Root planning / curettage

What is gum disease?

Gum disease is a complex condition affecting the gums and bone supporting your teeth. Several factors contribute to it, including family history, smoking and chronic diseases such as diabetes.

It begins with plaque, a soft, sticky substance, that builds up on your teeth. Plaque is mostly made up of bacteria, which feed on sugar from food and drink. Tartar, formed by hardened plaque, helps plaque to gather and makes it harder to remove.

If plaque is allowed to build up, the bacteria in it can make your gums sore and infected; they will look red and puffy and hey will probably bleed when you brush your teeth.

The gum will then start to become detached from the tooth, forming ‘pockets’ in which plaque can gather – and bone supporting the tooth will slowly be lost. Because this process is usually painless, it can become very bad without you noticing.

If left unchecked, gum disease will lead to the loss of teeth.

What is root planing / curettage?

Root planing is a way of helping to halt gum disease. It involves ‘deep’ scaling, to clean parts of teeth below the gumline, which cannot be reached with a toothbrush. Root planing cleans out the pockets, and removes plaque and tartar from the tooth roots.

What does the dentist or dental hygienist do?

Dentist and hygienist use two types of instrument for root planing:

  • Hand scalers come in different sizes and shapes to reach different parts of the teeth. This is why you will see the dentist or hygienist changing instruments quite often.
  • Electric scalers use a tip that vibrates very fast in a stream of water. The water is removed from your mouth using a small suction device. A hand scaler is also used along with an electric scaler, to check whether the roots are completely clean.

After a tooth has been root planed, the pocket should shrink, making the gum sit closer to the tooth. You then need to be especially careful about cleaning the teeth above the gumline. Root planing will probably need to be repeated regularly.

Root planing usually takes longer than a normal scale and polish, and is often done under a local anaesthetic. Your mouth might be treated in sections, at more than one visit.

Points to remember:

  • Root planing can help stop gum disease becoming worse and prevent tooth loss
  • Like scaling and polishing, root planing helps you to keep your teeth and gums clean at home.
  • To reduce the risk of your gum disease progressing, do not smoke, and eat a healthy, balanced diet.
  • Dentists and dental hygienists cannot keep your moth healthy by themselves. Your own cleaning is the key.

Speak to your local Clear Dental Practice to learn more.

Keeping a denture or bridge clean

Why is cleaning important?

Just like natural teeth, dentures and bridges collect bits of food, plaque (a sticky deposit, mostly made up of bacteria) and tartar (hardened plaque). By keeping them clean, you can stop decay in any remaining natural teeth and help prevent gum disease (which can lead to tooth-loss). It’s also good for your comfort and appearance to clean dentures, as dirty dentures can make your mouth swollen and sore.

Cleaning a denture is quite easy because, of course, you can take it out of your mouth. Cleaning all round and underneath a fixed bridge is harder. Your dentist or hygienist will show you how to do it.

How do I look after a denture?

  • Clean the denture over a basin of water so that it doesn’t break if you drop it.
  • Brush the denture inside and out every day. Use a soft-to-medium brush so that you do not scratch the denture. Use your normal toothpaste, or soap and water. Then rinse the denture.
  • Ask your dentist about denture-soaking solutions. Soaking a denture will not clean it. You also need to brush it. Rinse the denture before you put it back in your mouth.
  • Ideally, denture should be left out of the mouth for at least four to six hours, preferably eight hours, in every 24. However, if you find this impractical or embarrassing, you should still make sure you clean your dentures by brushing with toothbrush and toothpaste.
  • Keep a denture dry or in a denture-soaking solution when you are not wearing it. These solutions are mild disinfectants available at all chemists’ shops.

How do I clean a bridge?

  • How you clean will depend on where the bridge is in the mouth and its design. As well as normal brushing with a fluoride toothpaste and flossing at each end of the bridge, you need to keep the bridge clean underneath.

You might use:

  • Floss with a threader or a special floss with a stiff end which you can poke underneath the bridge and pull through
  • ‘Bottle brushes’ (your dentist will tell you what size and shape to buy) or
  • Water jets – sending a stream of water under the bridge

What are the benefits?

  • By keeping a denture or bridge clean, you help keep your gums and teeth healthy and avoid bad breath.
  • People who wear dentures sometimes get an infection called oral thrush. Thrush is more likely if you wear the denture all the time.

Good denture hygiene is important for preventing oral thrush.

Speak to your local Clear Dental Practice to learn more.

Tooth erosion

What is it?

Acids in the mouth can dissolve away tooth surfaces. Given the chance, teeth with repair themselves, using minerals from saliva. But if acid is in the mouth too often, teeth cannot repair themselves and the hard tooth surface (the enamel) becomes thinner – this is called ‘erosion’.

The teeth can then become extra sensitive to hot and cold food and drink. Eroded teeth can also be likely to suffer decay. The appearance of eroded teeth can also change: they can become discoloured (translucent or yellowish), and their shape can be altered.

The main cause of erosion is too frequent consumption of certain kinds of food and drink. All fizzy drinks (including ‘diet’ brands and fizzy mineral water), all ‘sports’ drinks, all squashes and all fruit juices are acidic to varying degrees. Pickles and citrus fruits are examples of acidic types of food.

Some medicines are acidic and, therefore, erosive.

And people with some illnesses (such as eating disorders) may suffer from erosion because of frequent vomiting, as stomach acids also erode teeth. For this reason, dentists may ask about eating disorders if they see teeth are very badly eroded.

How do I prevent erosion?

Don’t have acidic and/or drink too often during the day. Try to have them only at meal-times and drink acidic drinks quickly – don’t sip them. And don’t swash them around your mouth.

Between meals you should only have ‘safe’ drinks, which are not sugary or acidic. Milk and water are ‘safe’ drinks. So are tea and coffee if you do not add sugar to them (you can use non-sugar sweeteners).

You should try and avoid snacking between meals. If you do snack, only have ‘safe’ snacks, which are not sugary or acidic.  Fruits, vegetables and products such as sandwiches, toast, crumpets and pitta bread are all ‘safe’ snacks. You should try and avoid snacking between meals. Some fruits, especially citrus fruits, are acidic and are known to cause erosion if they are consumed in large quantities. This is not normally a problem for most people; however, you could discuss with your dentist or hygienist the safest way to enjoy these fruits.

Because acids temporarily soften the tooth surface, don’t brush your teeth immediately after eating or drinking something acidic. This will allow time for your salvia to neutralise the acid.

How can my dentist help?

Your dentist can identify erosion, pinpoint the causes and advise how to avoid further damage.

Speak to your local Clear Dental Practice to learn more.

Silver fillings

What are they?

A filling replaces part of a tooth that has been lost because of decay or through accidental damage.

Silver fillings are made of dental amalgam – a mixture of mercury with other metals, including silver, tin and copper. Amalgam is soft at first, but quickly becomes hard once placed in the tooth. Dentists use amalgam because it is tough and safe. However, there are alternatives to amalgam such as white fillings.

What will my dentist do?

Your dentist will:

  • usually numb the tooth and surrounding area with an injection – some small fillings may not need an anaesthetic.
  • Remove any decay, together with any old filling material, using a small, high-speed drill.
  • Remove any weak part of the tooth that might break later.
  • Shape the cavity, so that the tooth will hold the filling in place.
  • Possibly cut a cement lining in the bottom of the cavity before inserting the filling.
  • Pack soft amalgam tightly into the cavity – you might hear a squeaking noise as it goes in. The dentist might put a thin metal band around the tooth prior to packing the amalgam to help control the shape of the filling.
  • Carve the filling to fit the tooth.
  • Ask you to close your teeth together gently, to check that the filling is the right height and is comfortable.
  • Make any necessary small adjustments to the filling at the next visit.

What are the benefits?

  • A filling rebuilds the tooth so you can chew.
  • If decay is left unchecked, it can spread deep into the tooth, causing pain and infection. This could mean the tooth has to be root filled or even taken out.
  • A filling can prevent further toothache or discomfort.
  • Silver fillings are very strong and perform well in back teeth, where there is heavy wear from chewing. They do, however, have the cosmetic drawback of not being tooth coloured. Tooth coloured filling materials, which look better, require less drilling and can be repaired, are also available, but take longer to place and may wear less than silver fillings. Silver fillings are best used when existing silver fillings need to be replaced and in situations where the use of a tooth coloured filling material is difficult.

Speak to your local Clear Dental Practice to learn more.

Tooth whitening

What is it?

Like hair and skin, teeth vary in colour. Some are yellower or darker than others, even when they are quite healthy. teeth tend to get darker as people get older.

Teeth sometimes become darker if their roots have been damaged or diseased and the ‘nerve’ has died.

Tooth colour can be very effectively lightened with Hydrogen Peroxide (bleach), used on either the outside or the inside of the tooth.

Tooth bleaching is safe as long as the bleach does not touch your gums and burn them. Dentists use a special jelly bleach.

Tooth whitening should only be carried out by a trained dental professional.

What will my dentist do?

Where the ‘nerve’ of a tooth has ‘died’ (through damage or disease) and the tooth’s root has been filled, bleach is put inside the tooth, under a removable try or temporary dressing. This can take from a few days to a week.

There are two ways of bleaching the outside of teeth. One takes place at home and the other in a dentist’s surgery.

Home bleaching works like this:

  • The dentist will give you weak bleach jelly to use at home in a tray which fits closely round your teeth. The tray makes sure that the jelly does not burn your gums. You will need to put the tray in your mouth overnight (for a few hours) on several occasions, as instructed by your dentist (probably over a period of weeks)
  • The dentist will need to use a putty-like material to make moulds of your mouth (called ‘impressions’), so a dental technician can make the tray to fit. At your next appointment, your dentist will check that the tray fits and show how you put the bleach in the tray at home.

Bleaching in the surgery looks like this:

  • Your dentist (or dental care professional) will use a stronger bleach jelly than is used for home bleaching. Dentists use this method to bleach all the teeth at the same time in either your upper or lower jaw. The strong bleach will touch the teeth for less time than with home bleaching
  • The dentist should protect your gums. They will paint the bleach onto the teeth and either shine a special light at them or just leave the bleach on the teeth for some time
  • The bleach is then washed off with water.

For both techniques, your dentist will make a note of your tooth colour using model teeth in different shades before they treat you. Look at the colour match yourself before the treatment, so you can compare it with the colour after bleaching. Occasionally bleaching can cause your teeth to become more sensitive to hot, cold and sweet things. Should this occur, stop bleaching for a night or two if you are using the nightguard bleach, and use desensitising toothpaste. If the problems persists, see your dentist.

Over-bleaching can also lead to sensitivity or less of vitality (where the tooth dies) which is why it is essential for the procedure to be carried out by a trained dental professional.

What are the benefits?

Bleaching improves the appearance of your teeth without removing any of the natural tooth surface. Bleaching is a better option than a crown or veneer if you want to lighten the colour of healthy teeth, as the placing of crowns and veneers involves changing the shape of the tooth.

Speak to your local Clear Dental Practice to learn more about tooth whitening.

Periodontal (gum) diseases

What are they?

The simplest form of gum disease, gingivitis, is often a reaction to a build up of plaque on the junction of the gum and the teeth. Plaque is a soft, sticky film of bacteria, which grow on the warm, moist surface of the mouth. Plaque builds up in difficult to clean areas, especially below the contact areas between teeth. It is important to clean these areas daily with interdental brushes or dental floss.

The earliest sign of disease is bleeding of the gums. They may also look red or swollen. Gingivitis can often be cured simply with good mouth hygiene- brushing twice a day, together with interdental cleaning, as advised by a dental healthcare professional, and the use of clinically proven mouthwash. If your gums become infected or sore and you notice an unpleasant metallic taste, this is acute gingivitis and you should seek urgent treatment.

As gum disease progresses the tissues holding teeth in place start to break down and pockets (gaps) develop between gum and teeth. This allows even more plaque to gather. This stage is called chronic periodontitis. It is usually painless and can become quite severe if not treated resulting in teeth becoming loose, appearing to move position or eventually to fall out.

Symptoms to watch out for are:

  • bleeding gums
  • gums that have come away from teeth
  • pus between the teeth and gums
  • persistent bad breath or a bad taste
  • Permanent teeth that are loose or are changing position

Scaling and polishing by a dentist or hygienist can remove tartar and stains. This will help you to remove the plaque efficiently.

In more severe cases of gum disease, deep cleaning below the gumline by a dentist or hygienist may be neccesary. Occasionally surgery is required in which the gum is reshaped under local anaesthetic tro allow affected areas to be treated or cleaned.

If gum disease has progressed too far, the tooth or teeth involved may have to be removed.

Who gets gum disease?

Gum disease can start when you are a child, but chronic periodontitis is normally only a problem in adults.

Some people are more likely to have periodontal disease than others:

  • smoking makes gum disease considerably worse. Quitting smoking is important for your general and mouth health
  • diabetes and some other diseases reduce people’s resistance to gum disease. People who have these conditions need to be especially careful about their mouth hygiene
  • certain drugs and medicines can affect your gums: ask your dentist about these
  • crooked teeth are more difficult to keep clean, so the gums supporting such teeth might be more prone to gum disease
  • existing gum disease can be worsened by hormonal changes, due to pregnancy or oral contraceptives (‘the pill’). Here again, good hygiene is important
  • eating a healthy diet with plenty of fruit and vegetables helps resist gum disease
  • untreated gum disease can adversely affect your general health and wellbeing

Speak to your local Clear Dental Practice to learn more.