• Active Smile Oral Hygiene FAQ's


Bad Breath - What causes it and how can I treat it?

Q    How can I tell if I have bad breath?

A    Lots of small signals can show that you have bad breath. Have you noticed people stepping away when you start to talk? Do people turn their cheek when you kiss them goodbye?

If you think you might have bad breath, there is a simple test that you can do.  Simply lick the inside of your wrist and sniff – if the smell is bad, you can be pretty sure that your breath is too.

Or, ask a very good friend to be absolutely honest, but do make sure they are a true friend.

Q    What causes bad breath?

A    Bad breath is a very common problem and there are many different causes.  

Persistent bad breath is usually caused by the smelly gases released by the bacteria that coat your teeth and gums.  

Bits of food that get caught between the teeth and on the tongue will decay and can sometimes cause an unpleasant smell. So correct and regular brushing is very important to keep your breath smelling fresh.

However, strong foods like garlic, coffee and onions can add to the problem.

The bacteria on our teeth and gums (plaque) also cause gum disease and dental decay. One of the warning signs of gum disease is that you always have bad breath or a bad taste in your mouth. Again, your dentist or hygienist will be able to see and treat the problem during your regular check-ups. The earlier the problems are found, the more effective the treatment will be.

Q    What else causes bad breath?

A      Bad breath can also be caused by some medical problems. Dry mouth (xerostomia) is a condition that affects the flow of saliva.  This causes bacteria to build up in the mouth and this leads to bad breath. Dry mouth may be caused by some medicines, salivary gland problems or by continually breathing through the mouth instead of the nose. Older people may produce less saliva, causing further problems.

If you suffer from dry mouth, your dentist may be able to recommend or prescribe an artificial saliva product. Or your dentist may be able to suggest other ways of dealing with the problem.

Q    Can other medical conditions cause bad breath?

A    Other medical conditions that cause bad breath include infections in the throat, nose or lungs; sinusitis; bronchitis; diabetes; or liver or kidney problems. If your dentist finds that your mouth is healthy, you may be referred to your family GP or a specialist to find out the cause of your bad breath.  

Q    Can smoking cause bad breath?

A    Tobacco also causes its own form of bad breath. The only solution in this case is to stop smoking. As well as making your breath smell, smoking causes staining, causes loss of taste and irritates the gums. People who smoke are more likely to suffer from gum disease and also have a greater risk of developing cancer of the mouth, lung cancer and heart disease.  

Ask your dentist, pharmacist or practice nurse for help in quitting. If you do stop smoking, but still have bad breath, then you need to see your dentist or GP for advice.      

Q    How can my dentist help?

A    If you do have bad breath, you will need to start a routine for keeping your mouth clean and fresh.  

Regular check-ups will allow your dentist to watch out for any areas where plaque is caught between your teeth. Your dentist or hygienist will be able to clean all those areas that are difficult to reach. They will also be able to show you the best way to clean your teeth and gums, and show you any areas you may be missing, including your tongue.  

Q    Can I prevent bad breath?

A    To keep your breath fresh, you must get rid of any gum disease and tooth decay, and keep your mouth clean and fresh. If you do have bad breath, try keeping a diary of all the foods you eat and list any medicines you are taking. Take this diary to your dentist who may be able to suggest ways to solve the problem.

•    Brush your teeth and gums for two minutes, twice a day with fluoride toothpaste. 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.  Don’t forget to clean your tongue as well.  

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

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

•    Floss your teeth – brushing alone only cleans up to about 60 percent of the surface of your teeth. There are other products you can buy to clean between your teeth (they are called ‘interdental brushes’).

•    Use a mouthwash – some contain antibacterial agents that could kill bacteria that make your breath smell unpleasant. If you continue to suffer from bad breath visit your dentist or hygienist to make sure that the mouthwash is not masking a more serious underlying problem.

•    Chew sugar-free gum – it stimulates saliva and stops your mouth drying out. A dry mouth can lead to bad breath.    

Q    Will mouthwash help?

A    Most mouthwashes only disguise bad breath for a short time. So if you find that you are using a mouthwash all the time, talk to your dentist. Some mouthwashes that are recommended for gum disease can cause tooth staining if you use them for a long time. It is important to read the manufacturer’s instructions or ask your dentist about how to use them.

Q    How can I prevent bad breath if I wear dentures?

A    Take them out at night to give your mouth a chance to rest and clean them twice a day.  Clean them thoroughly with soap and lukewarm water, a denture cream or a denture-cleaning tablet. Use a denture brush kept just for the purpose.  Remember to clean the surfaces that fit against your gums and palate. This will make sure your dentures are always fresh and clean, and avoid the plaque build-up on the denture that may cause bad breath.  

Q    How can I tell someone they have bad breath?

A    The chances are we all know someone who has bad breath, but very few people feel brave enough to discuss the problem. It is obviously a very delicate matter to tell someone they have bad breath. There is always the risk that they will be offended or embarrassed and may never speak to you again! However, bad breath may be the result of any number of problems. Once the person knows they have bad breath, they can deal with whatever is causing it. You could try talking to their partner or a family member, as the bad breath may be caused by a medical condition which is already being treated.

You may like to leave this leaflet where the person in question is likely to see it.  Or you could try a more subtle approach, for instance asking if the person has been eating garlic lately!

Caring for my teeth - How do I keep my teeth and gums healthy?

Q Why are my teeth so important?

A Your teeth vary in shape and size depending on their position within your mouth. These differences allow the teeth to do many different jobs.

Teeth help us to chew and digest food. They help us to talk, and to pronounce different sounds clearly. Finally, teeth help to give our face its shape.

A healthy smile can be a great asset and because this is so important, it makes sense to give your teeth the best care possible.

Q What can go wrong?

A Tooth decay can be painful and lead to fillings, crowns or inlays. If tooth decay is not treated, the nerve of the tooth can become infected and die, causing an abscess. This may then need root canal treatment or even extraction.

It is very important that you keep up a good routine to keep your teeth and gums healthy at home. Gum disease is the largest cause of tooth loss in adults. Gum disease is a preventable condition and can be treated and kept under control with regular cleaning sessions and check-ups, preventing further problems. If teeth are lost, it may be necessary to fill the gaps with bridges, dentures or implants.

Q How do I keep my teeth and gums healthy?

A It is easy to get your mouth clean and healthy, and keep it that way. A simple routine of brushing twice a day with a fluoride toothpaste and cleaning between the teeth, good eating habits, having sugary food and drinks less often and regular dental check-ups can help prevent most dental problems.

Although most people brush regularly, many don’t clean between their teeth and some people don’t have regular dental check-ups. A few small changes in your daily routine can make a big difference in the long run.

Your dentist or dental hygienist can remove any build-up of plaque or tartar on your teeth and treat any gum disease that has already appeared. But daily dental care is up to you, and the main weapons are the toothbrush and interdental cleaning. (Cleaning between the teeth)

Q What is plaque?

A Plaque is a thin, sticky film of bacteria that constantly forms on your gums and teeth.

Q How can plaque cause decay?

A When you eat foods containing sugars and starches, the bacteria in plaque produce acids, which attack tooth enamel. The stickiness of the plaque keeps these acids in contact with teeth. After constant acid attacks, the enamel covering the tooth breaks down forming a hole or cavity.

Q How can plaque cause gum disease?

A If plaque is not removed by brushing it can harden into something called calculus another name for it is ‘tartar’. As calculus forms near the gumline, the plaque underneath releases poisons causing the gums to become irritated and inflamed. The gums begin to pull away from the teeth and the gaps become infected. If gum disease is not treated promptly, the bone supporting the teeth is destroyed and healthy teeth can become loose and fall out. Gum disease is the biggest cause of tooth loss in adults and can eventually lead to a need for dentures, bridges or implants.

Q How can I prevent gum disease?

A It is important to remove plaque and food debris from around your teeth as this will stop your gums from swelling and becoming infected and sore. If you leave plaque on your teeth it can harden into tartar, which can only be removed by the dentist or hygienist. It is important to have regular appointments so that your teeth can have a thorough cleaning if they need it.

Q How do I know if I have gum disease?

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

Q Why is brushing important?

A Daily brushing of your teeth and gums and cleaning between your teeth is important because it removes plaque. If the plaque isn’t removed, it continues to build up, feeding on the food debris left behind and causing tooth decay and gum disease.

Q Which type of toothbrush should I use?

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

You can now buy more specialised toothbrushes. For instance, people with sensitive teeth can now use ultra soft bristled brushes. There are also smaller headed toothbrushes for those people with crooked or irregular teeth.

Some people find it difficult to hold a toothbrush, for example because they have Parkinson’s disease or a physical disability. There are now toothbrushes, which have large handles and angled heads to make them easier to use.

Q How do electric toothbrushes work?

A An electric brush often has a rotating or vibrating head, which provides a large amount of cleaning action with very little movement needed from the user, although you do need to position the brush correctly.

Q Do electric toothbrushes clean better?

A Tests have proved that electric toothbrushes are more effective at removing plaque. Those with heads that rotate in both directions (‘oscillating’ heads) are the most effective. They are particularly useful for people with limited movement, such as disabled or elderly people, who often find that using a manual toothbrush does not allow them to clean thoroughly.

Electric or battery-operated toothbrushes can also be better for children as they may be more inclined to brush regularly because of the novelty of using an electric toothbrush. Discuss the idea with your dentist or hygienist to find out if you would benefit from using an electric toothbrush.

Q How should I brush?

A Brushing removes plaque and food particles from the inner, outer and biting surfaces of your teeth.

Here is one method of removing plaque:

1. Place the head of your toothbrush against your teeth, then tilt the bristle tips to a 45 degree angle against the gumline. Move the brush in small circular movements, several times, on all the surfaces of every tooth.
2. Brush the outer surfaces of each tooth, upper and lower, keeping the bristles angled against the gumline.
3. Use the same method on the inside surfaces of all your teeth.
4. Brush the biting surfaces of the teeth.
5. To clean the inside surfaces of the front teeth, tilt the brush vertically and make several small circular strokes with the front part of the brush.
6. Brushing your tongue will help freshen your breath and will clean your mouth by removing bacteria.

Q How do I know if I have removed all the plaque?

A Plaque can be stained with special dye painted onto your teeth with a cotton bud or with special disclosing tablets which you can get from the dentist. The stain is harmless and will show any areas of your mouth which need better brushing. Look particularly where your teeth and gums meet. Further brushing will remove the stained plaque.

Q How often should I brush my teeth?

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

Q How often should I change my toothbrush?

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

Q Should I use a fluoride toothpaste?

A Yes. Fluoride helps to strengthen and protect teeth, which can reduce tooth decay in adults and children.

Q What sort of toothpaste should I use?

A As well as regular family toothpastes, there are many specialist toothpastes. These include tartar control for people who are prone to tartar build-up, and ones for people with sensitive teeth. Total care toothpastes include ingredients to help fight gum disease, freshen breath and help reduce plaque build-up. Whitening toothpastes are good at removing staining, but are not strong enough to change the natural shade of the teeth.

All children up to three years old, should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). After three years old, they should use a toothpaste that contains 1350ppm -1500ppm.

Some children’s toothpastes only have about half the fluoride that adult toothpastes have. They only give limited protection for the teeth. If your children are under 7 you should keep an eye on them when they brush their teeth and encourage them not to swallow the toothpaste.

To have a clean and healthy mouth you need to use the correct dental care products. Ask your dentist or hygienist to tell you the options and give their recommendations

Q How much toothpaste should I use?

A You do not need to cover the head of your brush in toothpaste. A pea-sized amount is enough. Children should use a pea-sized smear of toothpaste.

Q How should I clean between my teeth?

A You can clean between your teeth with dental floss, interdental brushes, or tape. Dental tape is thicker than floss and many people find it easier to use. Flossing removes plaque and food particles from between your teeth and under the gumline, areas a toothbrush can’t reach. You should clean between your teeth at least once a day. Your dentist or hygienist can show you proper flossing techniques.

The following suggestions may help:

1. Break off about 18 inches of floss, and wind most of it around one of your middle fingers. Wind the remaining floss around the same finger of the other hand. As you use the floss, you will take up the used section with this finger.
2. Hold the floss tightly between your thumb and forefingers, with about an inch of floss between them, leaving no slack. Use a gentle ‘rocking’ motion to guide the floss between your teeth. Do not jerk the floss or snap the floss into the gums.
3. When the floss reaches the gumline, curve it into a C-shape against one tooth until you feel resistance.
4. Hold the floss against the tooth. Gently scrape the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth
5. Don’t forget the back of your last tooth.

When flossing, keep to a regular pattern. Start at the top and work from left to right, then move to the bottom and again work from the left to right. This way you’re less likely to miss any teeth. At first it also helps to look in the mirror.

It is also very important to clean around the edges of any crowns, bridges or implants. This can be difficult to do effectively using traditional floss and there are now specialist flosses to do the job thoroughly (such as super floss and specialist floss threaders). Ask your dentist or hygienist about on how to use these properly and which method you should use.

Q Should my gums bleed when I floss?

A Your gums may bleed or be sore for the first few days that you floss. This should stop once the plaque is broken up and your oral hygiene has improved. If the bleeding does not stop, tell your dentist. It may be that you are not flossing correctly or your teeth and gums need a more thorough cleaning by your dentist or hygienist.

Q What do I do if I have difficulty using floss?

A You can use a floss holder or an interdental cleaning aid. Interdental cleaning aids include woodsticks or small interdental brushes used to remove plaque from between the teeth. Your dentist or hygienist can explain how to use these properly.

Q Are oral irrigators useful?

A Oral irrigation devices use a stream of water to remove food particles from around the teeth. These can be particularly helpful for people wearing orthodontic appliances or fixed bridges where it is difficult to clean.

Q Should I use a mouthwash?

A Mouthwashes are mainly used to freshen breath. If you have to keep using a breath freshener to hide any bad breath, you should see your dentist. Bad breath can be a sign of unhealthy teeth and gums or of poor general health.

A fluoride mouthwash can help prevent tooth decay. Your dentist may recommend an antibacterial mouthwash to help control plaque and reduce gingivitis (gum disease).

Q Can my diet help?

A Many people think that it is a high level of sugar in your diet that causes decay, but this is not so. It is how often you have sugar in your diet, not the amount that causes problems. It takes an average of 40 minutes for the mouth to neutralise the acid caused by eating and drinking sugar. It is therefore important to limit the number of attacks by keeping sugary foods and drinks to mealtimes.

Q What do I do if I have dentures?

A It is just as important to clean dentures, as it is to clean your natural teeth. Food can become caught around the edges of dentures and clasps, and can rot if not cleaned thoroughly.

You should keep a separate toothbrush for cleaning your dentures. The general rule is: brush, soak, brush. Clean your dentures over a bowl of water in case you drop them. Brush your dentures before soaking, to help remove any food debris. Soak the dentures in a specialist cleaner for a short time and then brush the dentures again – as you would your natural teeth. Make sure you clean all of the surfaces of the dentures, including the surface which comes into contact with your gums. If you notice a build-up of stains or scale, have your denture cleaned by your dentist or hygienist.

Most dentists still recommend a small to medium-headed toothbrush.

Q I have implants, do I have to do anything special?

A Your dentist or oral surgeon will tell you how to care for your implants after surgery. It is very important to make sure you clean them regularly and thoroughly as instructed to prevent gum disease and possible infection.

Q Why should I visit the dentist regularly?

A Prevention is always better than cure. If you visit your dentist regularly, you will need less treatment and your dentist will spot any problems earlier, making any treatment easier.

The last word

Good dental health begins with you. By following this simple routine, you can keep your mouth clean and healthy:

• Brush your teeth for two minutes, twice a day using fluoride toothpaste.
• Use a small to medium size toothbrush.
• Use a toothbrush with soft to medium multi-tufted, round-ended nylon bristles.
• Use small circular movements to clean your teeth.
• Change your toothbrush regularly, every 3 months.
• Clean between your teeth using dental floss, wood sticks or Interdental brushes.
• Have sugary drinks and foods less often.
• Visit your dentist regularly, as often as they recommend.

A As well as regular family toothpastes, there are many specialist toothpastes. These include tartar control for people who are prone to tartar build-up, and ones for people with sensitive teeth. Total care toothpastes include ingredients to help fight gum disease, freshen breath and help reduce plaque build-up. Whitening toothpastes are good at removing staining, but are not strong enough to change the natural shade of the teeth.

Childrens teeth - How should I clean my child’s teeth?

Tell me about Children’s teeth

Q When should I take my child to the dentist?

A It is recommended that children go to the dentist with their parents as soon as possible. You should then take them regularly, as often as your dentist recommends. This will let them get used to the noises, smells and surroundings and prepare them for future visits. The earlier these visits begin, the more relaxed the child will be.

Q When will my child’s teeth come through?

A First or ‘baby’ teeth have usually developed before your child is born and will start to come through at around 6 months. All 20 baby teeth should be through by the age of two-and-a-half. (For more information, see our Tell me about Dental Care for Mother and Baby leaflet.)

The first permanent ‘adult’ molars (back teeth) will appear at about 6 years, behind the baby teeth and before the first teeth start to fall out at about 6 to 7. The adult teeth will then replace the baby teeth. It is usually the lower front teeth that are lost first, followed by the upper front teeth shortly after. All adult teeth should be in place by the age of 13, except the wisdom teeth. These may come through at any time between 18 and 25 years of age.

All children are different and develop at different rates. The diagram to the right gives an idea of where the adult teeth come through.

Q How should I clean my child’s teeth?

A Cleaning your child’s teeth should be part of their daily hygiene routine.

• You may find it easier to stand or sit behind your child, cradling their chin in your hand so you can reach their top and bottom teeth more easily.
• When the first teeth start to come through, try using a children’s toothbrush with a small smear of toothpaste.
• It is important to supervise your child’s brushing until they are at least seven.
• Once all the teeth have come through, use a small-headed soft toothbrush in small circular movements and try to concentrate on one section at a time.
• Don’t forget to brush gently behind the teeth and onto the gums.
• If possible make tooth brushing a routine – preferably in the morning, and last thing before your child goes to bed.
• Remember to encourage your child, as praise will often get results!

Q Should I use fluoride toothpaste?

A Fluoride comes from a number of different sources including toothpaste, specific fluoride applications and perhaps the drinking water in your area. These can all help to prevent tooth decay. If you are unsure about using fluoride toothpaste ask your dentist, health visitor or health authority. All children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). After three years old, they should use a toothpaste that contains 1350ppm to 1500ppm.

You can check the level of fluoride on the packaging of the toothpaste. You should supervise your children’s brushing up to the age of 7, and make sure they spit out the toothpaste and don’t swallow any if possible.

Q What sort of brush should I use?

A There are many different types of children’s toothbrushes. These include brightly coloured brushes, ones that change colour, ones with favourite characters on the handle, and some with a timer. These all encourage children to brush their teeth. The most important point is to use a small-headed toothbrush with soft, nylon bristles, suitable for the age of your child.

Q What could cause my child to have toothache?

A Toothache is painful and upsetting, especially in children, and the main cause is still tooth decay. This is due to too much sugar and acid, too often, in the diet.

Teething is another problem which starts at around 6 months and can continue as all the baby teeth start to come through. If your child needs pain relief, make sure you choose a sugar-free medicine. Remember to check with the doctor or pharmacist that you are being prescribed sugar-free medicines at all times. If the pain continues then contact your dentist for an appointment.

Q How can I prevent tooth decay in my child?

A The main cause of tooth decay is not the amount of sugar and acid in the diet, but how often it is eaten or drunk. The more often your child has sugary or acidic foods or drinks, the more likely they are to have decay. It is therefore important to keep sugary and acidic foods to mealtimes only. If you want to give your child a snack, try to stick to vegetables, fruit and cheese. Try to limit dried fruit as it is high in sugar and can stick to the teeth.

It is also worth remembering that some processed baby foods contain quite a lot of sugar. Try checking the list of ingredients: the higher up the list sugar is, the more there is in the product. Sometimes, on labels, sugar is called fructose, glucose, lactose or sucrose.

Thorough brushing for two minutes, twice a day, particularly last thing at night, will help to prevent tooth decay.

Q What if my child is very nervous about going to the dentist?

A Children can sense fear in their parents, so it is important not to let your child feel that a visit to the dentist is something to be worried about. Try to be supportive if your child needs to have any dental treatment. If you have any fears of your own about going to the dentist, don’t discuss them in front of your child.

Regular visits to the dentist are essential in helping your child to get used to the surroundings and what goes on there. A child can be much more anxious if it is their first visit to a dental practice. Pain and distress can happen at any time and it is important to prepare your child with regular visits.

Dental care for mother and baby - Do I need to see my dentist during my pregnancy?

Q Do I need to see my dentist during my pregnancy?

A Yes. Because of hormone changes during pregnancy, some women’s dental health needs more care during this time. For example, you may notice that your gums appear to bleed more easily.

Q Why are my gums bleeding?

A You may notice that your gums become sore and swollen during pregnancy, and they may bleed. This is due to hormone changes in your body. This means that you must keep your teeth and gums clean and visit your dentist regularly. You may also need appointments with the dental hygienist for thorough cleaning, and advice on caring for your teeth at home.

Q Is dental treatment safe during pregnancy?

A Yes. There should be no problems with routine treatment. If you are not sure what your treatment would involve, talk about all the options with your dentist. The Department of Health advises that you do not have amalgam fillings replaced until after your baby is born.

Q What if I need dental x-rays?

A As a general rule, dentists prefer to avoid dental x-rays during pregnancy if possible. However, if you need root canal treatment you may need to have an x-ray.

Q Will pregnancy cause damage to my teeth?

A There is no truth in the rumours about pregnancy causing tooth problems through a lack of calcium, or that you will lose one tooth for each child.

Q What about smoking and alcohol in pregnancy?

A Smoking and drinking in pregnancy can lead to an underweight baby and also affect your unborn baby’s dental health. An underweight baby has a greater risk of having poor teeth because of the tooth enamel not being formed properly. It is worth remembering that the adult teeth are already growing in the jaws below the baby teeth when your baby is born. So some babies whose mothers smoke and drink in pregnancy will have badly formed adult teeth too.

Q What about my diet during pregnancy?

A When you are pregnant you must have a healthy, balanced diet that has all the vitamins and minerals you and your baby need.

You need to have a good diet so that your baby’s teeth can develop. Calcium in particular is important to produce strong bones and healthy teeth. Calcium is in milk, cheese and other dairy products.
Women who suffer from morning sickness may want to eat ‘little and often’. If you are often sick, rinse your mouth afterwards with plain water to prevent the acid in your vomit attacking your teeth. Try to avoid sugary and acidic foods and drinks between meals. This will protect your teeth against decay.

Q When will my baby’s teeth appear?

A Your baby should start teething at around 6 months old and will continue until all 20 baby teeth come through. At around 6 years old, the adult teeth will begin to appear. This will continue until all the adult teeth, except the wisdom teeth, have come through at around 14 years old.

For more information, please see our ‘Tell me about’ leaflet Children’s teeth.

Q Is teething painful?

A Most children do suffer some teething pains. Babies may have a high temperature when they are teething and their cheeks may look red and be warm to the touch.

There are special teething gels that you can use to help reduce the pain. There are some that contain a mild analgesic (painkiller). You can apply the gel using your finger, and gently massage it onto your baby’s gums.

Teething rings can also help to soothe your baby. Certain teething rings can be cooled in the fridge, which may help. But, as teething pains can vary, it is best to check with your dentist or health visitor

Q When should I take my baby to the dentist for the first time?

A It is best to discuss this with your dentist first, but you could take your baby to your own routine check-ups. This can help the baby to get used to the surroundings. Your dentist will be able to offer advice and prescribe medicines for teething pains, and will be happy to answer any questions you may have. The baby’s own check-ups can start any time from about 6 months or from when the teeth start to appear.

Q Does breast feeding affect my baby’s teeth?

A Breast milk is the best food for babies, and it is recommended that you just give your baby breast milk during the first six months of its life.

At six months old, babies can start eating some solid foods. You should still keep breast feeding, or give breast milk substitutes (or both), after the first six months.

There needs to be more research to see whether, in some cases, the natural sugars in breast milk cause tooth decay in babies. However, it is widely accepted that breast milk is the best food for your baby. If you keep your baby’s teeth clean, tooth decay is unlikely to be a problem.

Q What about bottle feeding?

A When feeding with a bottle, you must sterilize the bottle properly. Some breast milk substitutes do contain sugar and you should clean your baby’s teeth after the last feed. Try to leave an hour after the feed before cleaning your baby’s teeth. Never add sugar or put sugary drinks into the bottle. Milk and water are the best drinks for teeth. Bottle feeding with drinks containing sugar can lead to ‘bottle caries’ (tooth decay). A baby is not born with a sweet tooth and will only have a taste for sugar if it is given it at an early age.

Q When should I stop bottle feeding?

A Early weaning from the bottle can help stop your baby from developing dental problems. Try to get your baby to drink milk or water from a special cup by the time they are about 6 months old, or when they are able to sit up and can hold things on their own.

Q What solid foods are better for my baby?

A Savoury foods such as cheese, pasta and vegetables are better than sweet foods. Food that doesn’t contain sugar is better for your baby’s teeth. Ask your health visitor for more advice about a balanced diet for your baby.

If your child has a drink in between meals it is important to give them only water or milk instead of sugary or acidic drinks, which can cause decay.

Q Will my baby need fluoride supplements?

A Fluoride does help to strengthen teeth. However, as fluoride is naturally found in some water supplies, it is important to ask your dentist whether your baby needs supplements. If so, supplements can start at about 6 months.

Q When should I start cleaning my baby’s teeth?

A Babies are obviously not able to clean their own teeth, and children will need help to make sure that they clean them properly until they are about 7 years old. As soon as teething has started you should start cleaning your child’s teeth.

Q How should I clean my baby’s teeth?

A As soon as the first baby teeth begin to appear you should start to clean them.

At first you may find it easier to use a piece of clean gauze or cloth wrapped around your forefinger. As more teeth appear, you will need to use a baby toothbrush.

Use a smear of fluoride toothpaste and gently massage it around the teeth and gums.

It can be easier to clean their teeth if you cradle your baby’s head in your arms in front of you.

As the child gets older it may be difficult to do it this way, but you can gradually give more responsibility for cleaning their teeth to the child. It is important to clean teeth twice a day with a toothpaste that contains at least 1000ppm (parts per million) of fluoride. After 3 years old, use a toothpaste that contains 1350ppm to 1500ppm.

Check with your dentist or health visitor if you are unsure about how to look after your baby’s teeth.

Q What if my baby sucks its thumb or needs a dummy?

A If you can, avoid using a dummy and discourage thumb sucking. These can both eventually cause problems with how the teeth grow and develop. And this may need treatment with a brace when the child gets older.

If your baby needs a dummy, there are ‘orthodontic’ soothers or dummies that reduce the risk of these problems. So if your baby does want to use a dummy, make sure you choose an orthodontic one. Look for products that carry the British Dental Health Foundation approved logo.

Never dip your baby’s dummy or teething ring into fruit syrups, honey, fruit juices or anything containing sugars, particularly at bedtime. The harmful sugars and acids can attack your baby’s newly formed teeth and cause decay.

Q What if my baby damages a tooth?

A If your child damages a tooth, contact your dentist straight away. A damaged tooth will often discolour over time.

If the damage happens outside normal opening hours, your dentist will have emergency cover. Phone the surgery anyway to find out who to call.

Dental care for older people - What particular problems may older people have?

Q Am I certain to lose my teeth?

A No. With the right home care and help from your dentist and hygienist, it is possible to keep your teeth for life. Gum disease and tooth decay can be prevented whatever your age.

Q What particular problems may older people have?

A Your gums may recede (shrink back) as you get older, and your teeth may become a little more sensitive as a result. Your dentist or hygienist will be able to show you the best brushing methods to keep any gum problems under control, and may suggest a mouthwash to deal with the sensitivity.

Normal cleaning may become rather more difficult if you have problems moving your hands or arms, or if your eyesight is less than perfect. Again, you can get help and advice on the best aids to use. A magnifying mirror and a good light are often helpful.

If you have lost some teeth, and have bridges or dentures, you may have particular cleaning needs and difficulties. Your dentist or hygienist can help you with these.

Some people take regular medication which makes their mouths dry. Saliva helps to protect your teeth against decay, so if you have less saliva than usual ask your dentist for advice. Or you can get special products, including artificial saliva, over the counter in most chemists.

Q Should I expect to have problems with my gums?

A Gum problems are caused by a build-up of bacteria called ‘plaque’, which forms constantly on your teeth and gums. It is important to remove this plaque in order to avoid gum inflammation. If the plaque is not removed, the gum inflammation will, in time, affect the bone under the gums. This bone supports the tooth roots, so your teeth may gradually become loose.

Q How do I know if I have gum disease?

A As it is often painless, many people may not know they have gum disease. Some common signs are: gums that bleed when brushed; teeth that are loose; receding gums and bad breath. Not everyone has all these signs. You may have only one.

Q Can I still get tooth decay?

A Yes. The same plaque which causes gum inflammation can cause decay, particularly when combined with sugary foods and drinks. There is a particular risk of decay at the gum edge when the gum has receded, as the ‘neck’ of the tooth is not protected by enamel.

Q How can I prevent gum disease and tooth decay?

A • Thoroughly remove plaque from your teeth (and dentures, if you
have them) at least twice a day.
• Use fluoride toothpaste. There are also many special toothpastes
on the market, including tartar-control and total-care toothpastes.
• You should clean in between your teeth at least once a day using
interdental products that suit you.
• Cut down on how often you have food and drinks containing sugar.
• Visit your dentist and hygienist regularly.

Q What do I need to clean my teeth properly?

A You need a small-headed, medium-textured toothbrush and a fluoride toothpaste. To help clean between your teeth you can use an ‘interspace brush’, tape, woodsticks or floss. If you have arthritis you may find it difficult to grip a toothbrush handle, but you can get handle adapters.

Electric toothbrushes are also ideal for people with limited movement. The handles are thicker and easier to hold and the oscillating head does most of the work. There are many products available, and your dentist or hygienist can help you decide which are best for you.

Q How do I know if I have removed all the plaque?

A Plaque can be stained with food dye painted on your teeth with a cotton bud, or with special disclosing tablets you can get from the dentist.

This stain is harmless and will show any areas of your mouth which need closer attention. Look particularly where the teeth and gums meet. A further brushing will remove the stained plaque.

Q What if I need dentures?

A Dentures replace lost or missing teeth so that you can enjoy a healthy diet and smile with confidence. For more information on dentures and how to take care of them, see our leaflet ‘Tell me about dentures’.

Q What causes mouth ulcers?

A Ulcers can be caused by broken teeth, poorly fitting dentures or sharp pieces of food. Once the cause is removed, ulcers should heal within 3 weeks. If you notice an ulcer which does not heal, see your dentist promptly. Many serious conditions, such as mouth cancer, can be better treated if diagnosed early at a routine check-up.

Q What if somebody is housebound?

A Contact your local Primary Care Trust to find out about dentists who will make home visits.

Dental care for people with special needs - Who can provide treatment?

Q Who needs special care dentistry?

A Everyone needs to be able to have dental care. However, some people need special facilities or services to have this care provided. People with physical disabilities may have problems getting into the surgery or even into the dental chair. People with learning disabilities may become overanxious at the thought of going to the dentist or may need extra reassurance. People suffering from severe medical problems may need extra precautions or care. Dentists are able to take account of all these things when providing dental care.

Q Who can provide treatment?

A Many dentists will happily treat people with special dental needs in their surgery. However, for some people access is difficult and so other arrangements should be made by the practice, for example home visits and special health centres. Some people need a specialist service. The local Community Dental Service offers treatment for people with learning difficulties or a medical disability. This includes anybody who has a medical condition that needs extra time, care or special facilities. Some hospitals or health centres will also help people needing specialist care and may be able to offer possible treatment alternatives, such as sedation or general anaesthetic.

Q How do I get specialist care?

A Usually the patient’s dentist or doctor is responsible for referring them to the clinic best suited to the patient’ needs. Some Community Dental Services allow patients to refer themselves. Normally, the dentist or doctor will write a referral letter and send it, with any hospital letters and x-rays, to give the Community Dental Officer an idea of the patient’s dental history.

Q What does the dentist need to know?

A The dentist will need to know the patient’s medical history and about any medicines they are taking. This includes any inhalers and regularly prescribed medicines from the doctor. The dentist will also need to know the name of the family doctor, hospital consultant, and about any recent operations and allergies the patient may have.

It is also helpful if the dental team know about any concerns or anxieties the patient has, so that they can help to make the patient feel at ease. This information can be given by the patient’s parents or carer. However, some patients do prefer to communicate directly with the dentist. Some patients may have other special needs, for example, the help of an interpreter or translator, or to have a guide dog. Dentists are prepared for working in these circumstances.

Q When is the best time to be treated?

A Some patients prefer to be seen at certain times of the day depending
on their needs. For instance, evening appointments may not be
suitable for those patients that tire easily or may spend the day worrying. Some patients rely heavily on routine and may need regular appointments at the same time.

Q How accessible are treatment clinics?

A All practices should offer facilities for wheelchair users, including access to the practice and ground floor surgeries. If wheelchair access is particularly important, contact the surgery and ask if this is something they are prepared for.

Some clinics have specially adapted surgeries for patients with mobility problems.

Q Can treatment be carried out at home?

A Some dentists may offer home or ‘domiciliary’ visits for people who are housebound or have difficulty visiting the surgery. However, treatment options are limited outside the surgery. The receptionist will be able to tell you if home visits are an option and make any relevant appointments.

Q What about children’s dental treatment?

A Children with learning disabilities or other medical conditions may be referred to the Community Dental Service by their doctor, dentist or health visitor. It is important to register children with a dentist at an early age. A low-sugar diet is also important, as they may be more likely to have dental decay due to difficulty in cleaning and through taking medication. Make sure fizzy drinks, and sugary foods and drinks are kept to mealtimes only and are taken in moderation.

Q Why is medication a factor?

A Many patients with disabilities have to rely on medication to keep their condition under control. It is therefore important to ask the GP to prescribe sugar - free medicines, especially syrups.

It is important to tell the dental team about any medication that the patient is taking, in case any further precautions should be taken or the treatment is affected.

Q Is there anything to make toothbrushing easier?

A For some people, manual movement can be a problem, which makes effective cleaning difficult. It is important to reach all the areas of the mouth to clean effectively. A small- to medium-headed toothbrush with soft to medium bristles is usually recommended. There are special handgrips and other adaptations which can be fitted to manual toothbrushes to make them easier to hold. In some cases, electric toothbrushes are recommended for people with mobility problems. They are also helpful to those with learning difficulties as they can be a novelty and therefore encourage toothbrushing. The dentist or dental team will be able to offer advice and practical help on toothbrushing and general mouth care.

Q Is sedation available?

A Intravenous sedation (injection) is an effective way of treating most nervous patients. The drugs given can relax and calm the patient, so treatment can be carried out with dentist and patient still able to talk to each other. There are certain things that affect a patient’s suitability for this type of sedation. These include weight, age and medical condition. This would all be discussed during the consultation and the necessary information given. Usually the patient would need to be referred to a specialist clinic for this treatment.

Q What other help is available?

A Relative Analgesia (RA) can also help patients get through their treatment more easily. Here, nitrous oxide and oxygen gases are breathed in through a nosepiece. It is the safest and simplest form of sedation and is often the one most suitable for both children and people with special needs. However, this is not appropriate for everyone, especially people with limited understanding, cerebral palsy or multiple sclerosis.

In some cases the dental team prefer to use alternative methods of calming the patient. These can include simply talking, visiting the practice to meet staff or even hypnosis. These can all be effective in making the patient less anxious.

Q How often should the dentist be seen?

A It is important to visit the dentist regularly. This would normally be every six months, but some people need to visit less often and others more often. The dentist will be able to tell you.

The dentist may also recommend appointments with a dental hygienist who will clean the teeth and offer advice on how to brush effectively and maintain good oral hygiene. The dentist may also offer advice to carers about the dental care of others. It is very important to build a relationship between the dental team, the patient and their carer, which can help greatly with people who have severe learning difficulties. Short, but regular appointments seem to work better at building trust between patient and dental team than irregular, long appointments.

Q What treatment should be paid for?

A Treatment may be available under the National Health Service or privately, depending on the practice. NHS treatment is free for people getting benefit. If the patient is on a particularly low income, but does not claim any benefits, then they may get help with charges by filling in an HC1 form. You can get these from either the dental practice or doctor’s surgery and you may be able to get help towards dental costs and eye tests among other things. It is also important to ask for a treatment plan and estimate of charges at the time of the check up to avoid confusion with payment.

The Community Dental Service will provide most treatment free of charge. However, charges will be made for any private treatment carried out. In some cases treatment needing laboratory work, such as dentures, bridges, and crowns, will also be charged for.

Denture Cleaning - How often and how should I clean my dentures?

Q How often should I clean my dentures?

A It is important to treat your dentures like you would treat your natural teeth. They should be kept as clean as possible to prevent further tooth loss, inflamed gums, or bacterial and fungal infections. We usually recommend that you clean them thoroughly twice a day, and after eating when necessary.

Q How should I clean them?

A 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. 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.

Q What should I use to clean my dentures?

A There are many different denture-cleaning products. However, most dentists still recommend a small- to medium- headed toothbrush to reach into the awkward corners, or a soft nailbrush, and ordinary soap. Soaking solutions can often help to remove staining and bacteria. We do not recommend that you use these solutions overnight.

Q Is there anything I should avoid?

A It is important not to use any type of bleaching product to clean your dentures. Bleaching can lead to weakening of the denture as well as making it look unsightly. Do not use very hot water to soak the denture. Again, it can weaken the denture causing it to break.

Q What should I do if I have a soft lining?

A Some people have sensitive gums and may need a softer lining made for their dentures. If you have one of these special linings, it is important to check with your dentist before using any cleaning products or fixatives as some products can damage the lining.

Q What if I have a metal denture?

A Some commercial cleaning products can damage metal dentures, so it is important to discuss cleaning options with your dentist if you have these. If your denture has clasps, you need to take particular care when cleaning to avoid damage.

Q Are there any special products I should use?

A There are some specialist products available for cleaning your dentures, including special brushes, cleaning pastes and soaking solutions. However, you should use these carefully and follow the manufacturer’s instructions. If you are not sure which products to use, ask your dentist.

Q Should I remove my dentures at night?

A Most dentists 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 water to prevent any warping or cracking.

Q Can my dentist clean them?

A Some people do build up tartar on their dentures just as they would on their natural teeth. If plaque is not removed properly, it can react with your saliva and harden into tartar. As with your own teeth, you will not be able to remove this tartar completely yourself and eventually it can make the denture uncomfortable and unsightly. Your dentist will be able to remove this tartar using a professional cleaning machine.

Q What can I do about staining?

A Like natural teeth, dentures can pick up staining every day. This is especially true if you smoke, or drink a lot of tea, coffee or red wine. In most cases you should be able to remove this staining with regular cleaning. However, more stubborn stains may take a little more cleaning, which your dentist should be able to help with.

Q Do I still need to see the dentist?

A It is important to visit your dentist regularly even if you don’t have any of your natural teeth. Dentists do not only check teeth, but also the soft parts of the mouth, including the tongue and cheeks. These examinations are just as important, so the dentist can spot any infections, mouth conditions or even mouth cancer at the earliest stages. Your dentist will be able to tell you how often you should visit.

Fluoride - What are the benefits of fluoride?

Q What is fluoride? 

A Fluoride is a natural mineral that is found in many foods and in all drinking water. The amount of fluoride in water varies from area to area.

Q What are the benefits of fluoride?

A Fluoride can greatly help dental health by strengthening the tooth enamel, making it more resistant to tooth decay. It also reduces the amount of acid that the bacteria on your teeth produce.

Children who have fluoride when their teeth are developing tend to have shallower grooves in their teeth, so plaque can be more easily removed. Plaque is a thin, sticky film of bacteria that constantly forms on your teeth.

The addition of fluoride to water has been researched for over 50 years, and water fluoridation has been proven to reduce decay by 40-60%.

Q Where can I find fluoride?

A Fluoride is found naturally in many foods and water supplies, and is also added to some drinking water. Having 0.7 to 1.2 parts of fluoride for every million parts of water (0.7ppm to 1.2ppm) has been shown to have the best effect.

All water contains some fluoride. Your local water supplier can tell you how much fluoride is in your drinking water.

Q Is there enough fluoride in my water supply?

A Possibly. However, only a few places (Hartlepool in the North East of England, and parts of Essex) have enough natural fluoride to benefit dental health. In other places it is added to only around 10% of the UK population's water supply – mainly in the West Midlands and the North East. Your water supplier will be able to tell you whether your water supply has fluoride added. The amount of fluoride added to the water will vary depending on which area you live in.

Fluoride is also naturally present in some foods and drinks, for example fish and tea. Some countries add fluoride to their table salt and milk instead of to the water supplies. One cup of tea can contain between 0.3 milligrams and O.5 milligrams of fluoride, and if you drink it with milk your teeth will also benefit from the calcium. It is best to drink tea without sugar to reduce the risk of tooth decay even more.

Q What about fluoride toothpaste?

A Most toothpastes now contain fluoride, and most people get their fluoride this way. Fluoride toothpaste is very effective in preventing tooth decay. The amount of fluoride in toothpaste is usually enough to lower the level of decay.

In areas where the water supply is fluoridated, fluoride toothpaste gives extra protection.

All children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). After three years old they should use a toothpaste that contains 1350ppm to 1500ppm.

Parents should supervise their children's tooth brushing, and use only a pea-sized smear of fluoride toothpaste until they are about 7 years old.

Q Should people have extra fluoride?

A Children living in poorer areas where the water supplies are not fluoridated can have 5 times more decay than children living in better-off or fluoridated areas. Research suggests that adding fluoride to the water is the best way of reducing these ‘dental inequalities’.

Your dentist or dental hygienist can apply fluorides to your teeth. These come as gels and are more concentrated than ones you can apply yourself, so you do not need them as often. Some adults can benefit from these applications. Fluoride gels can help to reduce root decay – especially for people with ‘dry mouth’.

Some people are more likely to have tooth decay, and the dentist may also advise using fluoride supplements as well as fluoride toothpaste for extra protection. It is very important that you only take fluoride supplements on the advice of a dentist, and that you use them in the way they say. Supplements are suitable for children from about 3 onwards and can help reduce decay.

Q What are the side effects?

A ‘Dental fluorosis’ is caused by having too much fluoride when the teeth are developing. This can happen when fluoride supplements are taken by children under 7 who live in areas where the water supply is fluoridated. It can also happen when children swallow toothpaste.

Q What is fluorosis?

A In its mildest form, dental fluorosis appears as very fine pearly white lines or flecking on the surface of the teeth. This mild fluorosis can often only be spotted by a dental expert. Severe fluorosis may lead to the enamel being pitted and discoloured.

Fortunately, severe fluorosis is rare in the UK.

Q Is fluoride safe?

A Many reports have been published throughout the world about the pros and cons of fluoride. After many years the scientific conclusion is that fluoride toothpaste and correctly fluoridated water, salt and milk are of great benefit to dental health, help to reduce decay, and cause no harmful side effects to general health. Studies carried out for the government by York University and the Medical Research Council have failed to find any evidence that fluoride added to water causes harmful side effects.

Opponents of fluoridation claim they have firm evidence that fluoride added to water is harmful. However, scientific analysis has not supported their claims.

Worldwide, over 300 million people drink fluoridated water supplies. Many millions more regularly use fluoridated toothpaste. In America for example, well over half of the population have fluoridated water supplies. This has led to improved levels of dental health which in turn benefits general health.

'York Report', October (2000)
'Oral Health Status and Fluoride Use' WHO Expert Committee (1994)
'Water Fluoridation and Health' Medical Research Council (2002)
'All methods of delivering fluoride' Dental Hygiene 57 (5) 37-47 May (1983)
British Fluoridation Society

My fear of the dentist - Why am I afraid of the dentist?

Q Why am I afraid of the dentist?

A Being ‘afraid of the dentist’ may mean different things to different people. It will probably help if you work out just what it is that worries you most.

Maybe the sounds and smells bring back memories of bad experiences as a child, or the thought that having treatment will hurt.

The good news is that more and more dentists now understand their patients’ fears, and with a combination of kindness and gentleness can do a great deal to make dental treatment an acceptable, normal part of life.

Q I have been scared of the dentist for a while – what is it like now?

A Dental techniques have improved so much over the last few years, that modern dental treatment can now be completely painless. Despite this, most people still feel a little nervous at the thought of going to the dentist.

If you have not been to see a dentist for some time, you will probably find that things have improved a lot since your last visit. The general attitude is likely to be more relaxed, the dental techniques and safety procedures will be much better, and the equipment will be more up to date.

Q How do I choose a dentist?

A Many dentists today offer some form of treatment for nervous patients. The first fear to deal with is the fear of admitting to other people that you are afraid of dental treatment. If you can discuss it with your friends or colleagues you are likely to find someone else who has similar problems, and who may be able to recommend a dentist to you. A dentist who is personally recommended by another nervous person is usually a very good choice.

Q Do some practices specialise in treating nervous patients?

A Yes. This means that they should be used to dealing with nervous patients regularly.

As someone who is nervous about dental treatment, you need to be looked after by a dental practice that will take special care of you. You may need to travel some distance, but it will be worth the effort when you are no longer afraid.

Q I haven’t been to the dentist in a long time – will I need a lot of treatment?

A Years ago it was normal for people to need fillings every time they went to their dentist, but things have changed for the better now. With the help of your dentist and hygienist, the aim now is for healthy teeth and mouths that stay healthy. Using a fluoride toothpaste will help to strengthen your teeth and prevent decay. Therefore, you may be surprised at how little treatment you need.

Teeth are for life and can last a lifetime if they are looked after properly. If you can get your mouth into good shape, with the help of the dentist and dental hygienist, you should need less treatment and there will be less for the dentist to do in the future.

It is important to keep up your regular visits to the dentist, not only to monitor tooth decay, but also to help prevent gum disease.

Once your mouth is healthy, your visits to the practice will often just be easy sessions for checking and cleaning.

Q How do I start?

A It may be helpful for you to see the practice before you arrange an appointment. Call in to speak to the receptionist, and see what the atmosphere is like. Do the other people there look cheerful and happy? Does it give you a feeling of confidence? Perhaps you could meet the dentist and have a look around the practice as a visitor.

Q What will happen at the first appointment?

A Your first appointment should just be for a consultation. See it as an opportunity for you to ‘interview’ the dentist, receptionist and dental nurse, and have a chat about what to expect next.

Q Should I tell the dental team that I am nervous?

A Make sure that the practice knows you are nervous, so that they can help you.

Tell your dentist what it is that you particularly dislike about dental treatment. If you think you know the reason, tell your dentist what may have caused your fear.

Q I am afraid of injections – what can I do?

A Many people are scared of the local anaesthetic injection needed to numb the tooth. Again, be sure to tell the dentist that this is something that bothers you. There are anaesthetic gels that can be applied to the area of the gum to be injected. This gel numbs the gum so that you cannot feel the needle.

Q What is the best time of day to visit the dentist?

A Book appointments at a time of day when you feel at your best, and when you do not have any other commitments to worry about. Allow plenty of time so that you can get to the practice in a relaxed frame of mind – arriving in a rush will only make you feel more nervous. It is usually best to have something to eat before you go, so there is no chance of you feeling faint while you are in the chair

Q Can I take a friend with me?

A People often feel better if a friend comes with them to the practice. Think about what would suit you best. A reassuring and capable friend is often a great help.

Q Can I take anything with me?

A Listening to music is also a good way to help you relax. Some practices have it playing in the treatment rooms, but the best way is to take a personal stereo so that you can have your own choice of music.

Q I have gone for a check-up, what do I do next?

A Take things one step at a time. Discuss any proposed treatment with your dentist, and decide what you feel you can cope with. This may be no more than an examination with a dental mirror first. If you succeed with that, you may feel you could have your teeth polished next, possibly by a dental hygienist. Don’t be afraid to say when you have had enough - there is usually no reason to hurry through the dental treatment.

Q What else can I do to help me relax during treatment?

A Thinking hard about something other than the treatment is a good distraction. Try to solve a puzzle in your mind, or perhaps work out a plan for each day of next year’s holiday. Or give yourself something tricky to do - try to wiggle each toe in turn, without moving any of the others.

Q Can I ask the dentist to stop if I need to?

A Agree with your dentist a sign that means ‘stop now - I need a break’ before the treatment is started. Usually you can just raise your hand, and the treatment can be stopped for a few minutes until you are ready to start again. Once you know that you can control the situation you will feel more confident.

Q What other techniques are available to help?

A There are various methods available, and it will depend which methods the practice is experienced with and which you feel would help you most. Relaxation techniques can often be learned from specialist teachers or at home and can be very useful in controlling anxiety. (See our leaflet ‘Tell Me About Relaxation & Sedation’)

Many practices offer several types of sedation, including inhalation (‘gas and air’) and intravenous (by injection).

Other practices offer hypnosis and relaxation techniques. You would learn these techniques, which would allow you to gain control over your feelings of distress or fear.

Counselling is another way of dealing with feelings of anxiety. This is usually carried out by a member of the practice team, in a room away from the surgery. You would be encouraged to discuss your fears so that they may be dealt with and overcome.

Q Can I go to sleep for treatment?

A General anaesthetics are now only rarely available for routine treatment. If a general anaesthetic is needed, patients are referred to a hospital where the necessary safety equipment is available.

Q Will things get better with time?

A As you get to know and trust your dentist, hygienist and other members of the practice you will find your fears begin to lessen. In time you will gain control over your fears, and dental care can become a normal part of your life.

Q What will it cost me?

A There may be an extra charge for some sedation and relaxation techniques on top of the normal cost of treatment. It is always recommended that you get a written estimate before starting treatment.

Q Who can I talk to?

A There are many organisations that help people suffering from phobias. Most of them also offer help to people nervous of the dentist because it is a very common problem. Contact the British Dental Health Foundation’s Dental Helpline on 0845 063 1188 to discuss your fears and find out about other organisations to contact.

My teeth - What are my teeth for and the best foods and drinks to keep my teeth healthy?

Q What are my teeth for?

A Your teeth do different jobs. They help you to cut up and chew your food when you are eating. They help you to talk and make different sounds. They also give your face its shape and they give you a nice smile.

You have four different types of teeth:

The incisors are the teeth at the very front of your mouth. They are the sharpest and help to cut up your food.

The canines are the pointed teeth either side of your incisors. They help to hold and tear the food.

The pre-molars sit behind your canine teeth. They have a flat chewing surface because they help to crush your food.

The molars are the very back teeth. They are big double teeth and are also flat. They help to chew and grind your food into small pieces ready to swallow.

Q What are the different parts of my teeth?

A Your teeth are fixed to your jawbone in your mouth. They sit in a curved line along your top and bottom jaws. The white part of your tooth that you can see when you smile or open your mouth is called the crown. Some of your tooth is hidden under the skin (gum) in your mouth. This is called the root and you cannot see this in your mouth. The white covering on your tooth is called enamel. Dental enamel is strong and helps to protect the tooth. Dental enamel is the hardest thing in your whole body.

Q When will I get all my teeth?

A Your first set of baby teeth would have appeared through your gums when you were about six months old. You should have had twenty teeth by the time you were about two-and–a-half years old. These teeth began to fall out when you were about six years old to make way for your adult (permanent) teeth.

All your adult teeth should be in your mouth by the time you are about thirteen. You should have twenty-eight adult teeth. When you are between eighteen and twenty-five you may also start to get four more back teeth, at the top and bottom. These are called your ‘wisdom teeth’ as people used to think that you got them when you had knowledge and became wise. This makes the total number of teeth you will have in your mouth thirty-two.

It is important to look after your adult teeth, as you will not get any more. As soon as your teeth appear in your mouth you could get tooth decay if you do not look after them properly.

Q What are plaque and tooth decay?

A Plaque is a creamy, sticky coating of germs (bacteria) that collect on everybody’s teeth every day. The germs won’t harm you, but they can harm your teeth. Tooth decay is caused by acid from the bacteria (plaque acids), which can cause a hole (cavity) in the enamel of your tooth. Tooth decay may make your tooth ache. If this happens you need to see a dentist, who may have to clean the hole and put a filling in the tooth to repair it.

Q What are the best foods and drinks to keep my teeth healthy?

The main cause of tooth decay is the sugar that is in the food and drinks you have. Every time you eat or drink anything sugary your teeth are under attack from the plaque acids for up to one hour. This is because the sugar mixes with the bacteria in the plaque to produce the harmful plaque acids.

This is why it is important to keep sugary foods and drinks to mealtimes only. If you are hungry between meals then you should choose foods that are kind to your teeth and do not have added sugar.

Here are some foods that are kind to your teeth: fresh fruit, raw vegetable pieces, plain popcorn, cheese, breadsticks, plain yoghurt, rice cakes, unsweetened cereal, crumpets, plain bagels, cheese scones and nuts.

When you are thirsty, plain water and plain milk are the kindest drinks for your teeth. If you drink fruit juices you should keep them to mealtimes only and add water to them. It’s best to drink fruit juices and fizzy drinks through a straw to help cut down the number of acid attacks on your teeth.

Q What is the best way to brush my teeth?

A You need to brush your teeth to remove all the plaque and to keep your teeth and gums healthy. It is important to brush your teeth twice a day while the plaque is still soft. Brushing your teeth should be part of your daily routine, just like washing your hands and face and brushing your hair.

• Brush your teeth carefully for two minutes before breakfast and after your last drink before bedtime.

• Choose a toothbrush with a small head and soft bristles.

• Use a smear of toothpaste that contains between 1350 to 1500ppm (parts per million) of fluoride. (Fluoride is a mineral that helps to keep your teeth strong.)

• Use small, round movements. The bristles of the brush should point towards the gum. Don’t forget to brush all the different sides and tops of your teeth.

• Visit your dentist regularly to make sure that your teeth and gums are healthy.

Caring for my brace and my teeth - What products can help me to look after my mouth and brace?

Q How long will I have to wear the brace?

A It really depends on how much work there is to do and how far your teeth need to be moved.

Fixed braces – usually take between 12 and 24 months, but could take longer if the problem is severe.

Removable braces – usually take less time than a fixed brace. However, you might need to wear a removable brace before and after you have finished your treatment with a fixed brace.

Your dentist or orthodontist will be able to give you advice about your brace and teeth. If you don’t do what they say, the brace can take longer to work and the treatment may be unsuccessful. If your brace is damaged or broken this can also delay the treatment.

Q How often should I see the dentist while I am wearing my brace?

A You will need to have your brace adjusted regularly to make sure it is working properly. Usually you will have an appointment roughly every six to eight weeks. It is extremely important that you go to these appointments otherwise the brace will take a lot longer to work.

Q Will my mouth be sore in between visits?

A Your mouth is very sensitive to change and it will take you a few days to get used to wearing your brace. At first, your teeth may feel uncomfortable because of the pressure put onto them by the brace. It may also feel uncomfortable and tight against your teeth after it has been adjusted. Painkillers like ibuprofen can help.

Some parts of the brace may also cause discomfort to your gums and lips, causing sore spots. Your dentist or orthodontist can give you clear wax to place over the part of the brace that is causing discomfort. However, if after a few days any part of your brace is causing continual soreness, you should go back to your dentist or orthodontist.

Q Will I be able to speak normally?

A Sometimes when a brace is fitted, it may affect your speech and cause problems in pronouncing certain words. Lisping may also be a problem at first, but most people soon adapt and quickly begin to speak clearly within a few days.

Q Is there anything I should avoid?

A Nail biting and chewing your pen or pencil can damage or break your brace.

Q Can I do sports while wearing my brace?

A If you have a removable brace then it is best to take it out and put it in a brace case. You can buy these from your dentist, or from most large chemists. If you do remove your brace, it is important to use a mouthguard and then put your brace back in as soon as possible. It is also best to take your brace out if you are swimming. If you have a fixed brace you should wear a special mouthguard for use during contact sports over the brace. Your dentist will be able to make you one.

Q Can I still play musical instruments?

A Braces may affect playing wind instruments, although with practice you should get used to it. If your brace is removable then it is best to remove it and store it safely in a brace case. Put it back in straight after you have finished playing.

Q Can I eat normally?

A Eating the wrong foods can damage or even break your brace. For the first few days, it may be better to keep to soft foods.

Whether you have a removable or a fixed brace you should avoid sticky, chewy and sugary foods. Chewing-gum is not recommended as it can stick to your brace. Avoid hard foods such as whole apples, carrots, French bread and crusty rolls. These foods could break the orthodontic wires and brackets.

At first it is best to cut your food into small pieces and keep to a soft diet. Food may build up in the brackets and in between your teeth and will need careful cleaning to remove it.

Avoid fizzy drinks and natural fruit juices as these are often high in sugar and can be acidic. This can lead to tooth decay and erosion. Fizzy drinks can also stain the orthodontic brackets. If you do drink fizzy drinks, avoid constant sipping of the drink and use a straw. Water and plain milk are the safest drinks.

Q Why should I look after my mouth when I have a brace?

A It is extremely important that you take the time and effort needed to keep your teeth and braces clean. This will help you avoid problems such as dental decay, inflamed gums, and ‘tooth decalcification’. Decalcification is when you lose the mineral calcium from the surface of your teeth, and this may leave white spots on your teeth after the brace is removed.

It is also important to keep having routine dental examinations with your regular dentist while you are having orthodontic treatment. This is to make sure that your teeth and mouth stay healthy.

Q What if I lose or damage my brace?

A If you lose or damage your brace tell your dentist or orthodontist as soon as possible. Do not wait until your next routine appointment because any time you are not wearing your brace, or it is not in the correct position, affects your treatment and makes it more likely that your teeth will go back to their old position. Dentists may charge for lost or broken braces before replacing them.

Q How should I clean my mouth and brace?

A Clean your teeth and the brace thoroughly after each meal. Pay special attention to each individual tooth and the gum line around it.

Q What products can help me to look after my mouth and brace?

Total care toothpastes
These contain a number of active ingredients such as fluoride or tartar control to make them an effective multi-action toothpaste. They help control plaque, dental decay and gum disease while also freshening your breath.

Electric or battery-operated toothbrushes
These can be used, although with care, as long as you can get to all your teeth. Ask your dentist or orthodontist about special small brushes which are suitable for cleaning your teeth when wearing a brace.

Interdental brushes
These can help you clean a fixed brace. They can get in between your teeth and are ideal for cleaning around the brackets of a fixed brace. Your dentist or chemist should stock these.

Floss threaders
You can use these to help you get dental floss under the orthodontic wires to remove trapped food particles.

Disclosing tablets
These contain a harmless dye which stains the dental plaque. This makes it easier to see where the plaque is when you are brushing. This helps you to make sure that you are brushing your teeth properly. Your dentist, chemist or supermarket will stock these.

Fluoride mouthrinses
Using fluoride mouthrinses regularly can help to prevent dental decay and tooth decalcification. You should only use them under the guidance and instruction of your dentist or orthodontist.

Q How do I clean my removable brace?

A Your dentist or orthodontist will be able to show you special techniques for cleaning your brace. It is best to clean your brace over a sink full of water so that it isn’t damaged if you drop it. Keep a separate toothbrush just for cleaning your brace. Use toothpaste to clean it. Gently brush the brace and rinse it thoroughly with fresh water afterwards.

Teenagers teeth - Why is a healthy smile important?

Why is a healthy smile important?

An attractive and healthy smile is important when meeting people and making friends. And it can boost your confidence by making you feel good about yourself.

If you don’t look after your teeth and gums properly you could suffer from a number of different conditions that will make you stand out from the crowd for all the wrong reasons:

•    bad breath
•    stained teeth
•    tooth decay
•    gum disease
•    tooth loss
•    dental erosion

You are what you eat

Why is a healthy diet important for my oral health?

Every time you eat or drink anything sugary, your teeth are under acid attack for up to one hour.  This is because the sugar will react with the bacteria in plaque and produce harmful acids.  Plaque is a build-up of bacteria which forms on your teeth.

It is better to have three meals a day, and no more than two snacks.

What is dental erosion?

Dental erosion is the loss of tooth enamel caused by acid attacks.  Enamel is the hard, protective coating of the tooth.  If it is worn away, the dentine underneath is uncovered and your teeth can look discoloured and become sensitive.

Drink up

Acidic foods and drinks cause dental erosion.

Still water and milk are the best things to drink. Tea without sugar is also good for teeth as it contains fluoride.

Fruit juices are acidic, so only drink them at meal times.  If you want to drink fruit juices between meals, try diluting them with water or drinking them through a straw.  

Snack attacks  

Avoid sugary snacks.  If you need to eat between meals try these foods instead:

•    plain popcorn
•    nuts
•    cheese
•    breadsticks
•    plain yoghurt
•    rice cakes
•    cheese scones
•    unsweetened cereal
•    crumpets
•    plain bagels
•    fresh soup
•    raw vegetable pieces
•    fresh fruit

The social scene

What effects will smoking, alcohol, sex and taking drugs have on my oral health?


Smoking can cause tooth staining, gum disease, tooth loss and – more seriously – mouth cancer. Smoking is also one of the main causes of bad breath.


Alcoholic drinks can also cause mouth cancer. Smoking and drinking at the same time increases the risk even more.

Alcohol can also increase the risk of tooth decay and erosion. Some alcoholic drinks have a lot of sugar in them, and some mixed drinks may contain acids.  So they can cause decay or dental erosion if you drink them often and in large amounts.  

Illegal drugs

Illegal drugs can lead to a range of health problems. Smoking cannabis can have the same effects as smoking tobacco. Other drugs can cause a dry mouth, and increase the risk of erosion, decay, gum disease and bad breath. Drugs can also cause you to grind your teeth, which can cause headaches and other problems.


The human papilloma virus (HPV) is the major cause of cervical cancer and affects the skin that lines the moist areas of the body (such as the mouth).  It can be spread through oral sex.  Practicing safe sex and limiting the number of partners you have may help reduce your chances of contracting HPV.  

You may hear about the option of having the HPV vaccine (this is offered to teenage girls) to help prevent the virus.  Speak to your medical practice, parents or guardians about this if you would like more information.

Your dentist may ask you questions about your lifestyle choices and general health because this may affect the health of your mouth.


How do I look?

Some people are unhappy with how their teeth look, and feel self-conscious smiling in photos or in social situations.  But you can have treatment to correct most problems.  Discuss any issues you have with your dentist.

How can I improve my smile?

Braces straighten or move your teeth to improve their appearance and the way they work.  They can also help to improve the long-term health of your teeth, gums and jaw joints by spreading the biting pressure over all the teeth.

There are many different braces and your dentist or orthodontist will be able to talk to you about what is best for you.

How long will I need to wear a brace?

It depends on how severe the problem is, and it may take anything from a few months to two and a half years.  However, most people can be treated in one to two years.

What about over-the-counter tooth whitening kits?

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.  Tooth whitening is not recommended for under-18s

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.

What is tooth jewellery?

Tooth jewellery involves sticking small jewels onto the teeth using dental cement. They should be fitted by a dentist, who can also 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.

What are the dangers of mouth piercing?

•    Infection
•    Possible swelling of the surrounding tissues
•    Blood infections  
•    Swollen tongue
•    Chipping and breaking of teeth
•    Speech, eating and swallowing can be difficult
•    Oral hygiene is difficult to keep up
•    Dental treatment can be difficult

Can I protect my teeth when playing sports?

A mouthguard will help protect you against broken and damaged teeth and even a broken or dislocated jaw.  

It is important to wear a professionally made mouthguard whenever you play any sport that involves contact or moving objects.

Ask your dentist about a mouthguard. It is a small price to pay for peace of mind.

Top tips for teens’ teeth

•    Brush your teeth twice a day with toothpaste containing between 1350 and 1500 parts per million (ppm) of fluoride. Use a small to medium-sized brush with soft to medium bristles, and brush for two minutes morning and night

•    Limit sugary and acidic food and drinks to meal times

•    Visit your dentist regularly, as often as they recommend

•    Clean in between your teeth every day with interdental brushes or floss to help remove plaque and food from between your teeth

•    Use a mouthwash to help remove bacteria and freshen your breath

•    Drink fizzy drinks through a straw, as this helps the liquid to go to the back of your mouth and reduces the acid attacks on your teeth

•    Wait for at least one hour after eating or drinking anything before you brush your teeth

•    Chew sugar-free gum after eating. This helps your mouth to make more saliva and this fights the acids that form in your mouth after eating

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