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Dental Practice

Why are my teeth so important?

Your teeth vary in shape and size depending on where they are in your mouth. These differences allow the teeth to do many different jobs. Teeth help us to chew and digest food. They help us to talk, and to pronounce different sounds clearly. Finally, teeth help to give our face its shape. A healthy smile can be a great asset; and because this is so important, it makes sense to give your teeth the best care possible.

What can go wrong?

Tooth decay can be painful and lead to fillings, crowns or inlays. If tooth decay is not treated, the nerve of the tooth can become infected and die, causing an abscess. This may then need root canal treatment or even for the tooth to be removed. It is very important that you keep up a good routine at home to keep your teeth and gums healthy. Gum disease is common and, if left untreated, may lead to bone loss around the teeth. In some cases, it may lead to loose teeth and teeth being lost. Gum disease is preventable. It can be treated and kept under control with regular cleaning sessions and check-ups, preventing further problems. If teeth are lost, it may be necessary to fill the gaps with bridges, dentures or implants.

How do I keep my teeth and gums healthy?

• It is easy to get your mouth clean and healthy, and keep it that way. A simple routine can help prevent most dental problems:
• brushing your teeth last thing at night and at least one other time during the day, with a fluoride toothpaste
  spit out after brushing and do not rinse, so that the fluoride stays on your teeth longer
• cleaning between the teeth with ‘interdental’ brushes or floss at least once a day
• good eating habits – having sugary foods and drinks less often, and
• regular dental check-ups.

Although most people brush regularly, many don’t clean between their teeth and some people don’t have regular dental check-ups. A few small changes in your daily routine can make a big difference in the long term. Your dental team can remove any build-up on your teeth and treat any gum disease that has already appeared. But daily dental care is up to you, and the main weapons are the toothbrush, toothpaste and interdental cleaning (cleaning between your teeth).

What is plaque?

Plaque is a thin, sticky film of bacteria that constantly forms on your teeth.

How can plaque cause decay?

When you eat foods 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 your teeth. After constant acid attack, the tooth enamel breaks down forming a hole or cavity.

How can plaque cause gum disease?

If plaque is not removed by brushing, it can harden into something called ‘calculus’ – another name for it is ‘tartar’. As calculus forms near the gumline, the plaque underneath releases harmful poisons causing the gums to become irritated and inflamed.

The gums start 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 can become loose and fall out. Severe gum disease can lead to teeth falling out and needing to be replaced.

How can I prevent gum disease?

It is important to remove plaque and bits of food from around your teeth as this will stop your gums from becoming inflamed and swollen, and becoming infected. If you leave plaque on your teeth it can harden into tartar, which can only be removed by the dental team. 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 is generally painless, even though it damages the bone supporting the teeth. Gum disease (gingivitis) will usually show itself as red, swollen gums that bleed when you brush or clean between your teeth. Many people are worried when they notice their gums are bleeding and then brush more gently, or stop altogether.

In fact, it is important that you continue to clean regularly and thoroughly if you are to fight the gum disease. If the bleeding does not go away within a few days see your dental team to ask for their advice.

Which type of toothbrush should I use?

Your dental team will be able to recommend a toothbrush suitable for you. However, adults should choose a small- to medium-sized brush head. This should have soft to medium, multi-tufted, round-ended nylon bristles or ‘filaments’. The head should be small enough to reach into all parts of the mouth: especially the back of the mouth where it can be difficult to reach. Children need to use smaller brushes but with the same type of filaments.

You can now buy more specialised toothbrushes. For instance, people with sensitive teeth can now use softer-bristled brushes. There are also smaller-headed toothbrushes for people with crooked or irregular teeth.Some people find it difficult to hold a toothbrush, for example because 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 use.

How do electric toothbrushes work?

A power brush has an oscillating rotating or vibrating head, which provides a large amount of cleaning action with very little movement needed from the user, although you do need to position the brush correctly.

Why is brushing important?

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 bits of food left behind and causing tooth decay and gum disease.

How do electric or ‘power’ toothbrushes work?

A power brush has an oscillating rotating or vibrating head, which provides a large amount of cleaning action with very little movement needed from the user, although you do need to position the brush correctly.

Do electric toothbrushes clean better?

Tests have shown that power toothbrushes are more effective at removing plaque. Those with heads that rotate in both directions (‘oscillating’ heads) are the most effective. Everyone can use a power brush. They are particularly useful for people with limited movement of the arm or hand, such as disabled or elderly people, who often find that using a normal toothbrush does not allow them to clean thoroughly.

Power brushes can also be better for children as they may be more likely to brush regularly because of the novelty of using a power brush. Discuss the idea with your dental team to find out if you would benefit from using a power brush.

How should I brush?

• Brushing removes plaque and bits of food from the inner, outer and biting surfaces of your teeth.
• Here is one way to remove plaque – discuss with your dental team which is the best for you:
• Place the head of your toothbrush against your teeth, then tilt the bristle tips to a 45-degree angle against your gumline. Move the brush in small circular movements, several times, on all the surfaces of every tooth.
• Brush the outer surface of each tooth, upper and lower, keeping the bristles angled against your gumline.
• Do this again, but on the inside surfaces of all your teeth.
• To clean the inside surfaces of your front teeth, tilt the brush vertically and make several small, circular strokes with the front part of the brush.
• Brush the biting surfaces of your teeth.
• Brush your tongue to help freshen your breath and clean your mouth by removing bacteria.

How often should I brush my teeth?

Be sure to brush thoroughly with a fluoride toothpaste last thing at night and at least one other time during the day. If you regularly keep getting discomfort or bleeding after brushing you should see your dentist.

How do I know if I have removed all the plaque?

You can stain the plaque with special dye, which you can paint onto your teeth with a cotton bud, or you can use special disclosing tablets. You can get these from your dental practice or pharmacy.

The stain is harmless and will show any areas of your mouth which need better brushing. Look particularly at where your teeth and gums meet. Further brushing will remove the stained plaque.

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 bristles become splayed, they do not clean properly.

Should I use a fluoride toothpaste?

Yes. Fluoride helps to strengthen and protect teeth, which can reduce tooth decay in adults and children.

All children up to three years old should use a smear of toothpaste with a fluoride level of no less than 1000ppm (parts per million). After three years old they should use a pea-sized amount of toothpaste that contains 1350ppm to 1500ppm.

Some children’s toothpastes only have about half the fluoride that adult toothpastes have. They only give limited protection for the teeth. If your children are under 7 you should keep an eye on them when they brush their teeth and encourage them not to swallow the toothpaste.

What sort of toothpaste should I use?

As well as regular family toothpastes, there are many specialised toothpastes. These include tartar control for people who get tartar build-up, and a choice of toothpastes for people with sensitive teeth. ‘Total care’ toothpastes include ingredients to help fight gum disease, freshen breath and reduce plaque build-up. ‘Whitening’ toothpastes are good at removing staining to help restore the natural colour of your teeth, but are not strong enough to change the natural shade of the teeth.

Some children’s toothpastes only have about half the fluoride that adult toothpastes have. They only give limited protection for the teeth. If your children are under 7 you should supervise them when they brush their teeth. Encourage them not to swallow the toothpaste and to just spit, not rinse, after brushing.

To have a clean and healthy mouth you need to use the correct dental-care products. Ask your dental team to tell you what choices there are and to give their recommendations.

How much toothpaste should I use?

You do not need to cover the head of your brush in toothpaste. Children under three should use a smear, and children over three, a pea-sized blob of toothpaste. Remember to spit out after brushing and do not rinse, so that the fluoride stays on your teeth longer.

Should my gums bleed when I clean in between my teeth?

Your gums may bleed or be sore for the first few days that you clean between your teeth. This should stop once the plaque is broken up and the health of your mouth has improved. If the bleeding does not stop, tell your dental team. It may be that you are not cleaning correctly, or that your teeth and gums need a more thorough clean by your dental team.

How should I clean between my teeth?

You can clean between your teeth with an ‘interdental’ brush or dental floss. Cleaning in between your teeth removes plaque and bits of food from between your teeth and under your gumline – areas a toothbrush can’t reach. When flossing or using interdental brushes, keep to a regular pattern and remember not to miss any teeth. It helps to look in the mirror.

Don’t forget the backs of your last teeth. It is also very important to clean around the edges of any crowns, bridges or implants. You should clean between your teeth at least once a day. Your dental team can show you how to clean between your teeth properly.

Interdental

Interdental brushes come in various sizes. It may be helpful to ask your dentist or hygienist to show you the correct sizes for your mouth.

Hold the interdental brush between your thumb and forefinger. Gently place the brush through the gap between your teeth. Do not force the brush head through the gap. If the brush splays or bends then it is too big – you will need a smaller brush head for this space.

Flossing

• Break off about 45 centimetres (18 inches) of floss, and wind some around one finger of each hand.
• Hold the floss tightly between your thumbs and forefingers, with about an inch of floss between them, leaving no slack. Use a gentle ‘rocking’ motion to guide the floss between your teeth. Do not jerk the floss or snap the floss into the gums.
• When the floss reaches your gumline, curve it into a C-shape against one tooth until you feel resistance.
• Hold the floss against the tooth. Gently scrape the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth.
• Don’t forget the back of your last tooth.
• When flossing, keep to a regular pattern. Start at the top and work from left to right, then move to the bottom and again work from the left to right. This way you’re less likely to miss any teeth.

Are ‘oral irrigators’ useful?

Oral irrigators use a stream or jet of water to remove plaque and bits of food from around your teeth. They can be particularly helpful if you wear an orthodontic appliance (‘brace’) or a fixed bridge that is difficult to clean, or if you find it difficult to use interdental brushes or floss.

Should I use a mouthwash?

A fluoride mouthwash can help prevent tooth decay. Your dental team may recommend an antibacterial mouthwash to help control plaque and reduce gum disease. If you find that you are regularly using a mouthwash just to freshen your breath see your dental team, because bad breath can be a sign of unhealthy teeth and gums or of poor general health.

Can my diet help?

Many people think that it is a high level of sugar in your diet that causes decay, but this is not true. It is how often you have sugar in your diet, not the amount, that causes problems. It takes up to an hour for your mouth to cancel out the acid caused by eating and drinking sugar. During this time your teeth are under attack from this acid. It is therefore important to limit the number of attacks by having sugary foods and drinks just at mealtimes. Chewing sugar-free gum and drinking water after meals or snacks can also help to cancel out the acid more quickly.

As well as causing decay, sugary fizzy drinks, fruit juices, sports drinks, and wine can be acidic – which can also cause dental erosion. This is when the acid in foods and drinks gradually wears away the hard enamel coating of the tooth. This may lead to the tooth being sensitive.

How should I clean my dentures?

It is just as important to clean dentures as it is to clean your natural teeth. Food can become caught around the edges of dentures and clasps, and the food can rot if you do not clean them thoroughly.

You should keep a separate toothbrush for cleaning your dentures. The general rule is: brush, soak and brush again. Clean your dentures over a bowl of water in case you drop them. Brush your dentures before soaking them, to help remove any bits of food. Soak the dentures in a specialist cleaner for a short time and then brush the dentures again. Brush them like you would your natural teeth.

Make sure you clean all the surfaces of the dentures, including the surface which fits against your gums. If you notice a build-up of stains or scale, have your dentures cleaned by your dental team. Most dentists still recommend a small- to medium-headed toothbrush.

I have implants, do I have to do anything special?

Your dental team or oral surgeon will tell you how to care for your implants after surgery. It is very important to make sure you clean them regularly and thoroughly to prevent gum disease and possible infection. Follow the instructions your dental team or oral surgeon gives you.

Why should I visit the dental team regularly?

It is always better to prevent problems rather than have to cure them when they happen. If you visit your dental team regularly you will need less treatment and they will spot any problems earlier, making any treatment easier.

Final words

Good dental health begins with you. By following these simple tips you can keep your mouth clean and healthy:

• Brush your teeth for two minutes, last thing at night and at least one other time during the day, using fluoride toothpaste.
  Spit toothpaste out after brushing and do not rinse.
• Use a toothbrush with a small- to medium-sized head.
• Use a toothbrush with soft to medium, multi-tufted, round-ended nylon bristles.
• Consider using a power toothbrush.
• Use small, circular movements to clean your teeth.
• Change your toothbrush regularly, and at least every 3 months.
• Clean between your teeth every day using interdental brushes or dental floss.
• Have sugary drinks and foods less often.
• Visit your dental team regularly, as often as they recommend.

 

 Courtesy of the BDHF

What are sensitive teeth?

Having sensitive teeth can mean anything from getting a mild twinge to having severe discomfort that can continue for several hours. It can also be an early warning sign of more serious dental problems.

Who suffers from sensitive teeth?

Many people suffer from sensitive teeth and it can start at any time. It is more common in people aged between 20 and 40, although it can affect people in their early teens and when they are over 70. Women are more likely to be affected than men.

What causes sensitive teeth?

• The part of the tooth we can see has a layer of enamel that protects the softer dentine underneath. If the dentine is exposed, a tooth can become sensitive. This usually happens where the tooth and the gum meet and the enamel layer is much thinner. Here are some causes of sensitivity:
• Brushing too hard (‘toothbrush abrasion’), and brushing from side to side, can cause enamel to be worn away – particularly where the teeth meet the gums. The freshly exposed dentine may then become sensitive.
• Dental erosion: this is loss of tooth enamel caused by attacks of acid from acidic food and drinks. If enamel is worn away, the dentine underneath is exposed which may lead to sensitivity. Gums may naturally recede (shrink back), and the roots of the teeth will become exposed and can be more sensitive. Root surfaces do not have an enamel layer to protect them.
• Gums may naturally recede (shrink back ), and the roots of the teeth will become exposed and can be more sensitive. Root surfaces do not have an enamel layer to protect them.
• Gum disease: a build-up of plaque or tartar can cause the gum to recede down the tooth and even destroy the bony support of the tooth. Pockets can form in the gums around the tooth, making the area difficult to keep clean and the problem worse.
• Tooth grinding: this is a habit which involves clenching and grinding the teeth together. This can cause the enamel of the teeth to be worn away, making the teeth sensitive.
• A cracked tooth or filling: a cracked tooth is one that has become broken.
• Tooth bleaching: some patients have sensitivity for a short time during bleaching or afterwards. Talk to your dental team about this before having treatment.

When are teeth more likely to be sensitive?

You are more likely to feel the sensitivity when drinking or eating something cold, from cold air catching your teeth, and sometimes with hot foods or drinks. Some people have sensitivity when they have sweet or acidic food and drinks. The pain can come and go, with some times being worse than others.

Is there anything I should avoid if I have sensitive teeth?

You may find that hot, cold, sweet or acidic drinks, or foods like ice cream, can bring on sensitivity, so you may want to avoid these. If you have sensitivity when brushing your teeth with cold water from the tap, you may need to use warm water instead. It is important to keep brushing your teeth regularly – if you don’t, this could make the problem worse.

Do I need to go and see my dentist?

Yes, if you have tried treating your sensitive teeth for a few weeks and have had no improvement.

What treatments can the dentist offer?

During an examination the dental team will talk to you about your symptoms. They will look at your teeth to find out what is causing the sensitivity and to find the best way of treating it. The dental team may treat the affected teeth with special ‘de-sensitising’ products to help relieve the symptoms. Fluoride gels, rinses or varnishes can be applied to sensitive teeth. These can be painted onto the teeth at regular appointments one or two weeks apart, to build up some protection. Sensitivity can take some time to settle, and you may need to have several appointments. If this still does not help, your dental team may seal or fill around the neck of the tooth, where the tooth and gum meet, to cover exposed dentine. In very serious cases it may be necessary to root-fill the tooth.

Is there anything I can do to treat sensitive teeth at home?

There are many brands of toothpaste on the market made to help ease the pain of sensitive teeth. You should use the fluoride toothpaste twice a day to brush your teeth. You can also rub it onto the sensitive areas. These toothpastes can take anything from a few days to several weeks to take effect. Your dental team should be able to advise you on which type of toothpaste would be best for you.

How can I prevent sensitive teeth?

• Brush your teeth last thing at night and at least one other time during the day, with fluoride toothpaste containing at least 1350ppm (parts per million) of fluoride. Consider using toothpaste specially designed for sensitive teeth. Use small, circular movements with a soft-to medium-bristled brush. Try to avoid brushing your teeth from side to side.
• Change your toothbrush every two to three months, or sooner if it becomes worn.
• Don’t brush straight after eating – some foods and drinks can soften the enamel of your teeth, so leave it for at least an hour before you brush.
• Have sugary foods, and fizzy and acidic drinks, less often. Try to have them just at mealtimes.
• If you grind your teeth, talk to your dental team about whether you should have a mouthguard made, to wear at night.
• If you are thinking about having your teeth bleached, discuss sensitivity with your dental team before starting treatment.
• Visit your dental team regularly, as often as they recommend.

 Courtesy of the BDHF

What is tooth decay?

Tooth decay damages your teeth and leads to fillings or even extractions. Decay happens when sugar reacts with the bacteria in plaque. This forms the acids that attack the teeth and destroy the enamel. After this happens many times, the tooth enamel may break down, forming a hole or ‘cavity’ into the dentine. The tooth can then decay more quickly.

What foods can cause decay?

All sugars can cause decay. Sugar can come in many forms. Usually ingredients ending in ‘ose’ are sugars, for example: sucrose, fructose and glucose are just three types. These sugars can all damage your teeth.

Many processed foods have sugar in them, and the higher up it appears in the list of ingredients, the more sugar there is in the product. Always read the list of ingredients on the labels when you are food shopping.

When you are reading the labels remember that ‘no added sugar’ does not necessarily mean that the product is sugar free. It simply means that no extra sugar has been added. These products may contain sugars such as those listed above, or the sugars may be listed as ‘carbohydrates’. Ask your dental team if you are not sure.

Can food and drink cause erosion?

Acidic food and drinks can cause dental erosion – the gradual dissolving of the tooth enamel. Listed below are the ‘pH values’ of some food and drinks. The lower the pH number, the more acidic the product. Anything with a pH value lower than 5.5 may cause erosion. ‘Alkalis’ have a high pH number and cancel out the acid effects of sugars. pH 7 is the middle figure between acid and alkali.

Mineral water (still) pH 7.6

Milk pH 6.9

Cheddar cheese pH 5.9

Lager pH 4.4

Orange juice pH 3.8

Grapefruit pH 3.3

Pickles pH 3.2

Cola pH 2.5

Red wine pH 2.5

Vinegar pH 2.0

Can I eat snacks?

It is better for your teeth and general health if you eat 3 meals a day instead of having 7 to 10 snacks. If you do need to snack between meals, choose foods that do not contain sugar. Fruit does contain acids, which can erode your teeth. However, this is only damaging to your teeth if you eat an unusually large amount. Try not to have a lot of dried fruit as it is high in sugar.

If you do eat fruit as a snack, try to eat something alkaline such as cheese afterwards. Savoury snacks are better, such as:

Cheese.

Raw vegetables.

Nuts.

Breadsticks.

Can I eat sweets?

The main point to remember is that it is not the amount of sugar you eat or drink, but how often you do it. Sweet foods are allowed, but it is important just to have them at mealtimes.

To help reduce tooth decay, cut down on how often you have sugary foods and drinks and try to have sugar-free varieties. Confectionery and chewing gum containing the artificial sweetener Xylitol may help to reduce tooth decay.

Sugary foods can also cause a range of health problems including heart disease and being overweight.

What should I drink?

Still water and milk are good choices. It is better for your teeth if you drink fruit juices just at meal times. If you are drinking them between meals, try diluting them with water.

Diluted sugar-free fruit drinks are the safest alternative to water and milk. If you make these, be sure that the drink is diluted 1 part fruit drink to 10 parts water. Some soft drinks contain sweeteners, which are not suitable for young children – ask your dental team if you are not sure.

Fizzy drinks can increase the risk of dental problems. The sugar can cause decay and the acid in both normal and diet drinks can dissolve the enamel on the teeth. The risk is higher when you have these drinks between meals.

Should I brush my teeth after every meal?

It is important that you brush last thing at night and at least one other time during the day, with a toothpaste containing fluoride.

Eating and drinking foods containing sugar and acids naturally weakens the enamel on your teeth. Brushing straight afterwards can cause tiny particles of enamel to be brushed away. It is best not to brush your teeth until at least one hour after eating.

It is especially important to brush before bed. This is because the flow of saliva, which is the mouth’s own cleaning system, slows down during the night and this leaves the mouth more at risk from decay.

Children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). Three-year-olds to adults should use a toothpaste that contains 1350ppm to 1500ppm of fluoride.

Why is a healthy diet important for my oral health?

Every time you eat or drink anything sugary, your teeth are under acid attack for up to one hour. This is because the sugar will react with the bacteria in plaque (the sticky coating on your teeth) and produce harmful acids. So it is important to have sugary foods or drinks just at mealtimes, limiting the amount of time your mouth is at risk.

Acidic foods and drinks can be just as harmful. The acid ‘erodes’ or dissolves the enamel, exposing the dentine underneath. This can make your teeth sensitive and unsightly.

A diet that is rich in vitamins, minerals and fresh fruit and vegetables can help to prevent gum disease. Gum disease can lead to tooth loss and cause bad breath.

Does chewing gum help?

Chewing gum makes your mouth produce more saliva, which helps to cancel out the acid in your mouth after eating or drinking. It has been proven that using sugar-free chewing gum after meals can prevent tooth decay. However, it is important to use only sugar-free gum, as ordinary chewing gum contains sugar and therefore may damage your teeth.

Courtesy of the BDHF

What is a denture?

People wear dentures to replace lost or missing teeth so they can enjoy a healthy diet and smile with confidence. Dentures are made of either acrylic (plastic) or metal.

A ‘complete’ or ‘full’ denture is one which replaces all the natural teeth in either the upper or lower jaw.

A ‘partial’ denture fills in the spaces left by lost or missing teeth. It may be fastened to your natural teeth with metal clasps or ‘precision attachments’.

Why should I wear dentures?

Full dentures, to replace all your own teeth, fit snugly over your gums. They will help you to eat comfortably and speak clearly, and will improve your confidence and self-esteem.

Partial dentures replace teeth that are missing, and can sometimes be supported by the teeth you have left. If you have gaps between your teeth, then your other teeth may move to take up some of the space, so you could end up with crooked or tilted teeth. This could affect the way you bite and could damage your other teeth.

How soon can I have a denture after my teeth are taken out?

Usually dentures can be fitted straight after your teeth have been removed. These are called ‘immediate dentures’. You will need to visit the dental team beforehand for them to take measurements and impressions of your mouth.

With immediate dentures you don’t have to be without teeth while your gums are healing. However, bone and gums can shrink over time, especially during the first six months after your teeth have been taken out. If your gums shrink, your immediate dentures may need relining, adjusting or even replacing. Your dental team will be able to talk to you about this.

Sometimes your dental team may advise you to wait until your gums are healed before having your dentures, as this can sometimes mean a better fit. Healing may take several months.

Who will make and fit my denture?

Your dentist may take measurements and impressions of your mouth, then order your dentures from a dental technician.

Will dentures make me look different?

Replacing lost or missing teeth is very good for your health and appearance. A complete or full denture replaces your natural teeth and gives support to your cheeks and lips. Without this support, sagging facial muscles can make a person look older and they will find it harder to eat and speak properly.

Dentures can be made to closely match your natural teeth so that your appearance hardly changes. Modern dentures may even improve the look of your smile and help to fill out the appearance of your face.

Will I be able to eat with dentures?

Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly, using both sides of your mouth at the same time to stop the denture moving. As you become more used to your denture, add other foods until you get back to your normal healthy diet.

Will dentures change how I speak?

Pronouncing certain words may take practice. Reading out loud and repeating difficult words will help.

If you find that your dentures occasionally slip when you laugh, cough or smile, reposition them by gently biting down and swallowing. If this happens a lot, see your dentist.

How long should I wear my dentures?

During the first few days, your dental team may advise you to wear them for most of the time, including while you are asleep. After your mouth gets used to your dentures, your dental team may advise you to take them out before going to bed. This allows your gums to rest and helps keep your mouth healthy. When you remove your dentures at night, it is best to store them in a small amount of water to stop them warping.

My upper denture fits fine, so why am I having problems with my lower one?

The upper denture usually has much more suction to hold it in place. There is much less gum support in the lower jaw, so the lower denture may feel more wobbly because it has to be balanced between your cheeks and your tongue.

After a little while you will learn the shape of your new denture and how to keep it in place, even when you open your mouth wide.

Should I use a denture fixative?

Dentures are custom made to fit your mouth and you shouldn’t need a denture fixative. However, some people prefer to use a fixative to give them extra confidence or if their dentures start to become loose before they have them replaced. A poorly fitting denture may cause irritation and sores. This can often happen if you have worn ‘immediate’ dentures for some time.

Do I need to do anything special to care for my mouth?

Even with full dentures, you still need to take good care of your mouth. Every morning and evening, brush your gums, tongue and the roof of your mouth with a soft brush. This removes plaque and helps the blood circulation in your mouth. If you wear partial dentures, it is even more important that you brush your teeth thoroughly every day. This will help stop tooth decay and gum disease that can lead to you losing more of your teeth. Your dentist may refer you to the hygienist to have your remaining natural teeth cleaned regularly.

How do I take care of my dentures?

Dentures may break if you drop them. Always clean your dentures over a bowl of water or a folded towel in case you drop them.

To clean your denture, the general rule is: brush, soak and brush again. Brush your dentures before soaking them, to help remove any bits of food. Using an effervescent (fizzy) denture cleaner will help remove stubborn stains and leave your denture feeling fresher – always follow the manufacturer’s instructions. Then brush the dentures again, as you would your own teeth. Be careful not to scrub too hard as this may cause grooves in the surface.

Most dentists advise using toothpaste and a small- to medium-headed toothbrush. Make sure you clean all the surfaces of the dentures, including the surface which fits against your gums. This is especially important if you use any kind of denture fixative.

If you notice a build-up of stains or scale, have your denture cleaned by your dental team.

Click here for more information on denture cleaning.

How long will my dentures last?

If you treat your dentures well, they should last several years. However, your dentures will need to be relined or re-made because of normal wear, or a change in the shape of your mouth. Bone and gum ridges can shrink, causing your jaws to meet differently. Loose dentures can cause discomfort, and health problems including sores and infections. A loose or badly fitting denture can also make eating and talking more difficult. It is important to replace worn or badly fitting dentures before they cause problems.

How often should I see my dentist?

Regular dental check-ups and having your teeth professionally cleaned are very important for keeping your teeth and gums healthy. Regular visits allow your dental team to check the soft parts of your mouth, including your tongue and cheeks. These examinations are important so that the dental team can spot any infections, mouth conditions or even mouth cancer at the earliest stages. If you have a full denture, check with your dental team about how often you should visit.

With regular professional care, a positive attitude and persistence, you can become one of the millions of people who wear their dentures with a smile.

Are dentures my only option?

No. Bridges and partial dentures and dental implants are other options to consider. Ask your dental team for more information.

 Courtesy of the BDHF

 

 

Why should I replace missing teeth?

 

Your appearance is one reason. Another is that the gap left by a missing tooth can mean more strain is put on the teeth at either side.

 

A gap can also mean your ‘bite’ is affected, because the teeth next to the space can lean into the gap and change the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes tooth decay and gum disease.

 

How are missing teeth replaced?

 

This depends on the number of teeth missing and on where they are in your mouth. The condition of the teeth you still have also affects the decision. 

There are three main ways to replace missing teeth. The first is with a removable false tooth (or teeth) – called a partial denture. The second is with a fixed bridge. A bridge is usually used when there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth. The third way is by the use of dental ‘implants’. This is where an artificial root is placed into the bone of the jaw and a crown or bridge placed on top of this. See our leaflet ‘Tell me about: dental implants’.

 

What is a partial denture?

 

This is a plate with one or more false teeth on it. It may be all plastic or a mixture of metal and plastic. Both types may have clips (clasps) to help keep the denture in place in your mouth. Depending on where they are, some of these clips may show when you smile or open your mouth.

What is the difference between a plastic partial denture and one that contains metal? 

Plastic partial dentures are less expensive to make. But unless they are designed very carefully they can damage the teeth they fit against. 

Metal partial dentures are usually made from an alloy of cobalt and chromium, and they are much stronger. They are lighter to wear and can be supported by the remaining teeth. Although the base is metal, they have gum-coloured plastic and natural-looking teeth fixed to them. They are more expensive than plastic ones.

How do I choose the best type for me?

 

Be guided by your dentist. They will know the condition of your remaining teeth. In most cases a metal-based partial denture gives the best result.

Can I have a bridge fitted straight after having a tooth removed? 

It can take up to 6 months for your gums to heal properly after an extraction. This means that you may need to have a temporary denture before the bridge is fitted.

How do I look after my denture? 

The general rule is: brush, soak and brush again. Always clean your denture over a bowl of water or a folded towel in case you drop it. Brush your denture before soaking them, to help remove any bits of food. Using an effervescent (fizzy) denture cleaner will help remove stubborn stains and leave your denture feeling fresher – always follow the manufacturer’s instructions. Then brush the denture again, as you would your own teeth, being careful not to scrub too hard as this may cause grooves in the surface. 

Most dentists advise using toothpaste and a small-to-medium-headed toothbrush. Make sure you clean all the surfaces of the denture, including the surface which fits against your gums. This is especially important if you use any kind of denture fixative.

 If you notice a build-up of stains or scale, have your denture cleaned by your dental team.

Should I take my denture out at night?

 Your dental team may recommend taking out your dentures at night to give your mouth a chance to rest. If you do this, it is important to leave it in water to prevent any warping or cracking.

What is the alternative to a partial denture?

 The main alternatives are a fixed bridge or a dental implant. A dental bridge is made by putting crowns on the teeth at either side of the gap, and then joining these two crowns together by placing a false tooth in the space. This is all made in the laboratory and then the pieces are cemented into place with special adhesives. The bridge can’t be removed.

 Another option is an adhesive bridge. This has ‘wings’ that are bonded to the back of the supporting teeth, with very little drilling needed.

Can I always have a bridge to replace missing teeth?

 You can have a bridge only if you have enough strong teeth with good bone support. Your dental team will help you decide which is the best way of replacing missing teeth.

What are bridges made of?

 Bridges are usually made of porcelain bonded to precious metal. Sometimes other non-precious metals are used in the base for strength. There are also new bridges made entirely of a special type of strong porcelain.

What will a bridge cost?

 The cost will vary depending on the size and type of bridge you need. Always get a written estimate and treatment plan before starting any dental treatment. Although a bridge may seem expensive it should last many years.

How do I look after my bridge?

 You need to clean your bridge every day, to prevent problems such as bad breath and gum disease. You also have to clean under the false tooth every day. Your dentist or hygienist will show you how to use a bridge needle or special floss, as a normal toothbrush cannot reach.

Are there other methods for fixing false teeth?

 There are other methods, such as using a combination of crowns and partial dentures that can keep the retaining clips out of sight. These are quite specialised dentures, so you should ask your dental team about them.

Can I have teeth which attach to the jawbone?

 Yes, by having implants. This treatment means you may be able to replace missing teeth without having crowns on other teeth. Click here for more information about dental implants. Remember that it is as important to care for your remaining teeth as it is to replace the missing ones.

  Courtesy of the BDHF

 

What is a crown?

A crown is an artificial restoration that fits over the remaining part of a prepared tooth, making it strong and giving it the shape of a natural tooth. A crown is sometimes known as a ‘cap’.

Why would I need a crown?

Crowns are an ideal way to repair teeth that have been broken, or have been weakened by tooth decay or a very large filling. A crown could be used for a number of other reasons, for example:

• You may have a discoloured filling and would like to improve the appearance of the tooth.
• You may have had a root filling and need a crown to protect what is left of the tooth.
• It may help to hold a bridge or denture firmly in place.

What is a crown made of?

Crowns can be made of a variety of different materials and new materials are continually being introduced. Some of the most popular options are listed below.

Porcelain bonded to precious metal:

This is what most crowns are made from. A precious metal base is made and then porcelain is applied in layers over it.

Porcelain

These crowns are made entirely out of porcelain and are not as strong as bonded crowns. But they can look very natural and are most often used for front teeth.

All-ceramic

This modern technique offers a metal-free alternative, which can give the strength of a bonded crown and the appearance of a porcelain crown. Therefore it is suitable for use in all areas of the mouth.

Glass

These crowns look very natural and can be used anywhere in the mouth.

Gold-alloy crowns

Gold is one of the oldest filling materials. Today it is used with other metal alloys to increase its strength, which makes it very hardwearing. These crowns are silver or gold in colour.

How is a crown prepared?

The dentist will prepare the tooth to the ideal shape for the crown. This will involve removing a layer of the outer surface, leaving a strong inner core. The amount of the tooth removed will be the same as the thickness of the crown.

Once the tooth is shaped, the dental team will take an impression (mould) of the prepared tooth, one of the opposite jaw and possibly another to show the way you bite together.

The impressions will then be given to a dental technician, along with information about the shade to use and any other information they need.

What is a post crown?

In root-filled teeth it may be necessary to insert a post into the tooth root before placing a crown. A post gives support and helps the crown to stay in place. The surface of the tooth may be removed down to the level of the gum.

A post can be made of prefabricated stainless steel which the dentist can fit directly into the root canal. Or a custom-made post can be constructed by a dental technician to accurately fit the shape of the prepared root canal. The post is placed into the root canal and cemented in position, ready for the crown to be attached.

Are there any alternatives to post crowns for root-filled teeth?

If a root-filled tooth is not completely broken down, it may be possible for your dentist to build it up again using filling material. This ‘core’ is then prepared in the same way as a natural tooth and the impressions are taken.

What will happen between visits?

A temporary crown will be made so that you can use the tooth while you wait for the crown to be made. This crown may be more noticeable but is only temporary.

How is the crown fitted?

When you and your dentist are happy with the fit and appearance of the new crown, it will be fixed in place with special dental cement or adhesive. The cement forms a seal to hold the crown in place.

How long does the treatment take?

You will need to have at least two visits. At the first visit, your dental team will prepare the tooth, take the impressions, make a note of the shade of your tooth, and fit the temporary crown. At the second visit, your dentist will fit the permanent crown. There will usually be about 1 to 2 weeks between appointments.

Does it hurt to have a tooth prepared for a crown?

No. You will have a local anaesthetic and the preparation work should feel no different from a filling. If the tooth does not have a nerve, and a post crown is being prepared, then you may not need a local anaesthetic.

Will the crown be noticeable?

The crown will be made to match your other teeth as closely as possible. The shade of the surrounding teeth will be recorded, to make sure that the colour looks natural and matches those teeth.

Will the crown feel different?

Because the shape of the crown will be slightly different from the shape of your tooth before it was crowned, you may be aware of it at first. Within a few days it should feel fine, and you will not notice it. The crown may need some adjustment if your bite does not feel comfortable, and if this is the case, you should ask your dentist to check and adjust it.

What will it cost?

Costs will vary according to the type of crown and the material used. Always get a written estimate and treatment plan before starting any dental treatment.

How do I care for my crown?

It is important to keep the crown just as clean as you would your natural teeth. The crown itself cannot decay, but decay can start where the edge of the crown joins the tooth. Brush last thing at night and at least one other time during the day with a fluoride toothpaste, and clean in between your teeth with ‘interdental’ brushes or floss.

How long will the crown last?

How long your crown lasts depends on how well you look after it. Properly cared for crowns should last for many years. Your dental team will be able to tell you how long your crown may be expected to last.

  Courtesy of the BDHF

 

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.

What does tooth whitening do?

Tooth whitening can be a highly effective, yet very simple way, of lightening the colour of teeth without removing any of the tooth surface. It cannot make a colour change, but lightens the existing colour.

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 2 or 3 visits to your dentist.  Your dentist will need to make a mouthguard 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 2-4 weeks for 30 minutes to 1 hour at a time.

However, some newer products can be applied for up to 8 hours at a time, which means that a satisfactory result can be obtained in as little as 1 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 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 1 to 3 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 also 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.

  Courtesy of the BDHF

 

What is root canal treatment?

Root canal treatment (also called ‘endodontics’) is needed when the blood or nerve supply of the tooth (called the ‘pulp’) is infected through decay or injury. You may not feel any pain in the early stages of the infection. In some cases your tooth could darken in colour, which may mean that the nerve of the tooth has died (or is dying). This would need root canal treatment.

Why is root canal treatment needed?

If the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess. An abscess is an inflamed area in which pus collects and can cause swelling of the tissues around the tooth. The symptoms of an abscess can range from a dull ache to severe pain, and the tooth may be tender when you bite. If root canal treatment is not done, the infection will spread and the tooth may need to be taken out.

Does root canal treatment hurt?

No. Usually, a local anaesthetic is used and it should feel no different to having an ordinary filling done. There may be some tenderness afterwards but this should gradually get less over time.

What does it involve?

The aim of the treatment is to remove all the infection from the root canal. The root is then cleaned and filled to prevent any further infection.

Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits to your dentist.

At the first appointment, the infected pulp is removed and any abscesses can be drained. The root canal is then cleaned and shaped ready for the filling. A temporary filling is put in and the tooth is left to settle.

The tooth is checked at a later visit and when all the infection has cleared, the tooth is permanently filled.

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 there is any discolouration, there are several treatments that will restore the natural appearance.

What if it happens again?

Root canal treatment is usually very successful. However, if the infection comes back, the treatment can sometimes be repeated.

What if I don’t have the treatment?

The alternative is to have the tooth out. Once the pulp is destroyed it can’t heal, and it is not recommended to leave an infected tooth in the mouth.

Although some people would prefer to have the tooth out, it is usually best to keep as many natural teeth as possible.

Will the tooth be safe after treatment?

Yes. However, because a ‘dead’ tooth is more brittle, you may need to have a crown to provide extra support and strength to the tooth.

Where is root canal treatment carried out?

Root canal treatment is a routine dental procedure, which your dentist will be happy to do for you. However, sometimes your dentist may refer you to an endodontist, who is a specialist in this type of treatment.

How do I care for my tooth afterwards?

Root-treated teeth should be looked after just the same as any other tooth. Remember to clean your teeth last thing at night and at least one other time during the day, with a fluoride toothpaste. Cut down on sugary foods and drinks, and have them only at mealtimes if possible. See your dental team as often as they recommend for regular check-ups.

  Courtesy of the BDHF

 

 

I’ve had my tooth out – what should I do now?

Take it easy for the rest of the day. Take as little exercise as you can, and rest as much as you can. Keep your head up to avoid any bleeding.

What precautions should I take?

Avoid hot food or drinks until the anaesthetic wears off. This is important as you cannot feel pain properly and may burn or scald your mouth. Also be careful not to chew your cheek. This is quite a common problem, which can happen when there is no feeling.

If you do rest, try to keep your head higher for the first night using an extra pillow if possible. It is also a good idea to use an old pillowcase, or put a towel on the pillow, in case you bleed a little.

Should I rinse my mouth out?

Do not be tempted to rinse the area for the first 24 hours. It is important to allow the socket to heal, and you must be careful not to damage the blood clot by eating on that side or letting your tongue disturb it. This can allow infection into the socket and affect healing.

Is there anything else I should avoid?

Avoid alcohol for at least 24 hours, as this can encourage bleeding and delay healing. Eat and drink lukewarm food as normal but avoid chewing on that area of your mouth.

When should I brush?

It is just as important, if not more so, to keep your mouth clean after an extraction. However, you do need to be careful around the extraction site.

What do I do if it bleeds?

The first thing to remember is that there may be some slight bleeding for the first day or so. Many people are concerned about the amount of bleeding. This is due to the fact that a small amount of blood is mixed with a larger amount of saliva, which looks more dramatic than it is.

If you do notice bleeding, do not rinse out, but apply pressure to the socket. Bite firmly on a folded piece of clean cotton material such as a handkerchief for at least 15 minutes. Make sure this is placed directly over the extraction site and that the pad is replaced if necessary.

If the bleeding has not stopped after an hour or two, contact your dentist.

How soon can I have a cigarette?

It is important not to do anything which will increase your blood pressure, as this can lead to further bleeding. We recommend that you avoid smoking for as long as you can after an extraction, but this should be at least for the rest of the day.

Is there anything I can do to help my mouth?

Different people heal at different speeds after an extraction. It is important to keep your mouth and the extraction site as clean as possible, making sure that the socket is kept clear of all food and debris. Don’t rinse for the first 24 hours, and this will help your mouth to start healing.

After this time use a salt-water mouthwash, which helps to heal the socket. A teaspoon of salt in a glass of warm water gently rinsed around the socket twice a day can help to clean and heal the area. Keep this up for at least a week or for as long as your dentist tells you.

It is important to keep to a healthy diet; and take a Vitamin C supplement, which will help your mouth to heal.

I am in pain, what should I take?

There will usually be some tenderness in the area for the first few days, and in most cases some simple pain relief is enough to ease the discomfort. What you would normally take for a headache should be enough. However, always follow the manufacturer’s instructions and if in doubt check with your doctor first. Do not take aspirin, as this will make your mouth bleed.

Are there any medicines I should avoid?

As we have said, it is important not to use anything containing aspirin as this can cause further bleeding. This happens because aspirin can thin the blood slightly. Asthma sufferers should avoid Ibuprofen-based pain relief. Again check with your chemist or dentist if you are worried or feel you need something stronger.

I am still in pain, what could it be?

Sometimes an infection can get in the socket, which can be very painful. This is where there is little or no blood clot in the tooth socket and the bony socket walls are exposed and become infected. This is called a dry socket and in some cases is worse than the original toothache!

In this case, it is important to see your dentist, who may place a dressing in the socket and prescribe a course of antibiotics to help relieve the infection. You may also feel the sharp edge of the socket with your tongue and sometimes small pieces of bone may work their way to the surface of the socket. This is perfectly normal.

Will my dentist need to see me again?

If it has been a particularly difficult extraction, the dentist will give you a follow-up appointment. This could be to remove any stitches that were needed, or simply to check the area is healing well.

  Courtesy of the BDHF

 

 

What is gum disease?

Gum disease is described as swelling, soreness or infection of the tissues supporting the teeth. There are two main forms of gum disease: gingivitis and periodontal disease.

What is gingivitis?

Gingivitis means ‘inflammation of the gums’. This is when the gums around the teeth become very red and swollen. Often the swollen gums bleed when they are brushed during cleaning.

What is periodontal disease?

Long-standing gingivitis can turn into periodontal disease. There are a number of types of periodontal disease and they all affect the tissues supporting the teeth. As the disease gets worse the bone anchoring the teeth in the jaw is lost, making the teeth loose. If this is not treated, the teeth may eventually fall out.

Am I likely to suffer from gum disease?

Probably. Most people suffer from some form of gum disease, and it is a major cause of tooth loss in adults. However, the disease develops very slowly in most people, and it can be slowed down to a rate that should allow you to keep most of your teeth for life.

What is the cause of gum disease?

All gum disease is caused by plaque. Plaque is a film of bacteria which forms on the surface of the teeth every day. Many of the bacteria in plaque are completely harmless, but there are some that have been shown to be the main cause of gum disease.

To prevent and treat gum disease, you need to make sure you remove all the plaque from your teeth every day. This is done by brushing and cleaning in between the teeth with ‘interdental’ brushes or floss.

See our advice on ‘caring for my teeth and gums’ for how to do this.

How will smoking affect my gums and teeth?

Smoking can also make gum disease worse. People who smoke are more likely to produce bacterial plaque, which leads to gum disease. The gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums don’t heal. Smoking causes people to have more plaque and the gum disease to get worse more quickly than in non-smokers. Gum disease is still a major cause of tooth loss in adults.

What happens if gum disease is not treated?

Unfortunately, gum disease does not usually cause pain as it gets worse so you do not notice the damage it is doing. However, the bacteria are sometimes more active and this makes your gums sore. This can lead to gum abscesses, and pus may ooze from around the teeth. Over a number of years, the bone supporting the teeth can be lost. If the disease is left untreated for a long time, treatment can be more difficult.

What do I do if I think I have gum disease?

The first thing to do is visit your dental team for a thorough check-up of your teeth and gums. They will measure the ‘cuff’ of gum around each tooth to see if there is any sign that periodontal disease has started. X-rays may also be needed to see the amount of bone that has been lost. This assessment is very important, so the correct treatment can be prescribed for you.

What treatments are needed?

Your dental team will remove all plaque and tartar from your teeth. You will also be shown how to remove plaque successfully yourself, cleaning all the surfaces of your teeth thoroughly and effectively. This may take a number of sessions with the dental team. A good oral care routine at home with brushing and interdental cleaning is the most important thing you can do to help prevent gum disease getting worse.

What else may be needed?

Once your teeth are clean, your dental team may need to treat the roots of the teeth to make sure that the last pockets of bacteria are removed. This is called ‘root planing’. You’ll probably need the treatment area to be numbed before anything is done. Afterwards, you may feel some discomfort for up to 48 hours.

How do I know if I have gum disease?

The first sign is blood on your toothbrush or in the toothpaste you spit out after cleaning your teeth. Your gums may also bleed when you are eating, leaving a bad taste in your mouth. Your breath may also become unpleasant.

Once I have had periodontal disease, can I get it again?

There is no cure for periodontal disease, but it can be controlled as long as you keep up the home care you have been taught. Any further loss of bone will be very slow and it may stop altogether. However, you must make sure you remove plaque every day, and go for regular check-ups by the dental team.

I have heard gum disease is linked with other health conditions – is this true?

In recent years gum disease has been linked with general health conditions such as diabetes, strokes, cardiovascular disease, poor pregnancy outcomes and even dementia. More research is needed to understand how these links work but there is more and more evidence that having a healthy mouth and gums can help improve your general health and reduce the costs of medical treatment.

 

  Courtesy of the BDHF

 

 How can smoking affect my oral health?

Most people are now aware that smoking is bad for their health. It can cause many different medical problems and, in some cases, fatal diseases. However, many people don’t realise the damage that smoking does to their mouth, gums and teeth.

Smoking can lead to tooth staining, gum disease, tooth loss, and in more severe cases mouth cancer.

Why are my teeth stained?

One of the effects of smoking is staining on the teeth due to the nicotine and tar in the tobacco. It can make your teeth yellow in a very short time, and heavy smokers often complain that their teeth are almost brown after years of smoking.

How will smoking affect my gums and teeth?

Smoking can also lead to gum disease. People who smoke are more likely to produce bacterial plaque, which leads to gum disease. The gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums don’t heal. Smoking causes people to have more dental plaque and causes gum disease to get worse more quickly than in non-smokers. Gum disease is still the most common cause of tooth loss in adults.

How is smoking linked with cancer?

Most people know that smoking can cause lung and throat cancer, but many people still don’t know that it is one of the main causes of mouth cancer too. Every year thousands of people die from mouth cancer brought on by smoking.

Are there special dental products I can use?

There are special toothpastes for people who smoke. They are sometimes a little more abrasive than ordinary toothpastes and you should use them with care. Your dental team may recommend that you use these toothpastes alternately with your usual toothpaste. There are several ‘whitening’ toothpastes on the market. Although they do not affect the natural colour of your teeth, they may be effective at removing staining, and therefore may improve the overall appearance of your teeth.

What about mouthwashes?

People who smoke may find they are more likely to have bad breath than non-smokers. Fresh-breath products such as mouthwashes may help to disguise the problem in the short term, but will not cure it.

How often should I visit my dentist?

It is important that you visit your dental team regularly for a normal check-up and a full mouth examination so that any other conditions can be spotted early.

You should visit your dental team regularly, as often as they recommend. People who smoke are more likely to have stained teeth, and therefore may need appointments more often with the dental hygienist.

What can my dentist do for me?

Your dentist will carry out a regular examination to make sure that your teeth and gums and whole mouth are healthy.

Your dental team will also examine your cheeks, tongue and throat for any signs of other conditions that may need more investigation.

They may also be able to put you in touch with organisations and self-help groups who will have the latest information to help you stop smoking.

Will I need any extra treatment?

Your dentist may also refer you to a dental hygienist, for extra treatment, thorough cleaning and to keep a closer check on the health of your mouth. Your dental hygienist will be able to advise you on how often you should visit them, although this should usually be every three to six months.

  Courtesy of the BDHF

 

How can I tell if I have bad breath?

Lots of small signs can show that you have bad breath. Have you noticed people stepping away from you when you start to talk? Do people turn their cheek when you kiss them goodbye?

If you think you might have bad breath, there is a simple test that you can do. Just lick the inside of your wrist and sniff – if the smell is bad, you can be fairly sure that your breath is too.

Or, ask a very good friend to be absolutely honest with you; but do make sure they are a true friend.

What causes bad breath?

Bad breath is a very common problem and there are many different causes. Persistent bad breath is usually caused by the smelly gases released by the bacteria that coat your teeth, gums and tongue. Also, bits of food that get caught between the teeth and on the tongue, will rot and can sometimes cause an unpleasant smell. Strong foods like garlic, coffee and onions can add to the problem. So, it is very important to brush your teeth correctly and regularly. This will help keep your breath smelling fresh.

The bacteria on our teeth and gums (called ‘plaque’) also cause gum disease and tooth decay. One of the warning signs of gum disease is that you always have bad breath or a bad taste in your mouth. Again, your dental team will be able to see and treat the problem during your regular check-ups. The earlier the problems are found, the more effective the treatment will be.

What else causes bad breath?

Bad breath can also be caused by some medical problems. ‘Dry mouth’ (xerostomia) is a condition that means your mouth produces less saliva. This causes bacteria to build up in your mouth and this leads to bad breath. Dry mouth may be caused by some medicines, by salivary gland problems or by continually breathing through your mouth instead of your nose. Older people may produce less saliva, causing further problems.

If you suffer from dry mouth, your dental team may be able to recommend or prescribe an artificial saliva product. Or they may be able to suggest other ways of dealing with the problem.
Can other medical conditions cause bad breath?

Other medical conditions that cause bad breath include infections in the throat, nose or lungs; sinusitis; bronchitis; diabetes; or liver or kidney problems. If your dentist finds that your mouth is healthy, you may be referred to your family GP or a specialist to find out the cause of your bad breath.

Can smoking cause bad breath?

Yes. Tobacco causes its own type of bad breath. The only answer in this case is to stop smoking. As well as making your breath smell, smoking causes staining and loss of taste, and irritates the gums. People who smoke are more likely to suffer from gum disease and have a greater risk of developing cancer of the mouth, lung cancer and heart disease. Ask your dentist, pharmacist or healthcare professional for help with stopping smoking. If you do stop smoking, but still have bad breath, then you need to see your dental team or doctor for advice.

How can my dentist help?

If you do have bad breath, you will need to start a routine for keeping your mouth clean and fresh. Regular check-ups will allow your dentist to watch out for any places where plaque is caught between your teeth. Your dental team will be able to clean all those areas that are difficult to reach. They will also be able to show you the best way to clean your teeth and gums, and show you any areas you may be missing, including your tongue.

Can I prevent bad breath?

To keep your breath fresh, you must get rid of any gum disease, and keep your mouth clean and fresh. If you do have bad breath, try keeping a diary of all the foods you eat and list any medicines you are taking. Take this diary to your dentist, who may be able to suggest ways to solve the problem.

• Brush your teeth and gums last thing at night and at least one other time during the day, with a fluoride toothpaste.
• Don’t forget to brush your tongue as well, or use a tongue scraper. Cut down on how often you have sugary food and drinks.
• Visit your dental team regularly, as often as they recommend.
• Clean in between your teeth with ‘interdental’ brushes or floss at least once a day – brushing alone only cleans up to about 60 percent of the surface of your teeth. There are other products you can buy to clean between your teeth.
• Use a mouthwash – some contain antibacterial agents that could kill bacteria that make your breath smell unpleasant.

If you continue to suffer from bad breath visit your dental team to make sure that the mouthwash is not covering up a more serious underlying problem. Chew sugar-free gum – it helps your mouth produce saliva and stops it drying out. A dry mouth can lead to bad breath.

Will mouthwash help?

You should not use a mouthwash just to disguise bad breath. So, if you find that you are using a mouthwash all the time, talk to your dental team. There are many mouthwashes that are specially formulated to help prevent bad breath and gum disease. Some mouthwashes that contain chlorhexidine, and are recommended for gum disease, can cause tooth staining if you use them for a long time. It is important to read the manufacturer’s instructions or ask how to use them.

How can I prevent bad breath if I wear dentures?

It is just as important to clean dentures as it is to clean your natural teeth. Bits of food can become caught around the edges of dentures and clasps, and the food can rot if you do not clean them thoroughly.

You should keep a separate toothbrush for cleaning your dentures. The general rule is: brush, soak and brush again. Clean your dentures over a bowl of water in case you drop them. Brush your dentures before soaking them, to help remove any bits of food.

Soak the dentures in a specialist cleaner for a short time and then brush the dentures again. Brush them like you would brush your natural teeth.

Make sure you clean all the surfaces of the dentures, including the surface which fits against your gums. If you notice a build-up of stains or scale, have your dentures cleaned by your dental team. Most dentists still recommend a small- to medium-head toothbrush, or a specialised denture brush if you can get one.

How can I tell someone they have bad breath?

We probably all know someone who has bad breath, but very few people feel brave enough to discuss the problem. It is obviously a very delicate matter to tell someone they have bad breath.

There is always the risk that they will be offended or embarrassed and may never speak to you again! However, it is always worth remembering that the bad breath may be caused by any number of problems. Once the person knows they have bad breath, they can deal with whatever is causing it.

You could try talking to their partner or a family member, as the bad breath may be caused by a medical condition which is already being treated.

You may like to leave a leaflet where the person is likely to see it.

 

  Courtesy of the BDHF

 

Botulinum toxin injections, such as Botox and Dysport, are medical treatments that can also be used to help relax facial muscles.

This makes lines and wrinkles, such as crow’s feet and frown lines, less obvious.

They can temporarily alter your appearance without the need for surgery.

When Botox or Dysport injections are used in this way for cosmetic reasons, they are not available on the NHS.

Before you go ahead

If you’re considering Botox or Dysport injections, be certain about why you want to have them.

The injections are expensive, and have their limitations.

Cost: In the UK, Botulinum toxin injections cost £150-£350 per session, depending on the amount of product used.

Limitations:

• The effect isn’t permanent.
• There’s no guarantee the desired effect will be achieved.
• The ageing process will still happen elsewhere – for example, Botox will not fix sagging eyelids.

Safety:  Take time to find a reputable practitioner who is properly qualified and practises in a clean, safe and appropriate environment. Ask the practitioner what you should do if something were to go wrong.

Botulinum toxin is a prescription-only medicine that should only be prescribed and given by an appropriately trained healthcare professional, such as a doctor, dentist, pharmacist prescriber, or nurse prescriber.

Legally, the prescriber can delegate the administration of the injections to another person, but they are responsible for ensuring it is given safely.You shouldn’t have Botulinum injections if you’re pregnant or breastfeeding, since the effects on the baby aren’t known.

What it involves

You’ll need to first meet with the doctor, nurse prescriber, pharmacist prescriber or dentist who will prescribe the medicine. This should always be a face-to-face meeting. 

They’ll want to fully understand your medical history and reasons for wanting the treatment before they go ahead.

The person who prescribed the medicine might administer it, or they might delegate this task to another person.

Local anaesthetic isn’t usually needed. Your skin is cleaned and small amounts of Botulinum toxin are injected into the muscles of the face to be treated.

Several injections are usually needed at different sites. It takes about 10 minutes. The injections may be a little painful. Most people tolerate the discomfort well.

Afterwards

You won’t see any difference straight away: it takes about three to five days before the injections take effect, and up to two weeks for the full effect to be seen.

Avoid massaging or rubbing the treated areas for up to three days.

The effects generally last for about four to six months. If you want to maintain the effect, you’ll need regular follow-up injections.

Risks

The risks of treatment include:

• flu-like symptoms– including a headache – for the first 24 hours after treatment
• bruisingat the injection site
• temporary weakness and droopiness of your facial features– for example, eyelids or eyebrows may droop temporarily if the injected medicine moves into these areas 
• your body developing resistance to the treatmentif it’s repeated too frequently
• In rare cases, serious problems can develop in the hours, days or weeks after treatment, including blurred or double vision (if the area around the eyes is injected) and breathing difficulties (if the neck area is injected).

Dermal fillers are injections used to fill out wrinkles and creases in the skin.

They can also be used to increase the volume and definition of the lips and cheeks.

The fillers are made from a variety of materials and the effects can be either temporary or permanent, depending on the type of filler:

• collagen– effects last three to four months
• hyaluronic acid– lasts about four to six months
• calcium hydroxylapatite– lasts about 18 months
• poly-L-lactic acid (PLLA)– effects of injections given over several months may last up to two years
• polymethylmethacrylate beads (PMMA)– permanent, but most risky

Before you go ahead

If you’re considering dermal fillers, be certain about why you want to have them.

The procedure can be expensive and has its limitations.

Cost: In the UK, facial fillers cost about £300 to £450 per session, depending on the amount of product used.

Limitations:

• Most fillers aren’t permanent.
• There’s no guarantee the desired effect will be achieved. The ageing process will still happen elsewhere – fillers will not, for example, fix a sagging jawline.

Safety:  Take time to find a reputable practitioner who is properly qualified and practises in a clean, safe and appropriate environment. Ask the practitioner what you should do if something were to go wrong.

 

What it involves

You may be offered a local anaesthetic cream or injection. The practitioner injects the filler in a series of small injections and may massage the area.The treatment time

can vary from 30 minutes to an hour. It may be uncomfortable, but should not be very painful.

Afterwards

The area may be a little swollen, tender and red for 24 hours. During that time you may be advised to avoid coffee, alcohol, hot drinks and the sun.

Risks

The risks of dermal fillers depend on whether the procedure was done correctly and the type of filler used. Permanent fillers have the highest risk of problems and some practitioners feel they are best avoided.

General risks of dermal fillers include:

• rashes, swelling, itching and bruising
• an infection
• the filler movingaway from the intended treatment area over time
• In rare cases the filler forming lumps under the skin– this may need to be treated with surgery or medication
• In rare cases the filler blocking a blood vessel– this can lead to tissue death, permanent blindness or a pulmonary embolism

What to do if you have problems

If you’ve had fillers and are not happy with the results or are experiencing problems such as lumpiness, take up the matter with your practitioner through the clinic where you were treated.If there are any complications that require medical attention, it is best that you go back to the practitioner who treated you. If this is not possible, you can go to your GP or local accident and emergency (A&E) department.

1. Practice Complaints Procedure
   
   In this practice we take complaints very seriously and try to ensure that all patients are pleased with
   their experience of our service. When patients complain, they are dealt with as courteously and promptly
   so that the matter is resolved as quickly as possible. This procedure is based on these objectives.
   Our aim is to react to complaints in the way in which we would want our complaint about a service to be
   handled. We learn from every mistake that we make and we respond to patients’ concerns in a caring and
   sensitive way.
   1. The person responsible for dealing with any complaint about the services we have provided to you
   is Mr Majid Jamshad, Practice Manager.
   2. If a patient complains on the telephone or at the reception desk, we will listen to the complaint
   and inform you when it will be possible for you do discuss the matter with Dr Majid Jamshad. The
   member of staff will take brief details of the complaint and pass them on.If we cannot arrange
   this within a reasonable period of time, or if the patient does not wish to wait to discuss the
   matter, arrangements will be made for someone else to deal with it.
   3. If the patient complains in writing Dr Majid Jamshad will acknowledge the patient’s complaint in
   writing and enclose a copy of this code of practice as soon as possible, normally within three
   working days. We will seek to investigate the complaint within ten working days of the complaint
   being received, to give an explanation of the circumstances which led to the complaint.If we are
   unable to investigate the complaint within ten working days we will notify the patient, giving
   reasons for the delay and a likely period within which the investigation will be completed.
   4. We will confirm the decision about the complaint in writing to the patient immediately after
   completing our investigation.
   5. Proper and comprehensive reports are kept of any complaint received.
   6. If patients are not satisfied with the result of our procedure then a complaint may be made to:

Cwm Taf Health Board
Ynysmeurig House
Navigation Park
Abercynon
Cf45 4SN
Or
HIW, Welsh Governmaent
Rhdycar Business park
Merthyr Tydfil
CF48 1UZ