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Dental Care and Oral Health

What is dental care?

Dental care involves everything in order to keep your mouth healthy.

This allows you to eat, speak and socialise without active disease, discomfort or embarrassment and contributes to general well-being. Your dentist and their team will help you achieve this and maintain it for life.

There are four key areas to achieving and maintaining dental care and a healthy mouth as recommended in the Health Development Agency’s document ‘Scientific basis of Dental Health Education’:

  1. Diet: reduce the consumption and especially the frequency of intake of foods and drinks with added sugars.
    The number of times that sugars enter the mouth is the most important factor in determining the rate of decay. When consumed, they should be part of a meal rather than between meals.
    Snacks and drinks should be free of added sugars, whenever possible, and the frequent consumption of acidic drinks (such as squashes or carbonated drinks) should be avoided.
  2. Tooth brushing: clean your teeth thoroughly twice every day with a fluoride toothpaste.
    Effective plaque removal is essential for the prevention of periodontal disease. The toothbrush is the only means of plaque removal that should be recommended on a public health basis. Other oral hygiene aids, apart from disclosing agents, are a matter for personal professional advice. Thorough brushing of all surfaces twice every day is of more value than more frequent cursory brushing, and a gentle scrub technique should be advised. The toothbrush size and design should allow the user to reach all tooth surfaces and gum margins easily and comfortably. Tooth brushing by itself will not prevent dental decay, but the use of fluoride toothpaste would be beneficial.
  3. Dental attendance: have an oral examination at least every year.
    Everyone, irrespective of age and dental condition, should have an oral examination approximately once a year so that cases of oral cancer or other oral diseases can be detected early and treated.
    This advice also applies to those without any natural teeth. Children and those at risk from oral disease may need to be seen more frequently, at intervals determined with professional advice.
    Plaque is a white, soft, sticky substance that is made up of bacteria and food. It forms on your teeth and causes that ‘furry feeling ’. It often builds up in between teeth and at the gum line and turns into calculus (tartar) if left for long enough.
    When you eat, the bacteria in plaque eat as well. The plaque bacteria then produce acids, which can dissolve the tooth minerals and result in a hole (cavity) otherwise known as decay. The acids produced by plaque also damage the structures that hold the teeth in the jaw.
What is tooth decay?

Tooth decay is a disease caused by bacteria which lives in plaque. Plaque is a thin layer of food and bacteria that lives on our teeth, which can only be removed by effective tooth brushing.

The bacteria breaks down sugar in our diet, into acids. This can dissolve away the tooth enamel, and could make a hole in the tooth.

Tooth decay can be prevented by limiting the amount of sugar in your diet, eating sweet foods and drinks at meal times only, and brushing twice a day with fluoride toothpaste. Fluoride mouthwash can be used at a different time to brushing (eg after lunch or an evening meal), as an extra preventative (alongside toothbrushing).

What is acid erosion?

This occurs when the tooth surface is worn away by acids.

Acid is found in fizzy drinks, fruit, fruit juices, pickles and vinegar.

To prevent acid erosion, only consume these foods/drink at meal times (3 times a day). When drinking fizzy drinks use a straw and try not to swish the drink around your mouth. Sugar free chewing gum and foods such as cheese are a good way to neutralise acid.

How should I clean my teeth properly?

Teeth should be cleaned twice a day for two minutes, using a fluoride toothpaste. It is also important to clean between your teeth with floss or mini interdental brushes daily. A mouthwash may also be useful.

What is gum disease?

The signs of gum disease are swelling and redness of your gums, these may also be sore and may bleed when brushing. This indicates that the gums may be infected and require treatment from the dentist or hygienist.

The main causes are plaque and calculus (calculus or tarter is plaque which has become hard and can only be removed by a dentist or hygienist).

The formation of calculus can be prevented by brushing twice a day to clean all the plaque off your teeth, and seeing your dental healthcare professional regularly who will clean any calculus off your teeth.

What causes bad breath (Halitosis)

This is an unpleasant condition which can cause embarrassment. If you are concerned, please mention it to the dentist who can help to identify the cause, and if orally related, develop a treatment plan to help eliminate it.

Bad breath can be caused by smoking, eating strong foods such as garlic or by the bacteria that live on teeth and gums, which cause gum disease.

This can be prevented by routine cleaning of the teeth and gums, 2-3 times per day. This can include daily flossing and mouth rinses. The use of a tongue scraper and sugar free chewing gum may help.

It can also be a sign of medical conditions such as diabetes, lung or liver and kidney problems, stomach disorders or sinus infections. Some medications may affect breath odour.

Bad breath can also be caused by dry mouth (xerostomia), which is reduced salivary flow. Saliva is essential to cleanse the mouth and remove particles which may cause odour. Medications, saliva gland problems or continuous mouth breathing may all cause a dry mouth.

Your dentist may prescribe artificial saliva, recommend sugar free gum, or frequent sips of water may help this problem.

Lifestyle habits can also play a major part. This includes smoking and chewing tobacco.

What will happen on my first appointment?

On your first appointment please try and arrive at least 10 minutes early.

This will give you time to complete a medical history . Please bring a list any medications you are taking, so a copy of your prescription will be useful.

On your first appointment, the dentist will welcome you to the practice and carry out a thorough dental history and examination.

After this has been carried out, a diagnosis and treatment plan will be discussed.

Please feel free to ask questions. Patients will be given a full estimate of the cost of treatments advised, unless treatment is lengthy or complicated, in which case it will be provided after further discussion at the next appointment.

How often should I visit the dentist?

This is dependent on a number of factors, which your dentist will take into account during your routine examination.

These include:

How clean your teeth are

If your diet is high in sugar or acid

Smoking and alcohol intake

Exposure to fluoride

Low saliva flow

General health – e.g. diabetes

A family history of gum disease

History of decay

Each individual is different and should always follow the dentist’s recommendations.

Generally, children and young people under 18 years should be seen at least every 3-12 months and adults 6-24months.

For more information, please follow the link to the National Institute of Clinical Excellence (NICE) website.

What are white fillings?

White fillings may be referred to as ‘tooth coloured’ or ‘composite fillings’ by your dentist. Your dentist will advise you whether a white filling is appropriate for the tooth you need restoring.

What are amalgam fillings?

Amalgam fillings are silver in colour when first placed but tarnish with time. They are made from a mixture of silver, tin, mercury and copper.

How long will a filling last?

It is impossible to say how long a filling will last as it depends on so many variables, such as-

What filling material was used?

How big was the filling?

How much of the tooth was left?

How difficult was the filling to place

What forces the filling will undergo in your mouth

How clean the mouth is kept

What does the dentist mean when they say I have pockets around my teeth?

The gums usually fit like a tight collar around your teeth. If the gums are damaged this tight collar can loosen and a pocket will form around the tooth.

Why does my dentist call out numbers to the nurse when they look at my teeth?

Dentists can be calling out numbers for two main reasons. They may be carrying out something called a basic periodontal exam (BPE exam). This is a screening technique to check the health of your gums around each tooth. The dentist will walk a probe around your gums and depending on what they find will assign a number from 0-4

0 means the gums are perfect

1 means the gums bleed but no pockets, calculus or plaque retention factors are present and you only need to improve your removal of plaque in the areas your dentist shows you.

2 means the deepest pockets are <3mm and/or calculus or plaque retention factors are present below the gum line.

This would indicate you need the teeth scaling to remove the calculus and removal of any plaque retention factors. (You will also be advised how to stop the plaque and calculus reforming)

3 means the deepest pockets are 4 or 5 mm, so the situation is a little more advanced than 2 but you require the same treatment.

4 means you have a tooth or teeth with pockets >6mm. Your dentist may recommend you see a periodontal specialist.

The second set of numbers the dentist may use during this examination refers to the different teeth in your mouth which is like a code corresponding to each one –

1=centralincisor 
2=lateralincisor 
3=canine 
4=firstpremolar 
5=secondpremolar 
6=1stmolar 
7=2ndmolar 
8=3rd molar or wisdom tooth

How does a dentist’s drill work?

The drill works by using compressed air which is passed through fine tubes at a very high pressure, and that turns miniature turbines connected to the drill itself. There are two types of drill a dentist will mainly use.

A high speed drill which is very fast and used for cutting enamel and old fillings.The high speed drill usually has water spraying out at the tip of it to prevent the drill getting very hot when cutting and damaging the tooth

A slow speed drill is mainly used to remove decay.

What options are there to replace a missing tooth?

There are many options for replacing a missing tooth-

Leave a gap. It may be that the tooth doesn’t need replacing

A denture

A bridge

An implant

Your dentist can advise you which options are available to you and the pros and cons of each of them.

What is a dental implant (screw in teeth)?

Dental implants is a way of replacing missing teeth.

There are many advantages to having implants, but they may not be suitable for everyone.

You need to have healthy gums and be in good general health.

You also need enough jaw bone to take the screw and support the replacement teeth. Some chronic diseases, such as diabetes, osteoporosis or chronic sinus problems could interfere with healing and make implants more likely to fail.

Because they are a complicated form of treatment, implants can be expensive.

Your dentist may refer you to an implantologist.

The dentist or specialist will expose the bone in the jaw where the tooth is missing. Then they will drill a hole and insert a screw into the bone. This is usually done under a local anaesthetic or under sedation. The gum is then stitched over the screw and it is left to heal for several months, while the bone grows around the post, making it secure. After this period, there will be a second operation in which replacement teeth are mounted onto the metal screw. This requires a small cut in the gum above the implant. The replacement teeth might be single or in a group, and possibly as a ‘bridge’, attached to neighbouring natural teeth. They may be fixed permanently or attached in a way that lets you remove them for cleaning.

After surgery, it is essential to maintain good mouth hygiene and visit your dentist regularly.

Smoking reduces the chances of success of the implant.

What is plaque?

Plaque is a white, soft, sticky substance that is made up of bacteria and food. It forms on your teeth and causes a ‘furry feeling’. It often builds up in between teeth and at the gum line and turns into calculus (tartar) if left for long enough.

Why is plaque bad for my teeth?

When you eat, the bacteria in plaque eat as well. The plaque bacteria then produce acids which can dissolve the minerals which make up the tooth and result in a hole (cavity). This process is called decay.

Why is plaque bad for my gums?

The acids produced by plaque not only damage the teeth but also damage the structures that hold the teeth in the jaw.

What are plaque retention factors?

These are any irregularities around the teeth which plaque can stick too. Calculus is the most common example of a plaque retention factor, other examples include overhanging or rough fillings, crowns or veneers with ledges, some types of dentures and crooked teeth.

If plaque is white how can I see it?

Plaque isn’t easy to see so dentist and hygienists recommend disclosing tablets. Disclosing tablets often called plaque check tablets are made of a vegetable dye called Erythrocine (E127).

Can anyone use disclosing tablets?

Disclosing tablets can be used by anyone over the age of 6, under the supervision of an adult. If allergic to Erythrocine or any of the other ingredients in disclosing tablets they should not be used.

How do I use disclosing tablets?

Chew one tablet thoroughly until no bits are left and spread saliva to all areas of your mouth with your tongue. Spit out residual saliva and gently rinse out mouth with water. DO NOT SWALLOW THE TABLET.

Look in the mirror – areas where plaque and food are present will be stained a bright colour. Clean the mouth step by step. (It is best to disclose teeth at night because the mouth may remain coloured for several hours).

How often should I use disclosing tablets?

Disclosing tablets should be used about once a week. With children it may be quite revealing to use a disclosing tablet after they have (allegedly!) cleaned their teeth to show where they have missed. Offering extra pocket money every time the teeth are found properly cleaned is a good incentive to encourage thorough cleaning.

What is calculus?

Calculus and tartar are the same thing (tartar is the term more commonly used by Americans). Calculus forms when plaque if left on the surface of a tooth for about 72 hours. It results from minerals found in saliva entering plaque, turning it hard (mineralization). Once plaque has mineralised to calculus it won’t come off by brushing alone, you will need to visit your dentist or hygienist who will scale (or scrape!) it off.

What is the best way to stop the build up of calculus?

Simply clean the plaque off your teeth before it mineralises to calculus. Clean the teeth using the steps described earlier.

Why does the dentist always find calculus behind my lower incisors?

This is a difficult area to reach with a toothbrush so is often not cleaned as well as other areas in the mouth. This area tends to get bathed in more mineral rich saliva than other areas of the mouth, so any plaque turns to calculus more rapidly. Some people find that an electric toothbrush with an oscillating rotating head helps reduce the build up of calculus in this area, because it is easy to manoeuvre and reach behind the teeth.

Which is better to clean my teeth an electric toothbrush or a manual one?

If your dentist or hygienist feels you are doing a good job at cleaning your teeth with a manual toothbrush there is no reason to change to an electric one. However, if you are constantly being told ‘your teeth could be cleaner ‘, it is probably worth trying an electric toothbrush as you may well find it more effective at cleaning your teeth.

Which is better a sonic toothbrush or an oscillating rotating head electric toothbrush?

Independent research would suggest the oscillating rotating type toothbrush is more effective at cleaning teeth.

What is the best toothpaste to use?

Always use a toothpaste containing fluoride. Ask your dentist to recommend what toothpaste is best for your needs.

Should I rinse out after brushing my teeth?

It is best not to rinse out or to only rinse with a small amount of water. Young children should be encouraged to spit out excess toothpaste otherwise they may develop fluorosis.

When should I brush my teeth?

Teeth should be brushed last thing at night and at least once more during the day.

Why is it important to brush last thing at night?

Less protective saliva flows at night and fluoride from toothpaste remains around the teeth longer giving added protection.

What is flossing?

Floss is a thread like material used to clean the point where two teeth touch. Dentists and dental hygienists will often recommend that you floss your teeth as part of your oral care routine.

Ask the dentist or hygienist to show you how to use floss.

When flossing for the first time you may find it difficult, but be patient and persevere with it – you will get used to it in time, and the benefits are well worth it.

Why do my gums bleed when I floss?

You may find your gums bleed a lot when you first start flossing – this is because the gums between the teeth can be very fragile due to the damage from plaque bacteria. As you floss more regularly and remove the bacteria, the gums will thicken up and the bleeding will reduce.

What are inter-dental brushes?

These are special brushes to clean between your teeth. They look like miniature bottle brushes. They come in various sizes according to the spaces between the teeth and are colour coded. Your dentist or hygienist will be able to recommend which one(s) to use.

What is oral health?

Dental health or oral health as it is often called has been defined by the Department of Health as:

‘a standard of health of the oral and related tissues which enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment and which contributes to general well-being’

The two most common dental diseases are tooth decay (dental caries) and gum disease (periodontal disease).

The main cause of tooth decay is frequent consumption of sugars in drinks and foods. The sugar is eaten by bacteria found in plaque on the teeth. Plaque is a white soft sticky substance. It forms on teeth and causes a furry feeling. It can often build up in between teeth and at the gum line and turn into calculus (tartar) if left for long enough.

When you eat, the bacteria in plaque eat as well producing acids which can dissolve the minerals which make up the tooth and result in a hole (cavity), which is the process of decay. If left untreated, this can result in pain and a possible abscess.

Gum disease is caused by poor cleaning of plaque from around the necks of the teeth. The waste products of the plaque bacteria’s digestion of sugars causes damage to the gums, often causing them to swell, look red and bleed easily. The dentist may refer to this as ‘gingivitis’ (the old fashioned term was known as pyorrhoea). If left untreated gingivitis can progress to ‘periodontitis’. This is the stage when the bone that holds the teeth in the jaw is destroyed, resulting in the teeth becoming loose or ‘mobile’ and maybe painful.

People who smoke are more likely to develop gum disease.

Gum disease is a much slower process than tooth decay but both can result in the loss of teeth.

Mouth cancer can develop in any part of the mouth including the tongue, gums, lining of the mouth and the lips. This obviously affects dental health. It is more common in men than in women and is rare in people under 40. The most important causes of mouth cancer are:

Smoking tobacco (cigarettes, cigars and pipes)

Chewing tobacco or betel quid with tobacco

Regularly drinking more than safe levels of alcohol

People who use tobacco and drink too much alcohol have the highest risk of mouth cancer. Three-quarters of mouth cancers are caused this way. Early diagnosis is essential. Signs and symptoms of possible oral cancer are:

A sore or ulcer anywhere in the mouth that does not heal

A white or red patch in the mouth that will not go away

A lump or thickening on the lip or in the mouth or throat

Difficulty or pain with chewing or swallowing

A sore throat that does not get better

A feeling that something is caught in the throat

New pain in the tongue or ear that persists

Unusual bleeding or numbness in the mouth

If you are concerned you should see your dentist or doctor.

The risk of mouth cancer can be reduced by contacting your dentist at an early stage if you discover any of the signs and symptoms listed above.

Stopping smoking or chewing tobacco; keeping within the safe limit for alcohol; and eating a healthy diet, are all factors which could help reduce the risk of mouth cancer.

Trauma of the mouth will reduce dental health, it is therefore important to protect your teeth with a gum shield when playing contact sports.

Although the aim of the dentist and their team is to maintain dental health, this is only possible if patients follow their recommendations and attend for regular check-ups.

Why would my dentist recommend I see an orthodontist?

An orthodontist is a dental specialist concerned with preventing or correcting irregularities of teeth. An orthodontic problem is called a malocclusion, meaning “bad bite.”

Children and adults can both benefit from orthodontics. Your dentist will check how your child’s teeth are developing at each routine examination and decide if a referral to an orthodontist is required.

Treatment may take a little longer for adults. Because an adult’s facial bones are no longer growing, certain corrections may not be accomplished with braces alone. The average treatment time is about 24 months and varies with individual patients.

What should I do if I need to cancel my appointment?

Please give at least 24 hours’ notice of changes to your appointment day otherwise there will be a short notice cancellation recorded on your notes. If you cancel at short notice on two occasions, you run the risk of loosing your dental place with the practice.

How does being pregnant affect my treatment?

Because some objects – like bacteria, for example can cross the placenta, the Department of Health advises dentists that putting in or removing amalgam fillings during pregnancy should be avoided. This is purely as a precautionary measure as there is no evidence that a pregnant mother’s fillings can affect her baby.

Are dental x-rays harmful to my unborn baby?

There is a very slight risk to your unborn child, which is why it is vital that you tell your dentist even if you only think you might be pregnant.

Is dental treatment free when I am pregnant?

NHS dental treatment is free to pregnant women and for the first year after your baby’s born. All you need to do is take a MatB1 certificate or NHS prescription maternity exemption certificate to your dentist as proof. You can get these either from your GP or from a registered midwife via form FW8. Follow this link forfurther information.

What is the difference between NHS and private dentistry?

Most dentists offer both NHS and private treatment.

Some treatments – like tooth whitening, for example – are only available privately, although the range of NHS treatments is quite broad.

The main difference between NHS and private care is the materials used, such as filling materials and types of denture.

Before you start a course of treatment, make sure you know whether you’re being treated as an NHS or a private patient, as this may make a difference in the price you have to pay.

How much is private dental treatment?

Each dental practice sets their own private fees.

Your dentist will provide a written cost estimate before treatment is started.

What treatments are available privately?

The range of treatments available privately is wider than those available on the NHS. The major treatments which are only available privately are teeth bleaching, white fillings and crowns on back teeth and implants

Is my treatment really necessary?

Whether you are considering NHS or private treatment, you should feel comfortable discussing your options with your dentist. They are there to help you and will be happy to explain.

If the dentist offers you a choice between treatments, ask them what the difference is, and, most importantly, what the end result will be. Don’t agree to a course of treatment until you are totally happy.

Is private dental treatment better than NHS treatment?

Not necessarily.

Often the difference between NHS and private dental work is in the materials used, like filling materials or even which technician makes the dentures.

The range of treatments a dentist can offer privately is wider than what the NHS has to offer.

The dentist will also spend more time with you if you are being treated privately. Ultimately, though, the choice is yours – whether you decide to opt for NHS or private care, you must feel comfortable with your dentist and with the treatment they recommend

Is private dentistry expensive?

Private charges are set by the dentist and are usually 3 times greater than the cost of the same treatment (if available) than on the NHS. The main reasons for this higher price are due to no money being received from the government towards the cost of treatment, longer times spent on treatment, better materials and private pension contribution. When thinking about the fees charged by private dentists, remember those fees charged by other professionals such as solicitors and accountants.

Why is one dentist offering treatment cheaper than another?

The price for private treatment will often vary from dentist to dentist. This could be because one dentist has more experience in a certain field – like treating gum disease – or because they dedicate more time to each patient, or simply because their practice is in a different area. Because dentists operate like small businesses, they have to pay for all their own equipment, their staff and their premises, so if they work in an expensive area – like in the middle of a town – they may have to pass this cost on through their charges.

How can I pay for my dental treatment?

Most people pay for their dental treatment on a ‘pay as you go’ basis and some practices may ask for payment in advance for certain treatments. If you need to visit the dentist more regularly, then you might want to consider signing up to a payment plan. Sometimes these are run by the practice themselves or by an external company on behalf of the practice and just involve paying a certain amount each month. The best known example of this is Denplan.

Other schemes are also available which are individual to you, so you can take the plan with you if you decide to change dental practice. Another popular scheme is the ‘cash plan’, where you pay a certain amount each month and then you get ‘cash back’ after treatment. These plans – like HSA – often cover more than dental treatment, so they’re well worth looking into.

What is dental phobia?

Dental phobia is a fear of going to the dentist. It can be a result of many things and may include:

Previously painful or negative experiences during visits to a dentist, usually as a child. This may include careless comments made by a dentist, hygienist or other professional.

Severe discomfort with feelings of helplessness and/or being out of control in the dentist’s chair.

A sense of embarrassment of your dental neglect, and fear of ridicule and/or belittlement when you go to the dentist.

Scary stories of negative dental experiences learned from family and friends.

Negative, menacing portrayals of dentists in movies, TV, newspapers and magazines.

A sense of depersonalization in the dental process, increased by today’s necessity for the use of barrier precautions, such as masks, latex gloves and shields.

A general fear of the unknown.

What is sedation?

Sedation in dentistry is an option for certain groups of people who are anxious or nervous of undergoing dental treatment. They include adults with dental anxieties or phobias, children who are apprehensive or frightened and patients with special needs. Some patients only require sedation for a specific surgical procedure. A range of sedation techniques are available which include:

Intravenous (by injection into a vein)

Inhalation (by breathing a mixture of gas and oxygen)

Oral (by tablet swallowed prior to the treatment)

If you are very nervous, sedation may be an option for you. Don’t be afraid to ask your dentist if they feel you may benefit from treatment under sedation.

What is a Dental Hygienist?

The dental hygienist is a significant member of the dental team whose role in patient care is becoming increasingly important. Patients are usually referred to the hygienist by their dentist. Hygienists help to treat and prevent gum disease by scaling and polishing teeth. They also advise patients how to care for their teeth through the use of various products such as toothbrushes, floss, interdental brushes, and give advice on a healthy diet.

To learn more, contact www.bsdht.org.uk

What is a dental technician?

The dental technician is a very important part of the dental team. They produce crowns, veneers, dentures, bleaching trays, gum shields and some orthodontic appliances from impressions and written instructions from a dentist.

Most technicians work in privately owned dental laboratories but some work in hospitals, general dental practices, the community dental service and the armed forces.

To learn more, contact www.dta-uk.org

What is a dental therapist?

Dental therapists can carry out the following treatments with appropriate training:

Scale and polish teeth

Apply materials to teeth such as fluoride and fissure sealants

Take dental radiographs

Provide dental health education on a one to one basis or in a group situation

Routine restorations in both deciduous and permanent teeth, on adults and children,

Treat adults as well as children

Extract baby teeth under local analgesia

Placement of pre-formed crowns on deciduous teeth.

Emergency temporary replacement of crowns and fillings.

Take impressions.

Treat patients under conscious sedation provided the dentist remains in the surgery throughout the treatment.

To learn more, contact.

Are electric toothbrushes better than manual?

Electric (battery or rechargeable) toothbrushes with circular bristle heads that rotate in alternating directions (oscillating) are better at removing plaque and reducing the risk of gum disease than ordinary manual toothbrushes, according to recent research.

The review by Peter Robinson and colleagues from Sheffield University included 42 studies and 3,855 participants. The studies compared manual, electric and battery-powered toothbrushes with a variety of bristle arrangements and motions and newer “ionic” brushes that buzz the tooth surface with small electric charges. Ionic brushes and powered brushes that did not use a circular, alternating motion were no better than manual toothbrushes in removing plaque and preventing gingivitis over one to three months, Robinson and colleagues conclude.

However, the powered brushes reduced gingivitis by 17% over the manual brushes after more than three months’ use. The researchers found no evidence that powered brushes of any kind caused more gum damage than manual brushes.

Despite the better performance by the rotating powered brushes, the benefits of regular brushing “occur whether the brush is manual or powered, and the results of this review do not indicate that tooth brushing is only worthwhile with a powered toothbrush,” the researchers write. “We did not want to say that electric brushes are necessary, just that they can help. It is possible to clean one’s teeth perfectly well without an electric brush,” Robinson says.

The review appears here.The Cochrane Library review, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Although the oscillating electric toothbrush seems more effective than the manual toothbrush, Robinson acknowledges that there is no standard for measuring how much of a reduction in plaque and gum inflammation is necessary to cause clinically significant improvements in oral health.

“There are standards proposed but they are arbitrary,” Robinson says. “We can be reasonably sure that plaque causes periodontitis, and even that more plaque causes more periodontitis. But we cannot be sure by how much we need to reduce plaque levels in order to have a long term effect on periodontitis.”

“Most people clean their teeth not to ward off gum disease but to feel fresh and confident. Likewise, some people simply enjoy gadgets. It would be difficult to put a value on those things,” Robinson says.

Fred Peterson, a spokesperson for the American Dental Association, says the association has no official recommendation regarding manual versus electric toothbrushes. “Both manual and powered toothbrushes can effectively clean your teeth. If you have arthritis or otherwise need assistance with movement, a powered brush may be easier to use,” Peterson says.

What are molars?

These are the teeth at the back of the mouth used for crushing and grinding food. The biting surfaces of these teeth are quite rough (fissured) and it is important to remember to brush them. When these teeth first erupt into the child’s mouth, the dentist may decide to seal them over to reduce roughness (fissure seal) and make them easier to clean. They are called number 6, 7 and 8 (also known as the wisdom teeth).

What are premolars?

These are the teeth between the canines and the molars. There are usually two, sometimes called bicuspids. One of the premolars may be removed if you need to have orthodontic treatment for crowded teeth. They are called No 4 and 5 teeth.

What are incisors?

These are the teeth at the front of you mouth. There are two central incisors right at the front on both the top and bottom jaws, and next to them a lateral incisor on either side. They are called number 1 or 2 teeth in adults or As and Bs if baby teeth.

What are canines?

These are found between the incisors and premolars. They are sometimes referred to as the eye-teeth in the upper jaw and have a fang like appearance. They are called no 3 if adult teeth or Cs if baby teeth.

What are wisdom teeth?

Wisdom teeth are the last teeth to appear, right at the back of the mouth, usually when you’re in your late teens. Most people have four wisdom teeth – two at the top, two at the bottom – but some people have fewer than this, or even none at all.

Because they are the last teeth to come through, there may not be room in your mouth for them. As a result, they can push the existing teeth forward, causing overcrowding in the mouth and possibly some discomfort.

For information on the removal of wisdom teeth follow this link:
 nice.org

What is fluorosis?

Fluorosis is the mottling of enamel that occurs if children swallow too much toothpaste when their teeth are developing.

Children aged less than 7 should be supervised when brushing and only use a pea sized amount of toothpaste.

During our life we have 2 sets of teeth. The first are deciduous teeth (also known as primary, baby or milk teeth), which are later replaced by permanent adult teeth.

Deciduous teeth:

When we are born we already have teeth beneath our gums. These milk teeth (deciduous teeth) begin to appear when we are about 6 or 7 months old and we have 20 of them by about the age of 3. These milk teeth are very important for chewing and speech, as well as helping develop the jaw, so it is important to look after them. Between the ages of about 6 or 7, the roots of these milk teeth dissolve and eventually the tooth falls out. Milk teeth also work as a guide for adult teeth to follow – so even though they drop out it is important to look after them to avoid damage to the adult teeth when they arrive.

Adult teeth

Permanent teeth begin to replace the front deciduous teeth from the age of about 6. For the next 6 to 8 years there is a gradual replacement of milk teeth by adult teeth. This stage is called mixed dentition, as both milk and adult teeth will be in the mouth at the same time. By the age of about 12-14 all adult teeth should have appeared with the exception of wisdom teeth (third molars). At this stage the mouth will contain 28 teeth. These teeth have to last for life as we only get one set.

The teeth are composed of various different elements.

Tooth crown – The visible part of the tooth in the mouth.

Enamel – Enamel is the tough outer coating of the tooth and is the hardest substance in the body and gives the tooth its white appearance.

Dentine – Dentine is the softer structure that comprises the majority of the tooth substance. It is full of tiny tubes that can transmit such signals as hot, cold and painful stimuli to the pulp of the tooth where the nerves and blood vessels are found. It is yellow in colour.

Gums – Firm flesh around the roots of the teeth.

Root – The tooth is like an iceberg – although all we see in the mouth is the crown, beneath the surface, embedded in the bone of the jaw is the complex structure of the root.

Pulp – A soft tissue made up of blood vessels and nerves, which feeds the hard dental tissues. It is often called the dental nerve. The nerves and blood vessels in the pulp are connected to the nervous and circulatory systems of the body.

Cement – The bone-like substance covering the root.

Periodontium – Tissue which keeps the tooth in place.

Jaw bone – The bone which forms the framework of the mouth and which holds the teeth in place.

There are different types of teeth in the mouth with different functions:

Incisors – Thin and sharp, used to cut and slice food.

Canines – Sharp and pointed, used to hold and tear food.

Premolars – Sharp, flat surfaces, to hold and crush food.

Molars – Broad and flat, used to chew and grind food.

You may be able to lighten your teeth by bleaching. Your dentist will first need to check you are suitable; some people may not benefit from bleaching or may have too sensitive teeth. If ok to go ahead you can either have your teeth bleached by your dentist at the surgery or they may make you thin gum shield type trays which you take home and fill with a bleaching gel and wear when convenient. The benefit of bleaching at home with the gum shields is that you can control how much you lighten your teeth and it is also cheaper in the long term as you only need to buy more bleaching gel from your dentist to top up in the future.

Your dentist may be able to show you examples of teeth they have bleached in the past – don’t be afraid to ask.

Why does my dentist take X-rays?

Dental X-rays are used to take pictures of the teeth, bones, and surrounding soft tissues. X-ray pictures can show tooth decay, hidden dental structures, and bone loss that cannot be seen during a visual examination.

The following types of dental X-rays are commonly used.

Bitewing X-rays use the least amount of radiation and show the upper and lower back teeth in a single view. They are used to detect decay between the teeth and to show how well the upper and lower teeth line up. They also show bone loss that usually indicates the presence of severe gum disease or a dental infection.

Periapical X-rays show the entire tooth from the exposed crown to the end of the root and the bones that support the tooth. These X-rays are used to detect dental problems below the gum line or in the jaw, including the presence of impacted teeth.

Occlusal X-rays show the roof or floor of the mouth and are used to detect the presence of extra teeth, teeth that have not yet broken through the gums, jaw fractures, a cleft in the roof of the mouth (cleft palate), cysts, or growths (such as a tumour). Occlusal X-rays may also be used to locate foreign objects.

Panoramic X-rays provide a broad view of the jaws, teeth, sinuses, nasal area, and temporomandibular (jaw) joints. These X-rays reveal problems such as impacted teeth, bone abnormalities, cysts, solid growths (tumours), infections, and fractures.

A full-mouth series of periapical X-rays, which may consist of 14 to 21 X-rays, are most often done during the first visit to the dentist. Bitewing’s are used during checkups to help the dentist diagnose tooth decay. Panoramic X-rays may be used periodically to screen for dental conditions. Like other aspects of your dental care, dental X-rays are scheduled on an individual basis and may vary with your age, risk for disease, and signs of disease.

Are dental X rays safe?

There is always a slight risk of damage to cells or tissue from being exposed to any radiation, including the low levels of radiation used for this test. However, the risk of damage from the X-rays is usually very low compared with the potential benefits of the test. In some cases, a previous X-ray can be used instead of having a new X-ray done.

If you are worried speak to your dentist and explain your fears.

Will my dental records and x-rays be sent on from my old dentist?

Dental records and x-rays are not automatically sent from your old to your new dentist.

Please contact your old dentist and ask if they will give you copies of your notes and x-rays to bring to your first appointment. There may be a charge made by your old dentist for these copies.

How does smoking affect my teeth?

Smoking stains the teeth which looks unsightly. Smokers often try to remove the stains by using smokers toothpastes, some of which are abrasive and cause permanent damage to the teeth by wearing them away. Smokers also tend to get more calculus which can make the teeth rough and more prone to trapping plaque (plaque retention factors) producing damaging acids causing decay.

How does smoking affect my gums?

There is a lot of high quality evidence showing smoking is linked to gum disease. Smokers are up to six times more likely to suffer from gum disease than non smokers.

If you are thinking of giving up smoking, speak to your doctor or follow this link.

or Freephone 
The Quitline 0800 002200

Help is also available in Asian languages via the Asian Quitline

The following languages are available:
Bengali 0800 002244 
Gujarati 0800 002255 
Hindi 0800 002266 
Punjabi 0800 002277 
Urdu 0800 002288

Why have my gums started to bleed since I stopped smoking?

Smoking causes the blood vessels in your gums to shrink. When you stop smoking they open up to their normal size thus bringing more blood to the gums to help repair the damage. The bleeding will reduce with time.

How does smoking affect my mouth?

Every year approximately 4000 new cases of oral cancer are diagnosed and almost 2000 people die each year of oral cancer. The cause of oral cancer is well established – excess tobacco and alcohol use. 
For more information follow this link.

Smoking also causes halitosis and reduces your ability to taste, especially salt.