X-rays

X-rays show what is happening inside and around the tooth and it’s roots – any decay or gum disease, bone loss, and, in children, how the jaw is growing too.

There are two types of x-ray commonly used. A ‘bite-wing’ x-ray is gripped between your teeth and shows the areas in between the teeth but not the roots. A ‘peri-apical’ x-ray is placed next to the tooth and shows the whole of the tooth and its root.

There are also large x-rays which show all of the jaw and teeth – these are called panoramic x-rays and the x-ray machine moves around your head while you stand still.

What happens?

Your x-ray examination will be carried out by your dentist. Training ensures safety as well as x-rays which are clear to read. All x-rays taken for health reasons entail a small radiation risk but the dental radiation dose is very low. If you are concerned about safety it may be helpful to know that:

• Your dentist will only take x-rays if they are needed.
• X-ray machines are checked regularly to ensure that they are using only the intended radiation dose.
• There is no reason not to use dental x-rays during pregnancy (although you might still be asked whether you are pregnant or whether you might be, and whether you would rather not have an x-ray).

When the x-ray is taken:

• You will need to keep very still for a few seconds to give a clear picture.
• The film is usually developed while you wait and then labelled.
• Sometimes it is useful for the dentist to compare a new x-ray with one taken some time ago. Your dentist will keep your old x-rays in your file.

The benefits of x-rays:

• All forms of dental treatment rely on dental x-rays. Simply looking in your mouth cannot give the dentist as much information.
• X-rays allow old treatment to be reviewed as well as new problems to be identified.

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Keeping your mouth clean

Keeping your mouth clean helps prevent dental disease:

• Sticky plaque builds up on everyone’s teeth every day and this can lead to gum disease. The gum comes away from the teeth, making the plaque more difficult to clean away. This makes gum disease worse. You can stop gum disease starting by cleaning your teeth carefully.
• Just brushing your teeth will not prevent tooth decay. You need to brush with a fluoride toothpaste. This helps the tooth mend itself after being attacked by plaque acids. Thorough brushing gets fluoride all around the mouth.
• Teeth also erode. This means they dissolve away when you have acidic food and drink too often. Rinsing acids away with water afterwards helps to prevent erosion.

As well as cleaning your teeth and gums thoroughly, try to have sticky and acidic food and drink less often.

How to brush your teeth:

Using a hand brush

• Brush you teeth thoroughly twice a day with a soft to medium brush and fluoride toothpaste. Replace the brush when the bristles get out of shape.
• Put the bristles at the join between teeth and gums, pointing towards the gums using short circular movements.
• Brush all round every tooth, carefully making sure you can feel the brush on your gums.
• Don’t use too much force.
• Small children usually cannot brush properly until they are eight or nine so brush their teeth yourself. One way is to stand behind your child and tilt their head back so you can reach round all the teeth.

Using an electric (Sonic) toothbrush

• The same principle applies except you do not do any circular motions but slowly move the bristles along the side of the teeth and gums.
• Also. Move the head of the brush across the top of the biting surfaces of the teeth.
• These brushes have a timer, allowing you to do exactly thirty seconds cleaning on each quarter of the mouth.
• Sonic brushes will normally switch themselves off after two minutes of brushing.
• Change the head every six months.

Dental Floss

Dental floss helps you clean in between your teeth. Your dentist will tell you whether you need to floss. If you do, they will show you how to do it. You may need to practise in front of a mirror.

• Use about 18 inches of floss. Wrap the ends around the middle fingers of each hand, leaving two to three inches between the first finger and thumb.
• Gently slide the floss between two teeth and put it around one tooth, next to the gum, using your fingers.
• Move the floss up and down the side of the tooth several times.
• Do the same for every tooth.

Children do not need to floss.


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Healthy Eating

Why does healthy eating matter?

The most common dental problems are caused by foods and drinks.

• Bits of food left on the teeth form plaque which causes gum disease if it is not cleaned off regularly.
• Bacteria in plaque produce acids which cause decay.
• Acids in food and drink can dissolve away tooth surface – this is called erosion.

Good oral hygiene will prevent most dental problems. But you can also reduce the risks for your mouth by having sticky or acidic food and drink less often.

How can I tell what’s healthy?

You won’t always be able to tell whether a product will harm your teeth.

• Labels sometimes hide what is in the product. A label might say ‘carbohydrate’ instead of ‘sugar’ for example.
• Some products say ‘no added sugars’ even though they could contain a lot of natural fruit sugar.
• Products containing small amounts of sugar could be harmless if they also contain ingredients such as calcium.
• There is not a simple test of how erosive foods and drinks are so labels cannot answer this question for you.

Milk and sugar are safe drinks. So are tea and coffee if you do not add sugar to them. Fruit, vegetables, dairy products (such as cheese) and starchy products (such as bread, rice and pasta) are all safe foods.

Because it is not easy to be sure exactly what is harmful, the best advice is to cut down on how often you have a sugary drink or acidic food and drink. Just use food and drink sensibly and don’t bathe your teeth in a stream of acid or sugar or other stickiness.

Remember the rules

• Clean your teeth twice a day.
• Don’t eat sugary, sticky or erosive foods more than five times a day.
• Eat at least five servings of fresh fruit and vegetables a day.

During the day, when you cannot clean your teeth, think about chewing sugar-free gum. Chewing gum increases the flow of saliva around the mouth, helping to remove bits of food. Also, minerals in saliva (and fluoride in the toothpaste) will help the tooth mend after it has been attacked by plaque acids.

What are the benefits?

• A healthy diet and good oral hygiene should prevent most dental problems.
• Nutritionists give the same advice as dentists about healthy eating. If you change how you eat so as to look after your teeth, the rest of your body will be healthier too.

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Fissure Sealants

Fissures are grooves in the chewing surfaces of the back teeth. They are difficult to keep clean so there is more risk of decay. Fissures can be sealed with tough plastic to protect them. The plastic is runny at first but sets hard, like paint. Sealants may be see-through or tooth-coloured. They are normally only used for children and only on permanent teeth, not on milk teeth.

Your dentist will discuss whether you need sealants. If you do, you will also have to agree which teeth need to be sealed. The need for sealants will depend on:

• the shape of each tooth.
• How much a child’s teeth have already decayed.
• How much decay a brother or sister has had (because there can be family patterns in tooth decay), and
• A child’s general health (because general health problems can make it especially important to avoid dental problems).

How we apply fissure sealants:

The dentist will:

• clean the tooth thoroughly with a rotating brush or rubber polisher.
• dry the tooth and keep it dry by putting cotton wool round it and using suction.
• dab a mild acid on the tooth and leave it for a short time to make the surface of the tooth rough ( this will not hurt at all).
• wash and dry the tooth by blowing water and then air on to it.
• change the cotton wool rolls around the tooth to keep it dry.
• paint plastic on to the fissures.
• harden the plastic by pointing a bright light at it ( you will see the dentist and dental nurse protecting their eyes).
• check that the tooth is comfortable to bite on, and
• trim and polish the sealant.

• Fissure sealants protect teeth from decay.
• They can last for years. Or, if they fall out or wear out, they can usually be replaced if there is no decay underneath.

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Tooth Whitening

The colour of your teeth can be lightened with Carbamide Peroxide, used either on the outside or the inside of your tooth or teeth.

• Like hair and skin, teeth vary in colour. Some are yellower or darker than others, even when they are quite healthy.
• Teeth sometimes darken if their roots have been diseased. A change in colour is caused by blood from the root canal.

Whitening is completely safe as long as the whitening agent (bleach) does not touch your gums and burn them. A special jelly bleach will be used.

How teeth are whitened:

For a tooth which is dark inside, the bleach is put in the root canal temporarily, before or after the tooth is root-filled.

There are two ways of bleaching the outside of teeth.

• You may be given a 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 use the tray for an hour or two a day, for up to six weeks.
• A dental technician will make the tray you use for bleaching your teeth at home from an impression of your teeth. The fit of the tray will be checked and you will be shown how to fit it and put the jelly in at home.
• Another method is to use a stronger bleach jelly. Here all the teeth are whitened at the same time in either your upper or lower jaw. The stronger bleach will touch the teeth for less time than with the home bleaching.

If the stronger bleach is used your gums will be protected. Bleach will be painted on to the teeth and heated with a light for a few minutes. This is then washed off with water.

• A note will be made of your tooth colour using model teeth in different shades before you are treated. You may look at the colour match yourself before the treatment so you can compare it with the colour after bleaching.
• Your teeth may be sensitive to hot and cold food and drink for a few days after bleaching.

The benefits of this treatment:

This technique improves the appearance of your teeth without removing any of the natural tooth surface. This is a better option than a crown or veneer if you want to lighten the colour of healthy teeth.


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Scaling & Polishing

A ‘Scale and polish’ cleans your teeth very thoroughly:
‘Scaling’ removes the hard ‘tartar’ which forms on your teeth like ‘scale’ inside a kettle and can’t be removed by brushing alone. Scaling also removes trapped food and sticky ‘plaque’ which contains millions of bacteria which cause decay and gum disease. Stains from coffee, tea, cigarettes or red wine are also cleaned away when the teeth are polished.

Your teeth will be scaled by one of our dentists. If your own tooth cleaning is very thorough then your scale and polish will take less time.

How we scale your teeth:

There are two ways to scale teeth:

• Hand scalers – These come in different sizes and shapes, to reach different parts of the teeth. This is why you will see the dentist changing the instruments quite often.
• Electric or Ultrasonic scalers – These use very fast vibration with water. The water is sucked out of your mouth.

For polishing, a rotating brush or rubber polisher is used afterwards, with toothpaste.

Root Planing:

Scaling cleans above and below the gums. If you have gum disease then scaling needs to be deeper, around the roots of the teeth. We call this ‘root planing’. You may be given a local anaesthetic to make it more comfortable.

The benefits of this treatment:

• Regular scaling and polishing by a dentist helps keep your teeth and gums healthy by making it easier for you to keep your teeth clean at home. You should see and feel the difference.
• Gums which bleed when you brush are signalling early gum disease. Regular scaling helps stop the disease progressing.
• Gum disease can cause bad breath; which can be prevented by regular scaling and thorough home care.

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Root planning & curettage

Root planning is ‘deep’ scaling to clean parts of the teeth below the gum-line which cannot be reached with a toothbrush.

Gums can become diseased so that they look red and puffy. They will probably bleed when you brush. Painless gum ‘pockets’start to form around the teeth and bone supporting the teeth is slowly lost.

Root planning cleans out these pockets and removes plaque and hard tartar from the tooth roots. It takes longer than a scale and polish and is often done under local anaesthetic. Your mouth might be treated in sections, or more than one visit.

What does the dentist do?:

Dentists use two types of tools for root planning.

• Hand scalers come in different sizes and shapes, to reach different parts of the teeth. This why you will see the dentist changing instruments.
• Electric scalers use very fast vibration with water. The water is removed from your mouth using suction. A hand scaler is used to check whether the roots are completely cleaned of deposits.

After a root 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 gum-line. Root planing will probably need to be repeated at intervals.

What are the benefits of this treatment?

• Gum disease is progressive and – because it is painless – it can become severe without you noticing. When there is not enough supporting bone left, teeth become loose and eventually have to be extracted. Root planning can stop gum disease becoming worse and prevent tooth loss.
• Like scaling and polishing root planning helps you to keep your teeth and gums clean at home. Dentists cannot keep your mouth healthy by themselves. Your own cleaning is just as important.

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Periodontal (gum) disease

Periodontal disease affects the gums and bone supporting your teeth. It is caused by sticky plaque and hard deposits of tartar. It usually happens when the teeth and gums are not kept clean enough. If you have very bad gum disease, you may have inherited it or you may have a problem with your general health which needs to be investigated.

Thoroughly brushing can remove sticky plaque. Scaling and polishing can remove hard tartar. Without regular cleaning, the gum will come away from the tooth, making pockets around the teeth where food and plaque can collect. Pockets are more difficult to keep clean so gum disease will usually get worse if nothing is done.

Gum disease has two stages:

• It starts with inflammation – redness and swelling. Dentists call this gingivitis. It can be cured with good oral hygiene.
• The next stage is called chronic periodontitis. Some of the bone that supports the teeth is lost and the teeth become loose until they eventually have to be taken out. Periodontitis cannot be reversed once it starts but it doesn’t have to get worse if you clean your teeth properly and have regular root planning from your dentist.

Who gets gum disease?:

Gum disease can start when you are a child. Chronic periodontitis is normally only a problem for adults. You might be worried about bad breath or your teeth looking longer as the gum covers less of them.

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

• Crooked teeth are more difficult to keep clean so you might have gum disease in just one part of your mouth.
• People have different bacteria in their mouths. This may explain why gum disease can get worse very quickly for some people but not for others.
• Smoking and drinking a lot of alcohol can make gum disease worse. Both are also linked with mouth cancer.
• Drugs and medicines can affect your gums so your dentist will ask you about your general health.
• Diabetes and some other diseases can reduce how resistant gums and bones are to damage.
• Hormone changes also affect gum health. It could make a difference if you are pregnant or using an oral contraceptive.

Why should I avoid periodontal problems?

• However healthy and strong your teeth are, they need to be supported by healthy gums and bone. Periodontal disease can lead to you losing teeth and all the difficulties that this can cause for eating and speaking.
• Scientists are now discovering that periodontal disease is linked to coronary heart disease and stroke, especially for people who are already at risk in other ways ( through poor diet, smoking or high blood pressure).

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Crowns

A crown completely covers a weakened tooth above the gum line and protects it.

Crowns are made of metal, porcelain, or porcelain with metal inside for strength.

How we prepare a crown:

• A local anaesthetic to numb the area may be given.
• The tooth is shaped so that, with the crown, it will be the same size as a normal tooth.
• Preparation time will depend on how damaged the tooth is and whether it needs to be built up with a filling first.
• The tooth might have to be root filled first – this sometimes called ‘removing the nerve’. The crown is sometimes held in place by a post in the root canal if a lot of tooth is missing.
• Soft mouldable material is used to make a precise ‘impression’ of the tooth to be crowned and the nearby teeth. A dental technician uses the impression to make the crown the exact height and size needed.
• A thin cord may be used to hold the gum away from the neck of the tooth so that the impression is accurate round the edges.
• A temporary crown made of plastic or metal is put over the tooth until the 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, small adjustments are made to ensure you can bite comfortably. The crown is tried in first, and the ‘glued’ into place.

The benefits of this treatment:

• A crown is strong and can look and feel almost 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 your oral hygiene is good and the crown is not accidentally damaged.
• Crowns can also improve appearance of misshapen or discoloured teeth.

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Veneers

A veneer is a thin layer of tooth-coloured material put onto the front of a tooth to make it look better. The tooth might have been damaged by decay or accident, or be discoloured.

How do we make a Veneer?

Some veneers are built up on the tooth using white filling material, while you are with the dentist. Others are made out of porcelain by a dental technician, from an impression of the tooth taken by the dentist. This type of veneer needs more than one visit.

• Any fillings in the teeth will be checked first.
• Very little tooth preparation is needed – just enough to prevent the veneer making the tooth feel bulky so it may not be necessary to numb the tooth.
• For veneers made in the surgery the surface of the tooth is roughened with mild acid. The ‘composite’ (white filling) is applied in layers until the look and shape of the tooth is right.
• For a veneer made by a dental technician, an impression is taken by the dentist first. This shows how the teeth bite together as well as telling the technician the shape and size of veneer needed.

Veneers sometimes come away from the tooth or break if the tooth is knocked. They can sometimes be glued back on but will have to be replaced if they are damaged.

• Veneers can greatly improve appearance. They hide imperfections and you lose very little natural tooth.
• Veneers also protect teeth from further damage. For example acid in foods and drinks or from the stomach can cause erosion. The teeth become thin and weak but veneers can protect them.
• If the tooth is sound and strong, a veneer is often a better option than a crown for improving a tooth’s appearance.

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Bridges

A bridge replaces a missing tooth (or teeth) by fixing the replacement to the natural teeth at each side of the gap. Some bridges have crowns at each end. Others are fixed to the surface of the teeth beside the gap. Sometimes a bridge is only fixed to the tooth on one side of the gap.

Bridges are made of metal and porcelain or occasionally of porcelain alone.

How do we prepare a bridge?

There are several stages in making a bridge:

* Normally you would have a local anaesthetic to numb the tooth and gum before starting treatment.

• The dentist uses soft, mouldable material to take impressions of your mouth. A dental technician makes exact plaster models of your upper and lower teeth and gums, which show how your teeth bite together.
• The teeth which will support the bridge are prepared so that the bridge is not too bulky.
• Another impression is taken of the teeth and any gaps and the dental technician uses this to make the bridge. A plastic temporary bridge or crown may be fitted in the meantime.
• At your final visit, the dentist will check that the bridge fits, make minor adjustments and then fix permanently in place.

Your dentist will show you the best way of keeping your new bridge clean.

The benefits of this treatment:

A bridge almost lets you forget that you have missing teeth:

• It can improve the way you look, bite, chew and speak.
• The teeth can be matched to the colour of your own teeth.
• A bridge can last many years if kept clean and if there is no accidental damage.
• Natural teeth are protected from wear and tear, and from moving or tilting out of line which could cause your teeth to bite together incorrectly.

The alternative to a bridge will probably be a removable partial denture. The dentist will explain the chances of success with a bridge. If the supporting teeth are not strong enough a denture might be a better treatment choice. If teeth have just been extracted, a denture night be made first, with a bridge fitted later when the gum has healed.


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Removable dentures

A removable denture replaces missing teeth. ‘Partial’ dentures replace a few missing teeth and ‘full’ dentures are required if all the natural teeth are missing. Dentures are made of plastic and sometimes metal as well to make them strong and less bulky.

How dentures are made:

• A putty like material is used to make moulds of your mouth – called ‘impressions’. A dental technician uses them to make plaster models for the dentures to be built on.
• The technician will make wax blocks which fit the plaster models. These will be trimmed to show the technician how your teeth should bite together, and shape to make the denture.
• A trial denture is made and tried in the mouth. You will be asked how it fits, feels and looks before making the final changes.
• The trial denture then goes back to the technician who permanently fixes the teeth. The denture is then ready to use.

You will need to be seen fairly soon after the dentures are fitted to see how you are getting on with them. If there are any problems, small adjustments can be made. This is called ‘easing’ your denture.

The benefits of this treatment:

If you have lost some teeth, dentures can improve the way you look, bite, chew and speak.

• They are custom-made to match your mouth and can be made to look as natural as possible.
• You will be able to chew more efficiently.
• Remaining teeth are protected from wear and tear. Without dentures, the natural teeth may move or tilt, stopping your teeth biting together properly.
• Dentures can be fitted straight after extractions so that nobody needs to know that you have had a tooth out. These are called ‘immediate’ dentures.

It is important to remember that dentures will never feel like your own teeth and it can take time to get used to them. If you haven’t had a denture before, you will have explained to you the difficulties of denture wearing as well as the benefits and how you should look after your new dentures and remaining teeth.


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White fillings

A filling replaces part of a tooth lost because of decay or accidental damage.

Unlike amalgam (silver) fillings, white fillings stick to teeth so they can be used to repair teeth (especially front teeth) which have been chipped, broken or decayed. They can sometimes be used in back teeth if there’s not too much decay or damage.

You will probably hear the dentist talk about ‘composite’ or ‘glass ionomer’ – these are just different types of white filling.

How do we do a white filling?

• The area around the tooth will be numbed.
• Any decay will be removed.
• Some or all of an old filling might also need to be removed.
• The tooth is washed and dried by blowing water and then air onto it. You will hear this and see the dentist holding something which looks like a water pistol.
• The filling material is put into or onto the tooth and shaped.
• The filling is usually hardened by pointing a bright light at it, inside your mouth. You will see the dentist and dental nurse protecting their eyes.
• The filling is trimmed and polished.

The benefits of this treatment:

• White fillings are tooth-coloured. They come in a range of shades so they can be matched to the colour of your own teeth.
• Because white fillings are sticky they can be used to reshape and rebuild broken edges or worn teeth. They can also be used to cover marks – discolouration – if they can’t be removed by cleaning.
• A tooth needs less preparation for a white filling than a silver filling.

White fillings are not as strong as silver fillings, so they may not be suitable for large fillings in back teeth. They also need very dry conditions which can be hard to achieve right at the back of your mouth.


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Silver fillings

A filling replaces part of a tooth lost because of decay through accidental damage. ‘Silver’ fillings are made of amalgam – a mixture of mercury with silver, tin and sometimes copper.

How we do a silver filling?

• The area around the tooth will be numbed.
• Any decay will be removed with any old filling.
• Any weak tooth that may break later will be removed.
• The hole will be shaped so that the tooth holds the filling in place.
• For a large filling we will sometimes use tiny pins and screws to help hold the tooth and the filling together.
• A lining will be put underneath the filling if it is very deep to make the tooth less sensitive to temperature changes.
• When the tooth is prepared soft amalgam is pressed tightly into the hole – you might hear it squeak as it goes in.
• The filling is carved to fit into the hole in the tooth. The dentist might put a thin metal band around the tooth while doing this to keep the amalgam in place while it is still soft.
• You will be asked to close your mouth gently on the filling to check that it is the right height and comfortable.
• The filling might be polished at the next visit when it is completely hard.

The benefits of this treatment:

• A filling rebuilds the tooth for chewing.
• If decay is left unchecked it can eat into the tooth and cause pain. The tooth might then have to be ‘root filled’ or extracted.
• A filling can end toothache or prevent toothache developing.
• Amalgam is soft and mouldable at first but quickly becomes very hard. Silver fillings are very strong so they can be ideal for back teeth where there is heavy wear from chewing.

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Root fillings

Teeth are held in the jaw by their roots. Front teeth normally have one root but teeth further back will have two, three or four.

Inside, there are nerves and a blood supply in the ‘root canal’. When the tooth is healthy, the nerves are alive but decay or injury can cause the nerves to die. A dead nerve inside a tooth can cause an abscess at the end of the root.

Root filling means removing damaged or dead nerves and filling the space left. The tooth that is left can then be repaired.

How we do a root filling?

• An x-ray will show the shape of the root canals and whether there are any signs of infection in the surrounding bone. Some tooth roots are easier to fill than others because of their shape. Sometimes the x-ray will show that a root filling will not be successful. This will be discussed with you.
• The area near the tooth will be numbed so the area is painless.
• To keep root canals dry during treatment your dentist may stretch a sheet of thin sheer rubber around the tooth, on a metal or plastic frame outside the mouth. This shouldn’t be uncomfortable.
• A hole will be made in the tooth and enlarged so that the opening to the root canal can be seen.
• Narrow files will be used to find all the root canals and remove the dead nerves.
• X-rays may be taken to measure the length of the root canals.
• The roots will be filled with a rubbery material and pastes that set hard.

A root filling often needs more than one visit.

The tooth could still be tender for a day or two afterwards and you might need to take a mild painkiller.

The benefits of this treatment:

• Nerve damage can cause severe toothache but the pain will usually end very quickly when the root canal is cleaned out.
• Without a root filling, a tooth with a dead nerve would probably have to be taken out.
• Root fillings are usually successful and can last many years.
• Sometimes there can be an infection (the tooth will ache and become painful to bite on) but re-treatment can be successful.

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Extraction of teeth

A tooth which is very decayed or damaged or loose because of gum disease may have to be ‘extracted’ – taken out of your mouth.

Sometimes children’s teeth are extracted for ‘orthodontic’ reasons to help the new or remaining teeth grow regularly or without being crowded.

What does the dentist do?

Some teeth are simpler to extract than others because of the size, shape, position in the mouth or the shape of their roots. After working out how best to carry out the extraction, the dentist will discuss with you:

• The type of anaesthetic to use.
• How long it will probably take.
• For certain types of pain control, whether you should bring someone with you.
• When it would be convenient for you to have the extraction done, if not immediately.
• How your mouth should recover afterwards.

You might also discuss other treatment needs – whether an immediate denture could be needed, for example. If you wear a denture this can be made ready with a new tooth at the same visit. Or you may have to have a gap for a while and come back to have the denture changed or have a new denture.

While the tooth is being extracted under local anaesthetic:

• You will be able to move your jaw as normal.
• You may feel some pressure as the tooth is eased out, but not any pain.

Afterwards:

• The dentist will give you a pad to bite on, to stop any bleeding.
• Sometimes stitches are used to help the mouth heal.
• You will be given advice on how to look after the hole where the tooth sat, while it is healing, how to control any pain when the anaesthetic wears off, and how to contact the practice if there are problems.

The benefits of extraction:

• An extraction can end pain and infection and can sometimes be the only way to keep your mouth healthy.

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Wisdom teeth

‘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 – even none.

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

Management of wisdom teeth:

Watching the growth of teeth and jaws is part of your regular dental care. If you feel there is a problem developing please let us know and we will be pleased to discuss it:

• X-rays can show where the wisdom teeth are in the jaw and how much room there is for them to come through, as well as whether any damage is being caused to teeth in front.
• The x-rays will also show how simple or difficult a wisdom tooth extraction might be. You may be referred to a specialist to have your wisdom teeth removed.

As wisdom teeth are coming through, the surrounding gum 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 after you have had pericoronitis because they often continue to cause trouble.

If you need to have a wisdom tooth removed you should be able to fit it in with work or other commitments. Sometimes, all wisdom teeth are removed at one time, in hospital under general anaesthetic. You may need several days off work.

The benefits of removing wisdom teeth:

• Removal ends pain and takes away possible sources of infection.
• Any damage to the teeth in front is stopped.

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Tooth grinding or bruxism

Bruxism is a habit that affects around 8 – 10% of the population. It is broadly characterised by grinding of the teeth and clenching of the jaw that causes tooth wear and breakage, pain and limited movement of the jaw and headache. Bruxism occurs in both children and adults but it is common in 25 – 44 year olds. However, most people grind and/or clench their teeth to a certain degree.

Bruxism is classified into awake bruxism and sleep bruxism. Awake bruxism is characterised by involuntary clenching of the teeth in reaction to certain stimuli. There is generally no tooth grinding with awake bruxism. Sleep bruxism is characterised by automatic teeth grinding with rhythmic and sustained jaw muscle contractions.

Bruxism is further divided into primary, (that occurs without any prior medical condition) and secondary bruxism, where a medical or psychiatric condition is known. The teeth grinding observed during wakefulness and secondary bruxism can be associated with certain medications such as antidepressants or recreational drugs such as cocaine and ecstasy, and disorders such as Parkinson’s disease, depression and major anxiety.

There is no specific cure for bruxism and it is important to manage the consequences of the disorder. Various preventative measures may be offered including the use of an occlusal splint or mouthguard.

Occlusal splints (also called occlusal biteguard, bruxism appliance, bite plate, night guard) are the most common and effective method of protecting the teeth. The occlusal splint is a small soft plastic shield that is worn over the upper or the lower teeth. The splint covers the teeth and reduces grinding noise and muscle activity associated with sleep bruxism.

Construction and provision of an occlusal splint is quick and simple. Impressions are taken of the patient’s teeth using a soft material in preformed trays. The impression material usually takes a short while to set solid in the mouth. The impressions are then forwarded to our Dental Technician who produces stone replica models and produces a soft plastic occlusal splint. This will be ready to fit and checked one week after the impressions were taken. The dentist will check the guard fits well and is comfortable and will give instructions on how and when to wear it and how to care for it. Following the fitting there would be a series of review appointments to assess the success of the treatment.


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Sports guards

Sports mouthguards (also referred to as football protectors, sports mouthpieces or spelt as two words mouth guards) are resilient plastic appliances that have been designed to cover over and encase a sports person’s teeth and the gums and bone that support them.

The idea is that when a guard is worn it helps to provide protection for the hard (teeth and jaw) and soft (lips, cheeks, gums) tissues of the mouth by absorbing and redistributing the forces generated by traumatic blows. The mouthguard also provides protection against dental restorations such as crowns, bridges, veneers and implants.

A sports mouthguard can help to dissipate the total amount of energy that has to be absorbed by any one tooth or region of the mouth. The spongy resiliency of a mouth guard can help to absorb some of the energy of a blow. The stiffness of the mouthguard can help distribute the energy of a traumatic force over a greater surface area. Both of these effects will lessen the total force load any one tooth is subjected to and therefore lessen the likelihood that chipping, breaking or even tooth dislodgement will occur.

Along these lines, to some degree a mouth protector can help to prevent a bone fracture. A mouthguard’s resiliency and stiffness once again both come into play and can help to minimize the total amount of force that any one portion of the jaw is subjected to.

Mouthguards can also help prevent tooth damage that might be caused by tooth to tooth contact. Hard collisions or blows directed to the head or mouth can result in a motion where the jaws come together forcibly. The resiliency of that portion of a mouth guard that covers over the chewing surface of the teeth can help cushion the effects of this reaction and therefore help to prevent tooth damage.

A mouthguard can help to minimize the amount of soft tissue damage that is caused by a traumatic event. A forceful blow can press a person’s lips or cheeks against teeth, dental work or dental appliances in a way where they become pierced or torn. The violent jaw movements created by a blow or collision can result in a biting laceration of the lips, cheeks or tongue.

Mouthguards can act as a buffer between the soft and hard tissues of the mouth. The rounded contours of a guard can help to protect soft tissues. The spongy resilience of a guard can possibly help to buffer or cushion the effects of a blow.

Mouthguards can help to minimize soft tissue injury created by dental appliances. The lips and cheeks of those sports people that wear braces (orthodontic appliances) can certainly benefit from the protection of a mouthguard. Also, the way the interior contours of a customised mouthguard fit into those regions where the teeth are missing makes it possible that a sports participant can leave their removable partial denture out during practice or games yet still have adequate support for their teeth. A removable partial denture could be dislodged during a traumatic event, resulting in tissue laceration or loss of or damage to the appliance itself.

All athletes participating in any contact sport (a sport where a player contact is common and an expected component of the sport) should wear a mouthguard. A list of contact sports would at minimum include the following: football, boxing, ice hockey, roller hockey, lacrosse, field hockey, rugby, soccer, basketball, water polo, martial arts and wrestling. Other sports, while typically not considered true contact sports, can still place an athlete at risk and therefore should necessitate the use of a mouth protector. Anyone participating in baseball, racquetball, squash, handball, skiing, skateboarding, rollerblading, skydiving, volleyball, surfing, acrobatics, gymnastics, tennis and bicycling should protect their mouth with a guard.

The making and provision of a mouthguard is quick and simple. Impressions are taken of the patient’s mouth using a soft material in preformed trays. The impression material usually takes a short while to set solid in the mouth. The impressions are then forwarded to our Dental Technician who produces stone replica models followed by the resilient plastic mouthguard. This will be ready to fit and checked one week after the impressions were taken. The dentist will check the mouthguard fits well and is comfortable and will give instructions on how to fit it, remove it and care for it. Mouthguards can be clear or a single colour or multiple colours. Patients will be asked for their preference.


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Invisalign Tooth Straightening

Thin removable aligners which are almost invisible because they are clear. Invisalign can help with straightening crooked teeth or closing gaps between teeth to give you the smile you have always wanted - for more information visit www.invisalign.com

Treatment with Invisalign is:

• Comfortable: No metal wire or bands to irritate your mouth.
• Convenient: You remove your aligners to eat food and to brush and floss your teeth.
• Discrete: Clear aligners are virtually invisible most people will not notice you are wearing them.

At your initial consultation we will be able to make an assessment to see if you are suitable for Invisalign aligners. If Invisalign is suitable for you on a future appointment we will take some impressions and work out a treatment plan and show you what results you can expect to achieve.

A series of aligners will be made to fit only you. Each aligner is slightly different and will gradually move your teeth into the desired position.


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