Q My upper wisdom tooth swells and feels really sore every few days. I have tried all the over-the- counter medications and regular salt-water rinses. What causes this and what should I do next?
A It sounds as if you could be suffering from pericoronitis. This is when your wisdom tooth hasn’t grown into the mouth properly and a flap of gum tissue covers part of the tooth. Bacteria and pieces of food might be getting trapped under the flap, causing the gum to become swollen and irritated.
You have done the right thing by rinsing regularly, but as the pain and swelling is recurring, you should see your dentist, who can advise on future treatment. It is possible the wisdom tooth may need to come out.
Q I have a few missing teeth. What will happen to the gaps if I don’t have implants fitted straightaway?
A Missing teeth leads to aesthetic and functional problems, is the warning from the Implantcenter in London. So, replace them promptly to avoid any repercussions, such as movement of the remaining teeth to compensate for the gaps, chewing problems, and inflammation of the gum and temporomandibular joint.
The major consequence of not replacing missing teeth is bone loss; jaw bones will deteriorate over time, which can result in deformed facial or neck muscles, affecting the spine and eventually the whole body.
Q When will drill-less dentistry become a reality?
A Drill-less dentistry, also called air abrasion, is being offered by some dentists already. Air abrasion can be used to remove tooth decay, prepare a tooth surface for bonding and remove stains and discolouration. The technique works like a sandblaster and sprays away the decay or stain.
Q Is professional teeth whitening painful?
A You might feel some discomfort in the throat or gums. Sensitivity can also occur after the use of any peroxide-based bleaching agents.
This normally comes in the form of short, sharp pain in response to hot or cold drinks.
The reason is that when the hydrogen peroxide soaks through the enamel, in the early stages of the process, it exposes the nerve endings.
These symptoms are usually temporary and disappear within a few days of treatment ending.
Q There are so many toothpastes to choose from in the shops. How do I know which one to use?
A The main thing to look for when buying a toothpaste is the fluoride concentration. Look for parts per million fluoride (ppmF).
Less than 1,000ppmF is a low concentration and offers limited or no protection against decay, whereas 1,450ppmF is generally used in over-the-counter UK toothpastes and is the recommended level.
Toothpastes can be full of other ingredients that aren’t always necessary – most people don’t need the added components to keep their teeth healthy.
Q When should interdental brushes be replaced?
A Interdental brushes can be washed out after use, just like a toothbrush. Careful use and regular rinsing can extend the life of a brush considerably.
As a rough guide, each brush will last as long as a week. You can re-use them until the bristles deteriorate or the wire has been bent severely several times. If you prefer, you can dispose of them after a single use.
Q My dentures are painful and making my life a misery. Is there a possible alternative?
A Many factors contribute towards dentures being uncomfortable, most commonly being that they move during talking and eating. So you may need new, better-fitting dentures.
‘Or it may be possible for you to get rid of removable dentures altogether and have implants,’ says Dr Mitesh Badiani of the Devon Centre of Dental Excellence. ‘They screw into the jaw and look and feel like your own teeth.’
Q How safe are dental X-rays and why are they needed?
A People are often concerned about being exposed to radiation during an X-ray. However, the risk from one or two routine X-rays is tiny. An X-ray of your teeth is equivalent to a few days’ worth of background radiation, and has less than a one in 100,000 chance of causing cancer.
If you’re a new patient, your dental team will probably suggest an X-ray to check for any hidden problems. After that, it’s recommended you have one every six to 24 months.
One in three men admit they don't brush their teeth twice a day, as recommended.
Q While looking into getting dental implants I was told I don’t have enough bone to hold them in place. What are my options?
A You could consider a bone graft. ‘This procedure usually involves removing a small amount of bone from another part of your body, such as your jaw or hip, which is then used to replace the missing teeth bone,’ explains Dr Peter Huntley of Orthodontic Excellence in Solihull. ‘When it’s all healed, you should have enough bone to support an implant.’
Q There is a space between my front teeth and they’re also a little crooked. Do I have any other options apart from braces?
A Alternatives to conventional fixed metal braces include tooth-coloured fixed braces which are fitted and work in the same way but are much less noticeable.
‘Lingual braces are even more discreet as they are placed behind the teeth, offering a cosmetic option,’ says Dr Mark Brickley of the Resolution Specialist Treatment Centre. ‘The latest invisible clear aligner braces have revolutionised care. They’re made up of a series of bespoke clear, plastic aligners, which are changed regularly.
‘As with any treatment, you should have a full orthodontic assessment with a specialist to determine which option is suitable for you.’
Q When would you recommend to have sealant on molars? Does it only work on children?
A Sealant is usually seen as a procedure for children. However, regardless of age, everyone is susceptible to tooth decay. Sealants can decrease the chances of this and prevent food and plaque from gathering in grooves on the tooth surface. By filling the gaps, it leaves no place for bacteria to grow.
Q I had gum disease when I had my own teeth. I’ve since had implants fitted – is there a way to avoid gum disease now I have them?
A Unfortunately it is possible to get gum disease around implants – it’s known as peri-implantitis.
‘The best way to avoid this is to have good oral hygiene and to avoid sugary or sticky food,’ says implantologist Dr Prem Sehmi from the Old Spire practice in Halifax.
‘Make sure you brush your teeth twice a day with fluoride toothpaste and use something to clean underneath the implant bridge and around the neck of the implants, such as a small interdental brush.
‘In addition, see your dentist and hygienist regularly so that they can assess the health of your gums. If your usual dentist didn’t put in the implants, then it’s also important to see the specialist who did for an annual review of your condition.’
Q Having chipped my tooth a few years ago, is there a procedure that can correct it now?
A Providing you have chipped off just a small piece of tooth enamel, your dentist may repair the damage with filling. However, if the tooth is at the front or can be seen when you smile, you will need a procedure called bonding, which uses a tooth-coloured composite resin.
‘If the front tooth is badly broken, a dental veneer can make it look whole and healthy again,’ suggests Dr Sam Afshar of Putney Dentists. ‘A veneer is a thin shell of tooth-coloured material that covers the whole of the front tooth, with a thicker section to replace the broken part.
‘If a large piece of the tooth has broken off or has bad decay, your dentist might file away part of the remaining tooth and cover it with a crown or tooth-shaped cap.’
All these procedures are common and carried out under local anaesthetic.
Q For more than 20 years I’ve had a phobia of the dentist and it is now starting to impact on my dental health because I keep putting off going. How can I conquer my fear?
A The first thing you should do is tell your dentist and let them know how afraid you are. ‘Don’t be embarrassed; you are not alone, and many dentists offer special techniques for nervous patients,’ says Dr Pieter Claassen, who takes a particular pride in offering ‘painless dentistry’ at his Hanover House practice in Kent. For patients who have left it so long they don’t even have a dentist, Dr Claassen suggests checking websites for understanding dentists. ‘Recommendation is always an advantage – especially when the person doing the recommending has overcome their own fears,’ he says.
Q Which should I do first, brushing or flossing?
A The order doesn’t matter too much, as long as you do a thorough job. Some experts recommend flossing first because you can then brush away any plaque particles or food debris that are removed.
Others advise brushing your teeth and then flossing before you rinse, as you’ll pull some of the toothpaste between your teeth as you floss.
Q At what age should my child first see a dentist?
A The dentist can help prevent decay and identify any oral health problems at an early stage. Take your child when their first milk teeth appear - this is so they become familiar with the environment and get to know the dentist, even though there's probably no obvious need for a check-up.
Just opening up their mouth for the dentist to take a look is useful for practice in the future.
Q Although I want my teeth straightened I’m worried about damaging my crowns. What are my options?
A There is no need to worry about your crowns if things are managed well. There are amazing adhesives that allow metal or ceramic braces to be bonded on to their surface so that, with the appropriate polish, they look exactly the same as before.
‘In fact all brace choices can be used,’ says orthodontics specialist Dr Peter Huntley. ‘Aligners such as Invisalign™ or lingual braces bonded on to the back of the teeth should be fine. However, it is always worth getting an opinion from an orthodontist who is experienced in all these treatments so that you learn which options can work best for you.’
Q I can’t afford dental care when a large amount crops up suddenly. What are my options?
A For a regular monthly sum, a dental insurance plan can help you manage the cost of dental needs, including check-ups, X-rays, scale and polish, fillings, bridges, crowns, and sports gum-shields.
There’s the option to cover dental accidents and emergencies, plus some plans, for example simplyhealth.co.uk, that let you add up to four children.
Prices start from as little as £8.68 per month and if you make a claim, the money will be paid straight into your bank account. Remember, however, that pre-existing conditions typically aren’t covered.