Why should I consider white fillings?: Most people have fillings of one sort or another in their mouths. Nowadays fillings are not only functional, but can be natural looking as well. Many people don't want silver fillings that show when they laugh or smile because they are more conscious about the way they look.
Are white fillings expensive?: Costs usually depend on the size and type of white filling used and the time it takes to complete the treatment.
Are white fillings as good as silver amalgam fillings?: White fillings have always been considered less long lasting than silver amalgam fillings. But there are now new materials available with properties comparable to silver amalgam, and these are proving to be very successful. The life expectancy of a white filling can depend greatly on where it is in your mouth and how heavily your teeth come together when you bite.
Is it worth replacing my amalgam fillings with white ones?: Absolutely. It is usually best to change fillings if you take care of your appearance, and want to avoid problems of metal allergy. If so you can ask to have it replaced in a tooth-coloured material.
What are tooth-coloured fillings made of?: This can vary, but they are mainly made of glass particles, synthetic resin and a setting ingredient. Your dentist should be able to give you more information about the particular material they use.
Are there any alternatives to fillings?: Adhesive dentistry is another form of this treatment. This involves bonding the filling to the tooth. The dentist has to remove less of the tooth, which is obviously better. As we have already said, there are alternatives such as crowns and inlays although they can cost a lot more. Veneers can be used on front teeth instead of crowns or fillings.

Bridges and partial dentures

Why should I replace missing teeth?: Your appearance is one reason. Another is that the gap left by a missing tooth can mean greater strain is put on the teeth at either side. A gap can also mean your 'bite' is affected, because the teeth next to the space can lean into the gap and alter the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes both decay and gum disease.
How are missing teeth replaced?: This depends on the number of teeth missing and on where they are in the mouth. The condition of the other teeth also affects the decision. There are two main ways to replace the missing teeth. The first is with a removable false tooth or teeth - a partial denture. The second is with a fixed bridge. A bridge is usually used where there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth.
What is a partial denture?: This is a plate with a number of false teeth on it. It may be all plastic or a mixture of metal and plastic. Both types may have clips (clasps), to help keep the denture in place in the mouth. Depending on where they are, some of these clips may show when you smile or open your mouth.
What are the replacement teeth made of?: Usually plastic, and occasionally porcelain. Each replacement tooth is made specially, to get the right shape, colour and size for you.
What is the difference between a plastic partial denture and one that contains metal?: Plastic partial dentures are less expensive to make. But unless they are designed very carefully they can damage the teeth they fit against. Metal partial dentures are usually from an alloy of cobalt and chromium and they are much stronger. They are lighter to wear and can be supported by the remaining teeth. Although the base is metal, they have gum-coloured plastic and natural-looking teeth fixed to them. They are more expensive than the plastic ones.
How do I choose the best type for me?: Be guided by your dentist. He or she will know the condition of your remaining teeth. In most cases a metal-based partial denture gives the best result, but the higher cost may make you decide against it.
How do I look after my denture?: You should remove the denture from your mouth for cleaning. You'll be shown how to clean it by your dentist or hygienist, probably with a small toothbrush and toothpaste, or by soaking it in cleansing solution. If you have a metal-based denture you'll need to choose a cleaning solution that's suitable for metal.
Should I take my denture out at night?: Yes. Leave it in water to stop it warping.
What is the alternative to a partial denture?: The main alternative is a fixed bridge. This is made by putting crowns on the teeth at either side of the space, and then joining these two crowns together by placing a false tooth in the space. This is all made in the laboratory and then the pieces are cemented into place with special adhesives. The bridge can't be removed.
Can I always have a bridge to replace missing teeth?: Yes, if you have enough strong teeth with good bone support. Your dentist will help you decide which is the best way of replacing them within your budget.
What are bridges made of?: Bridges usually made of a precious metal. If the bridge will show, porcelain is then bonded to the base. Sometimes, there are other non-precious metals used in the base for strength.
How do I look after my bridge?: You need to clean your bridge every day, to prevent problems such as bad breath and gum disease. You also have to clean under the false tooth every day. Your dentist or hygienist will show you how to use a bridge needle or special floss, as a normal toothbrush cannot reach.
Are there other methods for fixing false teeth?: There are other methods, such as using a combination of crowns and partial dentures that can keep the retaining clips out of sight. These are quite specialised dentures, so you should ask your dentist about them.
Can I have teeth which attach to the jawbone?: Yes. By having implants. The success of this technique means you may be able to replace missing teeth without crowning other teeth. Our leaflet on implants explains this in detail. Remember that it's as important to care for your remaining teeth as it is to replace the missing ones.

Crowns

What is a crown?

A crown is an artificial restoration that fits over the remaining part of a prepared tooth, making it strong and giving it the shape of a natural tooth. A crown is sometimes known as a 'cap'.

Why would I need a crown?

Crowns are an ideal restoration for teeth that have been broken, or have been weakened by decay or a very large filling. A crown could be used for a number of other reasons, for instance:

you may have discoloured fillings and would like to improve the appearance of the tooth
you may have had a root filling which will need a crown to protect it
it may help hold a bridge or denture firmly in place.

What is a post crown?

In root-filled teeth it may be necessary to insert a post before placing a crown. A post provides support and helps the crown stay in place. The weakened crown of the tooth is drilled off at the level of the gum.

A post can be made of prefabricated stainless steel which the dentist can fit directly into the root canal, to help secure the crown, or a custom-made post can be constructed by the dental technician to accurately fit the shape of the prepared root canal. The post is placed into the root canal and cemented in position, ready for the crown to be attached.

Are there any alternatives to post crowns for root-filled teeth?

If a root-filled tooth is not completely broken down, it may be possible to build it up again using filling material. This 'core' is then prepared in the same way as a natural tooth and the impressions are taken.

What is a crown made of?

Crowns can be made of a variety of different materials and new materials are continually being introduced. Some of the most popular options are listed below.

Porcelain bonded to precious metal: this is what most crowns are made from. A precious metal base is made and then porcelain is applied in layers over it.
Porcelain crowns: these crowns are made entirely out of porcelain and are not as strong as bonded crowns, but they can look very natural and are most often used for front teeth.
All-ceramic crowns: this modern technique offers a metal-free alternative, which can give the strength of a bonded crown and the appearance of a porcelain crown. Therefore it is suitable for use in all areas of the mouth.
Porcelain and composite: porcelain and composite resin materials can sometimes look the most natural. However, these crowns are not as strong as bonded metal crowns.
Glass: these crowns look very natural and are used on both front and back teeth.
Gold alloy crowns: gold is one of the oldest filling materials. Today it is used with other metal alloys to increase its strength, which makes it a very hardwearing restoration. These crowns are white or gold in colour.

How is a crown prepared?

The dentist will prepare the tooth to the ideal shape for the crown. This will involve removing most of the outer surface, and leaving a strong inner core. The amount of the tooth removed will be the same as the thickness of the crown.

Once the tooth is shaped, the dentist will take an impression (mould) of the prepared tooth, one of the opposite jaw and possibly another to mark the way you bite together.

The impressions will then be given to the dental technician, along with an appropriate shade and other information needed for the crown to be made.

What will happen between visits?

A temporary crown will be made so that you can use the tooth while you wait for the crown to be made. This crown may be more noticeable but is only a temporary measure.

How is the crown fitted?

When the dentist is happy with the fit and appearance of the new crown it will be fixed in place with special dental cement or adhesive. The cement forms a seal to hold the crown in place.

How long does the treatment take?

You will need to have at least two visits: the first for the preparation, impression, shade taking and fitting the temporary crown; and the second to fit the permanent crown. There will usually be about 1 to 2 weeks in between appointments.

Does it hurt to have a tooth prepared for a crown?

No. A local anaesthetic is used and the preparation should feel no different from a filling. If the tooth does not have a nerve, and a post crown is being prepared, then a local anaesthetic may not be needed.

Will the crown be noticeable?

No. The crown will be made to match your other teeth exactly. The shade of the neighbouring teeth will be recorded, to make sure that the colour looks natural and matches the surrounding teeth.

Will the crown feel different?

Because the shape of the crown will be slightly different from the shape of your tooth before it was crowned, you may be aware of it to begin with. Within a few days it should feel fine, and you will not notice it. The crown may need some adjustment if your bite does not feel comfortable, so you should ask your dentist to check and adjust it.

How do I care for my crown?

How long your crown lasts depends on how well you look after it. The crown itself cannot decay, but decay can start where the edge of the crown joins the tooth. Therefore, it is important to keep this area just as clean as you would your natural teeth in order to prevent decay affecting the crown.

How long will the crown last?

Properly cared for crowns should last for many years. Your dentist will be able to tell you how long the crown may be expected to last.

Denture cleaning

How often should I clean my dentures?: It is important to treat your dentures like you would treat your natural teeth. They should be kept as clean as possible to prevent further tooth loss, inflamed gums, or bacterial and fungal infections. We usually recommend that you clean them thoroughly twice a day, and after eating when necessary.
How should I clean them?: The general rule is: brush, soak, brush. Always clean your dentures over a bowl of water or a folded towel in case you drop them. Brush your dentures before soaking, to help remove any food debris. Soak the dentures in a specialist cleaner for a short time if you prefer and then brush the dentures again - as you would your own teeth, being careful not to scrub too hard as this may cause grooves in the surface. Make sure you clean all the surfaces of the dentures, including the surface which comes into contact with your gums. This is especially important if you use any kind of denture fixative.
What should I use to clean my dentures?: There are many different denture-cleaning products. However, most dentists still recommend a small- to medium- headed toothbrush to reach into the awkward corners, or a soft nailbrush, and ordinary soap. Soaking solutions can often help to remove staining and bacteria. We do not recommend that you use these solutions overnight.
Is there anything I should avoid?: It is important not to use any type of bleaching product to clean your dentures. Bleaching can lead to weakening of the denture as well as making it look unsightly. Do not use very hot water to soak the denture. Again, it can weaken the denture causing it to break.
What should I do if I have a soft lining?: Some people have sensitive gums and may need a softer lining made for their dentures. If you have one of these special linings, it is important to check with your dentist before using any cleaning products or fixatives as some products can damage the lining.
What if I have a metal denture?: Some commercial cleaning products can damage metal dentures, so it is important to discuss cleaning options with your dentist if you have these. If your denture has clasps, you need to take particular care when cleaning to avoid damage.
Are there any special products I should use?: There are some specialist products available for cleaning your dentures, including special brushes, cleaning pastes and soaking solutions. However, you should use these carefully and follow the manufacturer's instructions. If you are not sure which products to use, ask your dentist.
Should I remove my dentures at night?: Most dentists recommend removing your dentures at night to give your mouth a chance to rest. If you remove your dentures, it is important to leave them in water to prevent any warping or cracking.
Can my dentist clean them?: Some people do build up tartar on their dentures just as they would on their natural teeth. If plaque is not removed properly, it can react with your saliva and harden into tartar. As with your own teeth, you will not be able to remove this tartar completely yourself and eventually it can make the denture uncomfortable and unsightly. Your dentist will be able to remove this tartar using a professional cleaning machine.
What can I do about staining?: Like natural teeth, dentures can pick up staining every day. This is especially true if you smoke, or drink a lot of tea, coffee or red wine. In most cases you should be able to remove this staining with regular cleaning. However, more stubborn stains may take a little more cleaning, which your dentist should be able to help with.
Do I still need to see the dentist?: It is important to visit your dentist regularly even if you don't have any of your natural teeth. Dentists do not only check teeth, but also the soft parts of the mouth, including the tongue and cheeks. These examinations are just as important, so the dentist can spot any infections, mouth conditions or even mouth cancer at the earliest stages. Your dentist will be able to tell you how often you should visit.

Dentures

Why bother with dentures?: Replacing lost or missing teeth has substantial benefits for your health and appearance. A complete or full denture replaces the natural teeth and provides support for cheeks and lips. Without this support, sagging facial muscles can make a person appear older and reduce their ability to eat and speak.
What is a denture?: A denture is an appliance which is worn to replace lost or missing teeth to enable you to enjoy a healthy diet and smile with confidence. A complete or full denture is one which replaces all of the natural teeth in either the upper or lower jaws. A partial denture fills in the spaces created by lost or missing teeth and is attached to your natural teeth with metal clasps or devices called precision attachments.
What are dentures made of?: The base of a denture is called a plate and can be made of either acrylic (plastic) or metal. The teeth are normally made of acrylic and can be made to match your natural teeth. This is especially important in the case of partial dentures.
Will dentures make me look different?: Dentures can be made to closely resemble your natural teeth so that little change in appearance will be noticeable. Modern dentures may even improve the look of your smile and help fill out the appearance of your face.
Will I be able to eat with dentures?: Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the denture from moving. As you become more used to your denture, add other foods until you return to your normal healthy diet.
Will dentures change how I speak?: Pronouncing certain words may require practice. Reading out loud and repeating difficult words will help. If you find that your dentures occasionally slip when you laugh, cough or smile, reposition the denture by gently biting down and swallowing. If this continues consult your dentist.
How long should I wear my dentures?: During the first few days, you may be advised to wear them for most of the time, including while you are asleep. After an initial period of adjustment your dentist may advise that you remove them before going to bed. This allows your gums to rest and helps promote oral health.
Should I use a denture fixative?: Dentures are custom made to fit your mouth and a denture fixative should not be necessary. However, over a period, dentures may become loose and ill-fitting and a fixative may be used for a short period prior to having them replaced. A poorly fitting denture may cause irritation and possible sores, this can often happen if you have worn Immediate Dentures for some time.
Must I do anything special to care for my mouth?: Even with full dentures, you still need to take good care of your mouth. Every morning and evening, brush your gums, tongue and palate (roof of your mouth) with a soft -bristled brush. This removes plaque and stimulates circulation in the mouth. It is vitally important that partial denture wearers brush their teeth thoroughly every day to prevent tooth decay and gum disease that can lead to further teeth being lost.
What is the difference between conventional and Immediate Dentures?: Conventional dentures are made and inserted after teeth have been removed and the tissues have healed. Healing may take several months.; Immediate Dentures are inserted immediately after teeth have been removed. To do this, the dentist takes measurements and impressions of your mouth during a preliminary visit. An advantage of Immediate Dentures is that the wearer does not have to be without teeth during the healing period. However, bone and gums can shrink over time, especially during the first six months after teeth have been removed. When gums shrink, Immediate Dentures may require relining or even replacing to fit properly.
What will dentures feel like?: New dentures may feel awkward or even uncomfortable for a few weeks until you become accustomed to them. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place. Should this continue, consult your dentist.; It is not unusual to experience minor irritation or soreness during this period. You may also find that saliva flow temporarily increases. As your mouth becomes accustomed to the dentures, these problems should diminish. If any problems persist, particularly irritation or soreness, be sure to consult your dentist.
How do I take care of my dentures?: Dentures are very delicate and may break if dropped. When cleaning dentures it is recommended that you do so over a folded towel or sink of water. When you are not wearing your dentures, they should be stored in a container containing enough water to cover them. Like natural teeth, dentures must be brushed daily to remove food debris and plaque. Brushing helps prevent dentures becoming stained and helps your mouth stay healthy. There are special denture cleaning brushes available but a soft bristled toothbrush can also be used. Avoid using hard-bristled brushes which can cause damage.; The use of an effervescent denture cleaner will help remove stubborn stains and leave your denture feeling fresher.
Will my dentures need to be replaced?: Over a period of time, dentures will need to be relined or re-made due to normal wear or a change in the shape of your mouth. Bone and gum ridges can recede or shrink causing jaws to align differently. Loose dentures can cause health problems, including sores and infections not to mention discomfort. A loose or ill-fitting denture can also make eating and speaking more difficult. It is important to replace worn or poorly fitting dentures before they cause problems.
How often should I see my dentist?: Regular dental check-ups and having your teeth professionally cleaned are vital for maintaining healthy teeth and gums, most dentists recommend that under normal circumstances this should be done every 6 months. Full denture wearers should consult their dentist as to the frequency of visits.

Gum disease

What is gum disease?: Gum disease describes swelling, soreness or infection of the tissues supporting the teeth. There are two main forms of gum disease: gingivitis and periodontal disease.
What is gingivitis?: Gingivitis means inflammation of the gums. This is when the gums around the teeth become very red and swollen. Often the swollen gums bleed when they are brushed during cleaning.
What is periodontal disease?: Long-standing gingivitis can turn into periodontal disease. There are a number of types of periodontal disease and they all affect the tissues supporting the teeth. As the disease gets worse the bone anchoring the teeth in the jaw is lost, making the teeth loose. If this is not treated, the teeth may eventually fall out.
Am I likely to suffer from gum disease?: Probably. Most people suffer from some form of gum disease, and it is the major cause of tooth loss in adults. However, the disease develops very slowly in most people, and it can be slowed down to a rate that should allow you to keep most of your teeth for life.
What is the cause of gum disease?: All gum disease is caused by plaque. Plaque is a film of bacteria which forms on the surface of the teeth and gums every day. Many of the bacteria in plaque are completely harmless, but there are some that have been shown to be the main cause of gum disease. To prevent and treat gum disease, you need to make sure you remove all the plaque from your teeth every day. This is done by brushing and flossing.
How will smoking affect my gums and teeth?: Smoking can also lead to gum disease. Patients who smoke are more likely to produce bacterial plaque, which leads to gum disease. The gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums fail to heal. Smoking causes people to have more dental plaque and for gum disease to progress more rapidly than in non-smokers. Gum disease still remains the most common cause of tooth loss in adults.
What happens if gum disease is not treated?: Unfortunately, gum disease progresses painlessly on the whole so that you do notice the damage it is doing. However, the bacteria are sometimes more active and this makes your gums sore. This can lead to gum abscesses, and pus may ooze from around the teeth. Over a number of years, the bone supporting the teeth can be lost. If the disease is left untreated for a long time, treatment can become more difficult.
How do I know if I have gum disease?: The first sign is blood on the toothbrush or in the rinsing water when you clean your teeth. Your gums may also bleed when you are eating, leaving a bad taste in your mouth. Your breath may also become unpleasant.
What do I do if I think I have gum disease?: The first thing to do is visit your dentist for a thorough check-up of your teeth and gums. The dentist can measure the 'cuff' of gum around each tooth to see if there is any sign that periodontal disease has started. X-rays may also be needed to see the amount of bone that has been lost. This assessment is very important, so the correct treatment can be prescribed for you.
What treatments are needed?: Your dentist will usually give your teeth a thorough clean. You'll also be shown how to remove plaque successfully yourself, cleaning all surfaces of your teeth thoroughly and effectively. This may take a number of sessions with the dentist or hygienist.
What else may be needed?: Once your teeth are clean, your dentist may decide to carry out further cleaning of the roots of the teeth, to make sure that the last pockets of bacteria are removed. You'll probably need the treatment area to be numbered before anything is done. Afterwards, you may feel some discomfort for up to 48 hours.
Once I have had periodontal disease, can I get it again?: The periodontal diseases are never cured. But as long as you keep up the home care you have been taught, any further loss of bone will be very slow and it may stop altogether. However, you must make sure you remove plaque every day, and go for regular check ups by the dentist and hygienist.

Implants

What are dental implants?: A dental implant is a titanium metal rod which is placed into the jawbone. It is used to support one or more false teeth. In practice, both the false teeth and their supporting rod are known as 'implants'.
Are implants safe? How long will they last?: Implants are a well-established, tried-and-tested treatment. 90 per cent of modern implants last for at least 15 years.
I have some of my own teeth. Can I still have implants?: Yes. You can have any number of teeth replaced with implants - from one single tooth to a complete set.
Can implants always be used to replace missing teeth?: It depends on the state of the bone in your jaw. Your dentist will arrange for a number of special tests to assess the amount of bone still there. If there is not enough, or if it isn't healthy enough, it may not be possible to place implants without grafting bone into the area first.
Do implants hurt?: Placing the implants requires a small operation. This can be carried out under local anaesthetic with sedation or with a general anaesthetic. You will not feel any pain at the time, but you may feel some discomfort during the week following the surgery. This is usually due to having stitches in place, and the normal healing process.
How long does treatment take?: Your dentist will be able to give you a provisional timetable before the treatment begins. Usually the permanent teeth are fitted 6 - 9 months after the implants are put in.
How soon can I have the new teeth?: The implants need to bond (integrate) with the bone after they have been put in. This takes at least 3 months in the lower jaw and 6 months in the upper jaw. Sometimes the implants may be stable enough when they are fitted for the artificial teeth to be attached much sooner than this. If you are having one, two or three teeth replaced, you will have a temporary restoration in the meantime. If you have complete dentures, then these can be worn throughout the healing period once they have been modified after the surgery.
Are the teeth difficult to clean?: Cleaning around the teeth attached to the implants is no more difficult than cleaning natural teeth. However, there may be areas that give you problems and you'll be shown methods to help.
If I had gum disease when I had my own teeth, will I get it with the teeth attached to the implants?: Yes, if you don't care for them well enough. If you keep them clean, and don't smoke, then you should not have any problems.
Can I take the teeth out if they are fixed to implants?: Most artificial teeth attached to implants can only be placed and removed by the dentist. However, if you have complete dentures fixed to the implants by bars, then you'll be able to take them out for cleaning.
Do the implants show?: Your dentist will make sure that the implants won't show during all normal movements of the mouth and lips. You will need to be able to see them, so that you can clean them properly.
Do I have an implant for each missing tooth?: No, unless you're only having a single tooth replaced. Normally, five or six implants are used to replace all the teeth in one jaw, as each implant can usually support two teeth. For a few missing teeth, two or three implants may be used.
What if I get hit in the face?: Implants and the teeth they support can be damaged by an accident in the same way that natural teeth can. However, if the false teeth are damaged then the remnants are left in the bone and they may be more difficult to remove than natural teeth would be. After healing, new false teeth can then be placed alongside the fragments.
What happens if the implant does not bond (integrate) with the bone?: This happens very rarely. If the implant becomes loose during the healing period or just after, then it is easily removed and healing takes place in the normal way. Once the jaw has healed, another implant can be placed there. Or, the dentist can make a bridge, using the implanted false teeth that have 'taken'.
Is the treatment expensive?: Unfortunately, yes. However, in many situations, the cost of the treatment is only a little more than the cost of more conventional treatment with crowns and bridges.; There are advantages to it, too. An implant to replace a single tooth avoids the need to cut down the teeth either side for crowns to support a bridge. Normal dentures often mean you can't eat or speak well, due to the dentures moving about. But teeth attached to an implant don't cause this problem.

Medical conditions and oral health

Will I need to tell my dentist if I have a medical condition?: When you have your first dental check up, you will be asked to fill in a medical history form. In this you can tell your dentist about any medical conditions, recent operations, allergies, and tablets or medicines you are taking that may affect your dental treatment. You may think that some conditions are not important enough to mention. However, quite often these conditions are just as important. The information will help your dentist and the dental team work together to make sure you are treated in the safest way possible and are not put at any risk during treatment.
Is this information confidential?: Yes. It will be put in your dental notes and kept confidential by the law.
What if I am taking any medicines?: You will need to tell your dentist if you are taking or rely on any medicines. This should include any inhalers, a recent course of antibiotics or regular medication for an on-going complaint. It is also important to remember to tell your dentist if you have taken any over-the-counter medicines or tablets recently, have had a recent prescription from your GP or take recreational drugs.; You should also tell your dentist if you are taking the oral contraceptive pill. This is in case you need a course of antibiotics. These can cause the pill to become less effective and you will need to take extra contraceptive precautions. All this information is needed to make sure no dental treatment; drugs or materials will affect your health.
How often should I visit my dentist?: We recommend you visit your dentist at least once a year. However, if you have certain medical conditions your dentist may want to see you more often. Patients who suffer dry mouth due to certain medication may find they are more likely to get tooth decay and would therefore need checking more closely.; The dentist may also refer you to the dental hygienist in the practice for regular scale and polish appointments to keep up your good dental health.
What may happen if I have a heart complaint?: If you need dental treatment which could involve bleeding, such as a tooth extraction or a scale and polish, your dentist may give you a dose of antibiotics one hour before your appointment. This is to make sure there is no risk of infection of the heart valves. The dentist may also choose to use a different kind of local anaesthetic (without adrenalin).
What if I have a heart murmur or rheumatic fever?: If you suffer from either of these you may need to take a dose of antibiotics one hour before certain dental treatments to prevent infection.
Is there a link between gum problems and heart disease?: Recent scientific research has shown a link between poor oral health and other conditions such as heart and lung disease. This highlights the importance of good dental care. Keeping to a good oral hygiene routine at home and regular visits to your dentist will help to prevent gum disease and therefore avoid the risk of complications.
How can my dentist help if I have asthma?: People who suffer from asthma should tell their dentist when they register. It is important to take your inhaler to every dental appointment and tell your dentist if you feel unwell or out of breath. Patients with severe asthma may find they are unsuitable for treatment under general anaesthetic or sedation, and therefore the safest option would be a local anaesthetic.
What if I am taking warfarin?: It is important to tell your dentist before treatment if you are taking warfarin, particularly if you need to have a tooth out. You may be asked to have routine blood tests before starting treatment to make sure your blood will clot enough to stop the bleeding.; Your dentist may suggest stopping your warfarin for 2 to 3 days before your dental extraction. However, for some patients there is no need to alter the medication and there should be no risk of complications following the extraction.
Should I tell my dentist if I am taking anti-depressant drugs?: Yes. It is important to tell your dentist if you are taking any of these medicines. The local anaesthetic may interfere with tricylic anti-depressants and therefore the dentist may recommend an alternative brand of anaesthetic.; A side effect of some anti-depressant drugs is dry mouth. The reduced saliva flow can increase the chance of tooth decay and gum disease.
What will happen if I have haemophilia?: Haemophilia is a blood disorder. You must tell your dentist at your first check up if you are suffering from this condition.; If the blood does not clot it may cause serious problems during dental treatment. If you need to have a tooth out, the dentist will need to refer you to the local hospital to be treated by a specialist and in the situation safest for you. After a tooth has been extracted, a clot needs to form in the socket to help it heal.; Many patients take tablets for haemophilia and it is important to inform your dentist if you are on any medication.
Will chemotherapy affect my dental treatment?: If you are going to have a course of chemotherapy, visit your dentist as soon as possible to make sure any dental treatment you need is finished before you start.; External or internal radiation therapy can often cause damage to the salivary glands, leading to a permanently dry mouth. Due to the lack of saliva, there is more risk of dental decay so it is important to have regular dental check-ups.; Chemotherapy can cause gum ulcers or the gums to bleed. Regular appointments with the dental hygienist should help to keep this under control. The hygienist will also tell you if you are brushing correctly and will check that you are maintaining a good oral hygiene routine at home. Some cancer patients find the chemotherapy causes a sore throat, difficulty in swallowing and in some cases partial or complete loss of taste.
Should I tell my dentist if I am allergic to anything?: Yes. You will be asked at your first dental check up if you have any allergies to certain medication, foods or materials. If you have a penicillin allergy it is very important to tell your dentist in case you ever need a prescription of antibiotics. In this case, there are several alternative antibiotics that will be safer for you.; Patients and dental staff can be allergic to the dentist's gloves, which are usually made of latex. Dental materials and drugs used in routine treatment can sometimes produce skin reactions. This can usually be overcome by the dentist using a low-allergy brand of gloves or alternative materials.; It is important to tell your dentist if you have had a reaction at a previous appointment. This can then be avoided at your next appointment and marked on your notes for future reference.
Will epilepsy interfere with my dental treatment?: It is important to tell your dentist if you have epilepsy, or have ever had any sort of fit in the past. This is to make sure the dental team are fully prepared if you do fall ill during treatment and can have drugs on hand if necessary.; Epileptic patients may find they are more likely to have fits when they are anxious. Tell your dentist if you have any concerns before or during your treatment. The dental team will make sure the surgery is safe for you and there is no risk of harm to you.
Will diabetes affect my teeth and gums?: People who suffer from diabetes can have severe gum disease if their condition is uncontrolled. Therefore it is important to follow a thorough oral care routine at home and to visit your dentist at least once a year. You may also find that you heal more slowly after surgery and you should discuss this with your dentist before you have any treatment.
How can my dentist help if I have diabetes?: Book your appointments at a time when the dentist is least likely you keep you waiting, such as first thing in the morning. Try to avoid lunchtime in case you have to miss a meal.
Will I need to tell my dentist if I am pregnant?: It is important to tell your dentist as soon as you find out you are pregnant. If you need dental treatment, it may have to wait until after the birth of your baby. In most situations x-rays should be avoided, particularly during the first three months of pregnancy.; Some pregnant women find their gums bleed during pregnancy and need closer attention. You may be referred to the dental hygienist, if the practice has one, for regular cleaning and advice on how to maintain a good oral hygiene routine at home.

Root canal treatment

What is root canal treatment?: Root canal treatment (also called endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury.
Why is root canal treatment needed?: If the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess. If root canal treatment (RCT) is not carried out, the infection will spread and the tooth may need to be taken out.
Does it hurt?: No. A local anaesthetic is used and it should feel no different to having an ordinary filling done.
What does it involve?: The aim of the treatment is to remove all infection from the root canal. The root is then cleaned and filled to prevent any further infection. Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits to your dentist.; At the first appointment, the infected pulp is removed. Any abscesses, which may be present, can also be drained at this time. The root canal is then cleaned and shaped ready for the filling. A temporary filling is put in and the tooth is left to settle. The tooth is checked at a later visit and when all the infection has cleared, the tooth is permanently filled.
What will my tooth look like after treatment?: In the past, a root filled tooth would often darken after treatment. However, with modern techniques this does not usually happen. If there is any discolouration, there are several treatments available to restore the natural appearance.
What if it happens again?: Root canal treatment is usually very successful. However, if the infection comes back the treatment can be repeated.
What if I don't have the treatment?: The alternative is to have the tooth out. Once the pulp is destroyed, it can't heal and it is not recommended to leave an infected tooth in the mouth. Although some people would prefer an extraction, it is usually best to keep as many natural teeth as possible.
Will the tooth be safe after treatment?: Yes. However, it is better to restore the tooth with a crown to provide extra support and strength to the tooth.
What about aftercare?: Root-treated teeth should be treated just the same as any other tooth. Remember to clean your teeth at least once a day, preferably with a fluoride toothpaste. Cut down on sugary snacks, and keep them only to mealtimes if possible. See your dentist for regular check-ups.

Tooth whitening

What is tooth whitening?

Tooth whitening can be a highly effective way of lightening the natural colour of your teeth without removing any of the tooth surface. It cannot make a complete colour change; but it will lighten the existing shade.

Why would I need my teeth whitened?

There are a number of reasons why you might get your teeth whitened. Everyone is different; and just as our hair and skin colour vary, so do our teeth. Very few people have brilliant-white teeth, and our teeth can also become more discoloured as we get older. Your teeth can also be stained on the surface through food and drinks such as tea, coffee, red wine and blackcurrant. Smoking can also stain teeth. Calculus or tartar can also affect the colour of teeth. Some people may have staining under the surface, which can be caused by certain antibiotics or tiny cracks in the teeth which take up stains.

What does tooth whitening involve?

Professional bleaching is the most common form of tooth whitening. Your dentist will be able to tell you if you are suitable for the treatment, and will supervise it if you are. First the dentist will put a rubber shield or a gel on your gums to protect the soft tissue. They will then apply the whitening product to your teeth, using a specially made tray which fits into your mouth like a gum-shield. The 'active ingredient' in the product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel on the teeth and the tooth colour is made lighter.

How long does this take?

The total treatment can usually be done within three to four weeks. First, you will need two or three visits to the dentist. Your dentist will need to make a mouthguard and will take impressions for this at the first appointment. Once your dentist has started the treatment, you will need to continue the treatment at home. This means regularly applying the whitening product over two to four weeks, for 30 minutes to one hour at a time. However, there are now some new products which can be applied for up to eight hours at a time. This means a satisfactory result can be achieved in as little as one week.

What other procedures are there?

There is now laser whitening or 'power whitening'. During this procedure a rubber dam is put over your teeth to protect the gums, and a bleaching product is painted onto your teeth. Then a light or laser is shone on the teeth to activate the chemical. The light speeds up the chemical reaction of the whitening product and the colour change can be achieved more quickly using this procedure. Laser whitening can make teeth up to five or six shades lighter.

How long does this take?

Your dentist will need to assess your teeth to make sure that you are suitable for the treatment. Once it has been agreed, this procedure usually takes about one hour.

How long will my teeth stay whiter?

The effects of whitening can last up to three years. However, this will vary from person to person. The effect is less likely to last as long if you smoke, or eat or drink products that can stain your teeth. Ask your dentist for their opinion before you start the treatment.

What are the side effects?

Some people may find that their teeth become sensitive to cold during or after the treatment. Others report discomfort in the gums, a sore throat or white patches on the gum line. These symptoms are usually temporary and should disappear within a few days of the treatment finishing.

What about home kits?

Home kits are cheaper. But because tooth whitening is a complicated procedure you should only have it done by a dentist, after a thorough examination and assessment of your teeth.

What about whitening toothpastes?

There are several whitening toothpastes on the market. Although they do not affect the natural colour of your teeth, they may be effective at removing staining and therefore may improve the overall appearance of your teeth. Whitening toothpaste may also help the effect last, once your teeth have been professionally whitened.

Can a single tooth which has been root filled be whitened?

Yes. Many dead teeth go discoloured after a root filling. If the tooth has been root treated, the canal (which previously contained the nerve) may be reopened. The whitening product is applied working from the inside to whiten the tooth.

When might tooth whitening not work?

Tooth whitening can only lighten your existing tooth colour. Also it only works on natural teeth. It will not work on any types of 'false' teeth such as dentures, crowns and veneers. If your dentures are stained or discoloured visit your dentist and ask for them to be cleaned. Stained veneers, crowns or dentures may need replacing; again ask your dentist.

How can I look after my teeth once they have been whitened?

You can help to keep your teeth white by cutting down on the amount of food and drink you have that can stain teeth. Don't forget, stopping smoking can also help prevent discolouring and staining.

We recommend the following tips to care for your teeth:

brush your teeth twice a day with a fluoride toothpaste
cut down on how often you have sugary snacks and drinks
visit your dentist at least once a year.

Veneers

What is a veneer?: A veneer is a thin layer of porcelain made to fit over the front surface of a tooth, like a false fingernail fits over a nail. Sometimes a natural colour 'composite' material is used instead of porcelain.
When would I need a veneer?: Veneers can improve the colour, shape and position of your teeth. A precise shade of porcelain can be chosen to give the right colour to improve a single discoloured or stained tooth or to lighten front teeth (usually the upper ones) generally. A veneer can make a chipped tooth look intact again. The porcelain covers the whole of the front of the tooth with a thicker section replacing the broken part. Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.
What are the advantages of veneers?: Veneers make teeth look natural and healthy. Because they are very thin and are held in place by a special strong bond (rather like super-glue) very little preparation of the tooth is needed.
How are teeth prepared for a veneer?: Some of the shiny outer enamel surface of the tooth may be removed, to make sure that the veneer can be bonded permanently in place later. The amount of enamel removed is tiny and will be the same as the thickness of the veneer to be fitted, so that the tooth stays the same size. A local anaesthetic (injection) may be used to make sure that there is no discomfort, but often this is not necessary. Once the tooth has been prepared, the dentist will take an 'impression' (mould). This will be given to the dental technician, along with any other information needed to make the veneer. The colour of the surrounding teeth is matched on a shade guide to make sure that the veneer will look entirely natural.
How long will it take?: A veneer takes at least two visits: the first to prepare the tooth and to match the shade, and the second to fit it. Before bonding it in place, your dentist will show you the veneer on your tooth to make sure you are happy with it. Bonding a veneer in place is done with a special adhesive, which holds it firmly on the tooth.
Will I need a temporary veneer between visits?: Because the preparation of the tooth is so slight you will probably not need a temporary veneer. The tooth will look very much the same after preparation, but will feel slightly less smooth.
What happens after the veneer is fitted?: Only minor adjustments can be made to the veneer after it is fitted. It is usually best to wait a little while to get used to it before any changes are made. Your dentist will probably want to check and polish it a week or so after it is fitted, and make sure that you are happy with it.
How long will a veneer last?: Veneers should last for many years; but they can chip or break, just as your own teeth can. Your dentist will tell you how long each individual veneer should last. Small chips can be repaired, or a new veneer fitted if necessary.
What about alternatives?: A natural-coloured filling material can be used for minor repairs to front teeth. This is excellent where the tooth supports the filling, but may not work so well for broken tooth corners. There will always be a join between the tooth and the filling material. Crowns are used for teeth which need to be strengthened - either because they have broken, have been weakened by a very large filling, or have had root canal treatment.

What to do following an extraction

Ive had my tooth out - what should I do now?: Take it easy for the rest of the day. Take as little exercise as you can, and rest as much as you can. Keep your head up to avoid any bleeding.
What precautions should I take?: Avoid hot food or drinks until the anaesthetic 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.
Should I rinse my mouth out?: 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.
How soon can I have a cigarette?: 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.
Is there anything I can do to help my mouth?: 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. It is important to keep to a healthy diet; and take a Vitamin C supplement, which will help your mouth to heal.
I am in pain, what should I take?: 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.
Are there any medicines 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.
I am still in pain, what could it be?: 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 a 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.
Will my dentist need to see me again?: If it has been a particularly difficult extraction, the dentist will give you a follow-up appointment. This could be to remove any stitches that were needed, or simply to check the area is healing well.