Dental health: Teeth and gum care

With proper care, your teeth and gums can stay healthy throughout your life. The healthier your teeth and gums, the less risk you have of tooth decay and gum disease.

How should I care for my teeth and gums?

There are four basic steps to caring for teeth and gums:

1. Brushing
2. Flossing
3. Eating sensibly
4. Visiting the dentist

Tips for brushing

Brush at least twice a day. If you can, brush after every meal. Brushing removes plaque, a film of bacteria that clings to teeth. When bacteria in plaque come into contact with food, they produce acids. These acids lead to cavities. To brush:

• Place a pea-sized dab of fluoride toothpaste on the head of a soft toothbrush.
• Place the toothbrush against the teeth at a 45-degree angle to the gum line.
• Move the brush across the teeth using a small circular motion. Continue with this motion cleaning one tooth at a time. Keep the tips of the bristles against the gum line. Avoid pressing so hard that the bristles lie flat against the teeth and remember that only the tips of the toothbrush do the cleaning. Let the bristles reach into the spaces between teeth.
• Brush across the top of the chewing surfaces of the teeth. Make sure the bristles get into the grooves and crevices.
• Use the same small circular motion to clean the backside of the upper and lower teeth - the side that faces the tongue.
• To clean the inside of the bottom front teeth, angle the head in an up-and-down position towards the bottom inside of the mouth and move the toothbrush in a small circle.
• For the inside of the top front teeth, angle the brush in an up-and-down position with the tip of the head pointing towards the roof of the mouth. Move the toothbrush in a small circle.
• Give your tongue a few gentle brush strokes, brushing from the back of your tongue forwards. Do not scrub. This helps remove bacteria and freshens your breath.
• After brushing your teeth for two to three minutes, rinse your mouth with water.
• Replace your toothbrush every three to four months.

Tips for flossing

Floss once a day. Flossing gets rid of food and plaque between the teeth, where the toothbrush cannot reach. If plaque stays between teeth, it can harden into tartar, which can only be removed by a dentist. To floss:

• Remove about a 45 cm strip of floss from the dispenser.
• Wind the floss around the middle fingers of each hand, leaving a 3 cm section open for flossing. Floss the top teeth first, then the bottom.
• Place the floss in your mouth and use your index fingers to push the floss between the teeth. Be careful not to push too hard and injure the gums.
• Move the floss up and down against the tooth and up and around the gum line. The floss should form a C-shape around the tooth as you floss.
• Floss between each tooth as well as behind the back teeth.
• Use a clean section of floss as needed and take up used floss by winding it around the fingers.

Dental sealants

A sealant is a thin, plastic coating painted on the chewing surfaces of teeth, usually the back teeth (premolars and molars), to prevent tooth decay. The liquid sealant quickly bonds to the depressions and grooves of the teeth forming a protective shield over the enamel of each tooth.

Why use sealants?

Although thorough brushing and flossing can remove food particles and plaque from smooth surfaces of teeth, they cannot always get into all the nooks and crannies of the back teeth to remove the food and plaque. Sealants protect these vulnerable areas from tooth decay by "sealing out" plaque and food.

Who should use sealants?

Because of the likelihood of developing decay in the depressions and grooves of the premolars and molars, children and teenagers are obvious candidates for sealants. However, adults without decay or fillings in their molars can also benefit from sealants.

Typically, children should have sealants on their permanent molars and premolars as soon as these teeth come in. In this way, the dental sealants can protect the teeth through the cavity-prone years of ages six to 14.

In some cases, dental sealants may also be appropriate for baby teeth, such as when a child's baby teeth have deep depressions and grooves. Because baby teeth play such an important role in holding the correct spacing for permanent teeth, it is important to keep these teeth healthy so they are not lost too early.

How are sealants applied?

Applying the sealant is a simple and painless process. It takes only a few minutes for your dentist or hygienist to apply the sealant to seal each tooth. The application steps are as follows:

1. First the teeth that are to be sealed are thoroughly cleaned.
2. Each tooth is then dried and cotton or another absorbent material is put around the tooth to keep it dry.
3. An acid solution is put on the chewing surfaces of the teeth to roughen them up, which helps the sealant bond to the teeth.
4. The teeth are rinsed and dried.
5. Sealant is then painted onto the tooth enamel, where it bonds directly to the tooth and hardens. Sometimes a special curing light is used to help the sealant harden.

How long do sealants last?

Sealants can protect the teeth from decay for up to 10 years, but they need to be checked for chipping or wearing at regular dental check-ups. Your dentist can replace sealants as necessary.

Most NHS dentists can carry out the procedure free of charge, but generally only if they are for your child and there is a clear clinical need.

Will insurance cover the cost of sealants?

If you have private dental care insurance, your insurance plan may cover the cost. It is best to check before embarking on any treatment.

Dental health: Root canals

What should one expect after the root canal?

For the first few days following the completion of treatment, the tooth may feel sensitive due to natural tissue inflammation, especially if there was pain or infection before the procedure. This sensitivity or discomfort usually can be controlled with over-the-counter pain medications such as ibuprofen. Most patients can return to their normal activities the next day.

Until your root canal procedure is completely finished, that is to say, the permanent filling is in place and/or the crown, it's wise to minimise chewing on the tooth under repair. This step will help avoid recontamination of the interior of the tooth and also may prevent a fragile tooth from breaking before the tooth can be fully restored.

As far as oral health care is concerned, brush and floss as you would normally and see your dentist at the usual regular intervals.

How successful are root canals?

Root canal treatment is highly successful; the procedure has more than a 95% success rate. Many teeth fixed with a root canal can last a lifetime.

Also, because the final step of the root canal procedure is application of a restoration such as a crown or a filling, it will not be obvious to onlookers that a root canal was performed.

Complications of a root canal

Despite your dentist's best efforts to clean and seal a tooth, new infections might emerge. Among the likely reasons for this include:

• More than the normally anticipated number of root canals in a tooth (leaving one of them uncleaned).
• An undetected crack in the root of a tooth.
• A defective or inadequate dental restoration that has allowed bacteria to get past the restoration into the inner aspects of the tooth and recontaminate the area.
• A breakdown of the inner sealing material over time, allowing bacteria to recontaminate the inner aspects of the tooth.

Sometimes retreatment can be successful, other times endodontic surgery must be tried in order to save the tooth. The most common endodontic surgical procedure is an apicoectomy or root-end resection. This procedure relieves the inflammation or infection in the bony area around the end of your tooth that continues after endodontic treatment. In this procedure, the gum tissue is opened, the infected tissue is removed, and sometimes the very end of the root is removed. A small filling may be placed to seal the root canal.

Cost of a root canal

The cost varies depending on how severe the problem is and the tooth affected. If you are not covered by the NHS, then speak to your dentist about the cost for your specific case.

Alternatives to a root canal

Saving your natural teeth is the very best option, if possible. Your natural teeth allow you to eat a wide variety of foods necessary to maintain proper nutrition. The root canal procedure is the treatment of choice.

The only alternative to a root canal procedure is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting. These alternatives not only are more expensive than a root canal procedure but require more treatment time and additional procedures to adjacent teeth and supporting tissues.

Since some of the reasons why the nerve of a tooth and its pulp become inflamed and infected are due to deep decay, repeated dental procedures on a tooth and/or large fillings, following good oral hygiene practices (brushing twice a day, flossing at least once a day, and booking regular dental visits) may reduce the need for a root canal procedure. Trauma resulting from a sports related injury can be reduced by wearing a mouth guard.

Dental health: Root canals

What happens during the procedure? continued...

The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Your dentist or endodontist will then use local anaesthesia to numb the area near the tooth. Anaesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetise the area to make the patient more relaxed and at ease.

Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.

An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.

Once the tooth is thoroughly cleaned, it is sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep contaminants out between appointments.

At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.

The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking and restore it to full function. Your dentist will discuss the need for any additional dental work with you.

How painful is the procedure?

Root canal procedures have the reputation of being painful. Actually, most people report that the procedure itself is no more painful than having a filling done.

Dental health: Root canals

A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.

"Root canal" is the term used to describe the natural cavity within the centre of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.

A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory, to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.

Why does the pulp need to be removed?

When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:

Swelling that may spread to other areas of the face, neck, or head

Bone loss around the tip of the root

Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

What damages a tooth's nerve and pulp in the first place?

Nerve and pulp can become irritated, inflamed and infected due to deep decay, repeated dental procedures on a tooth and/or large fillings, a crack or chip in the tooth, or trauma to the face.

What are the signs that a root canal is needed?

Sometimes no symptoms are present; however, signs to look for include:

Severe toothachepain upon chewing or application of pressure

Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)

Discolouration (a darkening) of the tooth

Swelling and tenderness in the nearby gums

A persistent or recurring pimple on the gums

What happens during the procedure?

A root canal requires one or more dentist surgery visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specialises in the causes, diagnosis, prevention and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.

Dental implants

What is involved in getting a dental implant? continued...

Next, the tooth root implant, which is a small post made of titanium, is placed into the bone socket of the missing tooth. As the jawbone heals, it grows around the implanted metal post, anchoring it securely in the jaw. The healing process can take from six to 12 weeks.

Once the implant has bonded to the jawbone, a small connector post, called an abutment, is attached to the post to securely hold the new tooth. To make your new tooth or teeth, your dentist makes impressions of your teeth, and creates a model of your bite (which captures all of your teeth, their type, and arrangement). Your new tooth or teeth are based on this model. A replacement tooth, called a crown, is then attached to the abutment.

Instead of one or more individual crowns, some patients may have attachments placed on the implant that retain and support a removable denture.

Your dentist also will match the colour of your new teeth to your natural teeth. Because the implant is secured within the jawbone, the replacement teeth look, feel, and function just like your own natural teeth.

How painful are dental implants?

Most people who have received dental implants say that there is very little discomfort involved in the procedure. Local anaesthetic can be used during the procedure, and most patients report that implants involve less pain than a tooth extraction.

After the dental implant, mild soreness can be treated with over-the-counter pain medications, such as paracetamol.

How do I care for dental implants?

Dental implants require the same care as real teeth, including brushing, flossing and regular dental check-ups.

Further Reading:

The health perils of gum disease

Glossary of dental health terms

Gingivitis and periodontal disease (gum disease)

Dental health insurance

Treatments for gum disease

Dental health and oral piercings

Gum problem basics: Sore, swollen and bleeding gums

Dental implants

Despite improvements in dental care, millions of people suffer tooth loss, mostly due to tooth decay, gingivitis (gum disease), or injury. For many years, the only treatment options available for people with missing teeth were bridges and dentures, but today, dental implants are available.

What are dental implants?

Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.

What are the advantages of dental implants?

There are many advantages to dental implants, including:

• Improved appearance. Dental implants look and feel like your own teeth, and because they are designed to fuse with bone, they become permanent.
• Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that your teeth might slip.
• Improved comfort. Because they become part of you, implants eliminate the discomfort of removable dentures.
• Easier eating. Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favourite foods with confidence and without pain.
• Improved self-esteem. Dental implants can give you back your smile and help you feel better about yourself.
• Improved oral health. Dental implants don't require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving your long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
• Durability. Implants are very durable and will last many years. With good care, many implants last a lifetime.
• Convenience. Removable dentures are just that; removable. Dental implants eliminate the embarrasing inconvenience of removing your dentures, as well as the need for messy adhesives to keep your dentures in place.

How successful are dental implants?

Success rates of dental implants vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care (see below), implants can last a lifetime.

Can anyone get dental implants?

In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for a dental implant. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits. Heavy smokers, people suffering from uncontrolled chronic disorders, such as diabetes or heart disease, or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis. If you are considering implants, talk to your dentist to see if they are suitable for you.

What is involved in getting a dental implant?

The first step in the dental implant process is the development of an individual treatment plan. The plan addresses your specific needs and is prepared by a team of professionals who are specially trained and experienced in oral surgery and restorative dentistry. This team approach provides coordinated care based on the implant option that is best for you.