Tooth brushing

Daily brushing and cleaning between your teeth is important because it removes plaque. If the plaque isn’t removed, it continues to build up, feeding on the food debris left behind and causing tooth decay and gum disease.

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How can plaque cause decay?

When you eat food containing sugars and starches, the bacteria in plaque produce acids, which attack tooth enamel. The stickiness of the plaque keeps these acids in contact with teeth. After this happens many times, the tooth enamel can break down forming a hole or cavity.

How can plaque cause gum disease?

Plaque can harden into something called calculus another name for it is ‘tartar’. As calculus forms near the gum line, the plaque underneath releases poisons causing the gums to become irritated and inflamed. The gums begin to pull away from the teeth and the gaps become infected. If gum disease is not treated promptly, the bone supporting the teeth is destroyed and healthy teeth may be lost. Gum disease is the biggest cause of tooth loss in adults, which requires treatments such as dentures, bridges or implants.

How can I prevent gum disease?

It is important to remove plaque and food debris from around your teeth, as this will stop your gums from swelling and becoming infected. If you leave plaque on your teeth it can develop into tartar, which can only be removed by the dentist or hygienist. It is important to keep up your regular appointments so that your teeth can have a thorough cleaning if they need it.

How do I know if I have gum disease?

Gum disease (gingivitis) will show itself as red, swollen gums that bleed when brushed or flossed. Many people are alarmed when they notice this bleeding and will then brush more gently, if at all. It is important that you continue to clean regularly and firmly in order to fight the condition.

Which type of toothbrush should I use?

Your dentist or dental hygienist will be able to recommend a toothbrush to you. Adults should choose a small to medium size brush with soft to medium multi-tufted, round-ended nylon bristles or ‘filaments’. The head should be small enough to get into all parts of the mouth – especially the back of the mouth where cleaning can be difficult. Children need to use smaller brushes but with the same type of filaments.

You can now get more specialised toothbrushes. For instance, people with sensitive teeth can now use softer bristled brushes. There are also smaller headed toothbrushes for those people with crooked or irregular teeth. Some people find it difficult to hold a toothbrush because, for example, they have Parkinson’s disease or a physical disability. There are now toothbrushes, which have large handles and angled heads to make them easier to hold.

How often should I change my toothbrush?

Worn out toothbrushes cannot clean your teeth properly and may damage your gums. It is important to change your toothbrush every two to three months or sooner if the filaments become worn. When filaments become splayed, they do not clean properly.

How should I brush?

Brushing should remove plaque and food particles from the inner, outer and biting surfaces of your teeth. Here is one method of brushing that should remove plaque:

  1. Place the head of your toothbrush against your teeth and angled against the gum line. Move the brush in small circular movements, several times, on all the surfaces of each individual tooth.
  2. Brush the outer surfaces of each tooth, upper and lower, keeping the bristles angled against the gum line.
  3. Use the same method on the inside surfaces of all your teeth.
  4. Brush the chewing surfaces of the teeth.
  5. To clean the inside surfaces of the front teeth, tilt the brush vertically and make several small circular strokes with the front part of the brush.
  6. Brushing your tongue will help freshen your breath and will clean your mouth by removing bacteria.
How often should I brush my teeth?

Be sure to brush thoroughly with a toothpaste containing fluoride at least twice a day, more often if your dentist recommends it. If you keep getting discomfort or bleeding after brushing see your dentist.

Mothers, pregnancy, babies and toddlers

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Pregnancy

Pregnancy is an ideal time to get into good habits for the future, as you will need to set an example to your children as they grow up.

During pregnancy, the changes in the body’s hormones at this time can make gums more likely to bleed. However, it is still very important to continue cleaning your teeth as this removes plaque bacteria, which can cause gum disease.

Clean all the surfaces of the teeth and massage gently right up to the gums with a toothbrush with medium-soft bristles. To protect your teeth from tooth decay, brush morning and night using a toothpaste containing fluoride as this helps to keep teeth strong. Interdental (between the teeth) cleaning with dental floss is also very important.

Eating well has double dividends for an expectant mum! It contributes to your own health and to the development of your baby, including the teeth.

Try not to snack too often between meals and when you eat sweet foods, it is best to have them at meal times.

Your baby’s mouth

A baby’s teeth begin to form from about three months after conception. Therefore even before your baby’s teeth come through it is a good idea to clean the gums. This can be done with a piece of soft gauze wrapped around your finger.

Keep your own teeth very clean so you are less likely to pass bacteria on from your own mouth to your baby.

Once your baby’s mouth is big enough, use a small soft toothbrush to clean the teeth and gums, especially before bedtime. It is important to use a toothpaste containing fluoride right from the start, but only a small pea-sized amount as it may be swallowed.

Teething and chewing

During teething, which occurs any time between 6 and 14 months, the gums tend to look red and puffy and you may be able to feel the tip of a tooth coming through. Teething rings and hard food to gnaw on may soothe your baby’s gums. CALPOL® Infant Suspension may help relieve pain. CALGEL® Teething Gel can be used to relieve the pain of teething and soothe your baby’s sore gums.

Babies should be given ‘finger foods’, e.g. a small piece of cheese to chew on as soon as they can grasp them. This helps develop the muscles in the jaw and helps teeth grow straight. However, avoid small hard foods such as nuts, which can cause choking.

Use bottles with care

If teeth are bathed in sweet drinks or even milk formula for long periods of time, tooth decay can develop. This is because the mouth bacteria can use the sugars in those liquids to produce acid. These acids are what cause decay of the teeth. Never let your baby/child go to bed with a bottle containing milk formula, juice or sweet drinks.

When using feeding bottles, hold your baby until the feed is finished and never leave your baby propped up with a bottle, especially if they are likely to fall asleep. Apart from the risk of choking, during sleep sweet liquids may pool around the teeth and there is less saliva to wash away any acid produced.

If a feeding bottle is needed as a comforter between meals or at bedtime, fill it with water not squash, fruit juice, or milk formula. As soon as you can (from about six months) try to get your baby used to drinking from a cup. Once you start weaning, keep foods and drinks containing sugars to meal times.

Take your children along with you when you go to the dentist from about one year to make sure their teeth are developing properly and to get your child used to going to the dentist.

Looking after toddler’s teeth

It is important to take care of your child’s first teeth in the pre-school years, because they guide the permanent teeth into their proper spaces. Healthy, decay-free teeth also mean that the permanent teeth are less likely to decay. So, ensure that good habits are learned early on.

Strong teeth

The surface of teeth have a hard protective coating of enamel. Fluoride is a substance that helps to strengthen the enamel and makes teeth more resistant to acid attacks. In some areas, fluoride is present in the water supply but if not your dentist will tell you whether fluoride drops are needed.

Brushing up

Using a toothpaste containing fluoride is important. Get your child used to the feel of a small, soft toothbrush, preferably before the first teeth appear and then introduce the taste of toothpaste. A small, pea-sized amount is enough, as fluoride in large amounts can discolour the teeth. Encourage your child to spit out any excess rather than swallow it.

Gradually allow your child to try brushing by themselves. Always be there to supervise, and clean the teeth yourself, once a day, until the age of about six to seven years. Up to this age, children do not have the physical skills to do a thorough job.

Getting the balance

When food is eaten, bacteria in the mouth act on the hidden sugars present and on some starchy processed foods, to produce acid. Saliva helps to wash away the acid, but frequent snacking means that too much acid is produced for longer periods of time. This can eventually lead to decay. Growing, active children need to eat regularly and to include some high calorie foods. Foods containing sugar are a source of energy but take care not to give them too often. It is best to limit food and drinks containing sugars to meal times.

Drink up!

Drinks such as fruit juices, squashes and fizzy drinks should not be sipped over a long period of time or put in a feeding bottle. Consumed in this way they can promote tooth decay and the natural acidity of the drink can wear down the enamel directly (even if the drink is sugar-free).

It is best to encourage your child to drink from a cup as soon as possible, because there is less chance of liquid pooling around the teeth than with a bottle. Drinking through a straw is helpful.

Try to avoid giving drinks at bedtime, because saliva flow is reduced during sleep, so the acid has a better chance of attacking the teeth. Water is the best drink to give in between meals or at bedtime.

The dentist’s chair

Don’t wait until your child has painful teeth before going to the dentist. A check-up with your dentist is important to make sure that your child’s teeth are growing properly and enables the dentist to give you advice where necessary.

In summary
  • Teach your child to brush their teeth twice a day, as soon as possible, with a toothpaste containing fluoride. It is especially important to brush last thing at night.
  • Supervise brushing at least once a day yourself until your child is six to seven years old.
  • Eating too many snacks can contribute to tooth decay. Limit most food and drinks containing sugars to meal times. Avoid fruit juices and squashes at bedtime, give them water instead. Beware of juices that say ‘no added sugar’, these drinks still have sugars in them and are harmful to teeth. Also be aware of drinks such as Ribena and those made by Milupa which are sold as healthy drinks. These can contain large amounts of sugar.
  • Teach your baby to drink from a cup or beaker. Avoid prolonged bottle feeding with milk formulas, juices etc. NEVER use sweet drinks in a bottle as a comforter.

Growing up with healthy teeth

A lovely smile with sparkling teeth looks great and will give a child confidence. Fortunately you can keep them in tip-top condition, so get your children into the good habits outlined below and they will have healthy teeth for life.

This information is designed for parents and carers of children between 2 and 18 years old.

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The root of the problem

We all know about tooth decay. It happens when there are more acid attacks than the teeth can cope with. Acid attacks can result from plaque bacteria acting on the sugars in our diet.

Another less well-known problem is tooth erosion, where the surface enamel of the tooth is directly dissolved away by acids. These acids can come from our food and drink but also from stomach acids, for example when someone is sick. Erosion can make teeth more sensitive to hot and cold foods and needs treatment if severe.

Fortunately, the following simple measures will help to avoid both of these problems.

Brush twice a day under adult supervision

Teeth need brushing first thing in the morning and last thing at night with a toothpaste containing fluoride. Children under six years should practice cleaning their teeth themselves, but as they do not yet have the physical skills to do a thorough job, it is important that you brush their teeth gently at least once a day. Older children may still need a little encouragement and supervision.

Toothpaste matters

Fluoride works to strengthen enamel against acid attacks. Use a toothpaste with fluoride in it. After brushing, children should spit out but not rinse with water, as the fluoride left in the mouth will provide protection for a longer period.

Which toothbrush?

A child’s toothbrush needs to be fairly soft, and small enough to reach all the nooks and crannies of the mouth. It should be changed every three months or so as it becomes worn. We recommend the Oral-B range of toothbrushes.

What children eat

Any food containing sugar or acids will have an impact on your teeth. All sources of sugars including packet sugar, fruit sugars, honey and any food or drink containing them can feed the plaque bacteria which cause acid attacks. Similarly any food or drink containing acids can directly affect teeth. These include fruit juices, squashes, all types of fizzy drinks, fruit, yoghurt, pickles and even tomato sauce!

However, if all these foods and drinks were cut out from the diet, it would become unbalanced and less enjoyable. See below to find out how to include them sensibly so that the teeth can cope.

When children eat

Get into the habit of eating three regular meals and about two snacks a day. Take only water to bed.

Almost every time you eat, your teeth will be affected. The good news is that teeth can cope with acid attacks as long as they have time to recover and repair themselves between bouts of eating and drinking.

Eating five times a day is about right, for example three meals and two snacks. Try to keep sweet food, soft drinks and fruit juices limited to main meal times. If your child likes frequent drinks, give milk or water at other times. It is also important that children do not hold drinks in their mouths or swish them through their teeth.

Bedtime

During sleep, teeth are especially vulnerable to acid attacks as saliva flow, which repairs tooth damage, slows down. This means any sugar or acid in the mouth will do more harm. So make sure that your children have cleaned their teeth before bed and they do not have any more food or drink apart from water.

Bad breath in children

If a child has bad breath it is usually caused by one of the following factors:

  • Teeth that are not cleaned regularly and properly
  • Tooth decay as well as infected gums and teeth
  • Blocked airways because of e.g. infected tonsils and adenoids, blocked noses due to colds or hay fever problems
  • Drinking milk last thing at night after brushing their teeth
Top tips for great teeth
  • Brush every day first thing in the morning and last thing at night with toothpaste containing fluoride
  • Teeth that are brushed well can cope with about five separate eating and drinking occasions a day, for example three meals and two snacks, and still be healthy. Eat or drink all in one go rather than nibble or sipping.
  • No food in bed and only water to drink
Safe snacks and drinks for teeth

This is not a comprehensive list, but rather a rough guide to show that there is a wide selection of drinks and foods on supermarket shelves that will not harm teeth in between meals. By reading food labels and using a little imagination you will no doubt find many more. Look at labels carefully and beware of the following: sucrose, fructose, dextrose, glucose syrup, honey, corn soup, invert sugar syrup, molasses, treacle and maltose. These are all sugary types of products and can damage the teeth. Brown sugar is just as bad as white.

Drinks

Water, tea and coffee without sugar. Regarding milk, children under five should be given whole milk not skimmed or semi-skimmed, unless directed differently by your doctor.

The following drinks are all sugar free and will not cause decay but it should be remembered that as with any fruit drinks, they are acidic and if drunk to excess, can dissolve the surface of teeth:

  • Kia-ora whole orange drink, Robinson’s Special R fruit juice drinks
  • Supermarket own brands (check labels)
  • Diet lemonade, diet Coke, Diet Pepsi, Diet 7Up (very acidic on teeth, take care)

The sweetening agent in these will be one of the artificial sweeteners such as aspartame, saccharin or Acesulfame-K.

Snacks
  • Toast, rolls, sandwiches, pita bread, French bread, cheese scones, Cornish wafers (Jacob’s, Sainsbury’s), Twiglets, Crunchy Sticks (Tesco), Wotsits, Hula Hoops, breadsticks
  • Crisps: various assorted, check labels if unsure. Low fat and low salt crisps are also available. Crisp rolls (in pre-packaged bags from supermarkets)
Fillings and toppings for sandwiches and rolls
  • Meat and fish spreads, cold meat, eggs, tinned fish, Marmite (not suitable for children under six months of age)
  • Bovril (not suitable for children under six months of age)
  • Peanut butter: sugar free (crunchy or smooth)
  • Cheese: low fat if available. Kraft Dairylea cheese slices, Sun-Pat medium cheddar spread, Laughing Cow low fat dairy spread.
Raw fruit and vegetables

Fruit is sweet and, not surprisingly, contains sugars. Although not sugar free, it is a good alternative to biscuits or cakes, which are high in sugar.

  • Apples, oranges, pears, bananas, etc.
  • Carrots, celery, radish, etc.
Nuts and dried fruit

Nuts are not suitable for children under five. Dried fruit (e.g. raisins, sultanas) are high in sugar and therefore not a safe snack. Muesli bars, though often sold as healthy snacks, are often high in dried fruits, honey, glucose, syrup and sugar and are therefore potentially harmful to teeth.

Yogurts
  • Danone Shape, Marks & Spencer Lite, Tesco Healthy Eating (very low fat), Boots Shapers

The sweetening agent in these products will be aspartame or aspartame and Acesulfame-K.

Sweets
  • Chewing gum (various sugar free), Trebor Extra Cool sugar free, sugar free Polo Mints
Alternative sweeteners

In tablet and granule form

  • Aspartame: (NutraSweet) Canderel granules, Canderel tablets, Boots Shapers granulated sweetener, Boots Shapers tablets
  • Aspartame and Acesulfame-K: Hermesetas tablets
  • Aspartame and saccharin: Sweetex granulated

Bad breath (halitosis)

Bad breath is a common problem which often results from the activity of bacteria in the mouth. Although there is no way of knowing for sure, most adults probably suffer from bad breath occasionally, with perhaps a quarter suffering on a regular basis. Bad breath originates in the mouth about 85-90% of the time and more rarely from the gastrointestinal tract. The dentist should be the first person that a patient worried about bad breath should consult.

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Causes of bad breath

Most cases of bad breath appear to be caused by the breakdown of proteins by a variety of different micro organisms (bacteria) that live in the mouth. Several of the breakdown products are foul smelling gases (sulphides).

In people with healthy teeth and gums, the odour usually comes from the far back region of the tongue and grows stronger when the patient starts talking.

Saliva has a very important function in the control of bad breath. Therefore, a time of fasting, dieting, sleeping, prolonged speaking, exercise and taking some medication, can cause dryness in the mouth and therefore an increase in odours which cause bad breath.

Furthermore, plaque around the necks of teeth and beneath the gums will also give rise to malodour. Denture wearers who do not regularly clean their dentures may also get bad breath.

Other patients who have chronic sinusitis or chronic nasal problems may develop a post nasal drip which emanates from the back of the nose and drops onto the back of the tongue, giving foul tastes and a foul odour.

The main types of bad breath normally encountered are

  1. Tongue odour
  2. Gum odour (from plaque)
  3. Denture odour
  4. Smoker’s breath
  5. Nasal odour

Some other common oral sites of malodour are

  • Between the teeth
  • Between faulty fillings and restorations
  • In the mouth where there is food impaction and abscesses

Other rarer sources of bad breath are

  • Diabetes
  • Bronchial and lung infections
  • Kidney failure
  • Various cancers
  • Biochemical disorders

Other obvious causes are foods such as garlic and onions. Some of the odours here are retained in the mouth, while some are carried in the bloodstream for long periods and released into the breath and through the skin.

Common experience teaches us that people are frequently unaware of their own bad breath. Some people have a terrible odour without having the faintest inkling. Others do not have bad breath, but think they do, and this can lead to excessive worry and exaggerated fear over this problem.

Treatment

In most cases bad breath can be treated by proper dental care, deep tongue cleaning and, if necessary, rinsing with an effective mouthwash. Dentures can be cleaned and patients are instructed to leave them overnight in an antiseptic solution.

Patients should use dental tape for removing plaque between teeth as well as the correct toothbrush and correct brushing technique. These can be discussed with your dentist.

Gentle but effective deep tongue cleaning should be an important daily routine. A variety of tongue scrapers have been produced in recent years. Alternatively, cleaning the tongue can also be performed by brushing with a toothbrush, without using toothpaste.

In order to prevent tongue odour the tongue should be brushed in a gentle but thorough manner, keeping in mind that the back area is the least accessible, yet smells the worst.

Since bad breath is worse when the mouth dries out (e.g. at night or while fasting), maintain a good water balance. Chewing gum may also be helpful in reducing bad breath for a while during the daytime, although this should be restricted to only a few minutes at a time.

Many people continue to have bad breath even after trying their best to clean their mouth. In such cases rinsing and gargling with a strong mouthwash may be thought necessary (such as Corsodyl mouthwashes). However, many mouthwashes contain components which may have a non-beneficial affect on oral tissues. It is very important that you discuss this with your dentist.

The best time to use a mouthwash is probably before bedtime since

  1. The residue in the mouth rinse may remain in the mouth for a long period of time
  2. Bacterial activity increases at night when saliva flow is negligible
How to combat bad breath
  • Visit your dentist regularly.
  • Have your teeth de-scaled and polished periodically by your dentist.
  • Floss between your teeth, as recommended by your dentist.
  • Brush your teeth and gums properly.
  • Ask your dentist to recommend a toothbrush or scraper for your tongue and clean your tongue all the way to the back gently but thoroughly.
  • Drink plenty of fluids.
  • Chew sugar-free gum for a minute or two at a time, especially if your mouth feels dry.
  • Chewing parsley, mint, cloves or fennel seeds may also help.
  • Clean your mouth after eating or drinking milk products, fish and meat.
  • Unless your dentist advises otherwise, soak dentures overnight in an antiseptic solution.
  • Ask close friends or family members to advise you if you have bad breath.
  • Ask your dentist to recommend a mouthwash which has been shown to be clinically effective in fighting bad breath and use it most effectively, i.e. before sleeping.
Do nots
  • Don’t let concern about having bad breath ruin your life. Don’t be passive.
  • Don’t be depressed, get help.
  • Don’t drink too much coffee, it may make the situation worse.
  • Don’t forget to clean behind the back teeth in each row.
  • Don’t brush your tongue with regular toothpaste. It is better to dip your toothbrush in mouthwash for tongue cleaning.
  • Don’t run to your gastroenterologist (someone who specialises in treating digestive disorders) with concerns about bad breath. It usually comes from the mouth and almost never from the stomach.
  • Don’t give mouthwash to very young children as they can swallow it.
  • Don’t clean your tongue so hard that it hurts.
  • Don’t rely on mouthwash alone. Practice complete oral hygiene, i.e. brushing, flossing and tongue cleaning.

Periodontal disease

Periodontal disease affects four out of every five people and, in adults, is the major cause of lost teeth. Periodontal disease (gum disease) is an inflammation or infection which attacks the gums and bones which hold your teeth in place.

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The signs of periodontal disease

The key indicators of periodontal disease are

  • Red and puffy gums
  • Bleeding gums
  • Receding gums
  • Persistent bad breath
  • Spaces between teeth
  • Loose teeth
  • Vague aching, itching and other discomfort

However, you may have gum disease and not have any of these signs.

Periodontal disease is almost always painless in the early stages and therefore you may not notice the signs soon enough. The good news is that most periodontal diseases can be prevented or, if they have already started, can be treated. This is particularly true if they are recognised in the early stages. Treating and preventing gum disease brings great health benefits. By retaining your natural teeth, you can chew more comfortably and enjoy better digestion. You can have a healthy smile, a natural asset to your appearance. You can save money and avoid discomfort by preventing future dental problems. For looking and feeling good, nothing works better than your natural teeth.

Causes of gum disease

The main cause of gum disease is bacterial plaque, a sticky, colourless film which constantly forms on your teeth. Plaque is a growing colony of living bacteria. It produces toxins (poisons), which irritate and inflame the gums.

The inflammation is the start of periodontal disease. If plaque is not completely removed by brushing and flossing every day, it leads to the formation of calculus (tartar) with a pitted, rough surface. Calculus greatly complicates the problems of preventing periodontal disease. Each day, new plaque embeds itself in the rough surface of calculus in such a way that no brushing or flossing can ever remove it. Thus, all calculus will have plaque embedded on its surface, which is capable of starting or worsening periodontal disease. However, it is the hidden calculus under the gums that does the most harm.

The toxins produced by the bacteria of the plaque not only inflame the gums, but also cause destruction of the bone just beneath. As the gum inflammation continues, the bone destruction continues too, usually without any symptoms in the earlier stages of the disease. The toxins destroy supporting tissues around the teeth, forming pockets which fill with more plaque.

Many thousands of fibres, called periodontal fibres, go from their origins in the root of the teeth into the gums or into the surrounding bone. The great mass of fibres that go from the roots into the bone attach the teeth to the bone. The gums are a protective covering over the bone. In a healthy mouth, the gums hug the teeth like a tight collar to prevent bacteria and food debris from invading the bone. Simply put, the gums protect the bone, and the bone holds the teeth. The fibres going from the root into the gum pull the gum tightly against the crown. This area where the gum lies against the crown is called the gum crevice. The normal crevice measures one to three millimetres deep.

When sufficient bone has been lost, the crevice gets deeper and is then called a gum pocket. The tooth loosens until it either falls out or must be removed.

A few people are resistant to gum disease, while others are highly susceptible. However, most people have a varying resistance to the disease at different times in their lives. For example, a person’s resistance may be normal for years, then for no apparent reason temporarily diminish. Periodontal disease that was under control flares up. No one knows why resistance varies from person to person, or why it varies in the same person at different times.

Diagnosis of gum disease

Your dentist will note the colour of your gums, look for swollen gums and check for loose teeth. If the periodontal problem is advanced, your dentist may refer you to a periodontist, a specialist in the care of gums and the supporting bone. Compared to a general dentist, the periodontist has additional years of schooling and experience, which permit him or her to use special techniques in treating more difficult or advanced periodontal problems.

Gum disease in summary

Plaque has caused inflammation: the gums are red and swollen. Inflammation damages the periodontal fibres which hold the gums tight against the tooth. This allows plaque to enter deeper into the gum crevice where it can do even more damage. If plaque irritation persists, it causes the attachment of the gum to move down the root. This ‘creeping’ of the gum attachment makes the crevice deeper.

A crevice more than 3mm deep is considered a gum pocket. Gum pockets are bad because they are very hard to clean. They are impossible to keep clean once calculus has formed within them. The toxins from the plaque also now begin to destroy some adjacent bone in this pocket

Continuing plaque irritation causes the loss of more bone support, and the gum attachment creeps a little further down the root. If a pocket gets very deep, pus forms in the pocket and escapes into the mouth, causing bad breath. When more bone support is lost, the teeth become loose. If no treatment is introduced, not enough bone will remain and the inflammation will surround the entire root end. The tooth will become very loose and if the dentist doesn’t remove it, will eventually fall out.

Treatment

In the early stages of gum disease, treatment usually involves scaling and root planing. This means removing plaque and calculus in the gum pockets around the tooth and smoothing the root surfaces. It rids the mouth of harmful bacteria and irritants which cause inflammation. Usually this treatment allows the gums to adapt themselves back to the tooth or shrink enough to eliminate the pocket. In most cases of early gum disease, scaling, root planing and proper daily cleaning are sufficient to ensure satisfactory results.

More advanced cases of gum disease may require surgical treatment. The purpose of this treatment is to remove calculus from deep pockets around the teeth, shrink the pockets, smooth root surfaces and arrange gum tissue into a shape which will be easier to keep clean.

In advanced cases involving loose teeth, the dentist may need to treat the way your teeth fit together when you bite. Teeth may be splinted together to reduce movement and increase comfort and functionality. Other possibilities include a bite adjustment, or the placement of a plastic bite appliance.

The periodontist is trained to deal with many varieties of gum disease. Whatever your treatment plan entails, the periodontist’s aim is to establish oral health and then to help you maintain it. This is maintenance therapy. The watchword of maintenance therapy is prevention. Its aim is to protect your periodontal health. Through proper home care and maintenance therapy visits, you have an excellent chance of keeping your teeth for a lifetime.

Maintenance visits

Treating and preventing gum disease brings greater health benefits. By retaining your natural teeth, you can chew more comfortably, enjoy better digestion, have a healthy smile and feel more confident about your oral appearance. You can save money and avoid discomfort by preventing future dental problems.

For looking good and feeling good, nothing works better than your natural teeth.

How to brush your teeth

Begin with the right equipment - a soft bristled toothbrush which allows you to reach every tooth. If the bristles on your toothbrush are bent or frayed, buy a new one. A worn out brush won’t clean your teeth properly.

  • To clean the outside surfaces of all your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush back and forth several times using small, circular strokes. Apply light pressure to get the bristles between the teeth, but do not use so much pressure that you feel discomfort.
  • After cleaning the outside surfaces of all your teeth, use the same method on the inside of the back teeth. Move the brush in small circles, keeping it angled against the gum line.
  • To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several back and forth strokes over each tooth and its surrounding gum tissue.
  • To clean the biting surfaces of your teeth, use small, circular strokes.
  • Since the toothbrush can clean only one or two teeth at a time, change the position of the brush as often as necessary to reach and clean all tooth surfaces. Watch yourself in the mirror to make sure you cover each surface.
  • After brushing, rinse vigorously to remove loosened plaque. If you have any discomfort while brushing or have questions about how to brush properly, be sure to talk to your dentist or periodontist.
  • Use a solo brush (a single tuft toothbrush) now to ensure that all plaque is removed. Follow the contours of the junctions between the teeth and gums.
  • Use a disclosing tablet (these contain harmless red vegetable dye that reveals plaque left on your teeth by turning it red temporarily) and distribute evenly throughout the mouth. Rinse and examine your teeth carefully using a mouth mirror to find out where stained bacteria are located.
  • Record and chart how many stained spots you find. This will provide you with the possibility of comparison later.
  • If any stained spots remain on your teeth, your cleaning is inefficient and you must re-use the solo brush to try and brush the stain away.
Interdental cleaning

Periodontal disease occurs primarily between the teeth where a toothbrush cannot reach. These surfaces need to be cleaned thoroughly as well, using dental floss, interdental brushes (designed for cleaning between the teeth) or dental sticks (thin wood or plastic single-use sticks). These techniques require skill which takes time and practice.

Flossing

  1. Begin with a piece of waxed floss about 18 inches long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the opposite hand.
  2. To clean the upper teeth, hold the floss firmly between the thumb and the forefinger of each hand with the fingers no more than half an inch apart.
  3. Gently insert the floss between the teeth, using a sawing motion. Do not force or snap it into place. Guide the floss to the gum line. Curve the floss into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel resistance.
  4. Using both hands, move the floss up and down on the side of one tooth. Repeat this technique on each side of all the upper teeth. As the floss becomes frayed or soiled, a turn from one middle finger to the other will bring up a fresh section.
  5. To clean between the bottom teeth, you will find it easier to guide the floss using the forefingers of both hands. Don’t forget the back side of the last tooth on both sides, upper and lower.
  6. Rinse vigorously with water after flossing to remove plaque and food particles. For the first week of flossing, your gums may be sore and bleed. As you daily remove the plaque, your gums will heal and the bleeding will stop. If the bleeding does not stop within a few days, talk to your dentist.
Interdental brushes

The correct use of interdental brushes will be shown to you for use between the teeth, especially the back teeth where the spaces in between the teeth allow the use of these brushes.

Press the interdental brush head into the space between the teeth. Move the brush with small movements to and fro so that it is scrubbing the tooth surfaces and thereby cleaning both teeth.

Wisdom tooth removal

Your wisdom teeth are the last teeth to emerge from your gums. This usually happens during the late teens, or ‘the age of wisdom’, which gives them their name. Often there is not enough room for them in the jaw; they may become trapped (or impacted) in the jaw bone and gums, and remain fully or partially buried. In this case, they may need to be removed.

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Why do we have wisdom teeth?

Adults can have up to 32 teeth. The wisdom teeth are the last to come through, right at the back. They usually appear when you are between 17 and 25 years old, although sometimes they appear many years later.

Nowadays people often have jaws that are too small for all 32 teeth – 28 are often the most we have room for. So if all the other teeth are present and healthy there may not be enough space for the wisdom tooth to come through properly. If so, it will get stuck against the tooth in front of it. The wisdom tooth will be at an angle, and will be described by the dentist as ‘impacted’.

Why do we remove impacted wisdom teeth?

The gum around an impacted tooth may become infected. This may cause severe pain, swelling, jaw stiffness or general illness. An impacted tooth may decay even though it is not visible in the mouth. This may damage adjacent, healthy, teeth or push them out of position.

You may have had trouble already and been advised to have your wisdom teeth removed. If you wait until they cause trouble, you may have to be treated for pain and infection before they can be removed. Problems with wisdom teeth tend to get worse as you get older. Removing them is easier when you are young. Healing will also be quicker.

When we remove an impacted wisdom tooth we usually remove the opposing wisdom tooth if it is felt by your dentist to be prudent to avoid future problems. Very deeply buried impacted wisdom teeth are not usually removed unless there is a good reason. Depending on the position and likelihood of further problems we may remove all four wisdom teeth.

At our practice we offer to remove impacted wisdom teeth under intravenous sedation and local anaesthetic injection. This involves administering a strong sedative drug through a vein in your arm. Once you are sedated we freeze/numb the teeth to be extracted.

What should you expect after a removal of an impacted wisdom tooth?

The removal of an impacted wisdom tooth is not a simple extraction. It is a small operation. Some bone may need to be removed to allow removal of the tooth. Stitches are often needed too. As with any operation you can expect some discomfort afterwards. Your face will probably be swollen for a few days. You may have stiffness in your jaw joints - this is the body’s way of protecting the healing gum against too much movement. It may make eating and swallowing difficult for a while.

Sometimes bleeding may occur afterwards We try our best to ensure that this has stopped before you go home. You may also develop some bruising on your face. This is nothing to be concerned about. It usually disappears in a week to ten days.

The amount and duration of discomfort varies from person to person.

If your teeth are removed by a local anaesthetic injection you should expect your mouth to be uncomfortable for at least a day or two. If you have your teeth removed in hospital, there will be the added effect of a general anaesthetic. You will certainly need a few days to rest and recover.

Sometimes healing takes a little longer. Someone is always available to help if needed.

Are there any risks?

There are always some risks involved in surgery. Removal of wisdom teeth is no exception.

The removal of a wisdom tooth leaves a socket in the bone to heal. Sometimes healing may be delayed if the blood clot in the socket is dislodged or washed away. This may prolong your pain. It can be treated to make it more comfortable, so please contact us for help.

There are two nerves very close to your lower wisdom teeth, which supply the feeling to your teeth, lower lip and side of your tongue. The greatest care is taken to protect these nerves when your teeth are removed, but sometimes they are unavoidably injured, causing temporary tingling or numbness. It is rare for this to last more than a week at most. It does not alter your appearance. In an extremely small number of patients, some or all of the numbness may remain permanently.

Once wisdom teeth have been removed, they do not grow again.

If you have any queries or worries about your wisdom teeth, or if anything is not clear, please contact us.

Implants

A dental implant is a titanium metal rod which is placed into the jawbone. It is used to support one or more false teeth. In practice, both the false teeth and their supporting rod are known as ‘implants’.

If you are considering dental implants, more advice is available from the Association of Dental Implantology UK. The Broadway Dental Practice is a member of the ADI and we adhere to its charter. We use Bicon implants.

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Are implants safe? How long will they last?

Implants are a well-established, tried-and-tested treatment. Ninety per cent of modern implants last for at least 15 years.

I have some of my own teeth. Can I still have implants?

Yes. You can have any number of teeth replaced with implants – from one single tooth to a complete set.

Can implants always be used to replace missing teeth?

It depends on the state of the bone in your jaw. Your dentist will arrange for a number of special tests to assess the amount of bone still there. If there is not enough, or if it isn’t healthy enough, it may not be possible to place implants without grafting bone into the area first.

Do implants hurt?

Placing the implants requires a small operation. This can be carried out under local anaesthetic with sedation or with a general anaesthetic. You will not feel any pain at the time, but you may feel some discomfort during the week following the surgery. This is usually due to having stitches in place, and the normal healing process.

Can I have the new teeth straight away?

No. The implants need to bond (integrate) with the bone after they have been placed. This takes at least three months in the lower jaw and six months in the upper jaw. If you are having one, two or three teeth replaced, you will have a temporary restoration in the meantime. If you have complete dentures, then you can wear them throughout the healing period once they have been adjusted after the surgery.

How long does treatment take?

It takes about 12 months from the initial assessment to the time when the artificial teeth or dentures are finally attached to the implants. However, if only the lower jaw is involved then it may only take around five months. A lot depends on how complicated your treatment is. Your dentist will be able to give you a timetable once the surgery has been done.

Are the teeth difficult to clean?

Cleaning around the teeth attached to the implants is no more difficult than cleaning natural teeth. However, there may be areas that give you problems and you’ll be shown methods to help.

If I had gum disease when I had my own teeth, will I get it with the teeth attached to the implants?

Yes, if you don’t care for them well enough. If you keep them clean, and don’t smoke, then you should not have any problems.

Can I take the teeth out if they are fixed to implants?

Most artificial teeth attached to implants can only be placed and removed by the dentist. However, if you have complete dentures fixed to the implants by bars, then you’ll be able to take them out for cleaning.

Do the implants show?

Your dentist will make sure that the implants won’t show during all normal movements of the mouth and lips. You will need to be able to see them, so that you can clean them properly.

Do I have an implant for each missing tooth?

No, unless you’re only having a single tooth replaced. Normally, five or six implants are used to replace all the teeth in one jaw, as each implant can usually support two teeth. For a few missing teeth, two or three implants may be used.

What happens if the implant does not bond (integrate) with the bone?

This happens very rarely. If the implant becomes loose during the healing period or just after, then it is easily removed and healing takes place in the normal way. Once the jaw has healed, another implant can be placed there. Or, the dentist can make a bridge, using the implanted false teeth that have ‘taken’.

Where do I get this treatment?

Talk to your dentist, so you can be referred to a specialist for assessment and treatment. Your dentist may already carry out some or all of this type of treatment and will give you the advice you need.

Veneers

A veneer is a thin layer of porcelain made to fit over the front surface of a tooth, like a false fingernail fits over a nail. Sometimes a natural colour composite material is used instead of porcelain.

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What are the advantages of veneers?

Veneers make teeth look natural and healthy, and because they are very thin and are held in place by a special strong bond (rather like super glue) very little preparation of the tooth is needed.

When would I need a veneer?

Veneers can improve the colour, shape and position of teeth. A precise shade of porcelain can be chosen to give the right colour to improve a single discoloured or stained tooth or to lighten front teeth (usually the upper ones) generally. A veneer can make a chipped tooth look intact again. The porcelain covers the whole of the front of the tooth with a thicker section replacing the broken part. Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.

How are teeth prepared for a veneer?

Some of the shiny outer enamel surface of the tooth may be removed, to make sure that the veneer can be bonded permanently in place later. The amount of enamel removed is tiny and will be the same as the thickness of the veneer to be fitted, so that the tooth stays the same size. A local anaesthetic (injection) may be used to make sure that there is no discomfort, but often this is not necessary. Once the tooth has been prepared, the dentist will take an ‘impression’. This will be given to the dental technician, along with any other information needed to make the veneer. The colour of the surrounding teeth is matched on a shade guide to make sure that the veneer will look entirely natural.

How long will it take?

A veneer takes at least two visits; the first to prepare the tooth and to match the shade, and the second to fit it. Before bonding it in place, your dentist will show you the veneer on your tooth to make sure you are happy with it. Bonding a veneer in place is done with a special adhesive, which holds it firmly on the tooth.

What happens after the veneer is fitted?

Only minor adjustments can be made to the veneer after it is fitted. It is usually best to wait a little while to get used to it before any changes are made. Your dentist will probably want to check and polish it a week or so after it is fitted, and to make sure that you are happy with it.

What about alternatives?

A natural-coloured filling material can be used for minor repairs to front teeth. This is excellent where the tooth supports the filling, but may not work so well for broken tooth corners. There will always be a join between the tooth and the filling material. Crowns are used for teeth that need to be strengthened – either because they have broken, have been weakened by a very large filling, or have had root canal treatment.

How long will a veneer last?

Veneers should last for many years, but they can chip or break, just as your own teeth can. Your dentist will tell you how long each individual veneer should last. Small chips can be repaired, or a new veneer fitted if necessary.

Whitening

Tooth whitening can be a highly effective, simple way to lighten the colour of teeth without removing any of the tooth surface.

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What does the procedure involve?

In a live tooth the dentist applies the whitening product using a specially made tray which fits into the mouth like a gum shield. The chemical is then activated using heat, or heat and light combined. The active ingredient in the product is normally hydrogen peroxide or carbamide peroxide. If the tooth has been root treated, the canal, which previously contained the nerve, may be reopened and the whitening product is put in. In both cases, the procedure needs to be repeated until the right shade is reached.

How long does the procedure take?

First of all you will need two or three visits to your dentist. Your dentist will need to make a mouth guard and will need to take impressions for this at the first appointment. Once your dentist has started the treatment, you will have to continue the treatment at home. This will mean applying the bleach regularly over two to four weeks for 30 minutes to one hour at a time. However, some newer products can be applied for up to eight hours at a time, which means that a satisfactory result can be obtained in as little as one week.

Why would my teeth need to be bleached?

Everyone is different; and just as our hair and skin colour varies, so do our teeth. Some teeth have a yellowish tinge, some are more beige – very few are actually ‘white’. Teeth also yellow with age and can become stained on the surface by food and drinks such as tea, coffee and blackcurrant. Calculus (tartar) can also affect the colour of the teeth. Some people may have staining inside their teeth. This can be caused by certain antibiotics or tiny cracks in the teeth, which take up the stain.

Will I be happy with the results?

Treatment results may vary depending on the original shade of the teeth. Teeth will tend to darken slightly over time. The effect lasts for around one to three years, although sometimes it can last longer. Some people find that their teeth are sensitive for the first few days after treatment, but this wears off after a short while.

What about home kits?

Over-the-counter kits are not recommended as they contain only a small amount of hydrogen peroxide which makes the product less effective. Some also contain mild acids, while others are abrasive. Although these products are cheaper, whitening is a complicated treatment procedure and should only be carried out by a dentist after a thorough examination and assessment of your teeth. It is very important to follow the instructions your dentist gives you, and to make sure that you go for any follow-up appointments recommended.

When might whitening not work?

Whitening can only lighten your existing tooth colour. For a change to specific chosen shade veneering is another option. Whitening only works on natural teeth. It will not work on any type of false teeth. This includes dentures, crowns and veneers. If dentures are stained or discoloured, it may be worth visiting the dentist and asking him or her to clean them. Stained veneers, crowns and dentures may need replacing. Again, ask your dentist.

What about whitening toothpaste?

There are now several whitening toothpastes you can buy. Although they do not affect the natural colour of the tooth, they are effective at removing staining and therefore improving the overall appearance of the tooth. Whitening toothpaste may also help to keep up the appearance, once teeth have been professionally whitened.

Sedation

Intravenous sedation has been used in dentistry for many decades to help very nervous patients receive dental treatment. This can be safely done in the dental surgery in a relaxing environment, carried out at our practice by trained dentists with trained supporting staff. The practice is registered with the Health Authority to provide this form of care.

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How does sedation work?

Intravenous sedation involves administering a tranquiliser (Midazolam - this is a Valium type drug). The tranquiliser is given until the patient reaches a pleasant, relaxed state and after which the dentist then administers the usual local anaesthetics to freeze the teeth and then carry out the dental treatment. Usually the appointments are booked for one and a half hours and in this time, most of the treatment that is required is attempted to be carried out.

Sedation is also available for those patients receiving minor oral surgery for simple and difficult extractions, removal of wisdom teeth, cysts, infected roots, mouth polyps (abnormal growth of tissue), gum surgery, etc.

How safe is sedation?

One of the beneficial aspects of this treatment is that it is very safe, there are no nasty side effects and the drug totally clears from the body in approximately four hours post-operatively. One further beneficial side effect, which most patients find helpful, is that during the period of sedation, time passes very quickly and most patients when they recover do not remember the details of the procedure that was carried out on them. This sedation is only offered to healthy adult patients and is not normally suitable for children under 16 years of age.

What do I need to do on the day of my treatment?
  • All patients must be accompanied home by a responsible adult.
  • Do arrive for your appointment 15 minutes early so that pre-treatment documentation can be completed.
  • Do remove contact lenses before your treatment.
  • Do remove all make-up, particularly lipstick and nail varnish before your appointment.
  • Do remove all jewellery before attending for your appointment.
  • Do tie back long hair.
  • Do continue to take routine medicine unless the dental surgeon advises otherwise.
  • Do tell the dental surgeon if you have been to see the family doctor or attended hospital since your appointment was made.
  • Do give details of any medicines, tablets or pills which you are taking on or off prescription which you have not told us about before.
  • Do wear loose fitting and comfortable clothing. It is particularly important for sleeves to be loose.
  • For sedation, you do not need to starve yourself prior to treatment and it is advisable on the morning of the treatment that patients have their normal breakfast, etc. Weak tea with milk in small quantities may be taken up to one hour before your appointment.
  • All patients: do not drink any form of alcohol on the same day. Do not wear tight clothing or shoes with high heels. Do not wear make-up or jewellery. Do not bring anyone with you other than a responsible adult who will take you home. Please do not bring children and family members.
What precautions do I need to take after receiving sedation?
  • Do rest for a few hours and take it easy for the rest of the day.
  • Do eat light and easily digestible food for the rest of the day.
  • Do take any medicines, tablets or pills which have been prescribed for you.
  • Do not drink any form of alcohol until the following day.
  • Do not drive any vehicle, operate machinery or make any business decisions on the same day on which you have had your treatment as your reflexes and judgement may have been impaired.
How can I stay comfortable after my appointment?
  • Do clean your teeth as normal, but be gentle.
  • Do not rinse your mouth rigorously.
  • Avoid very hot fluids or hard foods. If a wound or extraction socket starts to bleed, roll up a cotton handkerchief, place accurately over the bleeding point and bite firmly for 15 minutes. If you continue to bleed profusely, then telephone your dental surgeon for advice.
  • Any pain or discomfort can be relieved by taking a pain relieving preparation which does not contain aspirin, e.g. paracetomol.
  • If prolonged bleeding or pain occurs do contact your dentist.

After fillings:

  • Avoid hard food and try to chew away from the new fillings where possible.
  • Chew softer foods and consume cool drinks. Try to avoid very hot and very cold drinks.
What training and experience have your staff had in intravenous sedation?

Dr. Hussain completed the sedation certification course (SAAD) in 1989, followed by regular update courses. He has also spent three to four years with a special consultant oral surgeon, spending one session a week carrying out oral surgery under intravenous sedation on patients. Experience was gained on approximately 1,000 patients during this period.

Dr. Murr completed the sedation certification course (SAAD) in 1998.

Ms. Jacqui Coveney and Ms. Sam Pearce have attended the SAAD course for dental assistants and have received certification. We undergo regular refresher courses in the practice to simulate emergency procedures to maintain basic life support.

All other staff have regular updates in basic life support for emergencies.

If you have any questions please do not hesitate to speak to your dentist or any other member of staff.