Dentist’s Insight- 50 shades of white

Thinking about whitening?
Whitening your teeth can be one of the most effective ways of improving your appearance. It is also the most cost effective and less harmful treatments on your teeth which can get wonderful results. But how much do you know about this treatment?

What Is It?
Tooth whitening uses peroxide to lighten teeth and helps to remove stains and discoloration, most commonly those from food and drinks, smoking and damaged teeth.

  • Extrinsic stains- most commonly those from food, drinks and smoking. Sometimes a scale and polish is all you need to remove these stains but other times this is not quite enough and whitening is required.
  • Intrinsic staining- Some people have stains that shine through from inside the tooth, for example, exposure to too much fluoride or tetracycline antibiotics as a child, most commonly trauma may also darken a tooth.

Tooth whitening is most effective on surface (extrinsic) stains but whitening may help intrinsic stains in combination with other treatments such as veneers.

So how do I go about whitening my smile?
You may find may dental practices offering upfront payment discounts on whitening, however, this is no guarantee this treatment will be right for you. Those who have a lot of fillings and/or crowns/bridges/veneers on their front teeth need to be aware that the bleach will NOT change the colour of these and you may need other treatment to coincide with your whitening.

It is very important a dentist is the one who prescribes your tooth whitening. It is illegal to sell whitening with peroxide unless you are a qualified dentist. This is for your protection and we are well trained to provide you the appropriate instructions and concentrations.

Most whitening happens at home, your dentist will make trays to hold the whitening gel that fit your teeth precisely. Home whitening gel usually needs to be applied daily for a few weeks. For a quick fix you can have treatment in the surgery , but this isn’t as predictable in the long run and for more reliable results it is sometimes recommended that you also to do the home whitening as well to ensure the results last  longer.

Bleaching can make some peoples teeth very sensitive while having the treatment done, and this may be a little uncomfortable for some people (myself included). This sensitivity usually wears off after you stop using the gel.

But one tooth is darker than the others?
Most likely this tooth had a knock in the past which means the nerve is no longer alive any more or you had a root canal filling in that tooth. The staining is coming from inside the tooth which is why it is called intrinsic staining. In these circumstances we use a different procedure that whitens the tooth from the inside. This is done by putting a whitening agent inside the tooth and put a temporary filling over it. The tooth will be left this way for several days. You may need this done only once, or it can be repeated until the tooth reaches the desired shade.

Is whitening a one-off treatment?
Whitening is not a permanent solution and the stains can come back over time. This amount of time varies i.e. if you smoke or consume a lot of staining foods or drinks, you may see the whiteness start to fade in a few months. If you avoid these sources of staining, you may not need a top up treatment until after 6 to 12 months. Having a regular scale and polish can help Re-whitening can be done in the dentist’s office or at home. If you have a custom-made mouthpiece and whitening agent at home, you can ask your dentist for more gel to top up.

What are the risks?
Whitening is unlikely to cause serious side effects, although some people’s teeth may become more sensitive for a short while. You may get mild gum irritation as well and should see your dentist if this occurs. Women should avoid whitening while pregnant. The effect of the whitening materials on the fetus is unknown, so it should be avoided until after delivery/breastfeeding.

Dentist’s Insight: We can rebuild him. We have the technology.

There comes a point where tooth brushing and diet alterations can no longer undo the damage of decay. Once this decay has spread into the dentine it is very likely the tooth will require a filling. This is often necessary because spreading decay compromises the integrity of the tooth, therefore putting it at risk of fracture. There is also a risk that the nerve may become infected if the decay spreads further which may lead to further complications (abscess, swelling, pain).

Those of you with fillings will know that there are different types, and these can generally be broken down into those you can clearly see (silver amalgam) and those you can’t (mainly tooth-coloured composite fillings). These days more and more patients are asking to have composite fillings placed, and it is becoming more important that patients understand what the benefits and risks are of having these fillings.

What is a composite filling?

A composite filling is a resin which is mixed with glass to make it resemble a tooth when placed in a cavity. The technology of these materials has advanced enough that they now have multiple uses, for example, front teeth can be altered to improve the smile, or repair fractures after accidents.

How is the filling done?

Composite materials are VERY moisture sensitive, so sometimes a dry rubber dam is placed to avoid the tooth getting wet. The cavity is prepared and then the composite is applied in layers which are set hard with a blue light. Once finished, the filling is shaped so it fits the tooth and then polished smooth.

What are the advantages of composites?

Composites are more aesthetically pleasing (i.e. they look more natural) than other materials. Placing this type of filling can be an art form, and different shades can be blended to create a colour nearly identical to that of the actual tooth. Resin fillings can provide some extra support for the remaining tooth structure which can help delay breakage and insulate the nerve of the tooth from temperature changes.

What are the disadvantages?

After having a composite filling, a patient may experience some sensitivity once the local anesthetic has worn off. Over time the colour of the composite can change slightly, especially if regular amounts of tea, coffee or other staining foods are consumed which may stain it. A coating can be placed over the filling to reduce how quickly it stains, however, regular maintenance is needed to remove staining. Composites tend to wear away a little faster than amalgam fillings when in large cavities, although they hold up as well in small cavities.

Here are some photos of composite fillings I have done recently:

         pre op mid oppost op



Dentist’s Insight- DIET: Is sugar the enemy?

“But I don’t eat any sugar” combined with a puzzled expression is something I experience frequently when examining dental patients who have decay.

Ask yourself if you have a high sugar diet and you probably think you are an normal sugar consumer. The problem with our modern high paced, fast food life style, is that we are not always aware of how much sugar is in the items we buy. Tooth decay unfortunately comes hand in hand with our modern lives and sugars are becoming increasingly harder to avoid. Sugar, mainly Sucrose, Glucose, maltose and fructose feed the bacteria on your teeth and caused plaque, which in turn causes a surge of acid in your mouth which leads to decay over a period of time.

What is decay?

Decay is a breakdown in the structure of the tooth. Enamel is very hard and decay in this can be reversible as it can remineralise if conditions improve. Once into the dentine (the inner part of the tooth), however, the tooth is damaged for good. Decay is not always painful, but if it is left for a long time then eventually it will reach the nerve of the tooth which can be very painful. Decay is so common in modern life that even dentists get it (myself included) and its early detection and treatment can save you expensive procedures later down the line.

So how can I change my diet?

Every time you consume sugar (no matter how small an amount) this bacterial acid will be released in your mouth. Guidelines recommend that people should keep sugars to meal times, which is about 3-4 times a day max, and try to eat sugar free snacks and drinks in between. It is healthy for your whole body to also try and cut down on the amount of sugar you have, and things like fruit juice, energy drinks and soft drinks are not recommended for everyday consumption as they are very high in acid and sugar content.

Take home points:

  • Keep sugars to mealtimes, cut down on overall intake of sugar
  • Find sugar free snacks, and drink more water less juices
  • Brush and floss properly in the first place to reduce plaque
  • Chew sugar free chewing gum after meals
  • Keep your dental check-ups regular. Early decay can be spotted and monitored so you can avoid big painful holes in your teeth.
  • Fluoride- use a toothpaste with 1450ppm and don’t rinse it off after use
  • Make a food diary on your smart phone and count how many times a day you are eating

Here is more information about diet and your oral health:

Click here for British Dental Health Foundation- Diet Advice

Dentist’s Insight – The Dreaded Root Canal… is it really that bad?

Lots of people know the term “root canal”, however, how much do you actually know about the treatment? What does it involve? Why they are advised? Often you hear horror stories about root canals, but in reality the treatment is routine and quite painless. Early detection is very important and finding a cavity early can avoid future pain. Root canal treatment is just like any other dental treatment, it just takes a little longer. I’ve had plenty of patients relaxed enough that they have fallen asleep while in the chair.

Here are two videos explaining why root canals are needed and how they are done. For any queries please feel free to message me.

Dentist’s Insight – Oral Hygiene- General housekeeping

Here is what I tell my patients to enable them to look after their teeth and gums… Every day your teeth grow plaque which is full of harmful bacteria. Ensuring your cleaning routine is up to scratch will go a long way in helping you to keep hold of your teeth.

4 simple steps every day:

1- POLISH in between your teeth- Floss/interdental brushes- lift that plaque up from in between the teeth where your toothbrush doesn’t reach. (See video direction on how to floss) If your gums bleed please don’t avoid the area, chances are the plaque is what’s making them bleed in the first place and over time bleeding should reduce.

2- RINSE- I recommend if you want to use a mouthwash that it is alcohol free, but that’s your preference, just get rid of all the bits left over from flossing

3- BRUSH (at least twice a day)- split your mouth into sections to make sure you are getting all the surfaces of your teeth, and the gum line needs a good brush too (check in the mirror you’re in the correct place). Again don’t be discouraged by any bleeding.
*Manual toothbrush technique- angle the brush into the gum and brush in circles, don’t scrub back and forth this won’t get the maximum cleaning done.
*Electric Toothbrush technique- angle the brush into the gum and hold it over the tooth against the gum and allow the brush to do the cleaning. I recommend electric toothbrushes and find patients get good results from them.

4- SPIT, DON’T RINSE- would you rinse your expensive face cream off straight after application? No? Then why rinse off your toothpaste? Fluoride toothpastes today contain all the ingredients your teeth need to remineralise (re-harden) and defend against bacteria. Mouthwashes have less fluoride than toothpaste, so save them for another time in the day (ie- after lunch).