All posts by Causeway Dental Practice

Chris Mulholland BDS (GDC 75428)

Chris qualified from Queen’s University Belfast in 1998. He has worked in the Oxfordshire area for 13 years. Chris recently returned to the Causeway Dental Practice after spending five years back in Ireland, where along with general family dental care he was also involved in practice inspections and improving the patient care and standards in over 20 practices.

Comparison of Filling Materials for the back teeth

If your dentist has advised you that you need to have fillings in your teeth, you have a choice as to the type of filling material that we use. The main choice is between amalgam (silver mercury) and composite (white) fillings. Please read the following so that you are able to make an informed decision about which type of filling you would prefer.

Amalgam fillings

Sometimes called “silver”, “mercury” or “metal” fillings. Amalgam is a mixture of silver, mercury, copper and some other trace metals

  • Available on the NHS for adults
  • Cheap
  • Very strong and usually long-lasting


  • Not attractive
  • Contain mercury
  • The tooth surrounding the filling may become brittle and break off
  • Not available for children or pregnant women

Summary: Amalgam fillings are most suitable for very deep cavities towards the back of the mouth where appearance is not important

Composite fillings

Sometimes called “white” or “tooth-coloured” fillings

  • Natural appearance
  • Bond strongly to the surrounding tooth to reduce the chance of tooth breakage
  • Do not contain metals
  • Often less tooth drilling needed


  • More costly and time consuming to place
  • Not possible to place where moisture control is difficult
  • Not so suitable for very deep cavities at the back of the mouth

Summary: Composite fillings are most suitable for shallow cavities or brittle teeth – especially where appearance is important or when you wish to avoid having metal in your mouth.

Many people are concerned about the effects of mercury on their health and wish to avoid the use of amalgam fillings. At this practice, we do not feel that there is a convincing case that amalgam should not be used, but would advise you to research the issue for yourself if you are concerned. There is much misinformation on the internet but there are reliable evidence based sites. (See the British Dental Association website:

Dental Erosion

Erosion is the loss of the tooth enamel caused by acid attack. Enamel is the hard, protective coating of the tooth, which covers the sensitive dentine underneath. When the enamel is worn away, the dentine underneath is exposed, which may lead to pain and sensitivity.

How do I know if I have dental erosion?
Erosion usually shows up as hollows in the teeth and a general wearing away of the tooth surface and the biting edges of the teeth. This can expose the dentine underneath, which is a darker, yellower, colour than the enamel. As the dentine is exposed, the teeth can become sensitive to hot, cold or sweet food and drinks. The front teeth may begin to look short and square, with sharp edges that break easily.

What causes dental erosion?
Every time acid touches the enamel on your teeth, the enamel becomes softer and loses some of its mineral content. The acid that causes the problems can come from food, drinks or from your stomach (in the case of vomiting or acid reflux).
Your saliva will slowly neutralise the acid in your mouth and restore it to its natural balance. However, if the acid attack happens often, the mouth does not have a chance to repair itself and tiny particles of enamel can be brushed away. Over time, the surfaces of the teeth become worn away.

Are there any medical problems, which can cause dental erosion?
There are many medical conditions, which can cause dental erosion. Acids produced by the stomach can come up into the mouth (gastro-oesophageal reflux). Patients suffering from Hiatus hernia and other oesophageal problems may also find that they suffer from dental erosion due to vomiting. Bulimia is a condition where patients make themselves sick in order to try to lose weight. Because there are high levels of acid in vomit, this can easily and quickly cause extensive damage to tooth enamel.

What problems can it lead to?
Dentine is the softer, sensitive internal part of the tooth. As this becomes exposed, it also becomes more liable to decay, leading to cavities and possible fillings. The dentine is also sensitive, which can cause pain when you have hot, cold or sweet foods and drinks.
The parts of the tooth suffering from erosion can also be unsightly. The dentine is darker and the teeth become shorter.

Can a change in my diet help prevent dental erosion?
Acidic foods and drinks such as fruit and fruit juices can be particularly harmful to teeth. Fruit juices and fruit contain natural acids, which are also harmful to teeth. Fizzy drinks are also a cause of enamel erosion. It is important to remember that even diet brands are still harmful. Even flavoured fizzy waters can have an effect if taken in large amounts, as they contain certain acids, which can harm teeth.

If you have acidic foods and drinks, you should have these at meal times only, not as snacks between meals.

Healthy foods such as fruit and fruit juices are not always the best options for teeth if you have them often. It is also recommended that you do not brush your teeth for at least one hour after eating or drinking anything acidic, so that your teeth can build up their mineral content again from your saliva.

Root Canal

Why Is Root Canal Treatment Needed?

Root Canal Treatment (also called Endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury. It is most often needed in teeth that already have very large or deep fillings, or in teeth that have recently had a filling due to deep dental caries (decay) in the tooth.

If the pulp becomes infected, the infection may spread through the root canal system of the tooth, which may eventually lead to an abscess. If Root Canal Treatment (RCT) is not carried out, the infection will spread and the tooth may need to be taken out.

We recently audited the root treatments we carry out at the Causeway revealing we have over a 90% success rate. The most common reason for these treatments to fail is because of tooth fracture so dentists usually recommend placing a crown after completion to protect the tooth.

Does Root Canal Treatment Hurt?

No. A local Anaesthetic is used and the whole procedure should feel no different to that of having an ordinary filling done, although the appointment will be longer than that for a normal filling. There will usually be some pain or discomfort for 3-4 days following the treatment. The tooth may feel slightly tender and “different” for a few months following treatment.

What Will My Tooth Look Like After Treatment?

In the past, a root filled tooth would often darken after treatment. However with modern techniques, this does not usually happen. If any discolouration should take place, there are several treatments available to restore the natural appearance.

What Does The Treatment Involve?

The aim of the treatment is to remove all infection from the root canal. The root is then cleaned and filled to prevent any further infection. RCT is a skilled and time-consuming procedure. Sometimes the treatment will involve two or more appointments. Firstly the infected pulp is removed. Any abscess, which may be present, can also be drained at this time. The root canal is then cleaned and shaped with specially machined rotary files ready for the permanent root-filling. The root canal is disinfected using strong antiseptics and once the dentist is confident that the infection is gone, the root filling can be placed into the canal. The root filling is a rubber material, which is compressed into the root to permanently seal it.

What If The Infection Comes Back?

Root canal treatment is usually very successful however, if there should be a recurrence of infection, the treatment can be repeated. If a tooth has a particularly difficult shape or a complication that prevents your dentist successfully treating the tooth, it is possible to refer to a specialist who can spend more time and use advanced techniques and instruments to treat your tooth. This can be a very expensive option. Sometimes an extraction of the tooth is the only option if treatment fails.

Victoria Shackleton BDS (GDC 251362)

Victoria Shackleton graduated from Cardiff University in 2014. Since then Victoria has worked in general practice, engaging in all aspects of general dentistry, and settled in the local area in 2016. Victoria has recently completed a further training course in restorative dentistry, an area she particularly enjoys. Victoria likes to help nervous patients and takes the time to get to know their treatment wishes.

Discoloured Teeth

What is Tooth Whitening?

There are many different ways to whiten teeth, some more effective than others. Teeth can appear yellow or discoloured due to surface staining from smoking, tea, coffee or red wine or internal darkening due to pigmentation of the underlying dentine.

How can surface staining be removed?

Air-polishing can be a more effective alternative to scaling and polishing.

How good are Over-the-counter products?

Any product bought over-the-counter in the UK and EU will be almost completely ineffective. This is due to an EU directive that limits the amount of peroxide, the active ingredient for tooth whitening products, to a level that is too low to have a noticeable effect. Some products available in the USA  contain more effective amounts of peroxide and will have a limited outcome.

Do Whitening Toothpastes work?

This is a misnomer. These toothpastes either contain abrasive particles, which can damage enamel (smoker’s toothpastes) or detergents that help to remove staining (e.g. Colgate Whitening toothpaste). The former should be avoided, but the detergent toothpastes are fine for removing superficial staining and keeping the teeth clean, they will however not whiten the teeth.

What is In-surgery Whitening ?

These techniques use high concentration peroxide gels to very effectively whiten the teeth. This technique can give spectacular instant results but is very expensive. As with any whitening procedure, the teeth will inevitably darken again with time but the effect can be topped up either by the same method or with home whitening. The teeth can be sensitive for a period of time afterwards.

What is Home Whitening?

This is the whitening technique we favour in our practice and our experience is backed up by studies in the dental academic literature. A stable gel called carbide peroxide is used in custom-made trays usually worn overnight. Your dentist will assess whether your teeth are suitable and monitor the progress over several visits.

Rachel Murray BDS MFGDP (GDC 76451)

Rachel Murray graduated from Newcastle upon Tyne in 1999 and went on to spend two further years in the dental hospital there gaining experience in secondary care such as oral surgery and children’s dentistry and prosthodontics as well as general practice.

Rachel gained a postgraduate qualification, the MFGDP(UK) in 2001 and started working at the Causeway Dental Practice becoming a partner in 2005. She enjoys all aspects of dentistry with a particular interest in oral surgery and treating children and nervous patients.

Laurie Powell BDS DPDS (GDC 69402)

Laurie Powell qualified from Sheffield University Dental School in 1993. He enjoys all aspects of general dentistry but particularly working with composite resin on front teeth and removable prosthetics. He has been working at the Causeway Dental Practice since 2000 and became a partner in 2005.

He is very active in postgraduate study and teaches part-time at Bristol University Dental School. He was awarded the Schottlander Prize for outstanding achievement in prosthetic dentistry whilst studying for his postgraduate diploma in 2013. He is the current chair of Oxfordshire Local Dental Committee.

He lives in Oxford with his wife and four children and  enjoys cycling and playing tennis.