Treatment Risks and Patient Safety

All dental treatment carries risk. Before proceeding, a second opinion from another registered dental practitioner is recommended.

There may be alternative treatment options available. We encourage you to ask us questions and to seek clarification about anything you are unsure of.

Individual results vary. Any before-and-after images or patient examples shown on our website, social media or advertising represent individual outcomes only. They are not a guarantee or a prediction of results for anyone else. Suitability can only be assessed in person.

Composite bonding uses tooth-coloured resin shaped directly onto the tooth, then set and polished at the same appointment.

It often needs little or no enamel removed, though some cases do need preparation. Where enamel is removed, it does not grow back.

Some cases also need the gum line reshaped. That is a separate procedure with its own risks — see Gum Contouring: Risks, Information and Considerations.

Whether this suits you can only be worked out in person.

Usually one appointment to place them, and a second a few weeks later to review, adjust and give them a final polish. Larger cases can need more.

There is no recovery period in the surgical sense, and most people go back to work the same day.

Sensitivity is the main thing afterwards. It generally settles within two weeks. Tell us if it hasn't.

• Sensitivity. Sensitivity to hot and cold is common afterwards. It generally settles within two weeks. Occasionally it persists rather than settling.
• Staining and chipping. Composite chips and picks up stain more readily than porcelain, particularly with coffee, tea, red wine and smoking.
• Debonding. Bonding can come away and need repairing.
• Decay at the margins. Decay can develop where the composite meets the tooth.
• Colour and shape. We match as closely as we can, but the result may not be exactly what you pictured.
• Gum tenderness. Tenderness in the gums around new restorations is common.
• Recession. Gums can recede over time and expose the margin.
• Your bite. It can take time to get used to the new shape and to how your teeth meet. Some people need a couple of small adjustments.
• Speech. Minor speech adaptation is possible while you get used to the new shape. In most cases speech settles within a few days.
• Reactions. Reactions to anaesthetic or dental materials are uncommon. Tell us about any allergies and all medications before we start.

Composite has a shorter working life than porcelain and needs periodic polishing, repair or replacement.

The upside is that it can usually be repaired rather than replaced completely, and it often requires little or no removal of tooth structure to begin with.

Repairs, replacements and adjustments after the initial plan carry additional cost. We will tell you what that is before doing anything.

Porcelain veneers (see Porcelain Veneers: Risks, Information and Considerations), orthodontic treatment, whitening, crowns, or leaving things as they are.

Where teeth are substantially out of position, orthodontic treatment often gives a better result while removing far less tooth.

We would suggest something else where there is active gum disease or untreated decay, significant grinding, not enough enamel to bond to, or extensive existing restorations.

All dental treatment carries risk. Before proceeding, a second opinion from another registered dental practitioner is recommended.

There may be alternative treatment options available. We encourage you to ask us questions and to seek clarification about anything you are unsure of.

Individual results vary. Any before-and-after images or patient examples shown on our website, social media or advertising represent individual outcomes only. They are not a guarantee or a prediction of results for anyone else. Suitability can only be assessed in person.

An implant is a titanium post placed in your jawbone to support a crown, bridge or denture.

The surgery is done under local anaesthetic, with sedation available through a visiting provider. See Sedation and General Anaesthetic: Risks, Information and Considerations below.

The implant then needs months to integrate with the bone before the final restoration goes on.

Some cases need bone grafting, or a sinus lift first. Implants need sufficient bone, and bone is lost through gum disease, tooth loss, an enlarged sinus cavity and simply through ageing. Grafting adds material, usually granules of processed bone mineral, to build the site up. In the upper back jaw, a sinus lift raises the sinus membrane to create space for it. These are separate procedures with their own risks.

Usually 3 to 6 appointments spread over several months, and more if grafting is needed. Grafting usually adds several months, because the graft must integrate before an implant can go in.

Avoid strenuous activity for 24 to 48 hours, as this can restart bleeding and increase swelling. Sport and the gym are best left for up to 7 days. Cold, soft food to begin with.

Most people need a few days before they feel normal, and some need longer. If you are having sedation, arrange for someone to be with you afterwards.

After grafting, expect to adjust normal activities for the first few days, with full settling typically around two weeks. Dissolvable stitches often stay in place for two to three weeks.

Do not smoke until the site has healed. If you can’t stop, cutting down still helps, as smoking severely limits your body’s ability to heal here.

• Swelling. Usually does not peak until around day four, then starts to reduce.
• Bruising.
• Bleeding. Bleeding for 24 to 48 hours after surgery is not unusual.
• Pain. Can last a couple of weeks and is managed with prescribed medication.
• Tiredness. For the first day or so.
• Implant failure. The implant can fail to integrate, which means removing it and, in some cases, trying again after healing. This can happen for biological reasons that can’t be predicted, and you may not notice it yourself, which is why regular review matters.
• Peri-implantitis. An inflammatory condition around the implant that can cause bone loss and eventual failure.
• Infection.
• Damage to adjacent teeth or roots.
• Bone fracture.
• Sinus. In the upper jaw, entry into or puncture of the sinus.
• Nerve injury. In the lower jaw a nerve runs through the bone supplying sensation to the lip, chin and part of the tongue. Surgery near it, or swelling afterwards, can alter or remove that sensation. This is usually temporary. It can be prolonged, and occasionally it is permanent. The risk is closely tied to how close the implant sits to that nerve, which is why we plan from 3D imaging and leave a margin. It is the clearest example of why the planning stage is not a formality.
• A change to the plan on the day. We may plan to place a fixed temporary tooth or bridge immediately, but that depends on the implant being stable enough at the time of surgery. If it isn’t, we may recommend a removable temporary while the implant heals. That is a change from the original plan. It does not mean the implant or the treatment has failed.
• Grafting and sinus lift risks. Tearing of the sinus membrane, sinus infection or ongoing sinus discomfort, and the graft failing to integrate, which can delay or prevent implant placement and may mean a further procedure at additional cost. After a graft you may notice small granules in your mouth that look like grains of sand. That is expected, and it reduces over time.

Smoking materially increases the risk of implant failure, infection and peri-implantitis, and it interferes with healing. You may be asked to stop well before surgery, not just on the day.

Uncontrolled diabetes, some medications including bisphosphonates, previous radiotherapy to the jaw, grinding, and untreated gum disease all affect outcomes. Tell us about these before the plan is made, not after.

Implants don’t decay, but the gum and bone around them can become diseased. That is the main reason implants are lost long-term.

Patients who keep up their maintenance appointments have substantially less peri-implantitis than those who don’t. You will need reviews every four to six months and the same daily cleaning discipline as natural teeth. Both carry ongoing cost.

Restorations on implants also wear and will need repair or replacement over time.

Bridge, denture, orthodontic space closure, shorter or narrower implants where the anatomy allows, implants placed elsewhere, or leaving the space. If you leave it, we will tell you what we would expect to happen over time.

All dental treatment carries risk. Before proceeding, a second opinion from another registered dental practitioner is recommended.

There may be alternative treatment options available. We encourage you to ask us questions and to seek clarification about anything you are unsure of.

Individual results vary. Any before-and-after images or patient examples shown on our website, social media or advertising represent individual outcomes only. They are not a guarantee or a prediction of results for anyone else. Suitability can only be assessed in person.

Implants need sufficient bone to hold them. Bone is lost through gum disease, tooth loss, an enlarged sinus cavity and simply through ageing.

Bone grafting adds material, usually granules of processed bone mineral, to build the site up.

In the upper back jaw, a sinus lift raises the sinus membrane to create the space for that material.

These are separate procedures from the implant itself, with their own risks. They are done where there is not enough bone to place an implant — see Dental Implants: Risks, Information and Considerations.

Whether this suits you can only be worked out in person.

Grafting usually adds several months to implant treatment, because the graft must integrate before an implant can go in.

After grafting, expect to adjust normal activities for the first few days, with full settling typically around two weeks.

Dissolvable stitches often stay in place for two to three weeks.

Do not smoke until the site has healed. If you can’t stop, cutting down still helps, as smoking severely limits your body’s ability to heal here.

• Tearing of the sinus membrane. The membrane raised during a sinus lift can tear.
• Sinus infection or discomfort. Sinus infection, or ongoing sinus discomfort, can develop after surgery.
• The graft failing to integrate. The graft may not fuse with your existing bone. This can delay or prevent implant placement and may mean a further procedure at additional cost.
• Granules in the mouth. After a graft you may notice small granules that look like grains of sand. That is expected, and it reduces over time.

A graft that does not integrate may mean a further procedure, at additional cost, before an implant can be placed.

Once the graft has integrated and an implant is placed, the ongoing care is the implant's — see Dental Implants: Risks, Information and Considerations.

Shorter or narrower implants where the anatomy allows, or implants placed elsewhere in the jaw.

A bridge or a denture instead of an implant.

Or leaving the space, and we will tell you what we would expect to happen over time if you do.

All dental treatment carries risk. Before proceeding, a second opinion from another registered dental practitioner is recommended.

There may be alternative treatment options available. We encourage you to ask us questions and to seek clarification about anything you are unsure of.

Individual results vary. Any before-and-after images or patient examples shown on our website, social media or advertising represent individual outcomes only. They are not a guarantee or a prediction of results for anyone else. Suitability can only be assessed in person.

Whitening uses bleaching agents to lighten the natural tooth surface. Treatment is done in the chair, at home in custom trays, or both.

A check-up and clean comes first, because whitening works poorly over plaque and existing decay.

Usually one appointment, with take-home trays for maintenance. No recovery time and no time off.

For about three days afterwards, avoid things that stain: tea, coffee, red wine, curry, soy sauce, tomato and beetroot sauces. Using a straw or diluting them does not help.

• Sensitivity to cold. During and after treatment. It can be sharp and can come as short shooting sensations. It usually settles on its own within a few days and occasionally persists beyond that.
• Gum irritation. Where the gel contacts soft tissue.
• Tray irritation. Where take-home trays don’t fit well.
• Uneven lightening. Particularly where teeth already have patches or banding.
• Existing dental work will not change colour. Whitening does not lighten crowns, veneers, fillings or bonding. If you have restorations on teeth that show, they will stay the shade they are and may need replacing afterwards to match, at additional cost.
• Some staining may not respond. Discolouration from trauma, certain antibiotics or internal staining may respond poorly or not at all. We will tell you which you have before you proceed.

Results fade. Some people notice a change within three to six months. How fast depends on diet, smoking and how you look after your teeth.

Holding the result means periodic top-ups with your take-home trays, and replacement gel carries a cost.

Professional cleaning and stain removal, composite bonding, veneers, crowns, or leaving things as they are.

We would suggest something else where there is untreated decay or gum disease, exposed root surfaces, significant existing sensitivity, or extensive restorations on the front teeth.

Whitening is generally deferred during pregnancy and breastfeeding.

All dental treatment carries risk. Before proceeding, a second opinion from another registered dental practitioner is recommended.

There may be alternative treatment options available. We encourage you to ask us questions and to seek clarification about anything you are unsure of.

Individual results vary. Any before-and-after images or patient examples shown on our website, social media or advertising represent individual outcomes only. They are not a guarantee or a prediction of results for anyone else. Suitability can only be assessed in person.

Surgical removal of one or more wisdom teeth, usually under local anaesthetic in the chair.

We assess with an X-ray, and a 3D scan where the roots sit close to the nerve.

How involved it is depends almost entirely on the position of the tooth. One that has erupted normally can be straightforward. One that is impacted, lying sideways, or close to the nerve canal is more involved, may need the tooth sectioned to remove it, and sometimes needs referral to an oral and maxillofacial surgeon.

We will tell you which yours is before you book.

Usually one appointment, with a review afterwards. Stitches, where used, are often dissolvable and take one to two weeks to disappear.

Swelling typically peaks around day two to three and then reduces.

Most people need two to three days before returning to work, and longer for impacted lower teeth. Soft, cool food for several days.

Avoid smoking, drinking through a straw and vigorous rinsing for the first few days — all three can dislodge the clot. Avoid strenuous activity for 24 to 48 hours.

• Swelling and bruising.
• Jaw stiffness. Limited mouth opening for several days.
• Bleeding. For the first 24 hours.
• Pain. Managed with medication.
• Eating and cleaning. Both are harder around the site for a while.
• Dry socket. Loss of the blood clot from the socket, usually three to five days afterwards. It is painful, it is not dangerous, and it needs a dressing placed and changed until it settles. It is more likely if you smoke.
• Infection. This can need antibiotics.
• Damage to adjacent teeth or existing fillings.
• Jaw joint pain. From being held open.
• Sinus. In the upper jaw, an opening into the sinus that may need closing.
• Jaw fracture. Rare.
• Nerve injury. Lower wisdom teeth can sit close to the nerve supplying the lip, chin and tongue. Removal can alter or remove that sensation. It is usually temporary, it can be prolonged, and occasionally it is permanent. Where imaging shows the roots close to the nerve we will tell you, and in some cases we will recommend referral or leaving the tooth in place rather than accepting that risk.

Nothing ongoing once healed.

The socket takes several weeks to fill in and several months to remodel fully. A gap where a lower wisdom tooth was can trap food for a while.

Leaving them in place with monitoring, where they aren’t causing problems and are unlikely to.

Removing only the tooth causing trouble rather than all four.

Referral to an oral and maxillofacial surgeon where the case is complex, or where you would prefer a hospital setting.

All dental treatment carries risk. Before proceeding, a second opinion from another registered dental practitioner is recommended.

There may be alternative treatment options available. We encourage you to ask us questions and to seek clarification about anything you are unsure of.

Individual results vary. Any before-and-after images or patient examples shown on our website, social media or advertising represent individual outcomes only. They are not a guarantee or a prediction of results for anyone else. Suitability can only be assessed in person.

Injections of botulinum toxin or dermal filler.

In dentistry these have both clinical and cosmetic uses, and the distinction matters. It changes what is being treated, and why.

Clinical use. Botulinum toxin is used in dental practice to manage clenching and grinding, jaw muscle pain and related conditions, where the target is a functional problem.

Cosmetic use. The same substances used to change the appearance of facial lines or volume. This is a cosmetic procedure, not a treatment for a dental condition, and it is regulated as a higher-risk non-surgical cosmetic procedure.

Assessment comes first. Before anything is booked there is a consultation and assessment — including an assessment of whether the procedure is appropriate for you at all. Practitioners are required to assess for underlying conditions, including body dysmorphic disorder, that may make someone an unsuitable candidate, and to refer for independent assessment where there is any concern. We will tell you if we think this isn’t the right thing for you.

Under 18. Botulinum toxin and dermal filler are not provided for cosmetic purposes to anyone under the age of 18.

Consent and cooling off. Consent is taken in writing as well as verbally, covering risks, alternatives, costs and who is performing the procedure. Where a cooling-off period applies there is a minimum of seven days between consent and the procedure, and nothing is paid during it apart from the consultation fee.

A consultation, then the procedure at a later appointment, then a review.

Botulinum toxin takes several days to take effect, and up to two weeks to reach full effect.

No time off for most people. Avoid rubbing the area, strenuous exercise and lying flat for the rest of the day after botulinum toxin.

• Redness, swelling, bruising and tenderness at the injection sites. These settle within days.
• Headache after botulinum toxin. This settles within days.
• Asymmetry.
• Drooping of an eyelid or brow.
• Unintended muscle weakness nearby, affecting expression, and less commonly speech or swallowing.
• Lumps or nodules where filler has been placed.
• Infection.
• Allergic reaction.
• More or less effect than intended. Botulinum toxin cannot be reversed and must wear off.
• Vascular occlusion — rare and serious. Dermal filler can enter or compress a blood vessel. This can cut off blood supply to the tissue, causing skin damage and tissue death. Where vessels supplying the eye are involved, it can cause vision loss, including permanent blindness. It is a medical emergency requiring immediate treatment. It is rare. It is also the reason these procedures are classed as higher risk, and the reason the consent conversation is a long one.

Botulinum toxin wears off over months, and the effect reverses completely.

Dermal filler varies by product. Some can be dissolved, some persists longer than expected, and some migrates from where it was placed.

Maintaining a result means repeat treatment and repeat cost, indefinitely.

For clenching and grinding: a night guard or occlusal management and addressing contributing factors.

For a gum line concern, see gum contouring above.

For cosmetic concerns, doing nothing is a reasonable option.