Prevention

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 food debris left behind and causing tooth decay and gum disease.

How can plaque cause decay?

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

How can plaque cause gum disease?

Plaque can harden into something called calculus (“tartar”). As calculus forms near the gumline, the plaque underneath releases poisons causing the gums to become irritated and inflamed. The gums begin to pull away from the teeth and the gaps become infected.

If gum disease is not treated promptly, the bone supporting the teeth is destroyed and healthy teeth may be lost. Gum disease is the biggest cause of tooth loss in adults and can lead to dentures, bridges or implants.

How can I prevent gum disease?

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

that your teeth can have a thorough cleaning if they need it.

How do I know if I have gum disease?

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

Which type of toothbrush should I use?

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

You can now get more specialised toothbrushes. For instance, people with
sensitive teeth can now use softer bristled brushes. There are also smaller headed toothbrushes for those people
with crooked or irregular teeth. Some people find it difficult to hold a toothbrush, 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 often should I change my toothbrush?

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

How should I brush?

Brushing removes plaque and food particles from the inner, outer and biting surfaces of your teeth.
Here is one method of removing plaque:

• Place the head of your toothbrush against your teeth and angle against the gumline. Move the brush in small circular movements, several times, on all the surfaces of each individual tooth.
• Brush the outer surfaces of each tooth, upper and lower, keeping the bristles angled against the gumline.
• Use the same method on the inside surfaces of all your teeth.
• Brush the chewing surfaces of the teeth.
• To clean the inside surfaces of the front teeth, tilt the brush vertically and make several small circular strokes with the toe (the front part) of the brush.
• Brushing your tongue will help freshen your breath and will clean your mouth by removing bacteria.

How often should I brush my teeth?

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

What is an interdental brush?

It is a small brush that can be held between your thumb and your fingers. Interdental brushes are available in various sizes which enables you to choose which size is most suitable for you. You may need to use more than one size to enable you to effectively clean all spaces between your teeth.

Why clean between teeth?

Over the course of a day, food and debris get lodged in between your teeth, and in any gaps you may have. If left, this debris can cause dental decay and gum disease. Removing food debris and plaque with an interdental brush will help keep your breath fresh. Cleaning in between your teeth makes sure that you are cleaning your mouth as thoroughly as possible.

Should I use an interdental brush instead of my normal toothbrush?

No. These small brushes should be used as part of your normal oral hygiene routine to be effective.

Why is my normal toothbrush not enough?

You will know that there are certain places in your mouth that are difficult to reach with your normal brush. There are also some gaps between your teeth that your toothbrush will not be able to access.

How can the interdental brush help?

With its small filaments and tiny bottle type head, the brush can be moved between the teeth to remove debris and plaque that will not have been removed by your usual toothbrush. They are available in two textures, original and Soft giving an effective option for even the most sensitive gums and teeth.

How do I use it?

Select a suitable sized interdental brush. Never force the brush between the teeth. Between front teeth, use a finer brush, turning slightly to ease the brush comfortably between the teeth. Remove the brush by gently pulling thereby removing plaque and debris. Repeat the turning motion to re-insert and pull out several times until you are satisfied the space is clean. For larger spaces nearer the back of the mouth, a larger headed brush might be needed. To be as effective as possible, shape the head into a slight curve DO NOT bend at right angles. You will then be able to easily locate and clean the space effectively. Always rinse brush in clean water during and after use

When should I use it?

You need to clean between all your teeth at least once a day.

Why tongue cleansing?

Tongue cleansing is a quick and efficient way to help achieve and sustain a healthy, fresh mouth.

Recent scientific evidence supports the need to practise regular tongue cleansing to help reduce harmful bacteria in the mouth.

What are the facts about the tongue?

The back of the tongue is the main focal point for the majority of micro-organisms in the mouth, which are a major source of bad breath, plaque-forming bacteria and those associated with gingivitis and tooth decay. It is therefore important to reduce these micro-organisms in all areas of the mouth, especially the tongue. A tongue cleanser is the ideal tool to use in conjunction with a toothbrush and floss/interdental brushes to help achieve optimum oral cleanliness.

• 9 out of 10 people suffer from bad breath at some time or another.
• 90% of bad breath comes from what is happening in the mouth. ¹
• 80% of bad breath emanates from the back of the tongue.
• The use of a specialist tongue cleanser is much more effective in reducing odour-causing bacteria than brushing the tongue with a toothbrush. ²

Why the TongueDetoxTM cleanser?

The TongueDetox has been specially designed to maximise the effectiveness of tongue cleansing. It is made of lightweight, supple plastic with an ergonomically designed double handle and is impregnated with a pleasant mint aroma. It is safe and easy to use, minimising the gag reflex. The TongueDetox effectively removes dead cells, food debris and the plaque bacteria that are the most common cause of bad breath.

What if I am a smoker?

Tongue cleansing will easily and effectively remove the extra thick brown coating which forms quite heavily on the tongue’s surface which in turn will reduce “smoker’s breath”.

¹ Kazor CE et al: Diversity of Bacterial Populations of the Tongue Dorsa of Patients with Halitosis and Healthy Patients. Jnl Clin Microbiology Feb 2003p, 558-563

² 2 Loeshe WJ and Kazor CE 2002. Microbiology and treatment of Halitosis. Periodontology 200 28:256-279

What is gum disease?

Gum disease describes 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 the 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 and gums 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 flossing.

What happens if gum disease is not treated?

Unfortunately, gum disease progresses painlessly on the whole so that you do 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 become more difficult.

How do I know if I have gum disease?

The first sign is blood on the toothbrush or in the rinsing water when you clean your teeth. Your gums may also bleed when you are eating, leaving a bad taste in your mouth. Your breath may also become unpleasant.

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

The first thing to do is visit your dentist for a thorough check-up of your teeth and gums. The dentist can 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 dentist will usually give your teeth a thorough clean. You’ll also be shown how to remove plaque successfully yourself, cleaning all surfaces of your teeth thoroughly and effectively. This may take a number of sessions with the dentist or hygienist.

What else may be needed?

Once your teeth are clean, your dentist may decide to carry out further cleaning of the roots of the teeth, to make sure that the last pockets of bacteria are removed.

You’ll probably need the treatment area to be numbed before anything is done. Afterwards, you may feel some discomfort for up to 48 hour.

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

Periodontal disease is never cured. But 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 dentist and hygienist.

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 is covered by 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.

Toothbrush abrasion – brushing too hard, and brushing from side to side, can cause dentine 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.

Gum recession – gums may naturally recede (shrink back), and the roots 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.

Other causes of pain from sensitivity may be:

A cracked tooth or filling – a cracked tooth is one that has become broken. A crack can run from the biting surface of a tooth down towards the root. Extreme temperatures, especially cold, may cause discomfort.

Tooth bleaching – some patients have sensitivity for a short time during or after having their teeth bleached. Discuss this with your dentist 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 drink. The pain can come and go, with some times being worse than others.

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. The toothpaste should be used twice a day to brush your teeth. It can also be rubbed onto the sensitive areas.

These toothpastes can take anything from a few days to several weeks to take effect. Your dentist should be able to advise you on which type of toothpaste would be best for you.

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 you do not avoid brushing your teeth regularly as 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 dentist 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 dentist 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 dentist 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.

How can I prevent sensitive teeth?

To prevent sensitive teeth follow the principles below:

• Brush your teeth twice a day for two minutes with fluoride toothpaste. 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.
• Have sugary foods, and fizzy and acidic drinks less often. Try to have them only at mealtimes.
• If you grind your teeth, talk to your dentist about the possibility of having a mouthguard made to wear at night.
• If you are thinking about having your teeth bleached, discuss sensitivity with your dentist before starting treatment.
• Visit your dentist at least once a year for a check up.

How can smoking affect my oral health?

Most people are now aware that smoking is bad for our 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 content. It can make the 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. Patients 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 fail to heal. Smoking causes people to have more dental plaque and for gum disease to progress more rapidly than in non-smokers. Gum disease still remains 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 are still unaware 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. (See our leaflet ‘Tell Me About Mouth Cancer’)

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 pastes and should be used with care. Your dentist may recommend that you use these toothpastes alternately with your usual toothpaste. As there are several toothpastes on the market which claim to whiten teeth it is important to look for those accredited by the British Dental Health Foundation. Our logo means that the claims on the packaging are scientifically proven to be correct and the product will be effective at removing staining caused by smoking.

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 only mask it.

How often should I visit my dentist?

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

You should visit your dentist at least once a year. However, this may be more often if your dentist feels it necessary. 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 dentist 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 further treatment, thorough cleaning and to keep a closer check on your oral hygiene.

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.

What are sealants?

Sealants are a safe and painless way or protecting your children’s teeth from decay. A sealant is a protective plastic coating, which is applied to the biting surfaces of the back teeth. The sealant forms a hard shield that keeps food and bacteria from getting into the tiny grooves in the teeth and causing decay.

Which teeth should be sealed?

Sealants are only applied to the back teeth – the molars and premolars. These are the teeth that have pits and fissures on their biting surfaces. Your dentist will tell you which teeth should be sealed after they have examined them, and checked whether the fissures are deep enough for sealing to help. Some teeth naturally form with deep grooves, which will need to be sealed, others with shallow ones which will not need sealing

What is involved?

The process is usually quick and straightforward taking only a few minutes per tooth. The tooth is thoroughly cleaned, prepared with a special solution, and dried. The liquid sealant is then applied and allowed to set hard – usually by shining an ultraviolet light onto it.

Will my child feel it?

No, it is totally pain free, and the teeth do not feel any different afterwards.

How long do they last?

Sealants usually last for many years, but your dentist will want to check them regularly to make sure that the seal is still intact. They can wear over time, and sometimes the dentist needs to add or replace some sealant to be sure that no decay can start underneath them.

How do they work?

The sealant forms a smooth, protective barrier, by covering all the little grooves and dips in the surface of the tooth. Dental decay easily starts in these grooves.

When should this be done?

Sealants are often applied as soon as the permanent teeth start to come through. This is usually between 6 and 7 years of age. The rest are usually sealed as soon as they appear which can be any time between 11 and 14 years of age.

Do my children still have to clean their teeth?

Yes. It is still vital that they do this. The smooth, sealed surface is now much easier to keep clean and healthy with normal toothbrushing. Using a fluoride toothpaste will also help to protect your children’s teeth. Pit and fissure sealing reduces tooth decay and the number of fillings your child might need.

What is snoring?

The noise of snoring is caused by the vibration of the soft tissues in the upper airway. During sleep the muscles of the upper airway relax resulting in the formation of bottlenecks or even complete obstruction of the airways. The body reacts by increasing the velocity of the air which in turn causes vibration of the soft tissues which generates the noise of snoring.

Who is likely to snore?

Research has shown that approximately 40% of the adult population snore. As a person gets older the chances of snoring increases. (i.e. in men aged 60 this increases to 60%.) The chances of snoring are also increased if a person is overweight or drinks alcohol.

What is Obstructive Sleep Apnoea?

This is a medical condition. People suffering from it are heard to gasp for breath while they are asleep. Additional symptoms are daytime drowsiness or the feeling of not having a full nights sleep. Where Sleep Apnoea is suspected an anti-snoring device may still be prescribed but it is essential that you consult your medical practitioner and if he confirms that Sleep Apnoea is suspected, that you are referred to the sleep clinic of a hospital for further investigation.

Not everyone that snores suffers from Sleep Apnoea – but nearly everyone who suffers from Sleep Apnoea will snore.

What help is available?

Your dentist could make you an oral appliance which is worn at night to prevent snoring.

This will consists of two thin plastic formings which fit over the upper and lower teeth. They are joined together by two connectors that gently hold the lower jaw in a forward position. Any opening of the mouth pulls the lower jaw further forward.

Can anyone use this appliance?

The appliance can not be made if you have no natural teeth or only a few natural teeth. Your dentist will be able to advise you as to your own situation.

What happens next?

Your dentist will ask you to complete a questionnaire (if possible with your partner) and then take moulds of your upper and lower tooth arches. Your appliance will be custom made to the moulds of your mouth and your dentist will fit it. (Allow about two weeks for your appliance to be manufactured.) You will be asked to wear it initially each night for a week to ensure that the noise of snoring has been eliminated. If after wearing it for a week the noise of snoring has not been completely eliminated your appliance should be returned to your dentist for adjustment.

Unfortunately it is not possible to guarantee that the appliance will work on everyone. Statistics demonstrate that in 62% of people that snore it will totally eliminate the noise of snoring. In the remaining cases the noise of snoring may be reduced or it will not work at all.

Does the appliance require maintenance?

The appliance does require regular maintenance but the intervals between maintenance periods are difficult to predict because they depend on the individuals case. If you grind your teeth at night the life of your appliance will be reduced.

Does the appliance come with a warranty?

Some appliances have an initial 6 months repair and servicing warranty from the date of manufacture of the appliance. You will need to discuss this with your dentist.

In line with current guidelines issued by the Department of Health we have recently introduced a topical fluoride programme aimed at preventing tooth decay in children.

As well as attending the practice for routine check-ups, the programme involves the application of a fluoride varnish every 3 months.  The process is extremely quick and simple and is aimed at reducing the risk of tooth decay.

Please check with your regular dentist to see if your child would benefit from participating in our topical fluoride programme.