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Understanding Oral Health

Background on the bigger ideas behind the treatment you may be offered. How a tooth is actually built, why some repairs last decades and others fail in a few years, and what really happens when a tooth is lost.

Why the background helps

Most dental decisions get made with the patient knowing very little about what is going on underneath, so the decision defaults to whatever the dentist suggests. Patients who understand the background make better long-term decisions. They can see why a slightly more expensive repair might save money over twenty years, or why replacing a missing tooth matters even when they can chew perfectly well without it.

Healthy natural tooth structure is the most durable thing you can have in your mouth, and nothing manufactured has ever matched it.

So we keep as much of your own structure as possible, repair what we must with materials that genuinely last, and replace what has been lost in ways that prevent further damage.

How teeth are actually built

A tooth is not a solid lump of bone. It is a layered structure, and each layer behaves differently.
A schematic cross-section — not to scale, but showing how the layers relate to one another.

Enamel

Cannot heal itself
The outer shell and the hardest substance in the human body, roughly as hard as mild steel. Unlike bone, enamel is laid down in childhood and then stays as it is for life — once damaged by decay, acid or grinding, the only options are to seal it, fill it or cover it. It has no nerve endings, which is why decay still inside it is usually painless and can progress unnoticed.

Dentine

Where sensitivity comes from
Sits beneath the enamel and is a living, softer, more elastic tissue that lets a tooth flex slightly under bite force. It contains microscopic channels to the centre of the tooth, so when exposed by worn enamel, receding gums or a failing filling, you feel it as sensitivity. Decay spreads through it much faster than enamel — a small surface hole often hides far larger damage underneath, which is why we take X-rays.

Pulp

Growth, not sensation
The outer shell and the hardest substance in the human body, roughly as hard as mild steel. Unlike bone, enamel is laid down in childhood and then stays as it is for life — once damaged by decay, acid or grinding, the only options are to seal it, fill it or cover it. It has no nerve endings, which is why decay still inside it is usually painless and can progress unnoticed.

Crown, Root & Ligament

Where adult tooth loss begins
The crown is the part you see above the gum; the root is anchored in the jawbone. Between them sits the periodontal ligament, holding the tooth in place while allowing tiny movements that absorb chewing force. Gum disease attacks this ligament — the tooth loosens, the surrounding bone erodes, and that is the main reason adults in the UK lose teeth.

What Makes a Dental Repair Last

Every dental repair has a lifespan. Some materials wear out in five to seven years, others last decades. So the real question is not only what fixes the tooth today, but how many times it will need re-treating across the rest of your life.
Each replacement is bigger than the last:
1

A filling fails

We remove it along with any decay underneath, which takes away more natural tooth than was there before.

2

Too little structure remains

After a few rounds of this, a crown becomes necessary to hold what's left together.

3

Sometimes root canal treatment

Further damage or decay can mean the nerve tissue needs treating too.

4

Eventually, extraction

A longer-lasting repair earlier breaks this cycle — and usually works out cheaper over a lifetime, even when it costs more upfront.

We no longer place new amalgam fillings — the old silver metal ones. They release small amounts of mercury vapour, they crack teeth over the years because they move differently to tooth structure, and they do not bond to the tooth. We can remove existing ones safely, though if yours are working, disturbing them is not always worth it.
Four things decide how long a repair survives:

Strength

Takes the force of chewing without crushing — several hundred pounds at the back of the mouth.

Wear rate

Wears at a rate close to enamel, so it doesn't grind down the tooth biting against it.

Expansion

Expands and contracts with hot and cold at a similar rate to the tooth, or the bond cracks under stress.

Stability

Stays chemically stable rather than corroding over time.

Cerec porcelain has roughly twice the compressive strength of natural enamel — and unusually for a repair material, it strengthens the remaining tooth once bonded in place.

Cerec is right for

Inlays, onlays, crowns and most everyday restorative work.

Not always the answer

Small fillings (simpler direct composite), heavy grinding, certain bridge/implant cases, and demanding cosmetic front-tooth work, which can suit a lab-made crown better.

What Happens when a tooth is lost

Every dental repair has a lifespan. Some materials wear out in five to seven years, others last decades. So the real question is not only what fixes the tooth today, but how many times it will need re-treating across the rest of your life.
1

Neighbouring teeth drift

They move towards the space and, over months and years, tilt into it — weakening their own stability and creating awkward shapes that are harder to keep clean.

2

The opposing tooth over-erupts

With nothing left to bite against, it slowly grows out of its socket into the space, upsetting the bite.

3

Supporting bone shrinks

Bone is maintained by the chewing forces passed through the teeth — once that stimulus goes, the body reabsorbs it.

4

Decay and gum disease often follow

Drifted teeth are harder to clean, which is why one lost tooth so frequently leads to more.

Replacement is not always possible later — the old silver metal ones. They release small amounts of mercury vapour, they crack teeth over the years because they move differently to tooth structure, and they do not bond to the tooth. We can remove existing ones safely, though if yours are working, disturbing them is not always worth it.It depends on having enough bone, healthy gums and neighbouring teeth in reasonable shape — once those are gone, even implants may not be an option. So where there is a real choice between treating a tooth and taking it out, treating it nearly always wins.
If a tooth is already gone, there are four routes:

Implant

Closest to natural
A titanium screw placed into the jawbone with a crown attached. Needs enough healthy bone, and needs maintaining — gum disease can attack an implant much as it attacks a tooth.

Bridge

10–15 yrs+
Uses the teeth either side of the gap as anchors, with a false tooth between them.

Dentures

Most affordable
Removable, and the most affordable option — though roughly one in four people cannot get on with them.

Doing nothing

Eyes open
Sometimes reasonable, particularly for a tooth right at the back — but only knowing what follows.
If a tooth does have to come out, socket preservation helps. A bone graft is placed into the empty socket at the same appointment, which slows bone loss and keeps the option of an implant open. It's also worth planning the replacement before the extraction, because an implant can sometimes go in the same day.

Frequently Asked Questions

Fluoride does not grow new enamel. It helps the enamel you already have to re-harden after acid has softened it. So very early decay can be reversed, but once a hole has formed, fluoride cannot fix it.

The living tissue inside has gone, but the surrounding bone, the ligament and the remaining tooth structure are all still alive and working. With a proper restoration on top, usually a crown, a root-treated tooth can last decades.

Independent studies suggest fifteen to twenty years or more for a properly placed Cerec inlay, onlay or crown, matching or exceeding gold. We have been using Cerec since 2007, among the first practices in the UK to do so.

Possibly not, but it depends on how much bone has been lost and the state of the rest of your mouth. Even where a straightforward implant is no longer possible, grafting can sometimes rebuild enough bone to place one.
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Tangmere Dental Care

  • Tangmere Dental Care, Chichester, West Sussex

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Tangmere Dental Care is a private dental practice combining advanced technology with prevention-led, holistic care. Our mission is to help patients across West Sussex maintain healthy, durable smiles for life.
Treatments
General Dentistry Cosmetic Dentistry Restorative Dentistry Orthodontics Emergency Dentistry
Opening Hours
Monday: 9am – 5pm
Tuesday: 9am – 7pm
Wednesday: 9am – 5pm
Thursday: 9am – 5pm
Friday: 9am – 4pm
Saturday: Mornings by arrangement
Sunday: Closed
Contact Details
Malcolm Rd, Tangmere, Chichester PO20 2HS, UK
01243 775545 smile@tangmeredental.co.uk
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