• Active Smile Dental Treatment FAQ's

Dental bridges and partial dentures - Why should I replace missing teeth?

Q Why should I replace missing teeth?

A Your appearance is one reason. Another is that the gap left by a missing tooth can mean greater strain is put on the teeth at either side. A gap can also mean your ‘bite’ is affected, because the teeth next to the space can lean into the gap and alter the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes both decay and gum disease.

Q How are missing teeth replaced?

A This depends on the number of teeth missing and on where they are in the mouth. The condition of the other teeth also affects the decision.

There are two main ways to replace the missing teeth. The first is with a removable false tooth or teeth – a partial denture. The second is with a fixed bridge. A bridge is usually used where there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth.

Q What is a partial denture?

A This is a plate with a number of false teeth on it. It may be all plastic or a mixture of metal and plastic. Both types may have clips (clasps), to help keep the denture in place in the mouth. Depending on where they are, some of these clips may show when you smile or open your mouth.

Q What is the difference between a plastic partial denture and one that contains metal?

A Plastic partial dentures are less expensive to make. But unless they are designed very carefully they can damage the teeth they fit against.

You can also get flexible plastic dentures. These dentures do not need clasps as they are held in place by flexing against your natural teeth.

Metal partial dentures are usually from an alloy of cobalt and chromium and they are much stronger. They are lighter to wear and can be supported by the remaining teeth. Although the base is metal, they have gum-coloured plastic and natural-looking teeth fixed to them. They are more expensive than the plastic ones.

Q How do I choose the best type for me?

A Be guided by your dentist. He or she will know the condition of your remaining teeth and will be able to advise you on your individual situation. In most cases a metal-based partial denture gives the best result.

Q Can I have a bridge fitted straight after having a tooth removed?

A In many people it can take up to 6 months for the gums to heal properly after an extraction. This means that you may need to have a temporary denture for 6 months before the bridge is fitted.

Q How do I look after my denture?

The general rule is: brush, soak, brush. Always clean your dentures over a bowl of water or a folded towel in case you drop them. Brush your dentures before soaking, to help remove any food debris. The use of an effervescent denture cleaner will help remove stubborn stains and leave your denture feeling fresher – always follow the manufacturers’ instructions - then brush the dentures again, as you would your own teeth, being careful not to scrub too hard as this may cause grooves in the surface.

Most dentists advise using a small to medium headed toothbrush or denture brush and toothpaste. Make sure you clean all the surfaces of the dentures, including the surface which comes into contact with your gums. This is especially important if you use any kind of denture fixative.

If you notice a build up of stains or scale, have your denture cleaned by your dentist or hygienist.

Q Should I take my denture out at night?

A Your dentist may recommend removing your dentures at night to give your mouth a chance to rest. If you remove your dentures, it is important to leave them in water to prevent any warping or cracking.

Q What is the alternative to a partial denture?

A The main alternative is a fixed bridge. This is made by putting crowns on the teeth at either side of the space, and then joining these two crowns together by placing a false tooth in the space.

This is all made in the laboratory and then cemented into place with special adhesives. The bridge cannot be removed for cleaning.

Another option is an adhesive or “Maryland” bridge. This has wings that are bonded to the back of the supporting teeth with very little drilling involved.

Q Can I always have a bridge to replace missing teeth?

A Bridges are only possible if you have enough strong teeth with good bone support. Your dentist will help you decide which is the best way of replacing missing teeth.

Q What are bridges made of?

A Bridges are usually made of porcelain bonded to precious metal. Sometimes, there are other non-precious metals used in the base for strength. There are also new bridges made entirely of a special type of strong porcelain.

Q What will a bridge cost?

A Costs will vary according to the size and type of bridge you need. Always get a written estimate and treatment plan before beginning any dental treatment. Although a bridge may seem expensive it should last many years.

Q How do I look after my bridge?

A You need to clean your bridge every day, to prevent problems such as bad breath and gum disease. You also have to clean under the false tooth every day. Your dentist or hygienist will show you how to use a bridge needle or special floss, as a normal toothbrush cannot reach.

Q Are there other methods for fixing false teeth?

A There are other methods, such as using a combination of crowns and partial dentures that can keep the retaining clips out of sight. These are quite specialised dentures, so you should ask your dentist about them.

Q Can I have teeth which attach to the jawbone?

A Yes, by having implants. The success of this technique means you may be able to replace missing teeth without crowning other teeth. For more information see our ‘Tell me about’ leaflet Implants.

Remember that it is as important to care for your remaining teeth as it is to replace the missing ones.

Cosmetic dentistry - Nowadays many people turn to cosmetic dentistry as a way of improving their appearance

Q What is cosmetic dentistry?

A Dentistry is no longer just a case of filling and extracting teeth, as it was for many years. Nowadays many people turn to cosmetic dentistry, or ‘aesthetic dentistry’, as a way of improving their appearance, much as they would use cosmetic surgery or even a new hairstyle. The treatments can be used to straighten, lighten, reshape and repair teeth. Cosmetic treatments include veneers, crowns, bridges, tooth-coloured fillings, implants and tooth whitening.

Q What is a veneer?

A Veneers are thin slices of porcelain. These are precisely made to fit over the visible surface of your front teeth, like a false fingernail fits over a nail.

Q Why might I have a veneer?

A Veneers are an ideal way of treating discoloured or unsightly teeth, closing gaps between front teeth, or repairing chips and cracks.

Q How are veneers made?

A A small amount of enamel is removed from the tooth, usually the same thickness as the veneer will be. An impression (mould) is taken by the dentist and sent to a dental technician for the veneer to be made in the laboratory. The veneer is then bonded to the tooth to form a strong and natural-looking repair.

Q Can I have white fillings?

A For over 150 years standard fillings have been made out of a silvery-grey material called ‘amalgam’. This is considered one of the strongest and longest-lasting materials for fillings. However, many people find it unattractive and some are concerned about possible health risks.

White fillings are now a popular alternative to amalgam fillings. The new dental materials mean it is much easier to find a perfect match for the shade of a particular tooth. In most cases, it is quite impossible to see that the tooth even has a filling. Sometimes white filling material can be used to cover unsightly marks on teeth, in a similar way to veneers.

Q My tooth is badly broken – what can I do?

A When a tooth is badly broken or heavily filled, the dentist may need to crown or ‘cap’ it to restore its appearance and strength.

Q How does the dentist make a crown?

A Fitting a crown usually involves shaping the tooth under local anaesthetic and then taking an impression using a rubber-like material. The impression is then sent to the laboratory along with the details of the shade to be used, and the technician makes the crown.

Q What happens to my tooth while the crown is being made?

A While your crown is being made, the prepared tooth can be protected with a temporary crown. This is easily removed just before fitting the permanent one. In most cases, the temporary crown is in place for about two weeks.

Q What is a crown made of?

A Crowns can be made of a variety of different materials, such as porcelain or porcelain bonded to gold or metal. New materials are being introduced all the time. It is a good idea to talk to your dentist about which crown would be best for you.

Q How can my dentist fill a gap in my mouth?

A If a tooth is missing, or needs extracting, there are several ways to fill the gap that is left. In some cases it is important to try to replace any missing teeth to balance the way your jaw bites. If you have several missing teeth, the remaining teeth are under more pressure, which can lead to broken fillings or even jaw problems.

A partial denture is the simplest way of replacing missing teeth. However, some people find dentures uncomfortable and eventually decide to look at alternatives, such as bridges or implants.

Q What is a bridge?

A Bridges are ideal for people who don’t like dentures and only have one or two teeth missing. Bridges are usually made by crowning the teeth on either side of the gap and attaching a false tooth in the middle. They are fixed in the same way as crowns. These bridges are usually made of precious metal bonded to porcelain. Sometimes other non-precious metals are used in the base to give it extra strength.

Q What if I don’t want my remaining teeth drilled?

A Adhesive bridges or Maryland bridges are another way of bridging a gap, and less of the tooth needs removing. These bridges are made up of a false tooth with metal ‘wings’ on either side. These wings are made to bond to the teeth on either side, with very little drilling involved. Instead, the teeth are roughened and the bridge is fitted using a very strong composite resin.

Q Can implants be used to replace missing teeth?

A ‘Implants’ are an alternative to dentures or bridgework, but they are more expensive. Implants are titanium rods, which are surgically placed into the jawbone and act as anchors for fastening dentures or crowns onto.

Q Can I lighten the colour of my teeth?

A Tooth whitening can be a highly effective way of lightening the natural colour of your teeth without removing any of the tooth surfaces. It cannot make a complete colour change, but it should lighten the existing shade.

Q What does tooth whitening involve?

A Professional bleaching is the most common form of tooth whitening.

Your dentist will apply the whitening product to your teeth, using a specially made tray which fits into your mouth like a gum-shield.

The ‘active ingredient’ in the product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel on the teeth and the tooth colour is made lighter.

Once your dentist has started this treatment you may be given the trays to take home and continue the treatment, or you may need more appointments at the dentist’s. This treatment can be done within 3 to 4 weeks, depending on how long you keep the trays in your mouth each time, and how much whiter you want your teeth to be.

Q What other tooth-whitening methods are there?

A There is now laser whitening or ‘power whitening’. During this treatment a light or laser is shone on the teeth to activate the chemical. The light speeds up the chemical reaction of the whitening product and the shade change can be achieved more quickly. Laser whitening can make teeth up to five or six shades lighter. This treatment usually takes about one hour and should be carried out by a qualified dentist. Under new European legislation the strength of peroxide used in most laser whitening has become illegal. So it is now much more common for you to take trays home to apply the whitening gel yourself.

Q How safe are whitening kiosks and beauticians?

A Under European law, tooth whitening with peroxide can now only be carried out by or under the supervision of a dentist. Whitening kiosks are now therefore illegal, as is whitening by a beautician. Only a dentist is able to properly examine your teeth to see whether whitening is appropriate, and to make sure that it is done safely without damaging your teeth or other parts of your mouth such as your gums. 

Q What is an ‘incorrect bite’?

A This is when the teeth do not meet together properly, or are not in balance with the rest of the face, or if teeth are lost and not replaced.

Q What can happen if it is not treated?

A If an incorrect bite is not treated the face can ‘collapse’. This can cause the face to sag, the chin to stick out or the smile to droop. It can even cause headaches, neck pain and pain in other parts of the body.

Q How can it be treated?

A There are a number of treatments, including crowns, veneers and orthodontics (braces). Ask your dentist which treatment is most suitable for you. Ask for an estimate of the cost and a written treatment plan before you start.

Q Can my crooked or twisted teeth be straightened?

A Teeth can be straightened with orthodontics (braces). This is usually done during the teenage years, when the jaws are going through a period of growth. However, many adults also have treatment to straighten their crooked teeth or to improve their appearance. The treatment can take much longer in adults and is therefore more expensive.

For cosmetic reasons, clear or plastic braces can be used, which are hardly noticeable. If you are considering orthodontic treatment, first go along to your dentist and get their advice. Your dentist can talk to you about your treatment options and if necessary refer you to an orthodontist.

Q Are there any alternatives to orthodontics?

A Cosmetic contouring can be used to improve the appearance of teeth. It is ideal if you have irregular-shaped or slightly crowded teeth.

However, in contouring the teeth a small amount of enamel would be lost. Contouring can also be used to improve the shape and appearance of your gums. These treatments are not recommended for young children.

Q What is tooth jewellery?

A Tooth jewellery involves sticking small jewels onto the teeth using dental cement. They should be fitted by a dentist, who can easily remove them if necessary. It is important to keep the area around the jewel clean, as plaque can easily build up around it and you will be more likely to get tooth decay.

Dental crowns - Why would I need a crown and what are my options?

Q What is a crown?

A A crown is an artificial restoration that fits over the remaining part of a prepared tooth, making it strong and giving it the shape of a natural tooth. A crown is sometimes known as a ‘cap’.

Q Why would I need a crown?

A Crowns are an ideal way to restore teeth that have been broken, or have been weakened by decay or a very large filling. A crown could be used for a number of other reasons, for example:

• you may have a discoloured filling and would like to improve the appearance of the tooth.
• you may have had a root filling which may need a crown to protect what is left of the tooth.
• it may help hold a bridge or denture firmly in place.

Q What is a crown made of?

A Crowns can be made of a variety of different materials and new materials are being introduced all the time. Here are some of the most popular options:

Porcelain bonded to precious or non-precious metal: this is what most crowns are made from. A precious or non-precious metal base is made and then porcelain is applied in layers over it.

Porcelain crowns: these crowns are made entirely out of porcelain and are not as strong as bonded crowns, but they can look very natural and are most often used for front teeth.

All-ceramic crowns: this modern material is metal free. It can give the strength of a bonded crown and the appearance of a porcelain crown. This makes it suitable for use in all areas of the mouth.

Glass: these crowns look very natural and are used on both front and back teeth.

Gold alloy crowns: gold is one of the oldest filling materials. Today it is used with other metals to increase its strength, which makes it a very hard-wearing restoration. These crowns are silver or gold in colour.

Q How is a crown prepared?

A The dentist will prepare the tooth so it is the ideal shape for the crown. This will involve removing most of the outer surface, and leaving a strong inner core. The amount of the tooth removed will be the same as the thickness of the crown. Once the tooth is shaped, the dentist will take an impression (mould) of the prepared tooth, one of the other jaw, and possibly another to mark the way you bite together.

The impressions will then be given to the dental technician, along with details of the shade to use and other information needed for the crown to be made.

Q What is a post crown?

A If a tooth is root filled the dentist may have to insert a post before placing a crown. A post provides support and helps the crown stay in place. The weakened crown of the tooth may be shortened to gum level.

There are ready-made stainless steel posts which the dentist can fit directly into the root canal, or the dental technician can make a custom-made post to accurately fit the shape of the prepared root canal. The post is placed into the root canal and cemented in position, ready for the crown to be attached.

Q Are there any alternatives to post crowns for root-filled teeth?

A If a root-filled tooth is not completely broken down, it may be possible to build it up again using filling material. This ‘core’ is then prepared in the same way as a natural tooth and the impressions are taken.

Q What will happen between visits?

A The dentist will fit a temporary crown so that you can use the tooth while you wait for the crown to be made. This crown may be more noticeable but you will only have it for 1 or 2 weeks.

Q How is the crown fitted?

A When you and your dentist are happy with the fit and appearance of the new crown it will be fixed in place with special dental cement or adhesive. The cement forms a seal to hold the crown in place.

Q How long does the treatment take?

A You will need to have at least two visits. The first is to have the tooth prepared, the impressions taken, the shade matched and the temporary crown fitted. The second is to fit the permanent crown. There will usually be about 1 to 2 weeks in between appointments.

Q Does it hurt to have a tooth prepared for a crown?

A No, you will have a local anaesthetic and the preparation should feel no different from a filling. If the tooth does not have a nerve, and you are having a post crown, you may not need a local anaesthetic.

Q What is a ‘one-visit’ crown?

A This is a fairly new type of crown that is made using computerised technology. The computer makes the crown in the surgery, so you can have the crown fitted on the same day. This means you don’t need to have a second appointment or a temporary crown.

Q Will the crown be noticeable?

A The crown will be made to match your other teeth as closely as possible. The shade of the neighbouring teeth will be recorded, to make sure that the colour looks natural and matches the surrounding teeth.

Q Will the crown feel different?

A Because the shape of the crown will be slightly different from the shape of your tooth before it was crowned, you may be aware of it to begin with. Within a few days it should feel fine, and you will not notice it. The crown may need some adjustment if your bite does not feel comfortable. If so, you should ask your dentist to check and adjust it.

Q What will it cost?

A Costs will vary depending on the type of crown and the material used. It is a good idea to get a written estimate and treatment plan before beginning any dental treatment.

Q How do I care for my crown?

A How long your crown lasts depends on how well you look after it. The crown itself cannot decay, but decay can start where the edge of the crown joins the tooth. Therefore, to prevent decay affecting the crown, it is important to keep this area just as clean as you would your natural teeth. Brush for two minutes twice a day with a fluoride toothpaste and clean in between your teeth with ‘interdental’ brushes or floss.

Q How long will the crown last?

A Properly cared for crowns should last for many years. Your dentist will be able to tell you how long you may expect the crown to last.

Dentures - Why should I wear dentures?

Q What is a denture?

A People wear dentures to replace lost or missing teeth so they can enjoy a healthy diet and smile with confidence. Dentures are made of either acrylic (plastic) or metal.

A ‘complete’ or ‘full’ denture is one which replaces all the natural teeth in either the upper or lower jaw.

A ‘partial’ denture fills in the spaces left by lost or missing teeth. It may be fastened to your natural teeth with metal clasps or ‘precision attachments’.

Q Why should I wear dentures?

A Full dentures, to replace all your own teeth, fit snugly over your gums. They will help you to eat comfortably and speak clearly, and will improve your confidence and self-esteem.

Partial dentures replace teeth that are missing and can sometimes be supported by the teeth you have left. If you have gaps between your teeth, then your other teeth may move to take up some of the space, so you could end up with crooked or tilted teeth. This could affect the way you bite and could damage your other teeth.

Q How soon can I have a denture after my teeth are taken out?

A Usually dentures can be fitted straight after your teeth have been removed. These are called ‘immediate dentures’. You will need to visit the dentist beforehand for them to take measurements and impressions of your mouth.

With immediate dentures you don’t have to be without teeth while your gums are healing. However, bone and gums can shrink over time, especially during the first six months after your teeth have been taken out. If your gums shrink, your immediate dentures may need relining, adjusting or even replacing. Your dentist will be able to talk to you about this.

Sometimes your dentist may advise you to wait until your gums are healed before having your dentures, as this can sometimes provide a better fit. Healing may take several months.

Q Who will make and fit my denture?

A Your dentist may take measurements and impressions of your mouth, then order your dentures from a dental technician. However, if you would prefer, you can ask to visit a clinical dental technician yourself.

Clinical dental technicians are dental technicians who have taken a further qualification to allow them to provide dentures directly to you. If you have full dentures, you can visit a clinical dental technician without seeing a dentist. But you should still visit your dentist regularly, as often as they recommend, so they can check the rest of your mouth, pick up any problems and check the fit of your dentures.

A clinical dental technician can fit you with partial dentures rather than your dentist. You would need to see your dentist first, and they will give you a treatment plan and a certificate of oral health. This must be given to a clinical dental technician at a dental laboratory for them to treat you.

Q Will dentures make me look different?

A Replacing lost or missing teeth is very good for your health and appearance. A complete or full denture replaces your natural teeth and gives support to your cheeks and lips. Without this support, sagging facial muscles can make a person look older and they will find it harder to eat and speak properly.

Dentures can be made to closely match your natural teeth so that your appearance hardly changes. Modern dentures may even improve the look of your smile and help fill out the appearance of your face.

Q Will I be able to eat with dentures?

A Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly, using both sides of your mouth at the same time to stop the denture from moving. As you become more used to your denture, add other foods until you get back to your normal healthy diet.

Q Will dentures change how I speak?

A Pronouncing certain words may take practice. Reading out loud and repeating difficult words will help.

If you find that your dentures occasionally slip when you laugh, cough or smile, reposition them by gently biting down and swallowing. If this continues see your dentist.

Q How long should I wear my dentures?

A During the first few days, your dentist may advise you to wear them for most of the time, including while you are asleep. After your mouth gets used to your dentures your dentist may advise that you take them out before going to bed. This allows your gums to rest and helps keep your mouth healthy. When you remove your dentures at night, it is best to store them in a small amount of water to stop them warping.

Q My upper denture fits fine, so why am I having problems with the lower plate?

A The upper denture usually has much more suction to hold it in place. There is much less gum support in the lower jaw, and the lower denture may feel more wobbly as it has to be balanced between your cheeks and your tongue.

After a little while you will learn the shape of your new denture and how to keep it in place, even when you open your mouth wide.

Q Should I use a denture fixative?

A Dentures are custom made to fit your mouth and you shouldn’t need a denture fixative. However, over time, dentures may become loose and not fit as well. When this happens, some people prefer to use a fixative for a short time before having them replaced. A poorly fitting denture may cause irritation and sores. This can often happen if you have worn ‘immediate’ dentures for some time.

Q Must I do anything special to care for my mouth?

A Even with full dentures, you still need to take good care of your mouth. Every morning and evening, brush your gums, tongue and the roof of your mouth with a soft brush. This removes plaque and helps the blood circulation in your mouth. If you wear partial dentures, it is even more important that you brush your teeth thoroughly every day. This will help stop tooth decay and gum disease that can lead to you losing more of your teeth. Your dentist may refer you to the hygienist to have your remaining natural teeth cleaned regularly.

Q How do I take care of my dentures?

A Dentures may break if you drop them. Always clean your dentures over a bowl of water or a folded towel in case you drop them.

To clean your denture, the general rule is: brush, soak, brush. Brush your dentures before soaking, to help remove any bits of food. Using an effervescent (fizzy) denture cleaner will help remove stubborn stains and leave your denture feeling fresher – always follow the manufacturer’s instructions. Then brush the dentures again, as you would your own teeth, being careful not to scrub too hard as this may cause grooves in the surface.

Most dentists advise using toothpaste and a small- to medium-headed toothbrush. Make sure you clean all the surfaces of the dentures, including the surface which touches your gums. This is especially important if you use any kind of denture fixative.

If you notice a build up of stains or scale, have your denture cleaned by your dentist or hygienist.

For more information on cleaning your dentures, look out for our ’Tell me about’ leaflet Denture cleaning.

Q How long will my dentures last?

A As long as you treat your dentures well, they should last several years. However, your dentures will need to be relined or re-made because of normal wear or a change in the shape of your mouth. Bone and gum ridges can shrink, causing your jaws to meet differently. Loose dentures can cause health problems, including sores and infections, not to mention discomfort. A loose or badly fitting denture can also make eating and talking more difficult. It is important to replace worn or badly fitting dentures before they cause problems.

Q How often should I see my dentist?

A Regular dental check-ups and having your teeth professionally cleaned are vital for keeping your teeth and gums healthy. Most dentists recommend a dental check up at least once a year. Regular visits allow your dentist to check the soft parts of your mouth, including the tongue and cheeks. These examinations are important so the dentist can spot any infections, mouth conditions or even mouth cancer at the earliest stages. Full-denture wearers should check with their dentist about how often they should visit.

With regular professional care, a positive attitude and persistence, you can become one of the millions of people who wear their dentures with a smile.

Q Are dentures my only option?

A No. Implants are another option to consider. Ask your dentist for more information, or see our ’Tell me about’ leaflet Implants.

Different types of dental fillings - What are my options if I need a dental filling?

Q I need a filling – what types are there?

A There are a number of different fillings including:

• amalgam (silver coloured)
• composite fillings (tooth coloured)
• glass ionomer (tooth coloured)
• gold inlays and onlays (gold coloured)
• porcelain inlays (tooth coloured)

Q What are amalgam fillings?

A Amalgam fillings are silver coloured. They are made by combining mercury and a silver alloy (50% mercury, 35% silver, 15% tin, copper and other metals). Amalgam is long lasting and hard wearing and has been used in fillings for at least 150 years. It is economical to use and it is not unusual for an amalgam filling to last 15 to 20 years.

This kind of filling is normally used on the back ‘chewing’ teeth. Before the filling can be placed, the area must be prepared by removing all the decay and shaping the cavity to hold the filling in place. If the tooth is badly broken, your dentist may need to place a small stainless steel pin to help secure the filling.

Q Are there any risks from amalgam fillings?
A Mercury in dental amalgam is not poisonous once it is combined with the other materials in the amalgam filling. Its chemical nature changes so that it is harmless.
Research into the safety of dental amalgam has been carried out for over 100 years. So far, no reputable controlled studies have found a connection between amalgam fillings and any medical problem.

Q What are composite fillings?

A Composite fillings are strong, but may not be as hard wearing as amalgam fillings. Composite fillings are tooth coloured and are made from powdered glass quartz, silica or other ceramic particles added to a resin base. After the tooth is prepared, the filling is bonded onto the area and a light shone onto it to set it. The dentist will choose a shade to match your existing teeth, although over time staining can happen.

Q What are glass ionomer fillings?

A Glass ionomer fillings form a chemical link with the tooth. They may also release fluoride, which helps to prevent further tooth decay. This type of filling is fairly weak and, because of this, is usually limited to use on baby teeth and non-biting surfaces such as around the necks of the teeth. Little preparation is needed as the filling bonds directly to the tooth.

Q What are gold inlays and onlays?

A These can be used in most areas of the mouth. An inlay is and within the biting surface of the tooth. An onlay can cover a larger area of the tooth. Gold is the most long lasting and hard wearing filling material and will last for many years. An advantage of gold is that it does not tarnish and has great strength.

One of the differences between gold and other filling materials is that the gold filling is made in a laboratory. Your dentist will usually take an impression of the prepared cavity and send it to the laboratory for the technician to make the inlay or onlay. In the meantime a temporary filling will be placed in the cavity. After the gold inlay or onlay has been made, your dentist will fix it in place with dental cement. This type of filling is more expensive.

Q What are porcelain inlays?

A Your dentist can now use digital technology (called CADCAM) to design and prepare perfectly fitted porcelain inlays in just one or two visits. Porcelain inlays can also be made in a laboratory but this will need at least two visits to your dentist. Porcelain can be hard wearing and long lasting and also has the benefit of being able to be coloured to match your natural tooth. Again, this type of filling can be quite expensive.

Q Where can I get more information?

A Your dentist will advise you on what kind of filling material is suited to your situation. Discuss with your dentist if you would like a particular type of filling material such as tooth-coloured fillings.

Always ask for a treatment plan and a written estimate before starting any treatment.

Dental Implants - Can implants always be used to replace missing teeth?

Q What are dental implants?

A A dental implant is used to support one or more false teeth. It is a titanium screw that can replace the root of a tooth when it fails. Just like a tooth root, it is placed into the jawbone.

Q Are implants safe and how long will they last?

A Implants are a safe, well-established, tried-and-tested treatment. It’s probably true to say that implants, much like natural teeth, will last for as long as you care for them.

How well you look after your implants – and whether you go for your regular maintenance appointments – will have the biggest impact on how long they will last.

If you don’t look after your implants they will develop a coating similar to that found on neglected natural teeth. Left untreated, this can lead to gum infection, bleeding, soreness and general discomfort. You could get all these problems with natural teeth.

If your implants are well looked after, and if the bone they are fitted to is strong and healthy, you can expect them to last for many years. However, just as with other surgical implants (such as a hip replacement) there is no lifetime guarantee.

Q I have some of my own teeth. Can I still have implants?

A Yes. You can have any number of teeth replaced with implants – from one single tooth to a complete set.

Q Can implants always be used to replace missing teeth?

A It depends on the condition of the bone in your jaw. Your dentist will arrange for a number of special tests to find out the amount of bone still there. If there is not enough, or if it isn’t healthy enough, it may not be possible to place implants without grafting bone into the area first.

Q Do implants hurt?

A Placing an implant is often easier than taking a tooth out and is usually done using a simple local anaesthetic. You will not feel any pain at the time, but just like after an extraction, you may feel some discomfort during the week after the surgery.

Sometimes your dentist might give you a sedative if you are very nervous or if the case is a complicated one. General anaesthetics are rarely used for implants and are generally only used for very complicated cases.

Q How long does the treatment take?

A Your dentist will be able to give you a rough timetable before the treatment starts.

Usually the permanent false teeth are fitted 3 to 4 months after the implants are put in. Some teeth can now even be fitted at the same time as the implants (these are called ‘immediate implants’) but you should check with your dentist to see whether these are suitable for you. Sometimes treatment takes longer and your dentist will be able to talk to you about your treatment time.

Q What about aftercare?

A Your dentist will give you instructions on how to look after your implant. They may give you some painkillers after the surgery – or check whether you have them at home – to take over the next few days if you need them.

Q What happens next?

A After your implants have been placed, the bone in your jaw needs to grow onto them and fuse to them. This usually takes a few months. Sometimes the implants may be stable enough when they are fitted for the false teeth to be attached sooner than this.

If you are having one, two or three teeth replaced, you may have a temporary denture in the meantime. If you have full dentures, you can keep wearing these while your implants are healing. Your dentures will need altering, to fit properly after the surgery, and a ‘healing cap’ will usually be placed onto the implant site to protect it.

Q Are the implant teeth difficult to clean?

A No. But aftercare is important if you are going to have a long-lasting, successful implant. Your dentist should give you detailed advice on how to look after your implants. Cleaning around the teeth attached to the implants is no more difficult than cleaning natural teeth. However, there may be areas that are difficult to reach and you’ll be shown methods to help you. You may need to visit your hygienist more often but your dentist will be able to talk to you about this.

Q If I had gum disease when I had my own teeth, will I get it with the implants?

A Yes, if you don’t care for them well enough. If you keep them clean and have them regularly checked by your dentist you should not have any problems. Smoking also affects the health of natural teeth and implants. So, if you smoke, you may need to look after your implants more carefully.

Q Can I take the teeth out if they are fixed to implants?

A Most teeth attached to implants can only be fitted and removed by the dentist. However, if you have removable dentures attached to the implants, then you’ll be able to take them out for cleaning.

Q Do the implants show?

A Most implants look exactly like natural teeth.

Q Do I have an implant for each missing tooth?

A If you have a single tooth missing, you will need an implant to support it. If you have a number of teeth missing, and these are next to each other, you could still have one implant for each tooth. Or you may find that two or more implants may be able to support more than one tooth each. Your dentist will talk to you about the best option for you.

Q What if I have an accident?

A Implants and the teeth they support can be damaged by an accident in the same way that natural teeth can. So it is important that you wear a professionally made mouthguard if you play sports that involve contact or moving objects. If just the teeth are damaged, they can usually be removed from the implant and replaced.

However, if the titanium implant itself is damaged beyond repair, it can be safely left in the jaw if it is too difficult to remove. Another implant may be fitted alongside it to replace the damaged one.

Q What happens if the implant does not fuse with the bone?

A This happens very rarely. If the implant becomes loose during the healing period, or just after, it is easily removed and your jaw will heal in the normal way. Once your jaw has healed, another implant can be placed there. Or the dentist can make a bridge, fitting it to the implanted false teeth that have ‘taken’.

Q Can I get the treatment on the NHS?

A Implants are not normally available on the NHS. Implants are available privately. However, in many situations, the cost of the treatment is only a little more than the cost of more conventional private dental treatment with crowns and bridges. Over the longer term, implants are usually a more cost- effective and satisfactory option.

There are other advantages to implants, too. If you have an implant to replace a single tooth, there is no need to cut down the teeth either side of it. If you had a bridge, your dentist would need to do this and fit crowns to these teeth to support the bridge.

Normal dentures often mean you can’t eat or speak well, because the dentures move about. But teeth attached to an implant don’t cause this problem as they are anchored to the bone more firmly than natural teeth.

Q Where do I get this treatment?

A Talk to your dentist, so they can refer you to an experienced ‘implantologist’ for assessment and treatment. Your dentist may already carry out some or all of this type of treatment and will give you the advice you need.

Remember to ask:

• exactly what treatment is proposed
• what experience the dentist has in this work
• the total cost of the treatment; and
• what the alternatives are.

Make sure you get a treatment plan, along with an estimate, and ask if a guarantee is included for your treatment.

If you are unhappy with any of the answers you get, then do ask for a second opinion. You will be spending a lot of time, effort and money, so you must be sure that you know what you are getting at the end of the treatment.

Mouthguards - When would I need a mouthguard?

Q What is a mouthguard? 

A A mouthguard is a specially made, rubber-like cover which fits exactly over your teeth and gums, cushioning them and protecting them from damage.

Q When would I need a mouthguard?

A It is important to wear a professionally made mouthguard whenever you play sport that involves physical contact or moving objects. This includes: cricket, hockey and football – which can cause broken and damaged teeth; and American football, boxing and rugby – which can all cause broken or dislocated jaws. A mouthguard will help protect against these events.

Q Where can I get one made?

A Your dentist will be happy to make you a custom-made mouthguard, which will fit your mouth exactly and protect your teeth and gums properly. Custom-made mouthguards can prevent damage to the jaw, neck and even the brain – helping to prevent the concussion and damage caused by a heavy blow.

Q How much will it cost?

A You cannot get mouthguards on the NHS, so costs can vary from dentist to dentist. Ask your dentist about mouthguards and always get an estimate before starting treatment. When you consider the cost of expensive dental work and the risk of missing teeth, it is a small price to pay for peace of mind.

Q How long do custom-made mouthguards last?

A Depending on your age, your mouthguard may need replacing fairly regularly. If you are still growing, new teeth will come through and move into position. So the mouthguard may become too tight or loose, and will need to be remade to fit the new shape of your mouth.

Adults may not need to have their mouthguards replaced quite so often. But they are like any other form of sports equipment and will suffer from wear and tear. It is recommended that you take your mouthguard along to the dentist when you go for your check-up, so it can be checked.

Q What about home kits?

A Mouthguards are made by taking an accurate impression of your mouth and making the mouthguard fit your own teeth. The dentist will register the way your jaws bite together to make sure the mouthguard meets properly with your teeth.

There are cheaper kits available. They involve heating the product in hot water and then putting it in your mouth until it sets. Unfortunately, these mouthguards can fit badly and be uncomfortable to wear. They can fall out or even cause choking. Also the material is at its thinnest where it is needed most.

Q Can I get coloured mouthguards?

A There are many types of mouthguard including striped, multi-coloured and clear. Many people now have coloured mouthguards made in their favourite team’s colours or to match their own sports strip. Your dentist will be able to tell you whether they can provide coloured mouthguards.

Q What do I do if I knock a tooth out?

A Firstly, if you can find the tooth and it is clean – put it back into the socket yourself.

• Do put it straight into a cup of milk or keep it in your mouth

• Do go to a dentist or hospital as soon as possible

• Do take painkillers if necessary

• Don’t hold the tooth by the root, as teeth are surrounded by fragile ligaments which need to be kept intact if the tooth is to be replaced

• Don't clean the tooth with disinfectant or water or let it dry out

• Don’t put aspirin or clove oil on the wound

• Don’t panic

The sooner the tooth is replaced, the better the chance of success. If you have not managed to do it yourself, the dentist will put the tooth back. They may use a dental splint to fasten the tooth against the teeth on either side. In most cases this is successful, and once the splint is removed the tooth is stable. However, you will almost certainly need more treatment in the future.

Orthodontic treatment - Why should I have orthodontic treatment?

Q What is orthodontic treatment?

A Orthodontic treatment is a way of straightening or moving teeth, to improve the appearance of the teeth and how they work. It can also help to look after the long-term health of the teeth, gums and jaw joints, by spreading the biting pressure over all the teeth.

Q Why should I have orthodontic treatment?

A Many people have crowded or crooked teeth. Orthodontic treatment will straighten the teeth or move them into a better position. This can not only improve their appearance but also the way the teeth bite together, while also making them easier to clean.

In some patients the upper front teeth can stick out and look unsightly. These ‘prominent’ teeth are more likely to be damaged, but orthodontic treatment can move them back into line. In others, the way the upper and lower jaws meet can cause teeth to look unsightly and lead to an incorrect bite. Orthodontic treatment may be able to correct both.

When the teeth don’t meet correctly, this can put strain on the muscles of the jaw, causing jaw and joint problems and in some cases headaches. Orthodontic treatment can help you to bite more evenly and reduce the strain.

Q At what age should I have orthodontic treatment?

A Orthodontic treatment is generally best carried out in children, but adults can have orthodontic treatment – and more and more are doing. Age is less important than having the proper number of teeth. In children it may be necessary to wait for enough teeth to come through before starting treatment.

Q Who carries out orthodontics?

A Any dentist may carry out orthodontic treatment. Or the dentist may send the person to a specialist who has extra qualifications. The specialist may be in a practice or in a hospital department, and is called an orthodontist.

Q What does it involve?

A The most important thing is to have a full examination. This will usually involve looking at your teeth, taking x-rays and making plaster models of your teeth.

Your dentist or orthodontist will then discuss what treatment is possible. Once you are sure you want to go ahead, the treatment can begin as soon as you have enough permanent teeth.

Q Will I need to have teeth taken out to make room?

A You may not have enough room for all your permanent teeth and so it may be necessary to take out some permanent teeth to make space. Your dentist will tell you whether this is the case. Sometimes space can be created using other forms of treatment.

Q How is treatment carried out?

A Orthodontic treatment can be done by many sorts of appliances, which most people know as ‘braces’.

Q What is a removable appliance?

A Simple treatment may be carried out with a removable appliance (a plate that can be taken out to be cleaned). It has delicate wires and springs attached, which move the teeth using gentle pressure.

Q What is a functional appliance?

A It is sometimes possible to change the way the jaws grow, using orthodontic appliances. These functional appliances use the power of your jaw muscles and can help with certain types of problem.

Q What is a fixed appliance?

A Often, teeth need to be guided more accurately than they can be using a removable plate. So fixed appliances are used. These have brackets and bands temporarily stuck to the teeth. A flexible wire joins all the brackets and allows the teeth to be moved. It is not possible for the patient to take the appliance out and so it is called a fixed appliance.

Q What are the brackets made of?

A Fixed braces are not always made of metal. Plastic and ceramic can be used, especially for adults. You cannot generally get these braces on the NHS but they are offered as a private treatment option.

Q What is headgear?

A As well as an appliance it is sometimes necessary to wear headgear. You usually only need to wear it in the evening or at night. If you do not wear it in the way you have been told, your front teeth will stick out at the end of the treatment.

Q What are elastics?

A It may be necessary to attach delicate elastic bands to a fixed brace to help move the teeth. Your orthodontist will tell you if you need elastics.

Q What are ‘invisible braces’?

A They are tough, clear plastic ‘aligners’ (moulds) that are used to straighten teeth. Several sets of specially moulded, slightly different aligners are made for each patient. Each set is worn for two weeks before being replaced with the next one. They are made from clear plastic, so they are nearly invisible. This means that no one need know you are straightening your teeth.

The aligners should be worn for 22 to 23 hours a day for the best results. They can be easily removed for eating, drinking, brushing and flossing. You need to have all your adult teeth before you can have this treatment.

Q How long will it take?

A The length of treatment depends on how severe the problem is, and may take anything from a few months to two-and-a-half years. Most people can be treated in one to two years.

Q What happens when the teeth are in the right position?

A When treatment is finished the teeth need to be held in position for a time. This period is called retention, and the appliances that hold the teeth in place are called retainers.

The retainers hold newly straightened teeth in position while the surrounding gum and bone settles. The retainers can be removable or fixed depending on the original problem.

Q How many visits will it take?

A Orthodontic appliances usually need adjusting every 4 to 6 weeks. Your orthodontist will tell you how often your appliance will need adjusting.

Q Will it hurt?

A All appliances may feel strange to begin with and can cause discomfort. If the problem doesn’t go away the orthodontist may be able to carry out adjustments to help. Teeth are usually uncomfortable immediately after adjustment but this will settle.

Q How successful will it be?

A Success depends on a partnership between the skills of the orthodontist, and the enthusiasm and help of patient and parents. It is important to attend regularly and carry out any instructions given by the orthodontist.

The success of the treatment also depends on the commitment of the patient. For children’s orthodontic treatment it is very important that the patient is as keen as the parent.

Q Can orthodontics damage my teeth?

A Your teeth can be damaged if they are not properly looked after during treatment. Appliances will not in themselves cause damage, but poor cleaning and too many sugary food and drinks can cause permanent damage. Brackets, wires and braces can trap food and cause more plaque than usual to build up. So the teeth and appliance need to be cleaned very thoroughly.

Q Is orthodontic work permanent?

A Even after retention, it is normal for minor tooth movements to happen throughout life, so no permanent guarantee can be given. However, it is unusual for teeth to alter enough to need further treatment.

Q How do I go about getting orthodontic treatment?

A The first thing to do is to go along to your own dentist and get his or her advice. Your dentist will know whether you need treatment and make the necessary arrangements.

Q How much does it cost?

A You can have orthodontic treatment under the National Health Service or as a private patient. National Health treatment is free for children up to the age of 18 and students up to the age of 19 as long as there is a clinical need. Other people entitled to free treatment are patients on a low income, pregnant women and nursing mothers. Everyone else has to pay the NHS charges. There is no charge for treatment in hospital departments.

You will only be entitled to treatment under the NHS if your condition is serious. Minor problems may be classed as cosmetic and would therefore be charged privately.

If you decide to have treatment privately, the orthodontist will be able to estimate the cost of your treatment and give you details. It is always a good idea to discuss the cost fully before treatment and, if necessary, have the cost confirmed in writing to avoid any confusion.

Q How do I care for my brace and teeth?

A It is important to continue to have your teeth checked by your dentist while having orthodontic treatment. You also need to take extra care of your teeth and mouth:

1 Clean your teeth carefully every day, including between your teeth where you can. Appliances are delicate and you need to make sure you clean them carefully so that they do not break. Your dentist or hygienist will be able to show you the special techniques to use depending on the appliance you are wearing.

2 Cut down on how often you have sugary foods and drinks. Avoid ‘snacking’ on foods or drinks containing sugars, and on fizzy drinks. Also, sticky and hard foods may damage the delicate orthodontic appliances.

3 Brush your teeth for two minutes, twice a day with fluoride toothpaste and, if necessary, use a mouthwash. Your dentist or hygienist may recommend a fluoride toothpaste or application for you to use. Look for a product carrying the British Dental Health Foundation’s accreditation logo. This shows that the product has been checked by a panel of experts and does what it says on the packet.

Pit and fissure sealants - How can sealants protect my teeth?

Q What are sealants?

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

Q How do they work?

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

Q Which teeth should be sealed?

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

Q When should this be done?

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

Q What is involved?

A Sealing is usually quick and straightforward, taking only a few minutes for each tooth. The tooth is thoroughly cleaned, prepared with a special solution, and then dried. The liquid sealant is then put onto the tooth and allowed to set hard – usually by shining a bright light onto it.

Q Will I feel it?

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

Q How long does the sealant last?

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

Q Do I still have to clean my teeth?

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

Q Where can I find out about the treatment?

A If you would like to know more about the treatment, ask your dentist or hygienist. They will tell you if fissure sealing will help your teeth and if it is the right time to do it.

Medical conditions and oral health - Will I need to tell my dentist if I have a medical condition?

Q    Will I need to tell my dentist if I have a medical condition?

A     When you have your first dental check up, you will be asked to fill in a medical history form. In this you can tell your dentist about any medical conditions, recent operations, allergies, and tablets or medicines you are taking that may affect your dental treatment.

You may think that some conditions are not important enough to mention. However, quite often these conditions are just as important. The information will help your dentist and the dental team work together to make sure you are treated in the safest way possible and are not put u at any risk during treatment.

Q    Is this information confidential?

A    Yes. It will be put in your dental notes and kept confidential under the 1998 Data Protection Act.

Q    What if I am taking any medicines?

A    You will need to tell your dentist if you are taking or rely on any medicines. This should include any inhalers, a recent course of antibiotics or regular medication for an on-going complaint. It is also important to remember to tell your dentist if you have taken any over-the-counter medicines or tablets recently, have had a recent prescription from your GP or take recreational drugs.

You should also tell your dentist if you are taking the oral contraceptive pill.  This is in case you need a course of antibiotics.  These can cause the pill to become less effective and you will need to take extra contraceptive precautions.

All this information is needed to make sure no dental treatment; drugs or materials will affect your health.

Q    Will my dentist contact my GP?

A    Maybe, but they should always ask your permission first. In some cases, particularly for difficult dental procedures or extractions, the dentist may want to contact your GP for advice. If you have had a recent operation, or rely on medication, your dentist may ask your GP if there are any problems which may affect your dental treatment.

Q    How often should I visit my dentist?

A    We recommend you visit your dentist regularly, as often as they recommend. However, if you have certain medical conditions your dentist may want to see you more often. Patients who suffer dry mouth due to certain medication may find they are more likely to get tooth decay and would therefore need checking more closely.  

The dentist may also refer you to the dental hygienist in the practice for regular scale and polish appointments to keep up your good dental health.

Q    Will I need to be treated in hospital?

A    In certain situations you may need to be seen by a specialist dental team at your local hospital or regional centre to make sure you get the best medical care. This is especially the case with patients who have blood disorders, heart complaints or who are severe asthmatics.

The staff will be specially trained to deal with patients who have medical conditions, and the necessary back up is there should it be needed. Your dentist may feel that due to your condition this is the safest option.

Q    Will I need a general anaesthetic?

A    Not always. General anaesthetics are not widely used nowadays, and a local anaesthetic is the safest option. Patients with heart complaints and severe asthma for example may find they are unsuitable for a general anaesthetic, and therefore would have to look at alternatives.  

Q    Are there any medical conditions that could affect my mouth?  

A    Some medical complaints which need regular medication can contribute to dry mouth, which in turn can cause tooth decay.

Also, patients with epilepsy who rely on Epilim should always ask for sugar-free alternatives if they need the drug in syrup or liquid form. Epanutin, another drug prescribed for epilepsy, can cause gum problems.

Q    What other medicines cause a dry mouth?

A    Dry mouth can be caused by radiation treatment to the head and neck, damage to the salivary glands or by certain drugs. Antispasmodics, tricyclic antidepressants, some anti-psychotic drugs and HAART (Highly Active Anti-Retroviral Therapy) for patients living with HIV can all cause dry mouth.

    There are many artificial saliva products, sprays and lozenges that your dentist can prescribe which may help to ease your symptoms. The reduced saliva flow can increase the chance of tooth decay. It is important to brush with a fluoride toothpaste and keep sugary foods and drinks to mealtimes only.

Q    What may happen if I have a heart complaint, heart      murmur or rheumatic fever?

A    Always make sure that your dentist is aware of your medical condition.  However, it is no longer considered necessary for people that have a heart complaint, heart murmur or rheumatic fever to receive an antibiotic cover one hour prior to dental treatment, such as, a tooth extraction or scale and polish.

The dentist may also choose to use a different kind of local anaesthetic (without adrenalin).

Q    Is there a link between gum problems and heart disease?    

A    Recent scientific research has shown a link between poor oral health and other conditions such as heart and lung disease.  This highlights the importance of good dental care.

    Keeping to a good oral hygiene routine at home and regular visits to your dentist will help to prevent gum disease and therefore avoid the risk of complications.

Q    How can my dentist help if I have asthma?

A    People who suffer from asthma should tell their dentist when they register. It is important to take your inhaler to every dental appointment and tell your dentist if you feel unwell or out of breath. Patients with severe asthma may find they are unsuitable for treatment under general anaesthetic or sedation, and therefore the safest option would be a local anaesthetic.

Q    What if I am taking warfarin?

A    It is important to tell your dentist before treatment if you are taking warfarin, particularly if you need to have a tooth out. You may be asked to have routine blood tests before starting treatment to make sure your blood will clot enough to stop the bleeding

Your dentist may suggest stopping your warfarin for 2 to 3 days before your dental extraction. However, for some patients there is no need to alter the medication and there should be no risk of complications following the extraction.  Your dentist will be able to tell you more and may contact your GP for advice before beginning the treatment.

Q    Should I tell my dentist if I am taking anti-depressant drugs?

A    Yes. It is important to tell your dentist if you are taking any of these medicines. The local anaesthetic may interfere with tricylic anti-depressants and therefore the dentist may recommend an alternative brand of anaesthetic.

A side effect of some anti-depressant drugs is dry mouth. The reduced saliva flow can increase the chance of tooth decay and gum disease.
Q    What will happen if I have haemophilia?

A    Haemophilia is a blood disorder. You must tell your dentist at your first check up if you are suffering from this condition.

If the blood does not clot it may cause serious problems during dental treatment.  If you need to have a tooth out, the dentist will need to refer you to the local hospital to be treated by a specialist and in the situation safest for you. After a tooth has been extracted, a clot needs to form in the socket to help it heal.

Many patients take tablets for haemophilia and it is important to inform your dentist if you are on any medication.

Q    I have anaemia, can this affect my dental health?

A    Patients with anaemia may find they get more mouth ulcers. They may also get red lines and patches on the tongue. Ulcers usually last 7 to 10 days.  However, patients with recurrent ulcers may find they take up to six weeks to heal.  An ulcer which does not heal within 3 weeks should be checked out by your dentist. There are various sprays and creams that your dentist can prescribe if your symptoms continue.  

Q    Why might I be tested for sickle cell anaemia?

A    Sickle cell disease is a form of anaemia which affects people of African and Caribbean origin.  If you are in this ethnic group and need a general anaesthetic, you will have blood tests to make sure this is safe for you.
Q    Can a dentist refuse to treat me if I have HIV or hepatitis?

A    A patient with either of these conditions is protected by the Disabilities Act. Therefore, a dentist cannot refuse to treat you if you have HIV or hepatitis. However, patients with hepatitis B and C may be referred.

Due to the risk of blood-borne infections, all dental practices now have to follow very strict policies to prevent cross-infection. Many dental instruments are disposable and for single use only, and all other equipment will be sterilised before re-use.

Q    Will HIV affect my oral health?

A    It is important to establish a very strict oral hygiene routine as early as possible and get regular professional care.

    Oral signs and symptoms are only common in uncontrolled HIV. Lesions can appear, which may be purple-red discolourations or larger growths. Oral thrush is also common when the immune system has failed, but quickly responds to oral medicine. Hairy leukoplakia is a common oral condition and appears as white lesions on the tongue – it can often be the first sign of HIV.

    Periodontal (gum) disease is common with HIV, and often develops very quickly when the condition is uncontrolled. Because the immune system is weakened, the gum disease is more severe and oral antibiotics are often needed.  

    Dry mouth is another side effect of HIV and can cause tooth decay due to the reduced levels of saliva. Your oral care routine should include using fluoride toothpaste and you may need fluoride supplements too. You can be prescribed sprays or lozenges to ease your discomfort. It is important to always ask for sugar-free alternatives.  

Q    Will chemotherapy affect my dental treatment?

A    If you are going to have a course of chemotherapy, visit your dentist as soon as possible to make sure any dental treatment you need is finished before you start.

External or internal radiation therapy can often cause damage to the salivary glands, leading to a permanently dry mouth. Due to the lack of saliva, there is more risk of dental decay so it is important to have regular dental check-ups.

Chemotherapy can cause gum ulcers or the gums to bleed.

Regular appointments with the dental hygienist should help to keep this under control. The hygienist will also tell you if you are brushing correctly and will check that you are maintaining a good oral hygiene routine at home.

Some cancer patients find the chemotherapy causes a sore throat, difficulty in swallowing and in some cases partial or complete loss of taste.

Q    Should I tell my dentist if I am allergic to anything?

A    Yes. You will be asked at your first dental check up if you have any allergies to certain medication, foods or materials. If you have a penicillin allergy it is very important to tell your dentist in case you ever need a prescription of antibiotics. In this case, there are several alternative antibiotics that will be safer for you.

    Patients and dental staff can be allergic to the dentist’s gloves, which are usually made of latex. Dental materials and drugs used in routine treatment can sometimes produce skin reactions. This can usually be overcome by the dentist using a low-allergy brand of gloves or alternative materials.

It is important to tell your dentist if you have had a reaction at a previous appointment.  This can then be avoided at your next appointment and marked on your notes for future reference.

Q    Will epilepsy interfere with my dental treatment?

A    It is important to tell your dentist if you have epilepsy, or have ever had any sort of fit in the past. This is to make sure the dental team are fully prepared if you do fall ill during treatment and can have drugs on hand if necessary.

     Epileptic patients may find they are more likely to have fits when they are anxious. Tell your dentist if you have any concerns before or during your treatment. The dental team will make sure the surgery is safe for you and there is no risk of harm to you.

Q    Will diabetes affect my teeth and gums?

A    People who suffer from diabetes can have severe gum disease if their condition is uncontrolled. Therefore it is important to follow a thorough oral care routine at home and to visit your dentist regularly, as often as they recommend. You may also find that you heal more slowly after surgery and you should discuss this with your dentist before you have any treatment.

Q    How can my dentist help if I have diabetes?

A    Book your appointments at a time when the dentist is least likely you keep you waiting, such as first thing in the morning. Try to avoid lunchtime in case you have to miss a meal.  

Q    What if my diabetes needs hospital treatment?     

A    Many hospitals nowadays have a diabetic team who will give you advice on managing your condition.

If you are having a general anaesthetic you will not be able to eat or drink for about four hours before treatment, and this could prove a problem with your diabetes. In this situation, the hospital should make every attempt to book you first on the list to avoid you having to wait for long periods.

Q    Will I need to tell my dentist if I am pregnant?

A    It is important to tell your dentist as soon as you find out you are pregnant. If you need dental treatment, it may have to wait until after the birth of your baby. In most situations x-rays should be avoided, particularly during the first three months of pregnancy.
Some pregnant women find their gums bleed during pregnancy and need closer attention. You may be referred to the dental hygienist, if the practice has one, for regular cleaning and advice on how to maintain a good oral hygiene routine at home.

Remember to take your maternity certificate to your check up appointment, as you will be entitled to free NHS routine dental treatment while you are pregnant and until your baby’s first birthday. (For more information please see our leaflet ‘Tell me about mother and baby’.)

Current guidelines suggest that old amalgam fillings should not be removed during pregnancy, but nor should new ones be put in. Speak to your dentist about alternative materials if you are unsure.

Preventive care and oral hygiene - Preventive dentistry is the modern way of helping you keep a healthy mouth

Q     What is preventive dentistry?

A     Preventive dentistry is the modern way of helping you keep a healthy mouth. It helps you to keep your teeth, and means you need to have less dental treatment. The two main causes of tooth loss are decay and gum disease. The better we prevent or deal with these two problems, the more chance people have of keeping their teeth for life.

When the dentist, hygienist and patient work together, this can help to prevent the need for treatment and avoid the traditional pattern of fillings and extractions. Your dental team may recommend a course of treatment to get your mouth into good condition, and then work out a ‘maintenance plan’ to help you keep it that way.

Q     Can everybody benefit from preventive dentistry?

A     Yes. Preventive dentistry will benefit anyone with some of their own teeth. People who don’t have any teeth can also benefit, because conditions such as mouth cancer and denture stomatitis can be spotted during regular visits to the dentist and then treated. It is excellent for children and young people, but it is never too late to start.

Q     What is involved?

A     Your dentist will first check your teeth and gums, and talk to you about any treatment you need. The main aim is to help you get your mouth really healthy. In a healthy mouth it is unlikely that decay or gum disease will continue to be a problem.

•    The hygienist or dentist will thoroughly ‘scale and polish’ your teeth.

•    The dentist or hygienist will show you the best ways to brush and clean in between your teeth using interdental brushes or floss to remove the bacterial ‘plaque’ which forms constantly on your teeth.   When you eat or drink something sugary, the bacteria in the plaque turn the sugar into acid, which may cause tooth decay. Plaque can also cause gum inflammation (swelling and soreness) if it is not regularly and thoroughly removed. The hard tartar (or ‘calculus’) which builds up on the teeth also starts off as plaque.

•    You will be told which oral care products are the best ones for you to use.

•    The hygienist will probably talk to you about your diet, and any habits such as smoking and drinking.

•    Your dentist will also make sure that all your fillings are in good repair and there are no rough edges to make cleaning difficult.

Q     Will my dentist recommend treatment?

A      A ‘preventive dentist’ will often recommend treatment to strengthen a tooth to make sure it does not break. For example, if the dentist sees that a tooth is cracked, or is weak and in danger of breaking, they may advise a new filling or perhaps a crown or ‘onlay’ to protect it. This is always better than waiting until the tooth breaks, and then dealing with it as an emergency.

Q     What else can the dentist and hygienist do to help prevent tooth decay?

A     Fluoride helps teeth resist decay. If your dentist thinks extra fluoride would be useful, they may recommend applying a fluoride varnish. They may also suggest fluoride rinses, tablets or drops to use at home as an extra help against decay. 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.

Q     What are pit and fissure sealants?

A    The biting surfaces of teeth can be protected by applying ‘sealants’.  These make the tooth surface smoother and easier to clean, and stop decay starting in the difficult-to-clean areas. Your dentist will suggest whether this would be right for you.  (See our ‘Tell me about’ leaflet Pit and fissure sealants.)

Q     Can diet affect my teeth?

A     Food and drinks containing sugar cause decay. If you cut down on how often you have sugary snacks and drinks this will help a lot. Foods such as cheese, fruit, nuts and vegetables are better for your teeth.

Q    What is ‘dental erosion’?

A    Dental erosion is the loss of enamel caused by acid attack. When the enamel is worn away it can lead to pain and sensitivity. Foods and drinks that contain acid, such as citrus fruits, fizzy drinks, smoothies, fruit juice and fruit teas, can all cause dental erosion if you have them often.

Q    Can I prevent dental erosion?

A    Acidic foods and drinks can be harmful if you have them often in large amounts. Try to keep acidic food and drinks to meal times and drink acidic drinks through a straw.

We recommend that you do not brush your teeth for at least one hour after eating or drinking anything. Every time you eat or drink, the enamel on your teeth becomes softer for a short while, and loses some of its mineral content. Waiting for an hour or so will allow your saliva to slowly restore it to its natural balance.

Q    Can smoking and drinking affect my teeth and gums?

A     Yes. Smoking can cause tooth staining, tooth loss, mouth cancer and make gum disease worse. If you smoke, you may need to visit the dentist or hygienist more often, but the best advice is to try to give up. Alcoholic drinks can also cause mouth cancer and if you smoke and drink you’re more at risk. Some alcoholic drinks contain a lot of sugar, and some mixed drinks may contain acids. So they can cause decay or erosion if you drink them often and in large amounts.

Q     What can I do at home?

A     It is very important that you keep up a good routine at home to keep your teeth and gums healthy.  We recommend that you:

•    brush your teeth for two minutes twice a day with fluoride toothpaste – this will mean brushing in the way your dentist or hygienist will have shown you

•    clean in between your teeth with ‘interdental’ brushes or floss – brushing alone only cleans up to about 60 percent of the surface of your teeth

•    use a mouthwash – this can help to freshen your breath. .  Many mouthwashes contain antibacterial ingredients to help prevent gum disease, and fluoride to help prevent decay.

Q    Is there anything else I can do?

A    Yes. You can take other steps to help prevent tooth loss, decay and the need for treatment.

•    Cut down on how often you have sugary foods and drinks.

•    Use a straw when you have fizzy or acidic drinks – this helps the drink to go to the back of your mouth and reduces the acid attacks on the teeth.

•    Chew sugar-free gum – it makes your mouth produce more saliva and stops your mouth drying out, and can help to prevent dental decay and erosion.

•    Visit your dentist regularly, as often as they recommend.

Q    What oral care products should I use?

A    There are now many specialised toothpastes, including total care toothpastes and toothpastes made specially to help with plaque and gum disease, sensitive teeth and whitening.

Mouthwashes can help, and there are different types, including ones with anti-bacterial ingredients.

Adults should use a toothbrush with a small- to medium-sized head and soft to medium filaments (bristles).

Tests have shown that electric toothbrushes with an oscillating, rotating action are better than manual toothbrushes at removing plaque and can remove up to twice as much plaque as a manual toothbrush. If you are unsure, ask your dentist or hygienist for advice on the one that best suits your needs.

Relaxation and sedation - Is there anything that can help me with my fear of the dentist?

Q    Is there anything that can help me with my fear of the dentist?

A    Yes. Some people are so frightened of the dentist that they will not go for dental treatment. They can overcome their fears with relaxation or sedation. Dentists today are sympathetic about these feelings, and you can ask your dentist about these ways to help.

Q    What is sedation?

A    Your dentist may recommend an intravenous or ‘IV’ sedation. This is given by injection, either in the back of your hand or in your arm. The dose will depend on the amount of treatment needed and how long it will take to complete.

Q    How will IV sedation affect me?

You become drowsy and unaware of any treatment, but you are still able to co-operate with the dentist. The effects of a sedative medicine take some time to wear off and your dentist will tell you how long the drugs will take to clear from your body.  You won’t be able to drink alcohol, drive or work machinery during this time.

Q    What else can help?

A    You can be helped to feel relaxed by ‘relative analgesia’ sometimes known as inhalation sedation. This means breathing in a mixture of nitrous oxide and oxygen (‘laughing gas’) which quickly leads to a pleasant, relaxed feeling. The dentist puts you at ease at the same time, by talking softly and suggesting what you feel. You remain conscious all the time, although you may be a little drowsy, and any treatment given causes you no discomfort.

You breathe in the mixture through a nosepiece, which is very comfortable. You can’t overdose on the gas, as the mixture quickly leaves the body if you breathe in one or two breaths of ordinary air. There are no after-effects either, and you can drive a car after about 15 minutes. Many dentists use this safe and effective technique.

Q    How does relaxation work?

A    When we are faced with a challenge or something we’re afraid of, such as a visit to the dentist, our bodies produce substances which raise our anxiety. However, we can train our bodies to work against this anxiety, by learning to relax. It’s not possible to be anxious and relaxed at the same time, so learning relaxation helps control our anxiety.  

If you are a mother, you may have learned some relaxation techniques in childbirth classes. In fact, almost anyone can learn them. You can practise at home. Some people find that meditation and yoga work well, too.

Q    What about hypnosis?

A    Hypnosis is a way of relaxing where you concentrate on suggestions of relaxation given by the hypnotist. It’s a bit like daydreaming, although you are awake and in total control.

Q    How do I know which technique is right for me?

A    Talk to your dentist. Most people can use relaxation techniques, but relative analgesia and sedation may not be suitable for everyone. Your dentist will tell you.  You also need to tell your dentist about any medicines you may be taking, whether or not your doctor prescribes them.

Q    How much does it cost?

A    Some of the techniques may be carried out under the National Health Service, but some dentists charge privately. Talk to your dentist, and discuss the costs fully before you commit yourself to treatment. Always get a written estimate before starting any treatment.

Q    Are there any other techniques that may help before I get to the dentist?

A    Some people need something more to help them overcome their fears. The dentist or doctor may give you a sedative medicine, either in tablet or liquid form that you can take before your visit to relax you.  

Q    How can I look after my teeth?

A    The British Dental Health Foundation recommends the following simple routine to help avoid dental disease:

1.    brush your teeth twice a day with fluoride toothpaste. This means cleaning all the surfaces and involves more than just brushing. You need to clean between your teeth too. Your dentist or hygienist will show you the best techniques.

2.    cut down on how often you have sugary food and drink. It is better for your teeth if you limit them to mealtimes.

3.    visit your dentist at least once a year. Remember, use your dental team for advice to help you avoid treatment rather than waiting for the problems to happen.

Root canal treatment - Why is root canal treatment needed?

Q    What is root canal treatment?

A    Root canal treatment (also called endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury.  You may not feel any pain in the early stages of the infection.  In some cases, your tooth could darken in colour, which may mean that the nerve of the tooth has died (or is dying).  This would need root canal treatment.

Q    Why is root canal treatment needed?

A    If the pulp becomes infected, the infection may spread through the root canal system of the tooth.  This may eventually lead to an abscess.  An abscess is an inflamed area in which pus collects and can cause swelling of the tissues around the tooth.  The symptoms of an abscess can range from a dull ache to severe pain and the tooth may be tender when you bite.  If root canal treatment is not carried out, the infection will spread and the tooth may need to be taken out.  

Q    Does it hurt?

A    No.  Usually, a local anaesthetic is used and it should feel no different to having an ordinary filling done.  There may be some tenderness afterwards but this should gradually get less over time.

Q    What does it involve?

A    The aim of the treatment is to remove all infection from the root canal.  The root is then cleaned and filled to prevent any further infection.

Root canal treatment is a skilled and time-consuming procedure.  Most courses of treatment will involve two or more visits to your dentist.

At the first appointment, the infected pulp is removed, and any abscesses can be drained.  The root canal is then cleaned and shaped ready for the filling.  A temporary filling is put in and the tooth is left to settle.

The tooth is checked at a later visit and when all the infection has cleared, the tooth is permanently filled.

Q    What will my tooth look like after treatment?

A    In the past, a root-filled tooth would often darken after treatment.  However, with modern techniques this does not usually happen.  If there is any discolouration, there are several treatments available to restore the natural appearance.

Q    What if it happens again?

A    Root canal treatment is usually very successful.  However, if the infection comes back, the treatment can sometimes be repeated.

Q    What if I don’t have the treatment?

A    The alternative is to have the tooth out.  Once the pulp is destroyed it can’t heal, and it is not recommended to leave an infected tooth in the mouth.

Although some people would prefer to have the tooth out, it is usually best to keep as many natural teeth as possible.

Q    Will the tooth be safe after treatment?

A    Yes.  However, as a dead tooth is more brittle, it may be necessary to restore the tooth with a crown to provide extra support and strength to the tooth.

Q    Where can this treatment be carried out?

A    Root canal treatment is a routine dental procedure, which your dentist will be happy to do for you.  However, sometimes your dentist may refer you to an endodontist, who is a specialist in this type of treatment.

Q    What about aftercare?

A    Root-treated teeth should be treated just the same as any other tooth.  Remember to clean your teeth for two minutes, twice a day with a fluoride toothpaste.  Cut down on sugary foods and drinks, and keep them only to mealtimes if possible.  See your dentist as often as they recommend for regular check-ups.

Tooth Veneers - When would I need a veneer?

Q    What is a veneer?

A    A veneer is a thin layer of porcelain made to fit over the front surface of a tooth, like a false fingernail fits over a nail. Sometimes a natural colour ‘composite’ material is used instead of porcelain.

Q    When would I need a veneer?

A    Veneers can improve the colour, shape and position of your teeth. A precise shade of porcelain can be chosen to give the right colour to improve a single discoloured tooth or to lighten the front teeth. A veneer can make a chipped tooth look intact again. The porcelain covers the whole of the front of the tooth with a thicker section replacing the broken part. Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.

Q    What are the advantages of veneers?

A    Veneers make teeth look natural and healthy. Because they are very thin and are held in place by a special strong bond (rather like super-glue) very little preparation of the tooth is needed. Some types of veneers don't need any preparation at all.

Q    How are teeth prepared for a veneer?

A    Some of the shiny outer enamel surface of the tooth may be removed, to make sure that the veneer can be bonded permanently in place later. The amount of enamel removed is tiny and will be the same as the thickness of the veneer to be fitted, so that the tooth stays the same size. A local anaesthetic (injection) may be used to make sure that there is no discomfort, but often this is not necessary. Once the tooth has been prepared, the dentist will take an ‘impression’ (mould). This will be given to the dental technician, along with any other information needed to make the veneer. The colour of the surrounding teeth is matched on a shade guide to make sure that the veneer will look entirely natural.

Q    How long will it take?

A    A veneer takes at least two visits: the first to prepare the tooth and to match the shade, and the second to fit it. Before bonding it in place, your dentist will show you the veneer on your tooth to make sure you are happy with it. Bonding a veneer in place is done with a special adhesive, which holds it firmly on the tooth.

Q    Will I need a temporary veneer between visits?

A    Because the preparation of the tooth is so slight you will probably not need a temporary veneer. The tooth will look very much the same after preparation, but will feel slightly less smooth.

Q    What happens after the veneer is fitted?

A    Only minor adjustments can be made to the veneer after it is fitted.  It is usually best to wait a little while to get used to it before any changes are made. Your dentist will probably want to check and polish it a week or so after it is fitted, and make sure that you are happy with it.

Q    How much will it cost?

A    The costs for this treatment can vary from practice to practice so it is important to discuss charges and treatment options with your dentist before starting treatment.

Q    How long will a veneer last?

A    Veneers should last for many years; but they can chip or break, just as your own teeth can. Your dentist will tell you how long each individual veneer should last. Small chips can be repaired, or a new veneer fitted if necessary.

Q    What about alternatives?

A    A natural-coloured filling material can be used for minor repairs to front teeth. This is excellent where the tooth supports a filling, but may not work so well for broken tooth corners. There will always be a join between the tooth and the filling material.

Crowns are used for teeth which need to be strengthened – either because they have broken, have been weakened by a very large filling, or have had root canal treatment.

Tooth whitening - What does tooth whitening involve?

Q    What is tooth whitening?

A    Tooth whitening can be a very effective way of lightening the natural colour of your teeth without removing any of the tooth surface or damaging it. Usually the original shade of the tooth is whitened to a lighter colour, rather than being turned completely white.

Q    Why would I need my teeth whitened?

A    As we get older our teeth get darker. This is partly due to our getting older, but it is also caused by the foods we eat and drink, and by other habits such as smoking. Tea, coffee, blackcurrant juice, red wine and other foods that have strong colours can have an effect on the overall colour of our teeth. Teeth may also darken as a result of some antibiotics.

    Some people naturally have a more grey shade of teeth. Other people have white spots on their teeth. This can be caused by early tooth decay, or illness when the tooth was forming.    

There are a number of reasons why you might get your teeth whitened. Everyone is different; and just as our hair and skin colour vary, so do our teeth. Very few people have brilliant-white teeth.

    ‘Calculus’ or tartar can also affect the colour of your teeth. Some people may have staining under the enamel surface or tiny cracks can appear in the teeth which take up stains.

Q    What does tooth whitening involve?

A    Professional bleaching is the most usual method of tooth whitening. Your dentist will assess you first to see whether tooth whitening is suitable for you. They will tell you about the options you have for tooth whitening and which will be the most suitable for you.

    The most common type of whitening is called ‘dentist-supervised home whitening’. You will have trays made specially to fit into your mouth like gum-shields. The whitening gel is then put in the trays and you will be given a routine to follow at home.
Another option is called ‘chair-side whitening’. You will be told if you are suitable for the treatment, and your dentist will supervise it. First the dentist, hygienist or therapist will put a rubber shield or a gel on your gums to protect them. They will then apply the whitening product to your teeth, again using a specially made tray.

The ‘active ingredient’ in the whitening product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel and dentine of the teeth and the tooth colour is made lighter.

Q    How long does home whitening take?

A    The total length of the home bleaching treatment can vary depending on how discoloured your teeth are and the shade you want to get to. It can usually be finished within two to four weeks. First, you will need up to four visits to the dentist. Your dentist will need to make a thin mouthguard and will take impressions for this at the first appointment. Once your dentist has started the treatment, you will need to continue the treatment at home. This means regularly applying the whitening product over two to four weeks, for 30 minutes to one hour at a time. The dentist will discuss with you exactly how long you should keep the tray in your mouth. It is important to follow the instructions that you are given to get the best result.

There are some products which can be applied for up to eight hours at a time. This means you can get a satisfactory result in as little as two weeks.

Q    What other procedures are there?

A    There is also chair-side ‘power whitening’. Although this is often called ‘laser whitening’, it is not a laser that is used. Gel is painted onto your teeth and then a light is shone onto the gel to speed up the whitening reaction. During this procedure, a soft material is placed over your gums to protect them.

Q    How long does chair-side power whitening take?

A    Your dentist will need to assess your teeth to make sure that you are suitable for the treatment. Once it has been agreed, this procedure usually takes about one to two hours.

Q    How much does tooth whitening cost?

A    Private charges will vary from practice to practice and region to region. Chair-side whitening will be more expensive than professionally supervised home bleaching. We recommend you get a written estimate of the cost before you start any treatment.

Q    How long will my teeth stay whiter?

A    The effects of whitening are thought to last up to three years. However, this will vary from person to person. The effect is less likely to last as long if you smoke, or eat or drink products that can stain your teeth. Ask your dentist for their opinion before you start the treatment.

Q    What are the side effects?

A    Some people may find that their teeth become sensitive to cold during or after the treatment. Others may have discomfort in the gums, a sore throat or white patches on the gum line. These symptoms are usually temporary and should disappear within a few days of the treatment finishing.

If any of these side effects continue you should go to your dentist.

Q    What about over-the-counter home kits?

A    Home kits are cheaper but they are not always assessed for safety and tend to be more acidic. So there is a chance that these products could damage your teeth and gums. Because tooth whitening is a complicated procedure we advise that you always talk to your dentist before starting the treatment.

Regulations covering home kits vary from country to country. Kits sold in Europe cannot legally contain more than 0.1% peroxide and this is too little to be effective. In other countries where stronger peroxide is allowed, home whitening is more common. But you need to be careful as some kits sold over the internet may contain mild acids and abrasives.

Q        How safe are beauty kiosks and beauticians?
A        In Europe and in some other countries whitening can only legally be carried out by a dentist. So tooth whitening by beauticians and in whitening kiosks is illegal. In Europe, it is illegal to supply bleaching material containing more than 0.1% peroxide (or the equivalent in carbamide peroxide) to anyone other than a dentist, or direct to the public.

    These regulations are to protect the public. They make sure that anyone carrying out whitening is properly trained and has the right skills and knowledge to carry out the procedure without risking permanent damage to the teeth or gums.

Q    What about whitening toothpastes?

A    There are several whitening toothpastes on the market. Although they do not affect the natural colour of your teeth they may be effective at removing staining, helping to restore the natural colour of your teeth. Therefore, they may improve the overall appearance of your teeth. Whitening toothpaste may also help the effect to last after your teeth have been professionally whitened.

We recommend that you look for our approved logo on the packaging of oral-care products. This is a guarantee that the claims made about the product have been scientifically and clinically checked by an independent panel of experts. (Image of approved logo

Q    Can a single tooth which has been root-filled be whitened?

A    Sometimes. Many dead teeth become discoloured after a root filling. If the tooth has been root-treated, the canal (which contained the nerve) may be reopened. The whitening product is applied from the inside to whiten the tooth.

Q    When might tooth whitening not work?

A    Tooth whitening can only lighten your existing tooth colour. Also it only works on natural teeth. It will not work on any types of ‘false’ teeth such as dentures, crowns and veneers.

    If your dentures are stained or discoloured visit your dentist and ask for     them to be cleaned.

Q    How can I look after my teeth once they have been whitened?

A    Many people find that their teeth and gums feel cleaner after they have been whitened. The whitening treatment was first used as a treatment to help heal gums, so this is an added benefit.

You can help to keep your teeth white by cutting down on the amount of food and drink you have that can stain your teeth. Don’t forget, stopping smoking can also help prevent discolouration and staining.

    We recommend the following tips to care for your teeth:

•    brush your teeth for two minutes, twice a day with a fluoride     toothpaste
•    cut down on how often you have sugary foods and drinks
•    visit your dentist regularly, as often as they recommend.

For the most up-to-date information on the regulations about tooth whitening and who can provide it, go to www.safetoothwhitening.org or call the Dental Helpline on 0845 063 1188.


‘Incidence of tooth sensitivity after home tooth whitening’ by Jorgensen and Carroll, published in JADA p 1076 – 1082 (August 2002)
Tooth whitening in Restorative Dentistry – Linda Greenwall 2002
Success Strategies in Aesthetic Dental Practice – Linda Greenwall 2012.

Visiting a dental hygienist - What is the hygienist's role in the practice?

Q What is a hygienist?

Dental hygienists are specially trained to work as part of the dental team, to give care to patients.

They play an important part in dental health care and are mainly concerned with preventive dental health and treating gum disease - showing you correct home care and helping to keep your teeth and gums healthy.

Q What is the hygienist's role in the practice?

The hygienist's main work is to prevent and treat gum disease including professionally cleaning your teeth. This is usually called ‘scaling and polishing'. However, perhaps their most important role is showing you the best way to keep your teeth free of plaque. Plaque is a sticky coating that forms constantly on your teeth. If it is not brushed away properly, this hardens to form tartar which you cannot remove yourself. They also give advice on diet and preventing dental decay. The hygienist will work alongside your dentist to give you care that is tailored to your needs.

Q Can a hygienist do anything else?

Dental hygienists also take dental x-rays. The dentist will use these to help diagnose problems and decide on the possible treatment. All hygienists that take x-rays will have had proper training and will hold a certificate.

If the dentist suggests that you or your child have fissure sealants or fluoride varnishes, they may refer you to the dental hygienist because these are treatments they are trained to carry out.

Tooth whitening is also often carried out by the dental hygienist under the prescription of your dentist.

Q Does every practice have a hygienist?

Not all practices have a hygienist. However, more of them now offer this as part of the service to patients, using part-time and full-time hygienists. Hygienists see patients directly as well as under the prescription of a dentist.  If your practice does not have a hygienist, your dentist can either refer you to another dental practice or a hygienist practice. Or you can approach a practice yourself to ask if you can see the hygienist there.

Q Why is this treatment important?

Regular professional cleaning, combined with looking after your teeth and gums well at home, will help keep your mouth healthy. A clean and healthy mouth will improve your appearance, help you to keep your teeth and give you fresh breath, and help to maintain your general health.

Q Can a hygienist help prevent dental disease?

This is what the training of the hygienist is all about. Carefully removing the hard deposits of tartar (or ‘calculus') that build up on the teeth and teaching you how to prevent them coming back, will go a long way towards slowing the progress of gum disease.

By talking to you about your diet, and recommending other preventive measures, the hygienist can help you keep to a routine that will slow down the rate at which your teeth decay. Regular visits and advice will help build your confidence in keeping your mouth healthy.

Q What other help can be given to adults?

Adults who have a lot of decay can benefit from having fluoride applied. They can also have anti-bacterial gels and solutions applied under the gum to kill the bacteria causing gum disease.

Another very important part of the hygienist's work is showing you and telling you how to look after your mouth at home. The hygienist may also suggest giving up smoking, as this will reduce staining and improve your general health. Research has also shown that smokers have more gum disease and lose more teeth than non-smokers. Your hygienist will be able to advise you on various ways of giving up smoking. They can also give you special advice for home care if you have dental implants or orthodontic appliances.

Q What help is available for children?

Children can benefit from having their teeth polished. The hygienist can also apply fluoride varnishes to help prevent decay.

The permanent (or ‘adult') back teeth can also benefit from having the biting surfaces sealed. This is done by applying a special plastic coating to the biting surface soon after the teeth come through. For more information see our ‘Tell me about' leaflet Pit and fissure sealants.

Q Why doesn't the dentist do this work?

Some dentists will do this type of work themselves , however, many now realise that the hygienist has been specially trained to carry out scaling and polishing and can spend longer with you. They are also expert at teaching you how to look after your teeth and gums. Often the hygienist will spend a number of appointments getting the gums healthy ready for the dentist to restore the teeth with crowns and fillings.

Q Will the treatment hurt?

Scaling and polishing is usually pain free. However, if you do have any discomfort the hygienist can use anaesthetic creams, or give you some local anaesthetic. It is important that you let the hygienist know at the time so they can help with your discomfort.

Q Is the treatment expensive?

Costs of treatment with a dental hygienist will vary depending on what is being done, and from practice to practice. It is important to find out the cost before you start, by getting a written quotation.
Practices should have a price list at their reception giving a guide to the prices they charge for the service.

Q What can I do to help the hygienist?

You can do a great deal to help yourself and the hygienist, as you are in control of your mouth between visits to the practice. Your hygienist will have shown you how to remove plaque with a toothbrush and fluoride toothpaste.

They will also have shown you how to clean between your teeth with interdental brushes, floss or tape.

There are many oral care products now available including specialist toothpastes, power or electric toothbrushes, and mouthwashes. Your hygienist will recommend those that are best for you.

We recommend you follow three simple steps to help keep your teeth and gums healthy.
•    brush your teeth last thing at night and on at least one other occasion with a fluoride toothpaste.
•    cut down on how often you have sugary foods and drinks
•    visit your dentist regularly, as often as they recommend.

Cutting down the amount of sugar in your diet, and the number of times that you eat during the day, can help to reduce decay. Your hygienist can help you by looking at your decay problem and your diet, and by making some recommendations for you to consider.

Chewing sugar-free gum for 10 minutes after meals can also help to prevent tooth decay. Chewing gum makes your mouth produce more saliva, which in turn cancels out the acid produced in your mouth after drinking and eating.

What to do following a tooth extraction

Q         I’ve had my tooth out – what should I do now?

A        Take it easy for the rest of the day. Take as little exercise as you can, and rest as much as you can. Keep your head up to avoid any bleeding.

Q         What precautions should I take?

A        Avoid hot food or drinks until the anaesthetic wears off. This is important as you cannot feel pain properly and may burn or scald your mouth. Also be careful not to chew your cheek. This is quite a common problem, which can happen when there is no feeling.

          If you do rest, try to keep your head higher for the first night using an extra pillow if possible. It is also a good idea to use an old pillowcase, or put a towel on the pillow, in case you bleed a little.

Q         Should I rinse my mouth out?    

A        Do not be tempted to rinse the area for the first 24 hours. It is important to allow the socket to heal, and you must be careful not to damage the blood clot by eating on that side or letting your tongue disturb it. This can allow infection into the socket and affect healing.

Q         Is there anything else I should avoid?

A          Avoid alcohol for at least 24 hours, as this can encourage bleeding and delay healing. Eat and drink lukewarm food as normal but avoid chewing on that area of your mouth.

Q         When should I brush?

A        It is just as important, if not more so, to keep your mouth clean after an extraction. However, you do need to be careful around the extraction site.

Q         What do I do if it bleeds?

A        The first thing to remember is that there may be some slight bleeding for the first day or so. Many people are concerned about the amount of bleeding. This is due to the fact that a small amount of blood is mixed with a larger amount of saliva, which looks more dramatic than it is.

If you do notice bleeding, do not rinse out, but apply pressure to the socket. Bite firmly on a folded piece of clean cotton material such as a handkerchief for at least 15 minutes. Make sure this is placed directly over the extraction site and that the pad is replaced if necessary.

          If the bleeding has not stopped after an hour or two, contact your dentist.

Q         How soon can I have a cigarette?

A        It is important not to do anything which will increase your blood pressure, as this can lead to further bleeding. We recommend that you avoid smoking for as long as you can after an extraction, but this should be at least for the rest of the day. 

Q         Is there anything I can do to help my mouth?

A        Different people heal at different speeds after an extraction. It is important to keep your mouth and the extraction site as clean as possible, making sure that the socket is kept clear of all food and debris. Don’t rinse for the first 24 hours, and this will help your mouth to start healing. After this time use a salt-water mouthwash, which helps to heal the socket. A teaspoon of salt in a glass of warm water gently rinsed around the socket twice a day can help to clean and heal the area. Keep this up for at least a week or for as long as your dentist tells you.

It is important to keep to a healthy diet; and take a Vitamin C supplement, which will help your mouth to heal.

Q         I am in pain, what should I take?

A        There will usually be some tenderness in the area for the first few days, and in most cases some simple pain relief is enough to ease the discomfort. What you would normally take for a headache should be enough. However, always follow the manufacturer’s instructions and if in doubt check with your doctor first.  Do not take aspirin, as this will make your mouth bleed.

Q Are there any medicines I should avoid?

A          As we have said, it is important not to use anything containing aspirin as this can cause further bleeding. This happens because aspirin can thin the blood slightly. Asthma sufferers should avoid Ibuprofen-based pain relief. Again check with your chemist or dentist if you are worried or feel you need something stronger.  

Q        I am still in pain, what could it be?

A        Sometimes an infection can get in the socket, which can be very painful. This is where there is little or no blood clot in the tooth socket and the bony socket walls are exposed and become infected. This is called a dry socket and in some cases is worse than the original toothache!  In this case, it is important to see your dentist, who may place a dressing in the socket and prescribe a course of antibiotics to help relieve the infection. You may also feel the sharp edge of the socket with your tongue and sometimes small pieces of bone may work their way to the surface of the socket. This is perfectly normal.

Q         Will my dentist need to see me again?

A          If it has been a particularly difficult extraction, the dentist will give you a follow-up appointment. This could be to remove any stitches that were needed, or simply to check the area is healing well.

White dental fillings - Why should I consider white fillings?

Q    Why should I consider white fillings?

A        Most people have fillings of one sort or another in their mouths.  
Nowadays fillings can be natural looking, as well as doing the job they’re meant to do.  Many people don’t want silver fillings that show when they laugh or smile because they are more conscious about the way they look.

Q    Are white fillings expensive?

A    Because many white fillings are classed as a ‘cosmetic’ treatment, you can only have them done privately.  So costs can vary quite a lot from dentist to dentist.  Costs usually depend on the size and type of white filling used, and the time it takes to carry out the treatment.  Costs may also vary from region to region, but your dentist will be able to give you an idea of the cost before you agree to treatment.

Q    Are they as good as silver amalgam fillings?

A    White fillings have always been considered less long lasting than silver amalgam fillings.  But there are now new materials that are almost as good as silver amalgam, and these are proving to be very successful.  How long a white filling lasts can depend a lot on where it is in your mouth and how heavily your teeth come together when you bite.  Your dentist can tell you about how long your fillings should last.    

Q    Is it worth replacing my amalgam fillings with white ones?

A    It is usually best to change fillings only when your dentist decides that an old filling needs replacing.  When this happens you can ask to have it replaced with a tooth-coloured filling.  

Some dentists prefer not to put white fillings in back teeth as they are not always successful.  One way around this would be to use crowns or inlays, but this can mean removing more of the tooth and can be more expensive.

Q          What are tooth-coloured fillings made of?  

A    It can vary, but they are mainly made of glass particles, synthetic resin and a     setting ingredient.  Your dentist should be able to give     you more information about     the material they use. Here are some of the choices.

    Composite fillings

    Composite fillings are strong, but may not be as hard wearing as ordinary amalgam     fillings.

    Composite fillings are tooth coloured and are made from powdered glass, quartz, silica     or other ceramic particles added to a resin base. The dentist will choose a shade to     match your own teeth, although over time the filling can get stained. After the tooth is     prepared, the filling is bonded onto the area with an adhesive and a light shone onto it     to set it. With this type of filling, the dentist may have to remove less of the tooth,     which is obviously better.

    Glass ionomer

    Glass ionomer fillings form a chemical bond with the tooth. They may also release     fluoride, which helps prevent further tooth decay. This type of filling is fairly weak.     Because of this, they are usually used on baby teeth and non-biting surfaces, such as     around the neck of the tooth. Little preparation is needed as the filling bonds directly to     the tooth.

    Porcelain inlays

    Your dentist can now use computer technology (called CADCAM) to design and prepare     perfectly fitted porcelain inlays in just one or two visits. Porcelain inlays can also be     made in a laboratory, but this will need at least two visits to your dentist. Porcelain can     be hard wearing and long lasting, and it can be coloured to match your own teeth. This     type of filling can be quite expensive.

Q     Where can I get them done?

A      Most dental practices offer white fillings as a normal part of the treatment they give you.
Q      Are there any alternatives to fillings?

A      There are alternatives such as crowns and inlays although they can cost a lot more.  Veneers can be used on front teeth instead of crowns or fillings.  For more information, see our ‘Tell me about’ leaflets on crowns and veneers.

X-rays - Why would I need an x-ray of my teeth?

Q    Why would I need an x-ray?

A    Early tooth decay does not tend to show many physical signs.  Sometimes the tooth looks healthy, but your dentist will be able to see from an x-ray (radiograph) whether you have any decay present under the enamel, any possible infections in the roots, or any bone loss around the tooth.  X-rays can help the dentist to see in between your teeth or under the edge of your fillings. Finding and treating dental problems at an early stage can save both time and money.

In children, x-rays can be used to show where the second teeth are and when they will come through. This also applies to adults when the wisdom teeth start to come through.

Q    How often should I have x-rays taken?

A    If you are a new patient, unless you have had dental x-rays very recently, the dentist will probably suggest having x-rays. This helps them assess the condition of your mouth and to check for any hidden problems. After that, x-rays are usually recommended every 6 to 24 months depending on the person, their history of decay, age and the current condition of their mouth.

Q    Whose property are they?

A        X-rays are an essential part of your health records and must be kept
with your personal dental file. As dental records work differently to normal health records, your dentist must keep your dental records for at least two years from the date of your last course of treatment.  You are entitled to copies of your records and X-rays under the Access to Health Records  Act 1990.   But you will have to pay for these copies.  In most cases your X-rays and records will not be needed by your new dentist. However, if they are important, your new dentist will let you know and either ask for your permission to send for them, or ask you to fetch them personally.
Q    What will an x-ray show?

A    X-rays can show decay that may not normally be seen directly in the
mouth, for example: under a filling, or between teeth. They can show whether you have an infection in the root of your tooth and how severe the infection is.

In children an x-ray can show any teeth which haven’t come through yet, and let the dentist see whether there is enough space for the teeth to come through.  It can show any impacted wisdom teeth in adults that may need to be removed, before they cause any problems.

Q    Are x-rays dangerous?

A    The amount of radiation received from a dental x-ray is extremely small. We get more radiation from natural sources, including minerals in the soil, and from our general environment.

With modern techniques and equipment, risks are kept to a minimum.  However, your dentist will always take care to use X-rays only when they need to.

Q    What if I’m pregnant?

A    You should always tell your dentist if you are pregnant. They will take extra care and will probably not use X-rays unless they really have to,
particularly during the first three months.

Q    What types of x-rays are there?

A    There are various types of x-ray.  Some show one or two teeth and their roots while others can take pictures of several teeth at once.  

The most common x-rays are small ones, which are taken regularly to keep a check on the condition of the teeth and gums. These show a few teeth at a time, but include the roots and surrounding areas.    

There are large x-rays that show the whole mouth, including all the teeth and the bone structure that supports the teeth. These are called panoramic X-rays.

There are also medium-sized X-rays, which show either one jaw at a time, or one side of the face.   

There are also electronic imaging systems in use today. These use electronic probes instead of X-ray films and the picture is transmitted directly onto a screen.

Q    Why does the dentist leave the room?

A    The dental team might take hundreds of     X-rays every week. Staff limit the amount of radiation they receive by moving away from the X-ray beam. However, the risk to patients from one or two routine X-rays is tiny.

Staff check how much radiation they are exposed to by wearing a small badge during working hours. This is sent off to be analysed at regular intervals.

Emergency Contact

If you require treatment during Bank Holidays or outside or our normal opening hours, please contact our out of hours service on 03001 232 211

Alternatively for any emergency conditions you may attend the A&E department or Contact NHS 111 from any landline

Contact Us

Call Us: 01386 446 040
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Oral Health Information Centre

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