Patient Advice

Welcome to the Patient Advice section. This area provides you with advice on general symptoms or problems.
Each individual circumstance is different and although the advice given may be applicable to your symptoms, we advise that you consult your dentist before taking any action based on the information in this section.

The removal of a tooth, also known as an extraction, is a procedure conducted by a dentist that will see a whole tooth and its roots completely removed from your mouth. Often a last resort after failed treatment or injury, the removal of a tooth will leave a gap in the teeth that can then be filled by a number of artificial substitutes.

Reasons for extraction

There are a number of reasons why you may require an extraction, including:
Injury – If you have experienced facial impact that’s resulted in a jaw injury or tooth damage then you may require an extraction in order to aid recovery.
Lack of space – Wisdom teeth begin growing through from around 17 years onwards, but often there isn’t enough space in the mouth to accommodate them. If this is the case, the new teeth will have to be removed in order to prevent infection. Extraction may also be required to make space before the use of braces.
Tooth decay and infection – Some teeth may require extraction following decay or the onset of infection. In both cases, alternative options may be considered beforehand, but removal will be necessary if infection or disease is likely to spread to surrounding teeth.

The extraction process

Before the treatment begins, your dentist will need to take an x-ray to establish the position of the root to assess the appropriate method of removing the tooth. Many extractions will require the widening of the socket that holds the tooth, separating the tissue and bone that holds the tooth. Once the tooth is loosened, it will then be removed completely. However, if the tooth has deep roots your dentist may instead decide to cut through the gums and removed some of the bone in order to reach the tooth.
The procedure will take place under local anaesthetic, which will keep you awake during the treatment while blocking the pain. However, if the tooth will be particularly challenging your dentist may recommend general anaesthetic.

Extraction aftercare

You may experience some swelling or throbbing for a few days after the extraction but the pain should disappear quickly. After the procedure, your dentist may provide antibiotics or painkillers to help reduce the discomfort.

Artificial substitutes

After the removal, you may prefer to have the gap filled with an artificial substitute. There are a number of options available, although some may only be appropriate in certain circumstances.
Partial dentures provide a removal substitute and can be custom-made to ensure a comfortable fit. However, dentures require maintenance and you may require six months of healing time prior to the fitting.
A bridge is a permanent substitute that allows the use of a crown by fixing on the adjacent teeth. This prevents the teeth from leaning into the gap and creates the impression of a full set of teeth.
A dental implant is the closest alternative to a natural tooth. During the procedure, an artificial root is inserted into the gum, before a crown is placed on top. The implant then has the same strength and life-span of a natural tooth but an temporary substitute may be required after the insertion of the artificial root if the gum requires time to heal.

Your diet can have a significant effect on your dental health, leading to decay and disease if you don’t balance your nutrition. A healthy diet contains food from a number of groups including fruit and vegetables, carbohydrates, protein and dairy. However, some of the foods in these groups should be consumed in moderation if you are to avoid oral health problems.

Carbohydrates and dental health

There are two main types of carbohydrate, both of which can affect dental health. The first, sugar, is a leading cause of dental decay, which can lead to cavities, fillings or dental extractions. The decay occurs when the sugar reacts with the bacteria in plaque, leading to a breakdown of the enamel. Although it’s not advised to cut sugar out of your diet completely, it is important to limit your intake in order to prevent cavities.

dietLarge amount of acid are also present in many sugary foods including fruit, juice and fizzy drinks. Acid can also cause damage to teeth by eroding the surface, thinning the enamel. One way to prevent this is to reduce the amount of time you consume acidic foods to once or twice a day or balance your snacks with alkaline foods such as cheese and carrots.

Another method of preventing sugar-related tooth decay is to brush thoroughly twice a day with fluoride toothpaste, although the calcium and phosphate in your saliva will naturally repair your enamel if you leave enough time between sugar-based snacks.

The second type of carbohydrate, starches, can also cause tooth decay. Starchy foods, although less acidic that sugars, are more likely to cling to your teeth. This provides bacteria with a larger opportunity to react to the acids, causing damage to enamel.

Good foods

There are a number of foods that are particularly good for oral health such as orange vegetables, including pumpkins, carrots and sweet potatoes. These contain vitamin A, which aids the building of enamel during tooth development. Celery is also particularly effective at cleansing and stimulating the gums, while helping your mouth generate saliva.

Onions contain antibacterial sulphur compounds that kill bacteria in the mouth, preventing decay. Shiitake mushrooms have similar qualities; containing lentinan, the mushrooms prevent bacteria from forming plaque,

Although not strictly a food, the chewing of sugar-free gum has also been attributed with positive dental affects due to the fact that it encourages your mouth to produce saliva and break down bacteria.

Dental advice summary

• Don’t eat sugary or starchy foods more than twice a day
• Leave large breaks in between sugary meals to give your saliva the opportunity to break down the acids
• Use alkaline foods to counter acidic foods during meals
• Avoid sticky starch foods such as crisps
• Watch what you drink – fizzy drinks and fruit juices can cause as much damage as sugary foods
• Chew sugar-free gum to encourage the production of saliva after eating

Suffering from bad breath, also known as halitosis, can be embarrassing and restrictive, causing you to alter your behaviour in an attempt to hide your problem. But this needn’t be the case for many sufferers. There are a number of possible causes for bad breath, many of which can be rectified simply without the need for dental treatment.

What causes bad breath?

bad breathPoor oral hygiene – Bacteria on the teeth, tongue and gums can lead to the build up on plaque, an increase in tooth decay or even gum disease. Once this bacteria has combined with saliva it can release an unpleasant gas
Strong flavoured foods – Consuming strongly flavoured foods and drink such as garlic, onions and coffee can lead to strong odours if not dealt with quickly
Smoking – Smoking can make your breath smell but it also irritates your gums, which can lead to gum disease and bad breath
Medicines – Nitrate-based medicines, some chemotherapy medicine and phenothiazines can cause a bad smell in your breath
Medical conditions – Dry mouth is one medical condition that can cause bad breath due to a change in the flow of saliva, which allows bacteria to build up in the mouth. Lung and throat infections, bronchitis, sinusitis, diabetes and gastritis are other common causes.

Preventing bad breath

By altering your oral hygiene routine you can often prevent bad breath without requiring a visit to your dentist. Teeth brushing is particularly important, and should be conducted twice a day in order to prevent the build up of bacteria. During teeth brushing, it is important that the brush can fit into all the areas of the mouth, while a fluoride toothpaste should be used to kill bacteria already growing on the teeth and gums. It’s important that you purchase a new toothbrush every 3 – 4 months if you’re to prevent bad breath.

Cleaning between teeth

After you have brushed your teeth you should clean in between using floss or an interdental brush. The goal is to clear the spaces between your teeth of food and debris and prevent the build up of bacteria in places that cannot be reached with a tooth brush.

Food and drink

Avoiding certain types of food and drink can also prevent bad breath. Sugary and starchy foods are particularly bad, often containing large amounts of acid that react to bacteria and cause decay. Fizzy drinks have a similar affect, reacting with bacteria to cause enamel erosion.

Dental treatments

is important to seek advice from a dentist if you think you may be suffering from either tooth decay or gum disease and they will suggest suitable procedures or treatments that may cure help you manage your bad breath. These could include root canal treatments, extraction, hygienist visits or fillings.

Affecting between 15% and 20% of the world’s population and an estimated 50% of adults in the UK, gum disease is usually experienced at least once throughout a lifetime. Often causing the swelling or bleeding of the gums, this common dental problem is not always easy to detect but comes in two main forms.

gum diseaseGingivitis, the most common form of gum disease, is commonly caused when gums become irritated by plaque that has built up on your teeth. This plaque can then get underneath the gum line, causing gums to become red, swollen and prone to bleeding during brushing. An early stage of gum disease, gingivitis can be treated and cured if plaque is removed and your gums are given the opportunity to recover.

Periodontitis, or periodontal disease, is a more serious form of gum disease that occurs when gingivitis remains untreated. After a period of gingivitis, your gums may begin to pull away from your teeth, leaving small gaps. These gaps provide the perfect space in which bacteria, debris and plaque can build up, while remaining unreachable by a conventional toothbrush. As the gaps grow and become harder to clean, gums and bones may begin to shrink, known as periodontitis.

This severe form of gum disease can lead to teeth become loose or the shrinking of gums, which may expose roots. Once the disease has reached this stage is can no longer be cured, but with the correct treatment you can stop the process from developing any further.

Causes of gum disease

There are a number of common causes including:
• Personal habits, such as smoking
• Poor oral hygiene
• Genetics; some families are more susceptible to the disease than others
• Medication, including those that cause dry mouth
• Illnesses, such as cancer or HIV
• Hormonal changes, such as those occurring during pregnancy and puberty

Signs and symptoms

Commonly the first symptoms of gingivitis include bleeding gums when you brush your teeth and red or swollen gums throughout the rest of the day. These symptoms can develop into bad breath, wobbly teeth or gum abscesses if left untreated. Signs of more severe gum disease include painful ulcers, a metallic taste in your mouth, and receding gums.

Treatment of gum disease

The type of treatment required will depend on the severity of the disease. If you have mild gingivitis it may be possible to treat the problem using a structured oral hygiene routine. This may include brushing twice daily, using an antiseptic mouthwash and daily flossing to prevent the build up of plaque. For more developed forms of the disease, a scale and polish session with a hygienist may be necessary to remove up thick plaque or tartar that has formed between the teeth.

Periodontal disease may require further non-surgical or surgical treatment in order to prevent its development, although many of the effects may be irreversible. The specialist treatment may include extraction or cleaning within the gums to remove infection and bacteria.

A natural mineral, fluoride is found in food and drinking water across the UK. The amount of fluoride present in water varies throughout the country, with some counties and towns experiencing far higher levels than others.

What are the benefits of Fluoride?

flourideThe main benefit of fluoride is its prevention of tooth decay, which can lead to infection and gum disease if not addressed. The mineral disrupts the decay process by changing the structure of developing enamel, making it more resistant to acid, and by reducing the ability of plaque bacteria to produce acid, which is the cause of dental decay.
The benefits are particularly obvious within childhood, during which time teeth are still developing. In fact, studies have shown that the use of fluoride during this developmental stage will reduce the size of grooves on the teeth, making it easier to remove plaque later in life.

Where can I find it?

Fluoride occurs naturally in many foods and across the UK water supply. Research has found that a ratio of 0.7 to 1.2 parts of fluoride for every million parts of water (0.7ppm to 1.2ppm) will have the best effect on teeth, although other studies dispute this.
Some water suppliers add fluoride to water in a process called fluoridation, which has been taking place since the early 20th Century. Since its introduction, many scientists have found evidence suggesting that the process is beneficial, contributing to the reduction of decay in populations.
The mineral is also found in a number of toothpastes in varying levels. Often recommended in areas without fluoridated water, fluoride toothpaste has been found to reduce levels of decay and provide extra protection for teeth.

Can I give my children extra fluoride?

Research has suggested that children under three should use a toothpaste containing a fluorite level of at least 1000ppm, increasing to between 1350ppm and 1500ppm after three years. This should be done under parental supervision, with only a pea-sized amount used until the age of seven.
Many studies also show that children in poorer areas can have significantly higher levels of decay than those living in richer areas, where water typically contains higher levels of fluoride. These findings indicate that the addition of the mineral in similar areas may be equally beneficial and reduce the chances of decay.
Here at Synergy we can provide gels and mouthwash to both children and adults as a supplement in low fluoridated areas. Often more concentrated that traditional toothpastes, these additional product don’t require daily use.
All supplements and toothpastes should be used in the correct dosage to avoid fluorosis, a common side effect of overuse. Fluorosis commonly appears on the surface of teeth as find flecking or white lines, but severe fluorosis can lead to discolouration of the enamel.

Is fluoride safe?

There is some controversy surrounding the use of additional fluoride. In many parts of the world, including the UK and the US, it is often added to water and food as a means of preventing dental decay in the population. A number of government-issued studies have confirmed this benefit, suggesting that the mineral is a positive additional with regards to dental health.
There are a number of critics who believe that fluoride leads to a number of health conditions, although this is disputed. However, the increase in fluorosis in relation to additional fluoride has been noted across many populations.

Brushing your teeth is important to prevent the build up on plaque on and between your teeth. But brushing alone can only remove 60% of plaque, leaving the remainder free to cause infection and disease. In order to remove as much plaque as possible and prevent infection it’s necessary to floss in between teeth.

What is Flossing?

Flossing is a technique used to target the plaque caught between teeth. Able to access hard-to-reach places in the mouth, the thin material can be used to pull debris left after eating, so preventing the growth of bacteria. If plaque is left between teeth it can harden into tartar, a hard mineral deposit that requires professional removal to prevent the onset of infection.
If the correct technique is used, flossing can be used to prevent a number of potential oral hygiene issues including decay, tooth and root infections, gum disease and bad breath. Although not an alternative to traditional brushing, flossing is a beneficial addition to your routine and will target areas of your mouth that are vulnerable to cavities.

The correct technique

Using the correct technique is important to gain the full benefit of flossing. First, you must ensure you have the right length; around 18 inches wound around one of your middle fingers on each hand.
Using your thumb and forefinger, gently insert the floss in between two teeth, curving the floss into a “C” shape against the side of the tooth. Once the string is in position, gently pull the string down along the edge of the tooth, moving from the gum line down towards the edge.
This process should then be repeated for the adjacent tooth and then on all other teeth along the top and bottom of the mouth, ensuring that minimal pressure is used to avoid pushing debris against the gums. It is also important to use this technique behind your back teeth to prevent the build up of bacteria between the tooth and gum.
There are some special varieties of floss available for those requiring flossing in between crowns and bridges, which prevent the build up of bacteria without compromising the structure of the artificial tooth.
It is possible that you may experience bleeding when you first begin flossing, which is an indicator of disease. If you continue to floss the bleeding should eventually subside. However, it is important to seek advice from your dentist if the bleeding persists or if you require more information.

How often should I floss?

You should floss in between each of your teeth at least once a day to make sure debris doesn’t build up between your teeth. As part of your daily oral routine, flossing can prevent a number of dental issues caused by a lack of inter dental cleaning.

Pharmacies offer a huge variety of dental cleaning tools:

  • Waxed dental floss
  • Unwaxed dental floss
  • Interdental picks and special sticks
  • Oral irrigators, which use water to remove plaque caught between teeth
  • Mouth rinses

Both waxed and unwaxed dental floss works well to clean the spaces between your teeth. If the spaces are tight, waxed floss may glide more easily between them.

Waxed, unwaxed, high-tech teflon types, nylon types. Ask your dentist how to use them properly so you don’t hurt your gums.

Oral irrigators can help remove food caught between your teeth, too; but they shouldn’t replace dental floss and toothbrushing. Likewise, most mouthwashes won’t do an effective job of keeping your mouth healthy on their own.

Many are used simply to cover up breath odor, although some over-the-counter fluoride mouth rinses approved by the ADA can help prevent decay, and some anti-gingivitis or anti-plaque mouth rinses can help fight periodontal diseases.

Pregnancy can have an unexpectedly large effect on your dental health. A change in hormones, diet and lifestyle can take their toll on your general and your oral health. Once the baby is born, you also need to consider the dental care of your child, and it is important to seek advice from your dentist so you can provide them with the best dental care possible.

Pregnancy

During pregnancy your hormones can affect your dental health. Increased tooth decay and gum disease are just two side effects that are commonly seen and should be dealt with before they become a permanent problem, potentially leading to tooth loss. Increased levels of progesterone and oestrogen can also affect the bones and gums that support the teeth, leading to loose teeth and bleeding gums.
Is dental treatment safe during pregnancy?
Routine treatment is safe during pregnancy, but the department of health recommends that women avoid having amalgam fillings fitted during this time. Some patients also avoid having x-rays during pregnancy, but government guidelines also state that they are safe when the beam is directed away from the womb.

Post-pregnancy

After the birth of your child it is important that you continue to look after your teeth. However, the dental health and development of your child should now be considered during your daily dental routine. Appearing from around 6 months, your baby’s teeth will continue to grow through until all 20 are baby teeth are present. Also known as the teething stage, this process can be painful and cause a high temperature intermittently throughout. During this time, it is possible to use specialist gel to reduce the pain and discomfort.
When should I take my baby to the dentist?
It is possible to bring your baby to the dentist during your own routine check up, but babies do not need to visit a dentist until their teeth are beginning to grow through.
Breastfeeding and dental health
Research conducted by the World Health Organisation suggests that babies breastfeeding past the start of the teething stage can experience tooth decay due to the natural sugars within breast milk. The alternative, bottled milk, is considered an appropriate alternative provided no sugar is added to the drinks.

Solid food
Your doctor will advise you on the appropriate solid food to feed your baby, but food without sugar will be the best for your child’s dental health. Food and drink containing sugar can cause tooth decay and prevent the appropriate development of enamel in extreme cases. Fluoride supplements could be added to your baby’s diet in order to strengthen enamel and prevent decay, but it is important to seek advice from your dentist beforehand.
When should teeth cleaning begin?
As soon as your baby begins teething you should begin cleaning their teeth. Age-appropriate cleaning tools are often available to ensure that gums are not damage during the cleaning, but a toothbrush will be essential as more teeth grow through. Fluoride toothpaste is also available for young children and should be used to remove bacteria from teeth twice daily.
The effect of thumb-sucking and dummies
It is beneficial for babies if thumb-sucking and dummies are prevented throughout the development of teeth and beyond. Both can lead to the changes in the trajectory of growing teeth, leading to a need for braces at a later date.

Food debris left between teeth can lead to a build of bacteria and plaque, ultimately resulting in infection and gum disease if not addressed. Interdental brushes have been designed to fit in those hard to reach areas, preventing the build up of plaque and tartar.

What is an interdental brush?

An interdental brush is a small spiral shaped brush that is designed to fit in between teeth without causing damage to the gums or enamel. Available in different sizes, the brushes can be used in place of a toothbrush in places that are difficult to reach with conventional brushes, preventing the build up of bacteria and plaque.

Interdental brushes are also suitable as a substitute for conventional toothbrushes when used on bridges and crowns; allowing you to take extra care, the brush can clean on and around the artificial tooth without causing damage or missing food debris.

Brushes are an effective alternative to flossing, which is also used to removed plaque and debris from between teeth. Less awkward and time consuming, interdental brushing achieves the same end without requiring the measuring or adjusting of floss.

How do I use an interdental brush?

Your dentist may offer advice on how to use and choose the size of your dental brush. For different sized gaps you may require a number of different brushes, each designed to fit between teeth without causing damage.

Once you’ve chosen the correct brush size and removed the cap, gently insert it between your teeth and move the brush backwards and forwards without force. While using your brush, be sure not to put too much pressure on the gums, which may lead to bleeding.
If you find it difficult to clean between teeth you may need to choose a smaller size. Ask your dentist for more information if you’d like advice on different brush sizes or guidance on brushing technique.

How often should I use it?

As with flossing, interdental brushing should be undertaken once a day. This will ensure that all daily food debris is removed from between teeth and prevent the build-up of bacteria or plaque. If you experience persistent bleeding or soreness after using the brush, you may be brushing too frequently. However, bleeding and swollen gums can be expected within the first few days as you remove plaque build up. Ask your dentist for more information if you’re unsure or the bleeding persists.

The enamel on our teeth is relatively strong, but if we don’t look after our mouths then tooth decay can occur. Also known as dental decay, this is the process whereby plaque builds up on the teeth leading to tartar and eventually the breakdown of the tooth, leading to gaps and lesions.

What causes decay?

decayDecay is caused by plaque, which is formed from bacteria and produces acids that slowly soften the enamel on your teeth. As the acids continue to eat through the tissue, this can lead to small holes or large cavities in your teeth.
Aside from the gaps and cavities caused by decay, the process can also lead to infection and gum disease, both of which often have a number of negative symptoms. These symptoms include localised pain or discomfort, bleeding and swollen gums, and loose teeth. You should visit your dentist as soon as you notice any of these signs so you can start treatment immediately.

Treatment

The treatment required for decay is dependent on its severity. For minor decay it may be possible to have a small filling or inlay introduced into the mouth, which will successfully hide the cavity. For more serious decay, you may require a crown, bridge or even a dental implant to replace a damaged tooth. Before each treatment is undertaken, the area of the mouth affected will be thoroughly cleansed to ensure that decay doesn’t continue. Your dentist will advice you on the suitability of each treatment based on your individual circumstances.
It is also possible to treat the early stage of decay by altering your daily oral hygiene routine. This should include brushing twice a day, flossing between teeth, using mouthwash to kill bacteria and using fluoride toothpaste or supplements to protect your enamel.
Your diet can also have a large impact on the decay of your teeth and there are a number of tips you should remember when considering your dental health:
• Don’t eat sugary or starchy foods more than twice a day, these can lead to a increase in acid levels in your mouth
• Leave large breaks in between sugary meals to give your saliva the opportunity to break down the acids, preventing decay
• Use alkaline foods to counter acidic foods during meals to prevent the build up of acids
• Avoid sticky starch foods such as crisps, which may get stuck in your teeth and boost levels of bacteria in your mouth
• Watch what you drink – fizzy drinks and fruit juices can cause as much damage as sugary foods
• Chew sugar-free gum to encourage the production of saliva after eating, preventing the build up of plaque

Teeth are an important part of our body, vital for eating the correct food and also useful in communication. Aside from our baby teeth, or milk teeth, we only have one set of teeth to last us a lifetime, so it’s important that we take care of them.

Baby teeth

Teeth begin to develop as soon as babies are born, but they don’t often begin to come through until around the age of 6 months old. Through a process known as teething, the teeth will begin to grow through the gums until around three years old, when most babies will have a full set of 20 milk teeth.

Adult teeth

set of human teethMilk teeth will begin to fall at around five years old, making way for adult teeth. By the age of 12, most of these adult teeth will have grown into place, giving children a set of 28 teeth. A full set of adult teeth contains 32 teeth, but the final four may not grow through until the age of 21, if at all. These final four molars are known as wisdom teeth and commonly require removal due to a lack of space in the modern adult mouth.

Different parts of the tooth

There are a number of parts contained in each tooth, and all of these parts are made from slightly different substances. The section of the tooth present above the gum line is known as the crown. This section is covered in enamel, which is the hardest substance in the body and provides protection to the sensitive inside of the tooth.
Underneath the crown lies dentine, a sensitive part that runs down through most of the tooth. This is in place to protect the most sensitive part, the pulp. Containing the blood supply and nerve endings, the pulp is the substance that keeps the tooth alive and sends messages to the brain during eating or drinking. The pulp also runs into the root, which is the final part of the tooth.
Covered with cementum, the root of the tooth is combined with periodontal fibres and connects the tooth to the jawbone to hold it in place.

Types of teeth

There are four types of teeth inside the mouth, each of which has a different purpose. The first of these are the incisors. Located at the front of your mouth, you have four incisors on the top jaw and four on the bottom. These teeth are used for cutting and chopping food.
The second type of teeth are the canines. These are located next to the incisors, with one each side on each jaw, and they are designed to be sharp and pointy. These teeth are used to tear food, such as meat and other tough ingredients.
Premolars are also known as bicuspids and they are located next to your canines. There are eight in total, with four on the top jaw and four on the bottom. These teeth are larger that both incisors and canines, and they are designed for crushing and grinding food.
Finally, the molars are located in the back of each jaw. There are eight in total, although this is without the wisdom teeth, which make up the final four teeth. Molars are the strongest teeth in your mouth and they work to help you mash food and swallow safely.

Mouthwash can be used as part of your daily dental hygiene routine to prevent the build up of bacteria and the onset of infection. Although not a substitute for brushing, this popular dental wash comes in a variety of brands and types, and each option provides a different benefit.

Benefits of mouthwash

Depending on the type chosen, mouthwash provides a variety of benefits, including:
• The prevention of bad breath and mouth odour
• A reduction in bacteria and plaque, even in areas that can’t be reached by conventional toothbrushes
• The prevention of tooth decay and cavities through the removal of plaque
• The prevention of infection and gum disease through the killing of bacteria
• Help with targeting of plaque with a toothbrush

Types of mouthwash

There are a number of different types of mouthwash, but some may be more suitable for you than others. Alcohol-based mouthwashes can be highly effective, but it is often recommended that they are avoided by children or recovering alcoholics due to the high levels of alcohol. Many people also require sensitive mouthwashes if the stronger wash causes oral irritation, and this can also be useful after a dental procedure.
Some mouthwashes are target plaque control and contain ingredients specifically designed to reduce plaque between teeth and prevent infection. These mouthwashes may not be suitable for those wishing to target bad breath. This is also true for fluoride-based mouthwashes, which are specifically designed to target tooth decay.
Occasionally mouthwashes, such as Corsodyl, can only be used for a short period of time as they stain teeth and can alter taste perception. If you’re unsure about your chosen mouthwash, seek advice from your dentist.

How to use mouthwash

If you use mouthwash correctly, you are more likely to see the long-term benefits in your dental health. The first step in using mouthwash is to identify the correct amount and ensure that it’s not exceeded. This can often be achieved by using labelled caps on the bottle, which will help you measure the mouthwash before use. If your cap does not contain measurements, it is also possible to purchase specialist dispensers.
It is also important to dilute your mouthwash according to the instructions on the bottle. Although many mouthwashes are sold in the correct concentration, some require dilution before use. If you fail to dilute concentrated mouthwash you may experience irritation in your mouth or cause enamel erosion.
During use, mouthwash should be swished vigorously for 30-60 seconds. Take care not to swallow the solution and rinse your mouth with water after use, particularly when using a concentrates wash.

A modern method of reducing dental problems, preventative dentistry describes the process of working with your dentist and hygienist to maintain healthy teeth and gums. If approached correctly by the patient, preventative dentistry will help teeth last longer, while avoiding the most common dental problems, including tooth decay and gum disease.

Here at Synergy, we recommend a tailored course of preventative dentistry to ensure that each patient receives relevant care and attention. Working with your assigned dentist and hygienist, you can also take part in the planning of the treatment to ensure that you’re happy with your responsibilities with regards to daily dental care.

Does preventative dentistry benefit everyone?

Preventative dentistry can benefit anyone, whether they are caring for a full set of healthy teeth or fighting to beat gum disease. Even patients who are using dentures can benefit from a tailored plan that will prevent the build up of bacteria in the mouth, reducing the chances of infection and cancer. The process is particularly beneficial for children, providing them with early education into dental care.

The process

Before you begin discussing an appropriate dental plan, your dentist will assess your teeth and gums. This is your opportunity to inform your dentist of any issues you’ve been having, although any new problems can be worked into the programme at a later date if necessary. Once you have agreed on a plan, the dentist and hygienist can get to work with your chosen treatments.

Your hygienist will take the first steps in your preventative plan, scaling and polishing your teeth to remove and plaque or tartar that has built up on and around each tooth. Once complete, your hygienist will show you how to care for your teeth to prevent future build up, discussing the brushing technique, interdental brushing or flossing and the benefits of mouthwash. Each of these techniques is aimed at reducing the build-up of bacteria and to fighting potential dental problems before their onset.

Your dentist and hygienist may also discuss your personal habits, which may be contributing to dental problems. This could include your diet, which can increase the amount of acid in your mouth, or personal habits such as smoking and drinking. Finally, your dentist will make sure that all fillings and artificial teeth are in good shape and easy to clean, to aid your daily routine. If any of your fillings need changing, your dentist may discuss a separate appointment during which your replacement can be fitted.

Precautions

Avoid hot food or drinks until the anesthetic 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.

extraction

Use of mouthwash

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.

Is there anything else I should avoid?

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.

When should I brush?

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.

What do I do if it bleeds?

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.

Can I smoke?

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.

Helping the healing process

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.

Pain medication

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.

Medicines that I should avoid

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.

Pain persists

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 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.

Gum disease is the leading dental problem affecting people in the UK, with an estimated 50% of adults suffering from one form at any time. Caused by a build up of plaque, gum disease can lead to swelling and bleeding of the gums, pain, infection and tooth loss if not treated.

Plaque

plaquePlaque is a sticky, colourless substance containing bacteria that is continuously forming on the surface of your teeth and contains saliva, food and fluids. Without the correct daily dental routine, plaque can form on teeth, trapping stains and causing a number of gum problems. Plaque begins forming on the teeth within four to 12 hours after brushing, making it important to brush twice a day in order to prevent build up. The use of flossing and mouthwash is also encouraged in the fight against plaque as they prevent the build up between teeth. However, if plaque is not removed correctly, it can develop into tartar.

Tartar

Also known as calculus, tartar is a crusty substance that causes discolouration and traps stains on teeth. Tartar is formed when calcium and phosphate bind to form crystals, which then combines with plaque before hardening. Tartar is a strong substance and so can only be remove by dental professionals, rather than by brushing alone. The substance is capable of forming underneath the gumline and irritates gums, affecting the tooth from the root. Unlike plaque, tartar is a mineral build up and so can be seen when coated on teeth. Commonly, it is yellow or brown in colour.

How does tartar cause gum disease?

As tartar and plaque builds on your gums, bacteria begins to eat away at your tissue, causing inflammation and bleeding. During this process, bacteria is able to make its way into your gums through gaps caused by plaque, so spreading further down the tooth. This can lead to infection, causing pain and swelling in the gums.
As the gums swell and bacteria grows, the gums begin to recede and widen, making teeth loose and even more susceptible to infection. At this stage, it may be necessary to remove the tooth to prevent further spread of the disease.

Preventing gum disease

The key to preventing gum disease is a good oral hygiene. This involves:
• Brushing your teeth – this should be done twice each day just before eating or an hour afterwards. A traditional manual toothbrush is effective, but there are some electric toothbrushes that are favoured by dentists and my prove more effective in the removal of plaque
• Cleaning between teeth – It is equally as important to clean between your teeth. There are a number of areas that are often missed by a toothbrush but still contain food debris and bacteria, which can cause gum disease if ignored. There are a number of products that can clean between teeth, but commonly flossing interdental brushing is favoured, both of which should be used once or twice a day.

Wisdom teeth are the last teeth to appear in the mouth between the age of 17 and 25. Also known as your third molars, they don’t always emerge despite resting in the jaw. The maximum number of teeth an adult can have is 32, but many modern jaws are too small to hold more than 28, leading to the frequent removal of wisdom teeth.

Many suffer from pain and discomfort as their wisdom teeth attempt to come through the gums, particularly when they’re coming through at an angle or attempting to fit into a small mouth. But this is not the only reason for removal; in some cases wisdom teeth are removed to protect established teeth from damage as the wisdom teeth grow too close.

Caring for wisdom teeth

If you are lucky enough to have your wisdom teeth through in a healthy position, it is important to give them the same level of dental care as any other tooth. Although positioned far back in the mouth, wisdom teeth require twice daily brushing and flossing to avoid the build up of bacteria and the onset of gum disease.

Removing wisdom teeth

Similar to general surgical extraction, the removal of wisdom teeth will begin with an x-ray to establish its position and angle in the gum. If your dentist feels that your tooth may have enough room to grow through without causing problems, they may suggest that extraction is not necessary.

If extraction is necessary, however, then you will be given a local anaesthetic before the process begins. This will block the pain present in your gums during the procedure while you remain awake. However, if your dentist thinks your tooth is particularly challenging they may suggest you have the procedure under general anaesthetic.

Wisdom teeth extraction is similar to the removal of any other molar, and involves the widening of the tooth socket, separating the tissue and bone that holds the tooth. Once the tooth is loosened, it will then be removed completely. If your tooth has deep roots, however, it may be difficult to extract. If this is the case, your dentist may need to cut through the gums and remove some of your bone in order to remove the tooth.

Removal aftercare

After your procedure you are advised to rest, and those who have had a local anaesthetic may experience a numbing around the area for several hours. Some swelling and discomfort in and around the extraction area can also be expected for a few days after the procedure.
It is possible that your dentist will prescribe antibiotics or mouthwash to reduce the throbbing after the treatment, but if you require further pain relieve seek advice from them at a later date.

Tooth brushing is a vital part of your daily dental hygiene routine. By preventing the build-up of plaque, toothbrushing can help you avoid the onset of a number of gum and tooth problems including tooth decay, gum disease, and infection.

The benefits of toothbrushing

Brushing your teeth removes food debris, bacteria, and plaque from the surface of your teeth and the gaps under the gumline.

The build-up of bacteria in these areas can lead to a number of dental problems, which is why it is vital to get your brush into as many gaps and spaces as possible.

This removal of debris and bacteria will also affect your breath, which can become filled with bad-smelling gases if bacteria are allowed to build up.

How to brush your teeth

• Place the head of the toothbrush against the surface of your teeth and lean the bristles at a 45-degree angle against the gum line.

Begin moving the brush in small, circular movements on each surface. Make sure each surface receives several brushes before you move on.

• Brush the outer surfaces of every tooth on both your upper and lower jaw, ensuring that the bristles remain angled against the gumline
• Brush inside the mouth, ensuring that you repeat the motion on each chewing and biting surface
• When cleaning the inside surfaces of the front teeth, lean the brush vertically and make small, circular motions with the front part of the brush
• Brush your tongue lightly to freshen your breath and remove bacteria

Electric or manual?

Both electric and manual toothbrushes can achieve the same results provided they are used correctly. Some find it easier to brush with electric toothbrushes, which are also designed to fit into the mouth with ease.

However, a manual toothbrush does provide more control and can allow the user to reach further into the mouth without causing injury.

Toothpaste

There are a number of different types of toothpaste available, most of which contain fluoride. Advocated by the British Dental Health Foundation, fluoride toothpaste helps prevent cavities and control the decay of teeth.

It is particularly useful during the development of adult teeth as it strengthens growing enamel and increases protection.

It is important that each individual in a household is using the correct amount of fluoride in their toothpaste in order to prevent fluorosis. This is the process of excessive fluoride causing discolouration and flecks in teeth due to an overexposure to fluoride.

It is also important to use enough fluoride in order to protect the teeth.

The correct amount for each age group is:
• A smear of toothpaste containing no less that 1,000ppm (parts per million) of fluoride for children under three
• A pea-sized amount of toothpaste containing 1,350-1,500pppm fluoride for children aged three to six
• Toothpaste containing at least 1,450ppm fluoride for adults

Living with sensitive teeth can be frustrating and impair your ability to enjoy everyday food and drink. Encompassing anything from a mild twinge to severe pain and discomfort, sensitivity in teeth can be applied to anyone but commonly occurs between the ages of 20 and 40.

What causes sensitivity?

Tooth sensitivity is caused by exposure of the dentine under your enamel, which is the softer part of your tooth. Dentine is attached to the nerves in your teeth via tiny tubes filled with fluid. By regularly consuming food and drink that is hot, cold or sweet it is possible to change the movement of the fluid, causing the nerve endings to react in response.

There are a number of causes for the exposure of dentine including:
Tooth Abrasion – A toothbrush that is too hard or used with too much force can abrade the enamel on the tooth, particularly at the thinner areas near the gumline. Once this area is worn away, dentine can be exposed and lead to sensitivity.
Tooth Erosion – The excessive consumption of fizzy drinks or acidic food can erode teeth, dissolving enamel and ultimately exposing dentine.
Gum Recession – Extreme force during brushing can lead to recession of the gums, exposing the unprotected roots and the lower part of the dentine.
Gum Disease – Plaque and tartar build up can slowly wear away the surface of the tooth, causing cavities and gaps. These gaps expose the inner dentine, leading to sensitivity.
Cracked Tooth or Filling – A crack in a tooth or filling can run down to the root of the tooth, leaving nerves exposed.

Treating sensitivity

Your dentist will advise you about the best course of treatment for your sensitivity, but there are a number of common options that they may recommend:
• Desensitising toothpaste can help block pain from the nerves after a few uses, but may require regular use
• Fluoride can be applied to the sensitive area to strengthen enamel and reduce the pain
• Exposed root surfaces may be covered with a sealant, which will prevent pain caused by receding gums
• Root canal treatment can be used in cases involving extreme pain. This process involves the removal of the tooth’s soft core, so preventing the dentine from connecting with nerves and instigating pain

Preventing sensitive teeth

To prevent sensitive teeth from recurring, there are a number of daily rituals that you can follow. Brushing twice daily with a soft brush will prevent many of the causes of sensitive teeth, including receding gums and plaque build up. Soft brushing is also beneficial, preventing the abrasion of the tooth surface and exposure of the dentine. Limiting acidic food and drinks will also prevent the erosion of enamel, as will the use of alkaline foods to counter the acidity.

Dental x-rays enable dentists to visualise diseases and decay in your mouth that cannot be seen with a general oral examination or those that are in the early stages of development. Allowing dentists to see beneath the enamel and gums, x-rays can help identify infections, cavities or disease in the root and tooth below the gumline.

Types of x-ray

There are a number of interoral x-rays used by dentists, including:

• Bite-wing – These show the details of the upper and lower teeth in one chosen area of the mouth, from the crown of the tooth to the level supporting the bone

• Periapical – These show the whole tooth from the crown to beyond the end of the root where the tooth is anchored

• Occlusal – These are the largest x-rays and show the full development and placement of teeth across the lower and upper jaw

How often should you have an x-ray?

The frequency with which you have dental x-rays is dependent on your dental history and the current condition of your mouth. If you have a history of dental problems or you’re currently suffering from disease it may be necessary for you to have dental x-rays every six months. However, those with infrequent problems and a good level oral hygiene will only require x-rays every few years at the request of their dentist.

Are x-rays harmful?

The level of radiation emitted from dental x-rays is extremely low, and in many areas it measures below the level of rotation found naturally in soil and the environment. Here at Synergy, we also use the latest x-ray technology to make sure our patients receive the safest treatment possible. Despite this, synergy dentists will still only use x-rays when medically necessary.
The British Dental Association recommended that pregnant women inform their dentist before an x-ray, but there is no research to suggest that the small amounts of radiation emitted are harmful.

Who do they belong to?

X-rays will become part of your health records and should be kept in your dental file. 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 dental health records, including your x-rays, under the Access to Health Records Act 1990, but you will have to pay for these. If you change dentist, however, your new dentist will have access to your previous dental records free of charge.