dentistry

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.

Crowns

What are crowns?

The crown of a tooth is that part which is visible in the mouth. An artificial crown is used to protect and restore a broken, weakened or heavily filled tooth. They are also used to improve the appearance of very severely discoloured teeth.

Crowns are made of many different materials including metals and ceramics or a combination.

What will my dentist do?

  • The dentist will reduce and shape the tooth so that, when the artificial crown is fitted, it will be the same size and shape as a normal tooth.
  • Preparation time will depend on how damaged the tooth is and whether it needs to be built up first.
  • If the tooth has died or there isn’t enough left to support the crown it may have to be root-filled first; this is sometimes called removing the nerve. If a lot of tooth is missing the crown maybe held in place by a peg or post in the root canal.
  • Your dentist will use a soft mouldable material to make an exact impression of what remains of the tooth that is to be crowned and the adjacent teeth.
  • A dental technician uses the impressions to make the crown.
  • A temporary crown made of plastic or metal is usually put over the tooth until the permanent crown is made. You can chew on a temporary crown but it won’t be as strong as the finished one.
  • When the crown is fitted, your dentist may need to make small adjustments to make sure you can bite comfortably. The crown is tried on and then cemented into place.
  • The nerves / pulp of crowned teeth can sometimes go on to die, requiring a root filling or, in the worst case, an extraction.
  • Maintaining good oral hygiene is important to prevent decay around the margins of the crown.

What are the benefits?

  • The crown is strong and can look and feel exactly like a natural tooth. The colour and shape can be matched to your own teeth.
  • Depending on the strength of the tooth underneath, a crown can last for many years if you look after your mouth and teeth and the crown is not accidentally damaged.
  • Crowns can also improve your appearance.
  • Crowns are often necessary to protect weakened, root-filled teeth.

Speak to your local Clear Dental Practice to learn more about crowns.

Fluoride

What is fluoride?

Fluoride is a natural mineral that is very effective in protecting teeth against decay.

How does fluoride work?

Tooth decay begins with dental 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, producing acids as a waste product. The acid attacks the teeth by dissolving the minerals in the tooth structure. If this happens too often, tooth decay results.

Minerals in saliva can mend the teeth. If fluoride is present in the mouth, it helps teeth to repair themselves.

And if fluoride is consumed in appropriate amounts by young children, it helps to make growing teeth more resistant to decay.

Fluoride in toothpaste

Most people get fluoride from toothpaste. Packs tell you how much the toothpaste contains in parts per million (ppm). Adults should use toothpaste containing 1350-1500ppm, unless advised otherwise by a dentist.

For children, consuming too much fluoride can produce unattractive marks on their teeth. To prevent this, you should help children up to the age of seven to clean their teeth. Make sure they do not eat the toothpaste and only use the correct amount:

  • Children aged under 3 should only use a smear of toothpaste, which should contain no less than 1000ppm of fluoride.
  • Children aged 3-6 years should use a small pea-sized blob of toothpaste, containing 1350-1500ppm of fluoride.

Children may also have fluoride applied as varnish painted on by their dentist.

For patients with a lot of decay, dentists may recommend extra fluoride, either as tablets, drops or varnish, and for patients over 10 years of age, toothpastes with 2800ppm fluoride may be prescribed. For patients over 16 with high decay rates 5000ppm toothpaste may be prescribed.

Speak to your local Clear Dental Practice to learn more about fluoride.

Wisdom Teeth

What are they?

Wisdom teeth are the last teeth to appear, at the back of the mouth, from the late teens onwards. Most people have four wisdom teeth, but it is not unusual to have fewer – or even more.

Because they are the last teeth to form, there sometimes isn’t room for them. They come through at an angle, pressing against the teeth in front or the bone behind.

What will my dentist do?

Watching how your teeth and jaws grow is part of your regular dental care. Do tell your dentist if you think they might be a problem.

  • X-ray pictures can show where the wisdom teeth are in the jaw and how much room there is for them to come through, as well as showing if they are causing any damage to the teeth in front.
  • The X-rays will also show how simple or difficult it may be to take a wisdom tooth out.

As wisdom teeth are coming through, the surrounding gum sometimes becomes inflamed and sore. This is called pericoronitis. It may settle down or come and go over a period. It is usually better to remove a wisdom tooth if you have repeated bouts of pericoronitis.

If you need to have a wisdom tooth removed, you should be able to fit it in with work or other commitments.

Sometimes, you may be referred to a specialist to have a problem wisdom tooth removed in hospital.

Most wisdom teeth are removed under a local anaesthetic but depending on how difficult the tooth is to remove, sedation (something that makes you drowsy) or general anaesthetic (only given in hospitals) may be considered.

Depending on your job you may need to take two or three days off work to recover from your wisdom tooth operation. If you have had a general anaesthetic then you will need some time off work to recover from the effects of the anaesthetic.

Sometimes, nerves can be damaged when lower wisdom teeth are removed. This leads to numbness in part of the tongue or in some teeth and part of the lower lip and chin – but this is usually temporary.

What are the benefits of removing wisdom teeth which are causing problems?

  • If you have your wisdom teeth removed, there will be no more pain and infection.
  • It will usually make it easier for you to keep your mouth clean.

Normally there is no need to have wisdom teeth removed unless they are causing you problems.

To read more about what to do after a tooth extraction, click here.

Speak to your local Clear Dental Practice to learn more about wisdom teeth.

What to do after an extraction

You need to look after yourself carefully after you have had a tooth taken out, as with any operation, to speed up healing and prevent infection. This advice is to help you know what to expect and do, as your mouth recovers.

General Advice:

  • For the first 24 hours, don’t drink alcohol, eat hot food or disturb the clot, which will have formed in the space left by the tooth, because this may cause the socket to start bleeding again. Don’t smoke either, and avoid strenuous exercise for the rest of the day.
  • Don’t rinse your mouth for six hours after extraction.
  • After six hours, rinse gently with warm salty water to keep the socket clean and continue to do this for up to a week after meals and before bed. Use half a teaspoonful of salt in a glass or comfortable warm water.
  • Brush your teeth normally with toothpaste to keep the whole mouth clean but take care in the region where the tooth was extracted.
  • If you feel small pieces of bone working their way out of the socket, don’t worry – this is normal.
  • Some swelling or discomfort in the first few days is also normal.
  • Take painkillers if you need the. Ask your dentist for advice if you are not sure of what sort to take.

If the bleeding doesn’t stop:

  • Your dentist may have given you a small supply of gauze in case this happens. If not, clean cotton handkerchiefs will do, but not tissue papers. It is the effect of pressure from the gauze or handkerchief that prevents bleeding, this is why a tissue will not work.
  • Roll some small firm pads about on centimetre by three centimetres – a size that will fit over a socket.
  • Keep sitting up and gently clear away any clots of blood around the socket with the gauze of handkerchief.
  • Place a pad across the socket from the tongue side to the cheek and bite firmly on it for 10-15mins.
  • Take off the pad and heck whether the bleeding has stopped. If it hasn’t, use a fresh pad. If the socket is still bleeding, contact your dentist.

Occasionally after extraction of a tooth, the blood clot in the socket can break down, leaving a painful empty hole in the gum. This is called ‘dry socket’. If the socket becomes painful a few days after the extraction, this is usually the reason. If this happens, you should go back to your dentist to have the wound cleaned and packed with a dressing.; This will relieve the pain and reduce the risk of infection.

If you follow these instructions, your mouth should heal normally without becoming infected. But if anything in your mouth worries you, phone the practice for advice.