• Active Smile Oral Hygiene FAQ's

Avulsed teeth - I have knocked my tooth out, what can I do about it?

Q    What is an avulsed tooth?

A    An avulsed tooth is one that has been knocked out.

A tooth can be knocked out for a number of reasons: often a blow to the mouth, or an accident involving the face. This can happen for example during contact sports. It is possible to replace the tooth in the socket successfully if the right action is taken as soon as possible.

Q    I’m bleeding – what can I do?

A    Don’t panic. Get a clean handkerchief and fold it up, then hold it over  the socket and bite down. Keep your jaws together to apply pressure.  If you need something for the pain, don’t take any medication containing aspirin as this can encourage further bleeding. Do not apply clove oil to the wound.  

Q    I’ve still got the complete tooth, can it be replaced?

A    Maybe. The complete tooth needs to be replaced in the socket as soon as possible, ideally in under 30 minutes. But teeth have been successfully replaced up to 60 minutes after being knocked out.

Q    What should I do with the tooth?

A    Avoid handling the root. If it is very dirty, rinse it with milk or tap water.  Do not clean it with disinfectant or let it dry out.

Q    How do I put the tooth back in?

A    Hold the tooth by the crown and put it back into the socket firmly, root first. Bite on a clean handkerchief for about 15-20 minutes.

Q    What should I do if I can’t get the tooth back in?

A    Your tooth has more chance of survival if you keep it in your cheek until you can get emergency dental treatment. This will keep the tooth in its most natural environment. If this is not possible, keep it in some milk.  

Q    What if I have only got part of the tooth?

A    It is not a good idea to try and put the tooth back into the socket if it is not complete. Contact your dental surgery as soon as possible and your dentist will tell you what options are available to restore the tooth. You may need dental x-rays to see if there is any root damage.

Q    Is there anything I should do if I haven’t got the tooth?

A    If you cannot find the tooth, you may have swallowed it. If you think you may have swallowed or inhaled it, you may need an x-ray to be sure of this.

Q    What if it is a baby tooth?

A    Most dentists would not recommend re-implanting a baby tooth in case an infection damaged the adult tooth underneath. Contact your dentist as soon as possible for advice. They may need to examine the child to check if any fragments of tooth are still in the gum. There is no way of temporarily replacing a baby tooth, so the treatment is to wait for the adult tooth to come through.

Q    Where should I get emergency dental treatment?

A    It is important to get emergency dental treatment. If you are registered with a dentist, contact the dental practice as soon as possible and explain what has happened.  

If the incident has happened out of normal dental practice hours, you should still be able to contact your dentist for emergency treatment.  Phone the practice number and you should be given information on when and where you will be treated. The dentist will then tell you what treatment will be needed.  

Q    What if I’m not registered with a dentist?

A    If you are not registered with a dentist then phone NHS England (111) who will tell you about dentists in your area that are able to see you.  Remember to say that you need emergency treatment as soon as possible.

Q    What should happen at my emergency visit?

A    Your dentist will assess the immediate situation and may treat any facial injury. However, treatment may be limited if there is any bruising or bleeding. They may take x-rays and will check if the tooth has re-implanted successfully. You will probably need more appointments for follow up treatment.

Q    What further treatment options will be available to me?

A    If the tooth has re-implanted successfully you may not need any further treatment as long as you keep up your regular check-ups with your dentist. If the tooth becomes loose, it can be splinted to the teeth next to it. This means it will be temporarily attached to keep it firm until your dentist can tell whether it has re-implanted successfully.  

If the tooth is lost or doesn’t implant successfully, it can be replaced at first with a denture. Then, when the socket has healed fully, you can have a bridge or dental implant. For more information please see our other ‘Tell me about’ leaflets on these treatments.

Q    Is there anything that I can do to avoid getting a tooth knocked out?

A    You could wear a mouthguard – a rubber-like cover that fits over your teeth and protects you against a blow to the mouth. Your dentist can have one made for you by taking an impression of your teeth and sending it to a laboratory. The laboratory then makes the mouthguard so that it fits your mouth exactly. Mouthguards can be clear or coloured – for example in the colours of your team kit. For more information see our ‘Tell me about mouthguards’ leaflet

Cold sores - What is a cold sore and how do I get them?

Q What is a cold sore?

A A cold sore is a small, painful raised area of small, fluid-filled blisters, usually where the lip joins the surrounding skin. The blisters are painful and dry up to make a yellow crust which gradually heals in a few days. Cold sores are usually found on the lips but you can get them in other places, such as in the nostrils, on the nose or around the outside of the mouth. Cold sores tend to last 5 to 7 days and can keep coming back. Most people only have them once or twice a year.

Q How do I get them?

A Cold sores are caused by a virus (a ‘Herpes Simplex’ virus). You first get this virus in childhood or early adulthood, and it may cause a fever and mouth ulcers (called ‘primary herpetic gingivestomatitis’). About a third of people who get this ‘primary’ infection go on to develop cold sores in later life. However, many people with cold sores did not get this primary infection.

Q What brings on the cold sores?

A Cold sores usually appear when people are ill with something else, for example with a cold (hence the name) or ‘flu. Sunlight and ultra-violet light can often bring on an attack of cold sores, and occasionally women find that they develop cold sores at particular stages of their menstrual cycle.

Q Are they infectious?

A Yes. Cold sores are infectious and the infecting virus can be passed to other people by close contact (such as kissing). A cold sore is most infectious when it is blistering. It is important to try and avoid touching cold sores as you can pass the virus on to other people’s hands and even, very rarely, to your own eyes. Avoid squeezing, pinching or pricking the cold sore as this can spread the infection.

Q Can they be treated?

A Yes. Antiviral creams, such as aciclovir and penciclovir, ease the pain and blistering and help the sores heal more quickly. You can buy aciclovir from a chemist, but penciclovir has to be prescribed by your doctor. Both these creams should be applied as early as possible when the cold sore starts to develop and should be applied regularly.

Q How can I avoid getting one?

A Once you have had the virus it remains with you and there is little you can do to avoid an attack. How often the cold sores appear varies from person to person. However, if sunlight seems to bring on your cold sores, it is sensible to put sunblock on your lips when going out into strong sunlight.

Q If I have a cold sore should I see my doctor?

A Cold sores generally clear up without treatment in about a week. However, if you have a health condition that has weakened your immune system or the sores don't heal within two weeks on their own, see your doctor. If you often get attacks, your doctor may be able to prescribe an antiviral medication to treat the sores.

Q I have a cold sore but am due to see my dentist. Will they still be able to treat me?

A If you have a cold sore and are due to visit your dentist or hygienist, check with them first. Some dentists prefer not to treat patients with active cold sores as the affected area may be painful, and may crack and bleed during dental treatment

Q What if I’m breast-feeding?

A Breast-feeding shouldn’t be stopped. However, don’t kiss your baby, especially near the mouth or eyes, while you have an active sore as this may pass the infection to your baby.

Q Can you only get cold sores around the mouth or can you get them on other parts of the body?

A The virus that causes cold sores can also cause similar diseases on other parts of the body (for example, the fingers, eyes and genitals). It is therefore important not to touch cold sores as you may accidentally spread the virus to other parts of your body.

Cracked teeth - How can I tell if I have a cracked tooth, and can it be repaired?

Q    What is a cracked tooth?

A    A cracked tooth is a tooth that has become broken.

Q    Do all teeth crack in the same way?

A    No.  Teeth can crack in several different ways:

•    cracked tooth –  this is when a crack runs from the biting surface of the tooth down towards the root.  Sometimes it goes below the gum line and into the root.  A cracked tooth is not split into two parts but the soft, inner tissue of the tooth is usually damaged.  

•    craze lines – these are tiny cracks that affect only the outer enamel of the tooth.  They are common in all adult teeth and cause no pain.  Craze lines need no treatment.  

•    cracked cusp – the cusp is the pointed part of the biting surface of the tooth.  If a cusp becomes damaged, the tooth may break.  You will usually get a sharp pain in that tooth when biting.

•    split tooth – this is often the result of an untreated cracked tooth. The tooth splits into two parts.  Vertical root fractures are cracks that begin in the root and go up towards the biting surface.  

Q    Why do teeth crack?

A    Many things can cause teeth to crack; such as:

•    extreme tooth grinding, which can put the teeth under enormous pressure
•    large fillings that weaken the tooth
•    chewing or biting on something hard, for example, ice, boiled sweets, fruit stones or meat bones
•    a blow to the chin or lower jaw
•    gum disease, where there has been bone loss that could make the teeth more likely to suffer from root fractures
•    sudden changes in mouth temperature.

Q    How can I tell if I have a cracked tooth?

A    The signs can be difficult to spot and the symptoms varied.  You may get pain from time to time when you are chewing, especially when you release the biting pressure.  Extreme temperatures, especially cold, may cause discomfort, or you may be sensitive to sweetness, but with no signs of decay.  Swelling may be limited to a small area near to the affected tooth.

If the pain is severe, take pain relief.  Always check with your doctor or pharmacist if you are taking any other medication.

Q    Why don’t cracks show up on a dental x-ray?

A    Unfortunately, dental x-rays sometimes don’t show up the cracked tooth.  This is because the x-ray beam must be parallel to the crack before it can penetrate it.  

However, sometimes other signs of a crack may show up.  With a vertical root fracture, if the crack has been there long enough, vertical bone loss near to the root can be seen.  Your dentist may use a bright light or a magnifying glass to find the crack.  They may also use a special dye to follow the course of the crack.

Q    Will I need to have treatment?

A    Yes.  It is important to get advice as soon as possible to help the treatment be more effective.  If they are not treated, cracked teeth can lead to the death of the nerve, and an abscess might grow that could need root canal treatment or extraction.  In severe cases the tooth can actually split in two.  If this happens your dentist will not be able to save the tooth and it will need to be taken out.

Q    Will I lose my tooth?

A    In some cases, the tooth may need to be taken out, but not always.  It is important therefore to get advice as soon as possible.

Q    How are cracked teeth fixed?

A    The choice of treatment depends on the amount of damage to the tooth.  You should ask your dentist what the best treatment for you is.  

•    bonding –  this is when a plastic resin is used to fill the crack and it can easily repair a small chip off the biting edge of the tooth. Bonding can restore the shape of the tooth.

•    cosmetic contouring – this is done when the chip is very small.  The rough edges of the tooth are rounded and polished to blend away the crack.  

•    veneers – these are ideal for a tooth that still has a fair amount of structure remaining, as they are long lasting and need the least amount of tooth removing first.  A veneer is a thin layer of porcelain or plastic material made to fit over the front surface of the tooth.  For more information see our ‘Tell me about veneers’ leaflet.

•    crowns – these are used as a last resort for a tooth that is not suitable for a veneer.  A crown fits right over what is left of the tooth, making it strong and giving it the appearance of a natural tooth.  If the nerve has been damaged and becomes infected you may need to have root canal treatment first.  This involves removing all infection from the root canal.  The root is then cleaned and filled to prevent any further infections.  The tooth would then be fitted with a crown to give it extra support.  For more information see our ‘Tell me about crowns’ leaflet.

Q    After treatment for a cracked tooth, will my tooth completely heal?

A    Unlike broken bones, the crack in a tooth will never heal completely.  After treatment, a crack may get worse and you could still lose the tooth.  It is still important that you get treatment because most cracked teeth can work normally for years after treatment.  Your dentist will be able to tell you more about your particular problem and recommended treatment.

Q    Can I stop my teeth cracking?

A    Not altogether, but there are some precautions you can take:

•    wear a mouthguard – if you grind your teeth at night, have a night guard made to protect the teeth.  If you play sports, wear a custom-made mouthguard.

•    avoid biting or chewing on hard objects.

Q    How much will my treatment cost?

A    The cost will vary depending on what treatment you need.  There may be extra costs if there are complications and you need more treatment. Ask your dentist for a treatment plan and a written estimate before you start treatment.

Dental decay - What causes it and Is there anything I can do to protect my teeth against decay?

Q    What is dental decay?

A    Dental decay happens when the enamel and dentine of a tooth become softened by acid attack after you have eaten or drunk anything containing sugars. Over time, the acid makes a cavity (hole) in the tooth. ‘Dental decay’ is the same as tooth decay and is also known as ‘dental caries’.  

Q    What causes dental decay?

A    Dental decay is caused by plaque acids that gradually dissolve away the enamel and dentine of the tooth. Decay damages your teeth and may lead to the tooth needing to be filled or even taken out.

Q    What is plaque?

A    Plaque is a thin, sticky film that keeps forming on your teeth. It contains many types of bacteria.

Q    What is enamel?

A    Enamel is the hard, protective outer coating of the tooth and is the hardest part of the body.  It does not contain any nerves or blood vessels and is not sensitive to pain.

Q    What is dentine?

A    Dentine lies under the enamel, forming most of the tooth, and it can be very sensitive to pain.  Dentine covers the central ‘pulp’ of the tooth.  

Q    What is the pulp?

A    The pulp is a soft tissue which contains blood vessels and nerves and is in the middle of the tooth.

Q    Why do my teeth decay?

A    Decay happens when sugars in food and drinks react with the bacteria in plaque, forming acids.  Every time you eat or drink anything containing sugars, these acids attack the teeth and start to soften and dissolve the enamel.  The attacks can last for an hour after eating or drinking, before the natural salts in your saliva cause the enamel to ‘remineralise’ and harden again.  It’s not just sugars that are harmful: other types of carbohydrate foods and drinks react with plaque and form acids.  (These are the ‘fermentable’ carbohydrates such as the ‘hidden sugars’ in processed food, natural sugars like those in fruit, and cooked starches.)

Snacking between meals on sugary or acidic foods and drinks can increase the risk of decay, as the teeth come under constant attack and do not have time to recover.  It is therefore important not to keep snacking on sugary foods or sipping sugary drinks throughout the day.

Q    What are the signs of dental decay?

A    In the early stages of dental decay there are no symptoms, but your dentist may be able to spot a cavity in its early stages when they examine or x-ray your teeth. This is why you should visit your dentist regularly, as small cavities are much easier to treat than advanced decay.

Q    What happens if I have a cavity?

A    Once the cavity has reached the dentine your tooth may become sensitive, particularly with sweet foods and drinks, and acidic or hot foods.  
As the decay gets near the dental pulp you may suffer from toothache. If the toothache is brought on by hot or sweet foods this may last for only a few seconds. As the decay gets closer to the dental pulp the pain may last longer and you may need to take painkillers – paracetamol or ibuprofen – to control the pain. You must visit your dentist straight away as the tooth is dying and you may develop a dental abscess if it is not treated.

Q    What happens if I don’t get it treated early?

A    Toothache is a sign that you should visit a dentist straight away, as it is a warning that something is wrong.  If you don’t do anything, this will usually make matters worse and you may lose a tooth that could otherwise have been saved.

Q    What areas of my teeth are more likely to decay?

A    The biting surfaces of the teeth and the surfaces between the teeth are most likely to decay, as food and plaque can become stuck in these areas. But any part of the tooth can be at risk.

Q    What treatment will I need?

A    If the decay is not too serious, the dentist will remove all the decay and restore the tooth with a filling.  Sometimes the nerve in the middle of the tooth can be damaged.  If so, the dentist will need to carry out root canal treatment by removing the nerve and then restoring the tooth with a filling or a crown.  If the tooth is so badly decayed that it cannot be restored, the dentist may have to take the tooth out.

Q    Will I always need a filling?

A    No.  In the very early stages of decay, your dentist may apply a fluoride varnish onto the area.  This can help stop further decay and help ‘remineralise’ the tooth.  However, it is important to follow the cleaning routine your dentist or hygienist suggests, using fluoride toothpaste to prevent decay starting again.

Q    What can I do to prevent decay?

A    The best way to prevent dental decay is by brushing your teeth thoroughly twice a day with fluoride toothpaste, making sure that you brush the inner, outer and biting surfaces of your teeth.  Children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). Three-year-olds to adults should use a toothpaste that contains 1350ppm to 1500ppm of fluoride. Using ‘interdental’ brushes, or dental floss or tape also helps remove plaque and food from between your teeth and where they meet the gums. These are areas an ordinary toothbrush can’t reach.  

Q    Is there anything I can do to protect my teeth against decay?

A    As each of the adult molars (back teeth) appears, and if the tooth is free from decay, a ‘fissure sealant’ can be used to protect the tooth.  The sealant is a plastic coating that fills all the little crevices in the tooth surface, creating a flat surface that is easier to clean. This is called a ‘pit and fissure sealant’. Adults can also have this treatment if the teeth are free from decay.  Your dentist will discuss whether this is right for you.

Q    Is there anything else I can do?

A    Visit your dentist regularly, as often as they recommend, and have sugary and acidic food and drinks less often.  Avoid snacking between meals to limit the times your teeth are under attack from acids.

Chewing sugar-free gum for up to twenty minutes after a meal can help your mouth produce more saliva, which helps to cancel out any acids which have been formed.

Q    How can my dentist and hygienist help me prevent decay?

A    Your dentist or hygienist will show you what areas you need to take most care of when cleaning.  They will also show you how to brush and floss correctly.

Dental erosion - What is it and how can it be treated?

Q    What is dental erosion?

A    Erosion is the loss of tooth enamel caused by acid attack.  Enamel is the hard, protective coating of the tooth, which protects the sensitive dentine underneath.  When the enamel is worn away, the dentine underneath is exposed, which may lead to pain and sensitivity. 
   
Q    How do I know I have dental erosion?

A    Erosion usually shows up as hollows in the teeth and a general wearing away of the tooth surface and biting edges. This can expose the dentine underneath, which is a darker, yellower colour than the enamel.  Because the dentine is sensitive, your teeth can also be more sensitive to heat and cold, or acidic foods and drinks.

Q    What causes dental erosion?

A    Every time you eat or drink anything acidic, the enamel on your teeth becomes softer for a short while, and loses some of its mineral content.  Your saliva will slowly cancel out this acidity in your mouth and get it back to its natural balance.  However, if this acid attack happens too often, your mouth does not have a chance to repair itself and tiny particles of enamel can be brushed away.  Over time, you start to lose the surface of your teeth.

Q    Are there any medical problems which can cause dental erosion?

A    Bulimia is a condition where patients make themselves sick so that they lose weight. Because there are high levels of acid in the vomit, this can cause damage to tooth enamel.

    Acids produced by the stomach can come up into the mouth (this is called gastro-oesophageal reflux). People suffering from hiatus hernia or oesophageal problems, or who drink too much alcohol, may also find they suffer from dental erosion due to vomiting.

Q    Can my diet help prevent dental erosion?

A     Acidic foods and drinks can cause erosion. Acidity is measured by its ‘pH value’, and anything that has a pH value lower than 5.5 is more acidic and can harm your teeth.

    Fizzy drinks can cause erosion. It is important to remember that even the diet brands are still harmful.  Even flavoured fizzy waters can have an effect if taken in large amounts, as they contain weak acids which can harm your teeth.
   
         Acidic foods and drinks such as fruit and fruit juices, particularly citrus ones including lemon and orange, contain natural acids which can be harmful to your teeth, especially if you have a lot of them often.

    ‘Alcopop’ drinks that contain acidic fruits and are fizzy can cause erosion too.

Still water is the best drink for teeth, and milk is also good because it helps to neutralise the acids in your mouth.

Q    Are sports drinks safe?

A    Many sports drinks contain ingredients that can cause dental erosion. However, it is important for athletes to avoid dehydration because this can lead to a dry mouth and bad breath.

Q    What can I do to prevent dental erosion?

A    There are a number of things you can do:
•    Keep acidic products and fizzy drinks to mealtimes, to reduce the number of acid attacks on your teeth.

•    Drink quickly without holding in or ‘swishing’ around your mouth. Or use a straw to help drinks go to the back of your mouth and avoid long contact with your teeth.

•    Finish a meal with cheese or milk as this will help cancel out the acid.

•    Chew sugar-free gum after eating. This will help produce more saliva to help cancel out the acids which form in your mouth after eating.

•    Wait for at least one hour after eating or drinking anything acidic before brushing your teeth. This gives your teeth time to build up their mineral content again.

•    Brush your teeth for two minutes twice a day with a small-headed brush with medium to soft bristles and fluoride toothpaste.

Q    Should I use any other special products?

A    We recommend you use a fluoride toothpaste twice a day.  Children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million).  Three-year-olds to adults should use a toothpaste that contains 1350ppm to 1500ppm. In severe cases fluoride supplements such as rinses and gels may be used once a day. Your dentist or hygienist will tell you the best supplement to use.

Q    How can it be treated?

A    Dental erosion does not always need to be treated. With regular check ups your dentist can prevent the problem getting any worse and the erosion going any further. In other cases it is important to protect the tooth and the dentine underneath to prevent sensitivity. In these cases, simply bonding a filling onto the tooth will be enough to repair it.  However, in more severe cases the dentist may need to fit a veneer. (See our ‘Tell me about’ leaflet Veneers.)  

Q    How much will treatment cost?

A    Costs will vary, depending on the type of treatment you need.

It is important to talk about all the treatment options with your dentist and get a written estimate of the cost before starting treatment.


References

An investigation into the effects of sport supplement drinks on dental health.
R Kidner, Dental Health Vol 42 No 2 of 6 March

Dental erosion – changing prevalence? A review of British national children’s
surveys. J Nunn and others, International Journal of Paediatric Dentistry,
Volume 13, Issue 2, Page 98, March 2003

Dental Erosion and Acid Reflux Disease. Schroeder and others, Annals of Internal Medicine, 1 June 1995; 122: pages 809-815

Denture Stomatitis - What is it and how can it be treated?

Q    What is denture stomatitis (Thrush)?

A    It is a yeast/ fungus called candida or thrush, which causes an infection in the mouth. It is not a type of infection that can be passed on to others as everybody has some thrush in their mouths, even babies. It is possible to get thrush elsewhere.

Q    Who can get denture stomatitis?

A    Denture wearers are the most common group to be affected along with people who have difficulties keeping their mouths clean. Diabetics and anyone who takes steroids either through inhalers or by mouth may also have problems. Some antibiotics are responsible for causing thrush and many people find that taking certain antibiotics encourages a recurrence of infection, especially if taken over a long period of time.  

Q    How can the dentist recognise it?

A    When the denture is taken out, your dentist may be able to see a very red area under the denture. There may also be red sore areas at the corner of the lips.

Q    Why does it need treating?

A    If untreated, the condition can cause soreness in the mouth and may lead to poorly fitting dentures in the future.

Q    How is it treated?

Good Oral Hygiene
It is important to keep your mouth as clean as possible and rinse after meals.  Smoking promotes growth of further yeast infections, as does keeping dentures in the mouth for 24 hours at a time. It is important to let the mouth rest too!

Denture Hygiene
Dentures should be kept out as much as possible but definitely overnight. Some yeast infections will resolve completely if the dentures are not worn at night for two weeks.  The dentures should be cleaned in warm soapy water and scrubbed with a soft nailbrush on the fitting surface,  that is the non-polished side. The dentures can be soaked in any solution used to sterilize baby’s bottles e.g. Milton’s. If your denture has metal components, do not use anything with bleach but use chlorhexidine. Do not use the latter solution everyday as it will stain your denture. Use it once a week. There are many denture cleaners available but they tend to be more expensive than the ones mentioned.

Medication
If careful cleaning and hygiene has not helped you will be given some treatment.  There are many treatments available, most of them involving sucking tablets/lozenges slowly in your mouth, but there is no evidence to show whether any one is better than another. Treatment may need to be continued for one month.   

Q    What happens next?

A.    The dentist may want to check out your mouth after treatment to check that everything has cleared up. If this is not the case, they may recommend further treatment. In some cases you may need to treat the mouth for a long time.

It is important to have new dentures made every few years.

Even if you do not have any teeth left it is important for you to go for regular check-ups to your dentist to ensure that your mouth remains healthy.

Copyright: Dr Joanna M.Zakrzewska 1999

Dry mouth - How can I tell if I have it and how can I prevent it?

Q    What is dry mouth?

A    Your mouth needs saliva to be able to work properly. Saliva keeps your     mouth moist, and it helps to break down your food and helps you to     swallow. It also acts as a cleanser. It is constantly washing around your     mouth and teeth, fighting decay and helping to keep your teeth clean. Dry     mouth or ‘xerostomia’ is a condition which affects the flow of saliva, causing     your mouth to feel dry.

Q    How can I tell I have it?

A    There are several symptoms to look out for. The most obvious is, of course,     a     dry mouth. Some people feel that their saliva has become thick and sticky,     making it difficult to speak or swallow. Some people also have a     ‘prickly’ or     burning sensation in their mouth and become sensitive to certain foods. The     mouth can become sore and there is a higher risk of tooth decay and gum     disease. In some cases, the mouth can also become red and shiny. If you are     suffering from any of these symptoms it doesn’t necessarily mean that you     have dry mouth, but it may be best to talk to your dentist or doctor about it.

Q    What can cause it?

A    Dry mouth can be a symptom of many different problems and can happen     as you get older. Quite often it is a side effect of medication, especially     heart, blood pressure and depression tablets. Your doctor, chemist or     dentist     should be able to tell you whether your medication can cause     problems. Dry     mouth can also be caused by medical treatment such as     radiotherapy, or     surgery to the head or neck.

    In some cases, dry mouth can be a direct result of a medical condition (for     example diabetes, lupus, Sjogren’s syndrome and blocked salivary glands).

Q    Are women more likely to get dry mouth?

A    Women who are going through the menopause (‘change of life’) may suffer     from dry mouth. Women who have had their menopause and are taking     Hormone Replacement Therapy (HRT) may also find they suffer from dry     mouth. If you are taking medication and have any of the symptoms of dry     mouth, talk to your doctor to see whether the tablets could be altered.

Q    Can I prevent it?

A    Unfortunately there seems to be no way of actually preventing the problem,     although there are products to ease the symptoms.

Q    What problems can it cause?

A    Saliva helps to cancel out the acid that can attack your teeth, and is a very     important part of your dental health. Saliva helps to break down food while     you are chewing, allowing you to swallow more easily. Some people find     that they have problems with swallowing when their saliva flow is affected.

    Saliva is also very important in the fight against tooth decay. It helps to     fight the bacteria that form dental plaque and cause tooth decay and gum     disease. Plaque is the thin, sticky film that keeps forming on your teeth.

    Having less saliva can also affect the taste of food and makes it harder to     eat drier foods. Sometimes it can affect your speech and it makes people     more likely to have bad breath.

Q    What products are there to help?

A    There are a number of products designed to provide moisture and comfort.     These are usually gels or sprays. Some have extra ingredients which may     help prevent tooth and gum problems. There are also special products to     help with your day-to-day oral hygiene (for example toothpastes and mouth     rinses).        

Q    What can my dentist do to help prevent the problems caused by dry     mouth?

A    Your dentist won’t be able to help with the cause of dry mouth. But by     helping     you keep your mouth clean and by using fluoride they can, in many cases,     help to delay the start of dental decay. Your dentist or hygienist will be able     to give you advice about your diet and tell you how to care for your teeth     and gums properly.

Q    What toothpaste should I use?

A    It is important to use a toothpaste containing at least 1350 to 1500ppm     (parts per million) of fluoride. A ‘total care’ toothpaste may be best as these     contain antibacterial agents and other ingredients to control the build-up of     plaque.

    Some products contain Sodium Lauryl Sulphate, and some people with dry     mouth find this can irritate the mouth and make the condition worse.

Q    How often should I visit my dentist?

A    Because you have a higher risk of tooth decay and gum disease with dry     mouth, and because these can get worse more quickly than usual, it is     important to visit your dentist regularly. Your dentist will tell you how often     you should visit.

Q    What could I try to help relieve the symptoms?

A    There are different ways of relieving the symptoms of dry mouth. Some     people find that sipping water, or sucking sugar-free sweets, helps in the     short term. It is very important to use sugar-free products, as dry mouth     can make you more likely to have tooth decay. Chewing sugar-free gum can     also help as it encourages your mouth to make saliva. Your dentist might     recommend products such as rinses, gels, pastes and lozenges which you can     get from the chemist.

Geographic tongue - Why does it happen and can it be treated?

Q    What is a geographic tongue?

A    Geographic tongue is a common condition that causes a characteristic appearance, which experts recognise instantly. The tops of the tongue, sides and occasionally, undersurface of the tongue develop irregular, smooth red areas, which may look like the outline of a map. There are usually wavy white lines next to the red patches.

You may notice that after a few weeks or months the position of these lines and red patches change. This is why the condition is called erythema migrans in Latin, as its position changes and moves.  

Q    Why does it happen?

A    For reasons as yet not understood, the normal top layer of the ‘skin’ of the tongue is not shed evenly. In some parts the ‘skin’ is shed too early and so leaves a red, sore area like a scratch on the skin. Whereas in other areas the skin stays on too long and has a white appearance.

The red areas, because they are thin, can sometimes become infected with thrush (candida) and so feel sore. Thrush is very common in mouths.

Q    Who does it affect?

A    It affects all age groups and you may have first noticed it as a child. It is not something that you can pass on to others but it can run in families. It is not an infection.

Q    What makes it worse?

A    As the red patches are thin and raw, they tend to be painful when eating acidic things like citrus fruit or spicy foods; especially chillies. However these do not make the condition worse and you will soon come to notice which particular foods make the condition more uncomfortable or sore.

Q    Do I need any special tests?

A    No. Your doctor or dentist can make the diagnosis just from the appearance.

Q    How is it treated?

A    Unfortunately, there is no treatment. Sometimes treatments for thrush can ease the discomfort. You can buy these at the chemist, eg miconazole gel.  

It will never become cancerous, but you will have to learn to live with it. You will need to work out for yourself which foods make it worse and avoid them.

Q    What should I do if it gets worse in any way?

A    Ask your doctor or dentist to refer you to the hospital.

Gum disease - Am I likely to have gum disease and how can I prevent it?

Q What is gum disease?

A Gum disease is the swelling, soreness or infection of the tissues supporting the teeth. There are two main types of gum disease: ‘gingivitis’ and ‘periodontal disease’.

Q What is gingivitis?

A 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 you brush them.

Q What is periodontal disease?

A 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 fixing the teeth to the jaw is lost, making the teeth loose. If this is not treated, the teeth may eventually fall out.

Q Am I likely to have gum disease?

A Probably. Most people have 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.

Q What is the cause of gum disease?

A All gum disease is caused by plaque. Plaque is a film of bacteria which forms on the surface of the teeth every day. Many of the bacteria in plaque are 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. You can do this by brushing your teeth, and by cleaning in between the teeth with interdental brushes or floss. See Caring for My Teeth and Gums for how to do this


Q How will smoking affect my gums and teeth?

A People who smoke are more likely to have gum disease. Smoking may change the type of bacteria in dental plaque, increasing the number of bacteria that are more harmful. It also reduces the blood flow in the gums and supporting tissues of the tooth and makes them more likely to become inflamed. Smokers’ gum disease will get worse more quickly than in people who do not smoke. Because of the reduced blood flow smokers may not get the warning symptoms of bleeding gums as much as non-smokers. Gum disease is still a major cause of tooth loss in adults


Q How do I know if I have gum disease?

A The first sign may be blood on your toothbrush 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.

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

A 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.

Q What happens if gum disease is not treated?

A Unfortunately, gum disease usually develops painlessly so you do not notice the damage it is doing. However, the bacteria are sometimes more active and this is what 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.

Q What treatments are needed?

A Your dentist will usually clean your teeth thoroughly to remove the scale. You’ll also be shown how to remove plaque successfully yourself, cleaning all the surfaces of your teeth thoroughly and effectively. This may take a number of sessions with the dentist or hygienist.

A good oral-care routine at home, with brushing and interdental cleaning, is the most important thing you can do to help prevent gum disease getting worse.


Q What else may be needed?

A 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. This is known as ‘root planing’. You may need the treatment area to be numbed before anything is done. Afterwards, you may feel some discomfort for up to 48 hours.

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

A Periodontal disease is never cured, but it can be controlled 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.

Q I have heard gum disease is linked with other health conditions – is this true?

A In recent years gum disease has been linked with general health conditions such as diabetes, strokes, cardiovascular (heart) disease, poor pregnancy outcomes and even dementia. While we need more research to understand how these links work, there is more and more evidence that having a healthy mouth and gums can help improve general health and reduce the costs of medical treatment.

Jaw problems and headaches - How can I tell if I have a problem?

Q What is dental occlusion?

A Dental occlusion is another name for the way your teeth meet when your jaws bite together.

Q What is TMJ?

A The letters TMJ are short for of ‘temporo-mandibular joint’, which is the joint connecting your lower jaw and your skull. The movement in this joint lets you open and close your mouth and chew from side to side.

Q What kind of problems might I have?

A If your teeth don’t fit together properly, you can have problems not only in your teeth themselves, but also the gums, the temporo-mandibular joint or the muscles that move your jaw. These problems are called ‘occlusal’ problems.

Teeth

Teeth that are out of line, heavily worn or constantly breaking, fillings that fracture or crowns that work loose may all be signs of occlusal problems. Your teeth may also be tender to bite on or may ache constantly.

Gums

Loose teeth or receding gums can be made worse by an incorrect bite.

TMJ

Clicking, grinding or pain in your jaw joints, ringing or buzzing in your ears and difficulty in opening or closing your mouth could all be due to your teeth not meeting each other properly.

Muscles

If your jaw is in the wrong position, the muscles that move the jaw have to work a lot harder and can get tired. This leads to muscle spasm. The main symptoms are continual headaches or migraine, especially first thing in the morning; pain behind your eyes; sinus pain and pains in your neck and shoulders. Sometimes even back muscles are involved.

Q How can I tell if I have a problem?

A Many people have imperfect occlusion and missing teeth, yet never have symptoms because they adjust to their problems. Occasionally, in times of increased stress and tension, the symptoms may appear and then go away immediately. Or, your teeth and gums may be affected straight away and instead of headaches, you may suffer:

• flattened, worn teeth
• broken teeth, fillings and crowns
• loose teeth
• continual sensitivity of your teeth to temperature change
• toothache with no apparent cause.

If you think you have any of these problems, ask your dentist.

You may find that you clench or grind your teeth, although most people who do aren’t aware of it. Sometimes it can be caused by anxiety, but generally most people clench their teeth when they are concentrating on a task - housework, gardening, car mechanics, typing and so on.

You may wake up in the morning with a stiff jaw or tenderness when you bite together. This could be due to clenching or grinding your teeth in your sleep. Most people who grind their teeth do it while they are asleep and may not know they are doing it.

If you suffer from severe headaches, or neck and shoulder pain, you may not have linked this with possible jaw problems. Or you may keep having pain or discomfort on the side of your face around your ears or jaw joints or difficulty in moving your jaw. These are all symptoms of TMJ problems.

If you are missing some teeth at the back of your mouth, this may lead to an unbalanced bite, which can cause uneven pressure on your teeth.

Together, all these symptoms are called ‘TMJ syndrome’.

Q How are occlusal problems treated?

A See your dentist. He or she may be able to help you or may refer you to a specialist who deals with occlusal problems.

Depending on the problems you are having, it can be possible to spot the signs of an occlusal problem. Various muscles may be sore when tested, or the broken and worn areas of your teeth will show you are grinding your teeth - a common sign of an incorrect bite.

If your dentist suspects that your problems are due to an incorrect bite, he or she may help to improve the problem by supplying a temporary soft nightguard or hard plastic appliance that fits over your upper or lower teeth. This appliance needs to be measured and fitted very accurately so that when you bite on it, all your teeth meet at exactly the same time in a position where your muscles are relaxed. You may have to wear this all the time or, just at night. If the appliance relieves your symptoms then your bite may need to be corrected permanently.

Tooth Adjustment (equilibration)

Your teeth may need to be carefully adjusted to meet evenly. Changing the direction and position of the slopes that guide your teeth together can often help to reposition the jaw.

Replacement of teeth

The temporo-mandibular joint needs equal support from both sides of both jaws. The chewing action is designed to work properly only when all your teeth are present and in the correct position. Missing teeth may need to be replaced either with a partial denture or bridgework.

Replacement is not usually done until a diagnosis has been confirmed by using an appliance and this has fully relieved the symptoms. Relief in some patients is instant. In others it can take a long time.

Medication

Some drugs can help in certain cases, but this is usually only temporary. Hormone replacement therapy may also help some women.

Diet and Exercise

As with any joint pain, it can help to put less stress on the joint. So a soft diet can be helpful, as can corrective exercises and external heat. Physiotherapy exercises can often help, and your dentist may be able to show some of these to you.

Relaxation

Counselling and relaxation therapy may help in some cases. These techniques help the patient to become more aware of stressful situations and to control tension.

Q Will straightening my teeth help?

A If your teeth are too far out of line or in a totally incorrect bite position, it may be necessary to fit an orthodontic appliance to move them into a better position. For more information, please see our ‘Tell me about’ leaflet Orthodontic treatment.

Q How many people suffer from these problems?

A Up to 1 in 4 people may have some symptoms. Both men and women are affected equally, although women tend to seek treatment more often than men. The symptoms can often start with the menopause or other hormonal changes.

Oral lichen planus - What is it and how can it be treated?

Q What is oral lichen planus?

A Lichen planus is a long-lasting disease that can affect the mouth and sometimes other areas on the body. When it appears in your mouth it is called ‘oral lichen planus’. It can appear on its own or as part of a disease affecting other parts of your body. Oral lichen planus usually happens in middle to late life and more women get it than men.

Q What are the signs and symptoms?

A Lichen planus shows in many different ways. The most common signs are white patches on the lining of your mouth (usually your cheeks, tongue and gums). These don’t usually hurt, but sometimes there can be redness, ulcers or, very rarely, blistering as well as the white patches. If so, you may find it painful to eat hot or spicy foods.

Q What is the cause of oral lichen planus?

A We don’t know the cause of lichen planus with most patients. It may be a sign of a mild weakness in the body’s immune (defence) system, but patients with lichen planus are otherwise well. Occasionally it can be caused by a reaction to medicines such as some painkillers, diabetic treatments, drugs for high blood pressure, beta-blockers, gold, penicillamine and a number of other drugs.

Oral lichen planus does not seem to be caused by an infection, nor does it run in families.

Q How is oral lichen planus diagnosed?

A Usually it will be diagnosed after a careful examination by a specialist. Because the signs and symptoms of oral lichen planus can be like those of some other disorders, a ‘biopsy’ is usually needed to be sure about the diagnosis. A biopsy is a very simple procedure, done under a local anaesthetic, where a small piece of tissue is removed from the mouth. The area usually heals within 7 to 10 days.

Q What is the treatment of oral lichen planus?

A Usually lichen planus only needs to be treated when there are painful symptoms. Sometimes patients with white patches that are not painful complain of a mild roughness of the lining of the mouth. But this usually does not need any treatment.

When oral lichen planus does need treating, it is usually done by putting a corticosteroid cream on the area. Some areas may need other treatments, such as immunosuppressants applied to the area, and very rarely you might need to take a corticosteroid or other similar tablets.

Q Does oral lichen planus go away?

A Oral lichen planus generally never goes away. Patients will usually continue to have white patches on the lining of the mouth. Treatment will lessen the pain, although it is not usually possible to tell when painful periods are likely.

Q Are there any long-term complications of oral lichen planus?

A There may be some connection between oral lichen planus and cancer of the mouth in perhaps 1% to 3% of patients who have had the condition a long time. The exact connection between oral lichen planus and cancer is not certain, and only a very few patients with oral lichen planus ever have such complications.

Q Can I stop myself getting oral lichen planus?

A As the cause is usually not known it is impossible to stop oral lichen planus happening.

To avoid the risk of serious disease of the lining of your mouth:

• don’t smoke
• don’t drink large amounts of alcohol
• do have a diet with plenty of fresh fruit and vegetables.

Everyone, whether they have oral lichen planus or not, should clean their teeth regularly twice a day with a fluoride toothpaste. They should also have their teeth and gums checked regularly by a dentist so that any changes in the lining of the mouth can easily be spotted.

Mouth Cancer - What are the signs of mouth cancer?

Q What is mouth cancer?

A Most people have heard of cancer affecting parts of the body such as the lungs or breasts. However, cancer can occur in the mouth, where the disease can affect the lips, tongue, cheeks and throat.

Q Who can be affected by mouth cancer?

A Anyone can be affected by mouth cancer, whether they have their own teeth or not. Mouth cancers are more common in people over 40, particularly men. However, research has shown that mouth cancer is becoming more common in younger patients and in women. There are, on average, almost 6,500 new cases of mouth cancer diagnosed in the UK each year. The number of new cases of mouth cancer is on the increase.

Q Do people die from mouth cancer?

A Yes. Over 1,900 people in the UK die from mouth cancer every year. Many of these deaths could be prevented if the cancer was caught early enough. As it is, people with mouth cancer are more likely to die than those having cervical cancer or melanoma skin cancer.

Q What can cause mouth cancer?

A Most cases of mouth cancer are linked to tobacco and alcohol. Cigarette, cigar and pipe smoking are the main forms of tobacco use in the UK. However, the traditional ethnic habits of chewing tobacco, betel quid, gutkha and paan are particularly dangerous.

Alcohol increases the risk of mouth cancer, and if tobacco and alcohol are consumed together the risk is even greater. Over-exposure to sunlight can also increase the risk of cancer of the lips.

Many recent reports have linked mouth cancer to the human papillomavirus (HPV). HPV is the major cause of cervical cancer and affects the skin that lines the moist areas of the body.

HPV can be spread through oral sex, and research now suggests that it could soon rival smoking and drinking as one of the main causes of mouth cancer.

Practicing safe sex and limiting the number of partners you have may help reduce your chances of contracting HPV.

Q What are the signs of mouth cancer?

A Mouth cancer can appear in different forms and can affect all parts of the mouth, tongue and lips. Mouth cancer can appear as a painless mouth ulcer that does not heal normally. A white or red patch in the mouth can also develop into a cancer. It is important to visit your dentist if these areas do not heal within three weeks. 

Q How can mouth cancer be detected early?

A Mouth cancer can often be spotted in its early stages by your dentist during a thorough mouth examination. If mouth cancer is recognised early, then the chances of a cure are good. Many people with mouth cancer go to their dentist or doctor too late.

Q What is involved in a full check-up of the mouth?

A The dentist examines the inside of your mouth and your tongue with the help of a small mirror. Remember, your dentist is able to see parts of your mouth that you cannot see easily yourself.

Q What happens if my dentist finds a problem?

A If your dentist finds something unusual or abnormal they will refer you to a consultant at the local hospital, who will carry out a thorough examination of your mouth and throat. A small sample of the cells may be gathered from the area (a biopsy), and these cells will be examined under the microscope to see what is wrong.

Q What happens next?

A If the cells are cancerous, more tests will be carried out. These may include overall health checks, blood tests, x-rays or scans. These tests will decide what course of treatment is needed.

Q Can mouth cancer be cured?

A If mouth cancer is spotted early, the chances of a complete cure are good, and the smaller the area or ulcer the better the chance of a cure. However, too many people come forward too late, because they do not visit their dentist for regular examinations.

Q How can I make sure that my mouth stays healthy?

• It is important to visit your dentist regularly, as often as they recommend, even if you wear dentures. This is especially important if you smoke and drink alcohol.
• When brushing your teeth, look out for any changes in your mouth, and report any red or white patches, or ulcers, that have not cleared up within three weeks.
• When exposed to the sun, be sure to use a good protective sun cream, and put the correct type of barrier cream on your lips.
• A good diet, rich in vitamins A, C and E, provides protection against the development of mouth cancer. Plenty of fruit and vegetables help the body to protect itself, in general, from most cancers.
• Cut down on your smoking and drinking.

Regular visits to your dentist could save your life. Remember – if in doubt, get checked out


Whilst financial support for this publication is provided in part by Sanofi Pasteur and Denplan the British Dental Health Foundation is solely responsible for all contents of this leaflet.

Mouth ulcers - How can I prevent mouth ulcers?

Q What are mouth ulcers?

A Ulcers are painful sores that appear inside the mouth. They are usually red or yellow. They are different from cold sores, which appear on the outer lips and are due to a virus.

Q What are the common causes of mouth ulcers?

A Usually a single mouth ulcer is due to damage caused by say biting the cheek or tongue, sharp teeth, tooth brushing or poorly fitting dentures. These ulcers are called ‘traumatic ulcers’.

If you have a number of mouth ulcers the usual cause is ‘recurrent aphthous stomatitis’.

Q How do I know if I have a traumatic ulcer?

A Traumatic ulcers are usually on their own, are next to the cause of the damage and go away once the source of the problem is removed.

Q What are the signs of recurrent aphthous stomatitis?

A Recurrent aphthous stomatitis is a common problem and leads to repeated bouts of mouth ulcers in otherwise healthy children and young people. The cause is not known, but it is not infectious and is unlikely to be inherited.

Q Are there different types of recurrent mouth ulcers?

A Yes.

• Minor ulcers are the most common. They can appear inside the cheeks, on the lips, tongue and gums and, more rarely, on the roof of the mouth. Most of these ulcers are the size of the top of a pencil and can sometimes come in clusters. You can get four to six at any one time.

• Large ulcers are more severe and can longer to heal. Any ulcer that lasts longer than three weeks should be checked out by your dentist. Large ulcers may appear near the tonsils and can be very painful, especially when swallowing. You usually only get one at a time.

• It is also possible to have up to 100 very small painful ulcers which last for one to two weeks.

However, these last two varieties are very rare.

You may get ulcers in other parts of the body such as your eyes or genital area. It is important to tell your dentist about this.

Q What are the less common causes of mouth ulcers?

A Infections can cause mouth ulcers. Herpes simplex often leads to widespread mouth ulcers in children and some adults. Other less common viral and bacterial infections may cause mouth ulcers, but this is rare.

Mouth ulcers can be caused by anaemia and occasionally by other blood disorders and some skin or gastrointestinal diseases. Sometimes the mouth ulcers are the only sign of an underlying disease.

Q Can cancer cause mouth ulcers?

A Cancer of the mouth can first appear as a mouth ulcer. The ulcers caused by mouth cancer are usually single and last a long time without any obvious local cause (for example a sharp tooth).

Any ulcer that lasts longer than three weeks should be looked at by your dentist.

Ulcers caused by cancer usually appear on or under the tongue, but may occasionally appear somewhere else in the mouth.

Cancer of the mouth is usually associated with heavy smoking and drinking. Doing both together greatly increases the risk.

Q Can I catch mouth ulcers?

A Mouth ulcers cannot be caught by kissing or sharing drinks and utensils as they are not caused by an infection.

Q What types of treatment are there for mouth ulcers?

A The treatment depends on the cause of the ulcers. Sometimes all that is needed is for a sharp tooth to be smoothed down or a denture adjusted, although some patients may need a variety of mouthwashes or tablets.

Q What should I do if I think I have mouth ulcers?

A If an ulcer lasts more than a few weeks you should always ask your dentist or doctor for advice. They may be able to tell you the cause and provide treatment, or they may arrange further tests or refer you to a specialist if necessary.

Q How can I prevent mouth ulcers?

A You may be able to reduce the risk of mouth ulcers by:

• maintaining good oral hygiene
• using high-quality toothbrushes (to reduce the risk of damage to your mouth)
• eating a good diet which is rich in vitamins A, C and E and which includes foods such as fresh fruit and vegetables (to lessen the risk of mouth cancer)
• regularly visiting your dentist.

Q Should I worry about my ulcers?

A Most ulcers heal up on their own. However, if they don’t heal within three weeks you should visit your dentist. Your dentist will be able to examine your mouth to check that the problem is an ulcer and not something more serious such as mouth cancer.

If you suffer from ulcers that come and go often, you should visit your dentist or doctor to check that there is not an underlying medical cause.


Golden rules if you have mouth ulcers

Always see your dentist or doctor if:

• the ulcer lasts for more than 3 weeks
• you are unwell
• the ulcers keep coming back.

Sensitive teeth - What causes sensitive teeth?

Q What are ‘sensitive’ teeth?

A Having sensitive teeth can mean anything from getting a mild twinge to having severe discomfort that can last for several hours.

It can also be an early warning sign of more serious dental problems.

Q Who suffers from sensitive teeth?

A 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 anyone from teenagers to people over 70. Women are more likely to be affected than men.

Q What causes sensitive teeth?

A The part of the tooth we can see above the gum 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 enamel 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 can even destroy the bony support of the tooth. Pockets can form in the gum 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 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. Talk to your dentist about this before having treatment.

Q When are teeth more likely to be sensitive?

A 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.

Q Is there anything I can do to treat sensitive teeth at home?

A There are many brands of toothpaste on the market made to help ease the pain of sensitive teeth. Use the toothpaste twice a day to brush your teeth. You can also rub it 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.

Q Is there anything I should avoid if I have sensitive teeth?

A 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.

Q Do I need to go and see my dentist?

A Yes, if you have tried treating your sensitive teeth for a few weeks and have had no improvement.

Q What treatments can the dentist offer?

A 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.

Q How can I prevent sensitive teeth?

• Brush your teeth twice a day for two minutes with a fluoride toothpaste containing at least 1350ppm (parts per million) of fluoride. 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 for you to wear at night.
• If you are thinking about having your teeth bleached, talk to your dentist about sensitivity before starting treatment.
• Visit your dentist regularly, as often as they recommend.

References

Dental News Issue No1, GlaxoSmithkline
Tell me about cracked teeth – British Dental Health Foundation
Tell me about dental erosion – British Dental Health Foundation
Textbook for Dental Nurses, H.Levison
www.sensodyne.com
Dentistry magazine, 20/03/03 and 20/02/03


Wisdom teeth - Do they always cause problems?

Q Why do we have wisdom teeth?

A Adults can have a maximum of 32 teeth. The wisdom teeth or third molars are the last to come through, right at the back. They usually appear between the ages of 17 and 25. Although sometimes they appear many years later.

Nowadays people often have jaws that are too small for all 32 teeth – 28 is often the most we have room for. So if all the other teeth are present and healthy there may not be enough space for the wisdom teeth to come through properly.

Q Do they always cause problems?

A No. If there is enough room they will usually come through into a useful position and cause no more problems than any other tooth.

Often there will be some slight discomfort as they come through, but this is only temporary and will disappear once the tooth is fully in position.

Q What is an impacted wisdom tooth?

A If there is not enough room, the wisdom tooth may try to come through, but will get stuck against the tooth in front of it. The wisdom tooth will be at an angle, and will be described by the dentist as ‘impacted’.

Q What problems should I be prepared for?

A If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and perhaps swollen. Food particles and bacteria can collect under the gum edge, and it will be difficult to clean the area effectively. This is known as pericoronitis.

This is a temporary problem that can be dealt with by using mouthwashes and special cleaning methods and possibly antibiotics. If the problem keeps coming back, it may be better to have the tooth removed.

Q What can I do to help myself?

A A mouthwash of medium hot water with a teaspoonful of salt will help to reduce gum soreness and inflammation. (Check that it is not too hot before using it.) Swish the salt water around the tooth, trying to get into the areas your toothbrush cannot reach. This should be done several times a day. An antibacterial mouthwash containing chlorhexidine can also reduce the inflammation. Pain-relieving tablets such as paracetamol or aspirin can also be useful in the short term, but consult your dentist if the pain continues. These should always be swallowed and in no circumstances be placed on the area.

Q But if it does not help?

A If the pain does not go away or if you find it difficult to open your mouth, you should see a dentist. They will be able to see the cause of the problem, and advise you accordingly. It may be useful to clean around the tooth very thoroughly, and an antibiotic may be prescribed.

Q Are x-rays needed?

A The dentist will usually take x-rays to see the position of the root, and to assess whether there is room for the tooth to come through into a useful position.

Q What are the main reasons for taking wisdom teeth out?

Far fewer wisdom teeth are now taken out than in the past. If the tooth is not causing problems, your dentist will not want to remove it. They will only remove wisdom teeth:

• when it is clear that they will not be able to come through into a useful position because there is not enough room, and they are also causing some pain or discomfort

• if they have only partly come through and are decayed – such teeth will often decay as it will be difficult to clean them as thoroughly as your other teeth

• if they are painful.

Q Are wisdom teeth difficult to take out?

A It all depends on the position and the shape of the roots. Your dentist will advise you as to how easy or difficult each tooth will be to remove after looking at the x-rays. Upper wisdom teeth are often more straightforward to remove than lower ones, which are more likely to be impacted. Your dentist will advise you whether the tooth should be taken out at the dental practice, or whether you should be referred to a specialist (oral surgeon) at a hospital. Very occasionally there is a possibility of some numbness of the lip after the removal of a lower tooth – your dentist will tell you if it is possible in your case.

Either local anaesthetic – as you would have for a filling – or sedation will probably be recommended. A general anaesthetic (where you would be asleep) can also be used, but this will only be given in a hospital.

Q Will it make any difference to my face or mouth?

A Removing wisdom teeth may produce some swelling for a few days but as soon as the area is healed, there will be no difference to your face or appearance. Your mouth will feel more comfortable and less crowded, especially if the teeth are impacted.

Q What should I expect after a wisdom tooth is taken out?

A The amount of discomfort will depend on how easy the removal of the tooth was. There is usually some swelling and discomfort for a few days afterwards, and it is important to follow any advice you get about mouthwashes etc, to help with the healing. Some people also find homeopathic remedies help to reduce discomfort. Usual pain-killers such as paracetamol, aspirin or ibuprofen will usually deal with any pain. It is best to stay fairly quiet and relaxed and avoid smoking and drinking for 24 hours afterwards to make sure there are no bleeding problems. There may be some stitches to help the gum heal over – your dentist will probably want to see you again about a week later to check on the healing, and to remove any stitches.

Q What does it cost?

The cost of removal of wisdom teeth will vary according to the difficulty of the procedure and whether it is being carried out in a dental practice or hospital. It is always recommended that you get a written estimate before starting treatment


Ref: NICE Guidelines – Wisdom Teeth Removal (N0 1)

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Oral Health Information Centre

Active Smile, 10 Vine Street
Evesham, Worcestershire WR11 4RE