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What is Deep Cleaning?
Deep Scaling and Root Planing. If plaque and tartar is left on the teeth, as we mentioned before, it provides the right conditions for bacteria to thrive. The bacteria irritate the gums, which means that they bleed more easily. You may notice this if you are brushing your teeth, or eating, and sometimes your gums may bleed a bit. This is the early stage of gum disease called gingivitis. If you have gingivitis, your dentist or hygienist will clean your teeth by scaling and polishing them. They may also recommend an antiseptic mouthwash containing chlorhexidine (e. g. Corsodyl in the UK, Eludril or Parodontax in EU) ), and show you how to brush and floss your teeth effectively. Most adults have some degree of gum disease. If gingivitis not treated and nothing is done about it, the inflammation will work its way down towards the foundations of the tooth causing a “periodontal pocket”. Again, within the confines of the pocket, the conditions are such that the bacteria can have a right old party, and cause more damage. Gum disease can break down the support (bone) structures of the teeth, so that eventually, they will become loose. The problem is that until it gets quite severe, the person often has no symptoms. Sadly, the damage to the support structures of the teeth is irreversible. The good news is that if gum disease is caught in time, its progression can be halted and improved upon, and that is the key. To stop gum disease from progressing, your dentist may advise periodontal therapy, or deep cleaning. This gets rid of the bacteria in the pocket and provides the necessary conditions for healing to occur. What is the difference between an ordinary cleaning and deep cleaning? There is some confusion about the difference between scaling and root planing. Scaling is basically the process of removing dental tartar from the surfaces of the teeth . Root planing is the process of smoothening the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gumline. The two processes tend to blur together since during the cleaning process, the dental worker scales away tartar and performs any necessary root planing at the same time. Any roughness can be planed away to result in a silky smooth surface. Does it hurt? Depending on the depth of the pocket and severity of the root surface irregularity, the dentist may wish to make the area numb so that the process is comfortable for you. Don’t hesitate to discuss with your dentist or hygienist how to best manage any discomfort. As an alternative to injectable anaesthetics, Oraqix might be an option to try with deeper pocket cleaning. It is a special non-injection device that delivers topical anaesthetic gel gently into the gum pockets thereby avoiding numbing of the lips and or tongue as can occur with injected local anesthetics. Oraqix mostly numbs the gum pocket itself so it may not be effective in eliminating sensations in the teeth themselves. Some offices may not have this device so it’s best to check with your dental office. Sometimes if the pockets are not too deep, there may be little or no discomfort during the procedure – even without numbing. The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothened. A root planed root surface free of tartar has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning. How long does it take? Typically with deeper pockets and extensive rough root surfaces, the deep scaling and root planing procedure might be broken down into quadrants of work per appointment. For example, the upper right side of the mouth might be worked on one day, and the three other parts worked on at separate appointments. Or alternatively, one half of the mouth (right or left, upper or lower) might be cleaned per appointment. This also allows for only a part of the mouth being frozen at a time and makes for more manageable, shorter appointments. The dentist may use antibiotic gels within the periodontal pocket, again to remove any nasty bugs, or may rinse out the pocket with various medications such as chlorhexidine. What can I expect afterwards?
Gum disease.
Gum disease is a very common condition where the gums become swollen, sore or infected. Most adults in have gum disease to some degree and most people experience it at least once. It's much less common in children. If you have gum disease, your gums may bleed when you brush your teeth and you may have bad breath. This early stage of gum disease is known as gingivitis. If gingivitis isn't treated, a condition called periodontitis can develop. This affects more tissues that support teeth and hold them in place. If periodontitis isn't treated, the bone in your jaw may be damaged and small spaces can open up between the gum and teeth. Your teeth can become loose and may eventually fall out. What causes gum disease? Gum disease is caused by a build-up of plaque on the teeth. Plaque is a sticky substance that contains bacteria. Some bacteria in plaque are harmless, but some are harmful for the health of your gums. If you don't remove plaque from your teeth by brushing them, it builds up and irritates your gums. This can lead to redness with bleeding, swelling and soreness. Seeing your dentist. You should make an appointment to see your dentist if your gums are painful, swollen or if they bleed when you brush your teeth. Your dentist can carry out a thorough dental examination to check the health of your gums, which may involve inserting a thin metal stick with a bend in one end (periodontal probe) beside your teeth. In some cases, a number of X-rays may be needed to check the condition of your teeth and jaw bone. Preventing and treating gum disease. Mild cases of gum disease can usually be treated by maintaining a good level of oral hygiene. This includes brushing your teeth at least twice a day and flossing regularly. You should also make sure you attend regular dental check-ups. In most cases, your dentist or dental hygienist will be able to give your teeth a thorough clean and remove any hardened plaque (tartar). They'll also be able to show you how to clean your teeth effectively to help prevent plaque building up in the future. If you have severe gum disease, you'll usually need to have further medical and dental treatment and, in some cases, surgery may need to be carried out. This will usually be performed by a specialist in gum problems (periodontics). Dental check-ups. It's important to have regular dental check-ups so any problems with your teeth and gums can be detected and treated early. If you've never had gum disease and have good oral health, you may only need to visit your dentist every one to two years for a check-up. You may need to visit your dentist more frequently if you've had problems with gum disease in the past. At each appointment your dentist will advise when you need your next appointment. If you have an increased risk of developing gum problems – for example, if you smoke or have diabetes – you may be advised to visit your dentist more often so your teeth and gums can be closely monitored. Complications of gum disease. If you have untreated gum disease that develops into periodontitis, it can lead to further complications, such as:
Oral Surgery
Recovering from wisdom tooth removal. It can take up to two weeks to fully recover after having your wisdom teeth removed. During this time, you may experience:
Self-care advice. To reduce pain and aid your recovery, it can be helpful to:
It's usually recommended that you take a day or two off work after having a wisdom tooth removed. You can drive immediately after the procedure if local anaesthetic was used, but you should avoid driving for at least 24 hours if a sedative was used, or 48 hours if the procedure was carried out under general anaesthetic. Returning to normal. After your wisdom teeth have been removed and any swelling and bruising has disappeared, your mouth and face should return to normal. You'll usually be able to brush your teeth normally after a few days. Make sure you finish any course of antibiotics you've been given. A check-up appointment may be arranged for about a week or so after the procedure. At this point, any remaining stitches may be removed. Toothache refers to pain in and around the teeth and jaws that's usually caused by tooth decay.
You may feel toothache in many ways. It can come and go or be constant. Eating or drinking can make the pain worse, particularly if the food or drink is hot or cold. The pain can also be mild or severe. It may feel "sharp" and start suddenly. It can be worse at night, particularly when you're lying down. A lost filling or broken tooth can sometimes start the pain. It can also sometimes be difficult to decide whether the pain is in your upper or lower teeth. When a lower molar tooth is affected, the pain can often feel like it's coming from the ear. Toothache in other upper teeth may feel like it's coming from the sinuses, the small, air-filled cavities behind your cheekbones and forehead. The area of your jaw close to the infected tooth may also be sore and tender to touch. It's also possible for periodontal disease to give rise to a "dull" pain. Periodontal disease is a bacterial infection that affects the soft and hard structures that support the teeth. When to see your dentist? If you have toothache for more than one or two days, visit your dentist as soon as possible to have it treated. The longer you leave it, the worse it will get. If your toothache isn't treated, the pulp inside your tooth will eventually become infected. This can usually lead to a dental abscess, with severe and continuous throbbing pain. Painkillers, such as paracetamol and ibuprofen, may reduce the pain and discomfort while you're waiting for an appointment. Children under 16 years of age shouldn't be given aspirin. You can also try numbing the pain using an over-the-counter dental gel containing local anaesthetic, although this isn't suitable for children under 12. What causes toothache? Toothache occurs when the innermost layer of the tooth (dental pulp) becomes inflamed. The pulp is made up of sensitive nerves and blood vessels. Dental pulp can become inflamed as a result of:
These include:
Treating toothache. The type of treatment you have for toothache will depend on the cause of the pain, so your dentist will examine your mouth and may carry out an X-ray to try to identify the problem. If your toothache is caused by tooth decay, your dentist will remove the decayed area and replace it with a filling. If your toothache is caused by a loose or broken filling, the filling will be taken out, any decay will be removed, and a new filling put in place. If the pulp inside your tooth is infected, you may need root canal treatment. This procedure involves removing the infected pulp and then inserting a special type of filling to seal the tooth and prevent reinfection. Your tooth may need to be removed if the toothache can't be treated using these methods, or the tooth is wedged between another tooth and your jaw (impacted). Preventing toothache. The best way to avoid getting toothache and other dental problems is to keep your teeth and gums as healthy as possible. To do this, you should:
The time between check-ups can vary, depending on how healthy your teeth and gums are and your risk of developing future problems. Y our dentist will suggest when you should have your next check-up based on your overall oral health. Children should have a dental check-up every six months so tooth decay can be spotted and treated early. Dentures.
Dentures are removable false teeth made of acrylic (plastic), nylon or metal. They fit snugly over the gums to replace missing teeth and eliminate potential problems caused by gaps. Gaps left by missing teeth can cause problems with eating and speech, and teeth either side of the gap may grow into the space at an angle. Sometimes, all the teeth need to be removed and replaced. You may therefore need either:
How dentures are fitted. Complete dentures. A full denture will be fitted if all your upper or lower teeth need to be removed or you're having an old complete denture replaced. The denture will usually be fitted as soon as your teeth are removed, which means you won't be without teeth. The denture will fit snugly over your gums and jawbone. However, if you have dentures fitted immediately after the removal of several teeth, the gums and bone will alter in shape fairly quickly and the dentures will probably need relining or remaking after a few months. Occasionally, your gums may need to be left to heal and alter in shape for several months before dentures can be fitted. You can either see a dentist or a qualified clinical dental technician to have your dentures made and fitted. The difference between a dentist and a clinical dental technician (in terms of producing dentures) is outlined below.
Partial dentures. A partial denture is designed to fill in the gaps left by one or more missing teeth. It's a plastic, nylon or metal plate with a number of false teeth attached to it. It usually clips onto some of your natural teeth via metal clasps, which hold it securely in place in your mouth. It can easily be unclipped and removed. Occasionally, the clips can be made of a tooth- or gum-coloured material, although this type of clip isn't always suitable, because it tends to be more brittle than metal. Your dentist can measure your mouth and order a partial denture for you, or you can see a qualified clinical dental technician, who can provide a partial denture for you directly after you've first seen your dentist for a treatment plan and certificate of oral health. A fixed bridge is an alternative to a partial denture and may be suitable for some people. Crowns are put on the teeth either side of the gap and joined together by a false tooth that's put in the gap. Looking after your dentures? Dentures may feel a bit strange to begin with, but you'll soon get used to wearing them. At first, you may need to wear your dentures all the time, including while sleeping. Your dentist or clinical dental technician will advise you on whether you should remove your dentures before you go to sleep. It isn't always necessary to remove your dentures at night, but doing so can allow your gums to rest as you sleep. If you remove your dentures, they should be kept moist – for example, in water or a polythene bag with some dampened cotton wool in it, or in a suitable overnight denture-cleaning solution. This will stop the denture material from drying out and changing shape. Dental hygiene. Keeping your mouth clean is just as important when you wear dentures. You should brush your remaining teeth, gums and tongue every morning and evening with fluoride toothpaste to prevent tooth decay, gum disease and other dental problems. Cleaning dentures. It's important to regularly remove plaque and food deposits from your dentures, because unclean dentures can also lead to problems, such as bad breath, gum disease, tooth decay and oral thrush. Clean your dentures as often as you would normal teeth (at least twice a day – every morning and night). You should:
Eating with dentures. When you first start wearing dentures, you should eat soft foods cut into small pieces and chew slowly, using both sides of your mouth. Avoid chewing gum and any food that's sticky, hard or has sharp edges. You can gradually start to eat other types of food until you're back to your old diet. Never use toothpicks. Denture adhesive. If your dentures fit properly, you shouldn't necessarily need to use denture fixative (adhesive). However, if your jawbone has shrunk significantly, adhesive may be the only way to help retain your dentures. Your dentist or clinical dental technician will advise you if this is the case. At first, some people feel more confident with their dentures if they use adhesive. Follow the manufacturer's instructions and avoid using excessive amounts. Adhesive can be removed from the denture by brushing with soap and water. Remnants of adhesive left in the mouth may need to be removed with some damp kitchen roll or a clean damp flannel. When to see your dentist. You should continue to see your dentist regularly if you have dentures (even if you have complete dentures) so they can check for any problems. Your dentures should last several years if you take good care of them. However, your gums and jawbone will eventually shrink, which means the dentures may not fit as well as they used to and can become loose, or they may become worn. See your dentist as soon as possible if:
Braces and orthodontix. Why have braces? The purpose of orthodontic treatment is to make the best of your teeth. This includes allowing you to bite correctly, eat more comfortably, and to care for your teeth and gums more easily. And your smile will benefit, too. Treatment almost always involves using braces to straighten crooked, crowded or protruding teeth, close gaps between teeth, and correct the bite of the teeth so the top and bottom teeth meet when you close your mouth. Treatment usually lasts from 18 months to two years, and visits to the orthodontist are needed every four to six weeks. How common is orthodontic treatment? According to the British Orthodontic Society, 202,300 people started orthodontic treatment in England and Wales in 2014-15. The vast majority were children, with 72,300 children under 13 years old and 128,500 children aged 13 to 17 beginning orthodontic treatment to straighten their teeth last year. Braces are usually more successful in children, which is why most orthodontic patients are children. Fewer than 1 in 100 orthodontic patients are adults – just 1,500 adults began orthodontic treatment in England and Wales in 2014-15. But more adults than ever now want treatment, many having missed out when they were children. Can I have private treatment? Private treatment is widely available but expensive. The British Orthodontic Society says fees vary, but are usually around £2,000 to £2,500. However, they can be much higher. One advantage of private treatment is you have a wider choice of braces, including clear or invisible ones. What's the best age to have braces? The ideal age to have orthodontic treatment is around 12 or 13, while you're still growing. The opportunity for improvement in an adult is more limited and surgery is more likely to be needed. How do I get braces fitted? To get braces fitted you need to be referred to an orthodontist by your dentist. What are braces like? There are many different types of braces. Some are removable, which you take out at night, to eat a meal, or clean. Some are fixed and stay in all the time. NHS braces are made of metal, but plastic and ceramic ones are also available privately. Some of these are clear, so you can hardly see them on your teeth. How successful are braces? Orthodontics usually works very well, but it's important to look after your teeth while you're wearing braces. Braces can trap food and cause more plaque to build up than usual. You need to take extra care cleaning your teeth and watch what you eat – for example, by avoiding sugary foods and drinks. You also need to see your dentist regularly while having orthodontic treatment. . To treat a cavity your dentist will remove the decayed portion of the tooth and then "fill" the area on the tooth where the decayed material was removed.
Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding). What Steps Are Involved in Filling a Tooth? First, the dentist will use a local anesthetic to numb the area around the tooth to be filled. Next, a drill, air abrasion instrument, or laser will be used to remove the decayed area. The choice of instrument depends on the individual dentist's comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay. Next, your dentist will probe or test the area to determine if all the decay has been removed. Once the decay has been removed, the dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it. Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that "cures" or hardens each layer is applied. When the multilayering process is completed, the dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration. What Types of Filling Materials Are Available?Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and materials called composite resin fillings. There is also a material that contains glass particles and is known as glass ionomer. This material is used in ways similar to the use of composite resin fillings. The location and extent of the decay, cost of filling material, your insurance coverage, and your dentist's recommendation assist in determining the type of filling best for you. Cast Gold Fillings Advantages of cast gold fillings:
Silver Fillings (Amalgams) Advantages of silver fillings:
Tooth-colored Composites. Advantages of composites:
What's a Temporary Filling and Why Would I Need One? Temporary fillings are used under the following circumstances:
Are Amalgam-Type Fillings Safe? Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgam fillings. Because these fillings contain the toxic substance mercury, some people think they are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis. The American Dental Association (ADA), the FDA, and numerous public health agencies say there's no proof that dental fillings cause harm to consumers. The causes of autism, Alzheimer's disease, and multiple sclerosis remain unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases. Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth. In June 2008, the FDA said, "Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses." And there's more. "Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner," according to the FDA. The changes come in response to a lawsuit filed by consumer groups and individuals concerned about mercury exposure. To settle the suit, the FDA agreed to update its web site. How Should I Care for My Teeth With Fillings? To maintain fillings, you should follow good oral hygiene -- visiting your dentist regularly for cleanings, brushing with a fluoride toothpaste, flossing and using an antibacterial mouthwash at least once daily. If your dentist suspects that a filling might be cracked or is "leaking" (when the sides of the filling don't fit tightly against the tooth, this allows debris and saliva to seep down between the filling and the tooth, which can lead to decay), he or she will take X-rays to assess the situation. If your tooth is extremely sensitive, if you feel a sharp edge, if you notice a crack in the filling, or if a piece of the filling is missing, call your dentist for an appointment. Problems With Dental Fillings Tooth Pain and Sensitivity Tooth sensitivity following placement of a filling is fairly common. A tooth may be sensitive to pressure, air, sweet foods, or temperature. Usually, the sensitivity resolves on its own within a few weeks. During this time, avoid those things that are causing the sensitivity. Pain relievers are generally not required. Contact your dentist if the sensitivity does not subside within two to four weeks or if your tooth is extremely sensitive. He or she may recommend a desensitizing toothpaste, may apply a desensitizing agent to the tooth, or possibly suggest a root canal procedure. Pain around the fillings can also occur. If you experience pain when you bite, the filling may be interfering with your bite. You will need to return to your dentist and have the filling reshaped. If you experience pain when your teeth touch, the pain is likely caused by the touching of two different metal surfaces (for example, the silver amalgam in a newly filled tooth and a gold crown on another tooth with which it touches). This pain should resolve on its own within a short period of time. If the decay was very deep or close to the pulp of the tooth, you may experience a "toothache-type" pain. This "toothache" response may indicate this tissue is no longer healthy. If this is the case, root canal therapy may be required. Sometimes people experience what is known as referred pain -- pain or sensitivity in other teeth besides the one that received the filling. With this particular pain, there is likely nothing wrong with your teeth. The filled tooth is simply passing along "pain signals" it's receiving to other teeth. This pain should decrease on its own over 1 to 2 weeks. Filling Allergies Allergic reactions to silver fillings are rare. Fewer than 100 cases have ever been reported, according to the ADA. In these rare circumstances, mercury or one of the metals used in an amalgam restoration is thought to trigger the allergic response. Symptoms of amalgam allergy are similar to those experienced in a typical skin allergy and include skin rashes and itching. Patients who suffer amalgam allergies typically have a medical or family history of allergies to metals. Once an allergy is confirmed, another restorative material can be used. Deteriorating Fillings Constant pressure from chewing, grinding, or clenching can cause dental fillings to wear away, chip, or crack. Although you may not be able to tell that a filling is wearing down, your dentist can identify weaknesses in them during a regular check-up. If the seal between the tooth enamel and the filling breaks down, food particles and decay-causing bacteria can work their way under the filling. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscessed tooth.# If the filling is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, your dentist may need to replace the filling with a crown. New fillings that fall out may be the result of improper cavity preparation, contamination before the filling is placed, or a fracture of the filling from bite or chewing trauma. Older restorations will generally be lost due to decay or fracturing of the remaining tooth What causes sensitive teeth?
Toothbrush and/or toothpaste damage may be the most frequent cause of sensitive teeth. By brushing too hard and/or using abrasive toothpaste, you may be removing tooth structure at the necks of your teeth. This can result in pain, especially to cold drinks, food, and air, but also to physical pressure, hot, sweet and sour. The reason for the pain is exposed dentine – the inner substance of the tooth, which is covered by enamel. The enamel can get quite thin, especially where the tooth meets the root (at the gumline). The root is covered by a substance called cementum, which is easily worn away. Dentine contains little tunnels (tubules) that link to the nerves on the inside of the tooth, and when dentine is exposed, these nerves are easily stimulated, resulting in pain. Other things which can cause sensitive teeth include:
To prevent further damage, brush your teeth gently as described on our toothbrush abrasion page and avoid abrasive toothpaste or use a non-alcohol mouthwash to wet your toothbrush instead. Toothpastes for sensitive teeth. Desensitizing agents such as Sensodyne (there’s loads of different ones on the market now) work by blocking off the dentinal tubules, so that the nerves don’t get stimulated. Sensodyne & Co. don’t work that well used as a toothpaste. They work a lot better by gently massaging the paste or gel into the sore spot with a finger. Do not rinse it off with water or mouthwash. It may take several weeks before the desired effect is achieved. Desensitising toothpastes can be used indefinitely. The warning on the US packet not to use Sensodyne for more than a month is a legal requirement, designed so that people won’t put off seeing a dentist when something might be seriously wrong. There are no actual health reasons for not using desensitising agents long-term. High-fluoride mouthwashes. Not everyone finds that sensitive toothpastes work. You may want to try a non-alcohol mouthwash with a high fluoride content instead. Some of them are specifically designed to reduce sensitivity. They should be used twice a day after brushing – one of those times should be just before you go to bed, so the mouthwash doesn’t get rinsed away when you drink or eat something. Swish the mouthwash back and forth between the teeth for at least 30 seconds, and do not rinse with water afterwards. Recaldent.Some people also find that GC Tooth Mousse and Recaldent MI Paste help (these are quite expensive though). What can dentists do about sensitive teeth?
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AuthorDr Bogdan Krastev PhD Archives
May 2017
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