxwell has had an interest in orthodontics from the very beginning, but found that orthodontics was very much a secret society of specialists. Many families were denied orthodontics because of the attitude and expense of the treatment regimes proposed and insisted upon.
Dr Maxwell has been doing orthodontic training since the end of 2001, and has now achieved a level of advancement with the International Association for Orthodontics thanks to the availability of outside specialists who have been running courses in orthodontics. Dr Maxwell has very much enjoyed the experience of learning new skills and even better ways of approaching old age problems. It turns out that there are newer and better ways of doing orthodontics.
There has in fact been a sea change of understanding in this field. The most amazing of which is the realization that airway problems and orthodontic problems are two sides of the same coin. To put it simply, the roof of the mouth is also the floor of the nose. Thus a constricted upper jaw and a constricted airway go together as part of the same problem. This not only leads to crowded teeth etc., but also to endless throat infections, tonsillitis, asthma, sleep breathing difficulties (apnea), middle ear infections and so on. Thus the natural co- professionals who should work with orthodontists are in fact ear nose and throat specialists and respiratory specialists.
The other sea change in orthodontics is the realization that jaws can be slowly expanded without extracting teeth to correct both the teeth crowding problems and to open up the airway. this leads to some exceptional improvements in breathing function! Ironically this can be easily achieved by early intervention (before 9 years old) with Australian invented (clever country) appliances which come off the shelf! Later, things can be improved and corrected with devices and methods which are infrequently seen, but which work into adulthood.
The irony is that the new paradigm in orthodontia is not only far more functional, but it leads to far more cosmetic results. Faces are fuller and turn out more attractive. Much research has been, and is being done in this area by a fantastic Australian orthodontist called Dr Dereck Mahoney and his world wide network of like minded orthodontists. This is actually a very exciting field and Dr Maxwell is very excited to have discovered it! Dr Dereck Mahoney's website can be viwed here.

Air abrasion dentistry: we don't believe in Air Abrasion. Basically, air abrasion is the drill you use when you don't need a drill. It is essentially a sandblaster with a tiny fraction of the power of a conventional drill, This air abrader seems to be used to turn blemishes which have never been considered clinically significant in the past into restorative work for some dentists. Refer to the phone book for people who carry out this type of work, we don't want to know about it.

Sedation: we offer what is safe and effective outside of a hospital setting. Dr Maxwell used to do full intravenous sedation and employ a visiting anaesthetist but discontinued this practise because of the stresses involved. If you need a general anaesthetic, then we will refer you. Make no mistake, deaths have occurred in the past and this is not an area to be messed about with; although we never had any such accidents. Some people may say "why don't you just put me to sleep or give me a wiff": The answer is that many people have died in this manner including Dr Maxwell's own grandmother who left 5 motherless children. No thanks!
The current cost of nitrous oxide sedation is $80 and we also often give suitable premedication tablet(s) if we think it is appropriate. In most cases this is a safe and effective answer for nervous patients or for unpleasant and prolonged procedures.

Referred pain: pain is a complex problem believe it or not. Often pain refers from the upper jaw to the lower jaw and from front to back. In the case of Temporo Mandibular Dysfunction it can also include the muscles of mastication as well as the neck and the joints. The whole mess is increased by stress and sleep deprivation.
After over 30 years, and much research on the subject, there is no easy fix. Diagnosis is by careful elimination. Like a multiple choice exam paper, what seems the most obvious answer is often the incorrect answer. The problem arises from the neural connections in the brain and nervous system, and is a very complex issue. Like I said, we have had a great deal of experience and we don't like being told how to do our job especially when we are trying to sort out something difficult. If you want to do that then just check the local phone book and leave us alone!

Infected teeth: been feeling off colour lately? Well recent research has been suggesting that infected teeth are far more toxic than they were previously thought to be.
Dr Maxwell is not at all surprised by this "new" suggestion. The inside of the tooth had a minute honeycomb structure which makes an ideal breeding ground for bacteria some of which are manufacturers of some of the most poisonous toxins known to science. Basically when a tooth dies from either trauma or decay, it acts as a miniature poisons factory which is directly connected to your body. Root canal therapy (RCT) may attempt to clean out the dead and infected tissue from the inside of the tooth, but it is never totally satisfactory or complete. Thus there develops a stalemate condition between the micro organisms and the bodies' immune system. This may be quite effective until something comes along to upset the status quo. This maybe an illness or a severe stress such as a divorce. Then the tooth blows up and gives you a very hard time just when you don't need it! Dr Maxwell will probably recommend the removal of the offending culprit.
Periodontal disease is similar in it's chronic toxicity, but arises from the death (necrosis) of the supporting structures on the outside of the tooth. The mechanics are different but the effect is the same. Not much has been thought about periodontal disease as a systemic problem until recently when it has been implicated in heart conditions. Why would this be such a surprise?

Temporo Mandibular Dysfunction, or TMJ: the jaw apparatus and the muscles that operate it are the most complicated bio mechanical mechanism in the body. They therefore have a very large part of the brain associated with them and the largest and fastest nerve fibres with which to service them. The TMJ basically consists of the temporo mandibula joints which is not only the only double joint in the body, it is also the only three dimensional joint in the body. It in fact hinges, slides and swings from both sides at the same time. There are four muscles on each side of the jaw which coordinate this action. They are the strongest muscles for their size in the body. The teeth act to support the joint and visa versa.
A dysfunction can be likened to the action of a door with a mechanical closer and a latch; which isn't closing straight. You know, where it drags across the floor and then you have to give it a heave and a shove to get the latch to snick shut. Such a door puts an undue load on the hinges (joints), closer (muscles) and the teeth (latch). Swinging a door correctly can take a carpenter a full day and is not a simple matter. This situation is much more difficult with this complex and often degenerated biological system.
The symptoms are painful and clicking joints, muscles which cramp and give awful headaches and ear aches, also teeth which wobble and ache and are very sensitive to everything such as hot and cold drinks. Most often it is greatly exacerbated by stress. Thus we often/ usually see it in people who are going through some kind of turmoil such as a divorce.
Some surgeons try to fiddle or even to replace the joints with artificial prosthetics which is an area where even the bravest angels fear to tread. Massage of the muscles and joints is very helpful especially with Voltarin or Goanna cream; but the only real and practical answer to chronic TMJ dysfunction is to balance and support the joints by means of the teeth. This may mean filling in gaps with partial dentures or building up worn down teeth, as well as selectively grinding other teeth. This is NOT an immediate and simple procedure. Often it is necessary to make a functional splint and then to carefully consider the treatment options so that the balance can be re- established and maintained. This is why long term ill fitting dentures are so unhelpful and so difficult to correct.

Autoclaving: an autoclave is a fancy pressure cooker used for sterilising instruments. Ours reaches a temperature of 135 C, at which temperature all known pathogens perish within 2 minutes. All instruments in this practise are either autoclaved or disposable.
To our knowledge we had never had an accident with cross infection. Dr Maxwell instituted a program of autoclaving in 1989 long before the wide spread problems that we now face in the age of HIV, Hepatitis B and Hepatitis C.

Intra oral camera: we have an Intra Oral Camera, but we hardly ever use it. It shows up and records pictures of jobs that either need doing or have been done. We do take extensive clinical photos for orthodontic purposes and are considering taking photos routinely for our clinical records. In the past, the vast majority of our clients have trusted our judgement and followed our recommendations.


To be clear...
bullet Children's Medicare is very welcome and we Bulk Bill. Just bring your Medicare Card. Most children of school age are eligible.
bulletA great smile and cosmetic result is everyone's dream, no one is more committed to great results than Dr Maxwell.
bulletQuality and gentle Dentistry has always been a consuming goal for Dr Maxwell. His long Service record and reputation for honest care is the best possible testimonial.
bulletWhitening: excellent results are normally obtained with professional cleaning combined with off the shelf whitening toothpaste. Dr Maxwell is dubious of many of the strong chemical bleaches that are commonly pushed in the industry.
bulletFamily Dentistry has always been a source of great satisfaction to Dr Maxwell, and many families have trusted him for generations due to his honesty, kindness and competence.
bulletPain Control; Dr Maxwell is a master of diagnosis and control of not only tooth pain, but also Joint pain, clicking joints and jaw dysfunction [TMD]. This usually manifests as ear aches and/or headaches. Diagnosis and treatment are not simple considerations. Many perceived migraines are actually TMD in origin.
bulletSnoring appliances and breathing appliances are not simple, but are provided by Dr Maxwell
bulletRoot Canal Therapy [RCT], why lose teeth unnecessarily? Dr Maxwell has probably saved thousands of teeth with successful RCT. This technology has undergone a sea change in the last decade. It's reputation of unpleasantness is a thing of the past.
bullet Orthodontics, braces and appliances for skeletal and dental problems make for very cosmetic results.
                   Orthopedics + orthodontics + retainers
                white braces and metal braces for optimal functional tooth movement.


Restoratives include;
bulletPorcelain crowns and veneers.
bulletPorcelain bridgework.
bulletWhite fillings in a variety of options.
bulletTooth build ups.
bulletTooth replacement.
bulletBridgework
bulletPartial dentures
bulletFull dentures
bulletDenture repairs and maintenance.
bulletBite support


Prevention and maintenance.
bulletGum treatments and prophylaxis + fluoride treatments.
bulletOral Surgery
bulletwisdom teeth and extractions are routine with minimum trauma.
bulletrepair of other trauma such as accident.
bulletMost X-rays are referred to Castlereagh Imaging for [Medicare] bulk billing of the imaging.
bulletReferral to Specialists if necessary.


 

We reserve the right to adjust our prices without notice. Any figures quoted on this website may be out of date.

Send mail to: fromadental@gmail.com  with questions or comments about this web site.
Copyright 2001 Froma Dental Clinic. See Contact Details page for full contact details.

designed by: Derek Bem 2001 derek@hermes.net.au