Below are some of the most frequently asked questions patients have about dentistry and their oral health. Should you need more information or advice, please get in touch with your dentist or contact us.
A: Brushing and flossing are necessary to control the plaque and bacteria (germs) that cause dental disease.
Plaque is a film of food debris, bacteria and saliva that sticks to the teeth and gums. The bacteria in plaque convert certain food particles into acids that cause tooth decay. Also, if plaque is not removed, it turns into calculus (tartar). If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.
Plaque formation and growth is continuous and can only be controlled by regular brushing and flossing.
Brush your teeth at least twice a day (especially before going to bed at night) with a soft bristle brush and toothpaste.
Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth and bone.
Rinse your mouth with water after brushing and/or flossing. This will help to remove remaining particles of food and plaque, loosened by brushing and flossing. If you are unable to brush after meals, rinse your mouth properly with water or a mouthwash to remove as much of remaining food particles as possible.
A: Brushing your teeth removes food particles, plaque and bacteria from all tooth surfaces, except in between the teeth. Unfortunately, your toothbrush can not reach these areas that are highly susceptible to decay and periodontal (gum) disease.
Daily flossing is the best way to clean between your teeth and under the gumline.
Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth and bone.
Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris and saliva. The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums. When plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar). This will further irritate and inflame the gums and slowly destroy the bone. This is the beginning of periodontal disease.
How to floss properly
A: Some concern about the safety of amalgam (silver) fillings have been expressed in recent years. Amalgam is a blend of copper, silver, tin and zinc, mixed with mercury. Dentists have used this mixture to fill teeth for more than 100 years. The controversy is caused by claims that exposure to the vapour and minute particles from the mercury can cause a variety of health problems.
Although some studies indicate that there are no measurable health risks to patients who have amalgam fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels.
With respect to amalgam fillings, one party of thought is that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe. The opposing view holds that due to the constant attrition and degradation of amalgam fillings in the mouth, mercury are actually set free in small amounts and that this can lead to health problems.
There are numerous other options to amalgam fillings, including composite (tooth-coloured) fillings, porcelain and gold fillings.
We believe you should be allowed to choose the type of filling material used in your mouth. We encourage you to discuss the options with your dentist, so together you can determine the best option for you.
For more information on the opposing views on amalgam safety:
A: Bad breath (halitosis) can be an unpleasant and embarrassing condition. You may not realise you have bad breath, but everyone has it from time to time, especially in the morning.
There are various reasons why you may have bad breath, but in healthy people, the major reason is due to bacterial deposits on the tongue. Especially towards the back of the tongue. Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.
What may cause bad breath?
What can I do to prevent bad breath?
In most cases, your dentist can treat the cause of bad breath. If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odour and to suggest appropriate treatment.
A: You should have your teeth checked and cleaned at least twice a year. However, in some special cases your dentist or oral hygienist may recommend more frequent visits.
During these visits to your dentist, your teeth will be cleaned and checked for cavities. Many other things will be checked and monitored to help detect, prevent and maintain your oral and dental health.
The dental examination will include:
The cleaning of your teeth will include:
A good dental examination and cleaning involve quite a lot more than just checking for cavities and polishing your teeth. To enable your dentist to provide you with the best possible care, regular check-ups and cleaning are essential.
A: Four out of five people have periodontal disease and do not know it! You might not be aware of it, because the disease is usually painless in the early stages. Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms. Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.
Periodontal disease begins when plaque – a sticky, colourless film of bacteria, food debris and saliva – is left on the teeth and gums. The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone. Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.
Apart from poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:
Signs and symptoms of periodontal disease
Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.
A: Bottle baby caries or bottle feeding syndrome is the result of an incorrect feeding method in infants that can result in such rampant decay of a toddler’s teeth that the child will suffer pain and may lose teeth at a very early age. To avoid this problem, it is important to understand the mechanism of this feeding problem.
When a baby sucks on a bottle, the baby’s tongue comes forward and almost draws the liquid through the teat. It is this tongue-forward action that allows a baby to suck while lying down and to happily fall asleep while sucking on a bottle. Herein lies the problem. As the baby falls asleep, the sucking action slows down and the liquid the baby is drinking starts to pool in the mouth for some seconds before swallowing. As the swallowing becomes slower and slower, the forwards position of the tongue covers the lower teeth and to a certain extent protects these teeth. However, the upper teeth are exposed to the pooling liquid, especially the upper front teeth since the teat is right between them and the tongue. Whatever is in the bottle remains in contact with these upper teeth for however long the bottle is in the mouth.
The next part of the problem is the content of the bottle. Acidic liquids damage the enamel of the teeth physically. Liquids high in sugar content encourage bacterial growth in the mouth. Carbonated cold drinks and pure fruit juices should be avoided in bottles.
Bottle baby caries shows a specific pattern of very seriously affecting the front upper teeth with the first upper primary molars having the next serious risk of decay. The lower teeth are often not affected at all. Sometimes the decay happens so quickly that mothers will say the teeth came out brown. It is relatively easy for a dentist to diagnose, but often very difficult to treat.
How to avoid bottle baby caries
A: The most important thing to remember about children’s teeth is: start brushing them once they start to appear in the mouth!
Brushing an infant or very young child’s teeth is difficult. They generally don’t like it and try to pull away. You have to overcome this resistance even though it’s likely to last until the child is about 2 years old. If you don’t make an effort, plaque will build up and decay will start. It’s as simple as that!
There are no rules or easy solutions. If your baby doesn’t like the brush, use gauze, a cloth or a towel wrapped around your finger. Be firm, but gentle. Hold the mouth open with a finger pushed in behind the back teeth if necessary. Don’t worry about toothpaste unless baby likes the taste and it makes the process easier! Toothpaste can be introduced later.
Please also see the questions on Infant Do’s and Don’ts, and on bottle baby caries. Visit the section: Tooth eruption charts.
Remember: As soon as the first teeth start to appear in a baby’s mouth, plaque will start to form and the teeth will decay unless they are kept clean!
A: Do rub baby’s gums with gauze or a damp face cloth even before the teeth start to erupt. This will get your baby to understand from an early age that like bathing and hair washing, mouth washing and cleaning is part of the routine! This will also help to ease the irritation of tooth eruption.
Don’t dip the dummy in syrup, honey or anything sweet. Sweetness in the mouth for prolonged periods is guaranteed to cause decay. Furthermore this will only encourage a sweet tooth, which is bad for future tooth decay and even obesity.
Don’t put extra sugar in the drinks that your baby takes in the bottle. Your child does not need extra sugar. There is enough energy for baby in the normal diet.
Don’t give your baby undiluted fruit juices in the bottle. Fruit juices contain acid and some of them – especially citrus fruit – are very high in acid. These acids demineralise the enamel of the teeth and lead to decay. Therefore, please avoid juices in a baby’s bottle or at least dilute the juice 50/50 with water.
Do avoid carbonated drinks until at least the age of three years. Never put these drinks into a baby’s bottle. Don’t let your baby sleep with a bottle in the mouth. This may lead to ‘bottle baby caries’. If it’s essential to put baby to bed with a bottle, make sure it contains only water. Please also see the question on ‘bottle baby caries’.
Do use an orthodontic dummy to ensure that prolonged use of the dummy doesn’t lead to an open space between the front teeth.
Don’t give an infant sweets or chocolates. At the very least, not until the age of 18 months. Infants don’t need extra sugar and certainly don’t know they are ‘missing’ something nice. All it does is to promote poor diet habits and tooth decay.
A: If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.
There are many cosmetic dental procedures available to improve your teeth and enhance your smile. Depending on your particular needs, cosmetic dental treatments can change your smile dramatically – from restoring a single tooth to having a full mouth make-over. Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.
Cosmetic procedures may include:
Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!
A: Porcelain veneers are very thin shells of tooth-shaped porcelain, individually crafted to cover the fronts of teeth. They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their teeth.
Veneers may be used to restore or correct the following dental conditions:
Veneers are an excellent dental treatment that can dramatically improve your teeth and give you a natural, beautiful smile.
A: Teeth whitening or bleaching has become an important aesthetic concern for many patients.
Professional teeth whitening is a simple, non-invasive dental treatment used to change the colour of natural tooth enamel. It’s an ideal way to enhance the beauty of your smile. Over-the-counter products are also available, but are much less effective than professional treatments.
As you age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade. The colour of your teeth also comes from the inside of the tooth, which may become darker over time. Smoking, drinking coffee, tea and wine may also contribute to tooth discolouration, turning your teeth yellow and dull. Sometimes, teeth can become discoloured from taking certain medications as a child, such as tetracycline. Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discoloured.
It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching. Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains. Since teeth whitening only works on natural tooth enamel, it’s also important to evaluate the condition of any old fillings, crowns, etc. before bleaching begins. Once the bleaching is done, your dentist can match any new restorations that are needed to the shade of your newly whitened teeth.
Since teeth whitening is not permanent, a touch-up may be needed from time to time to keep your smile looking bright.
The most widely used professional teeth whitening system is the home teeth whitening system. At-home products usually come in a gel form that is placed in a custom-fitted bleaching tray (mouthguard), made on a mould of your teeth. The trays are worn preferably overnight while you sleep. It usually takes several weeks to achieve the desired results, depending on the degree of staining and the desired level of whitening.
You may experience tooth sensitivity after having your teeth whitened. This is temporary and subsides shortly after you complete the bleaching process, usually within a few days.
Teeth whitening can be very effective and can give you a brighter, whiter, more confident smile!
A: The last four molar teeth, right at the back in each corner of the mouth are called the wisdom teeth. They normally erupt into the mouth at about 17 to 21 years of age. Because they are the last teeth to appear in the mouth there is sometimes not enough space and they get stuck behind the teeth in front of them. Sometimes wisdom teeth don’t grow into the mouth at all. These un-erupted or partially erupted wisdom teeth are then called impacted wisdom teeth.
In some cases wisdom teeth have enough space to erupt normally and will not cause problems. You are lucky if this happens to you, since you can then treat your wisdom teeth just like ordinary teeth with no treatment necessary.
Problems with impacted wisdom teeth normally fall into three categories:
It’s good practice to regularly evaluate erupting wisdom teeth and to take appropriate action before any problems occur. Normally young patients will be evaluated at 18 years for possible problems with their wisdom teeth. An X-ray will be taken to determine the presence and position of the wisdom teeth, as well as the potential for future problems with these teeth.
If wisdom teeth are causing specific problems, or if it appears that they will cause problems in the future, it will be recommended to have them removed.
Removal of wisdom teeth can often be done by a dentist in the dental surgery under local anaesthetics. Because of the amount of anaesthetic needed, wisdom teeth are often removed in sessions, two at a time.
In difficult cases or if patients are reluctant to have wisdom tooth surgery performed under local anaesthetics while they are awake, the surgery can be done under general anaesthetics in a hospital. Complicated cases, where the wisdom teeth are very deep in the jaw bone or where the nerves of especially the lower jaw are near the wisdom teeth, will be referred to a specialist maxillo, facial and oral surgeon.
Also see the question about wisdom tooth surgery and referral to a specialist surgeon.
A: Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the Age of Wisdom.
Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn’t leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.
What is an impacted tooth?
A tooth becomes impacted when there is a lack of space in the dental arch and its growth and eruption are prevented by overlying gum, bone or another tooth. A tooth may be partially impacted, which means a portion of it has broken through the gum, or totally impacted and unable to break through the gum at all.
How serious is an impacted tooth?
Impacted and partially impacted teeth can be painful and lead to infection. They may also crowd or damage adjacent teeth or roots. More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows, it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.
Despite the considerable concern regarding impacted third molars, a recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation finds that third molars – which have broken through the tissue and erupted into the mouth in a normal, upright position – may be as prone to disease as those third molars that remain impacted.
Must the tooth come out if it hasn’t caused any problems yet?
Not all problems related to third molars are painful or visible. Damage can occur without you being aware of it. As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, partially or totally impacted wisdom teeth are more likely to cause problems as you age.
No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It’s estimated that about 85% of third molars will eventually need to be removed.
When should I have my wisdom teeth removed?
It isn’t wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process. The AAOMS/OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing. The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.
What happens during surgery?
Before surgery, your oral and maxillofacial surgeon will discuss what you can expect. This is a good time to ask questions or express your concerns. It’s especially important to let the doctor know about any illness you have and medications you are taking.
The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Partially or totally impacted wisdom teeth may require a more involved surgical procedure.
Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under local anaesthesia, intravenous sedation or general anaesthesia. Your surgeon will discuss the anaesthetic option that is right for you.
What happens after surgery?
You may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.