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All Dental Topics,Prevention and saving money

Lemon water

27 Aug , 2015  

Dental erosion from lemon water

Dental erosion

There is a current trend amongst health enthusiasts to add squeezed lemon to water for a number of health benefits. However often it is not appreciated that lemons can actually be doing your teeth great harm, even if diluted in a large amount of water!

What is dental erosion?

Dental erosion is the loss of tooth enamel, as a result of acid attack. When the enamel is ‘dissolved’ away, it leaves the underlying dentine exposed (a more yellow version of enamel). The loss of dental enamel and exposure of dentine can lead to painful sensitivity and make your teeth more susceptible to decay.

Lemon juice has a very high acid content and is possibly one of the most erosive foods you can consume. Therefore over time, routine consumption of lemon juice will erode your enamel. Not only are eroded teeth unaesthetic (hollowed and yellow), they can cause your teeth to be extremely sensitive when eating hot or cold food or drink.

One should be aware of the acidity levels of the foods and drinks they consume. Just some of the foods and drinks that cause dental erosion are:

-fruit juices (orange, apple, grapefruit etc)

-wine

-fizzy drinks

-sports drinks

What else causes dental erosion?

Guys and girls with bulimia or acid reflux, are quite susceptible to dental erosion, as stomach acid used to digest food is strong enough to dissolve tooth enamel. Frequent vomiting puts your teeth in regular contact with stomach acid, and puts you at risk of dental erosion.

How to avoid dental erosion

-Dilute the lemon juice as much as possible, to make it less acidic.

-Drink the lemon water through a straw (so you limit its tooth) contact.  

-After drinking the lemon water, rinse your mouth with pure water immediately.

-Or chew sugar-free gum after consuming the lemon water as chewing gum stimulates saliva, so all of its ‘good bits’ can help neutralise the acid levels in your mouth.

-Brush your teeth, with a soft bristled toothbrush, at least 60 minutes after drinking the lemon water.  Preferably use a fluoridated toothpaste, as fluoride strengthens your teeth (but, if you would prefer to use a non-fluoridated toothpaste, ask your dentist or the Fillinggaps panel what suitable alternatives would be) and brush gently. It may sound strange to hold off brushing your teeth, but this is because acid leaves the enamel softened and more prone to erosion shortly after an acid attack!

-Eat dairy products after consuming acidic foods and drinks, as dairy products help buffer the saliva and provide protection after an acidic attack.

What if I already have dental erosion?

If you already have dental erosion, then consult with your dentist.  Depending on its severity, your dentist may recommend a desensitising paste or treatments such as sealants, composite resin bonding, or veneers in order to reduce sensitivity, restore aesthetics and protect your remaining tooth structure.

Take home points

Of course you may need the nutrients, vitamins and other ‘good stuff’ in certain foods, so by all means don’t rule them out when creating your nutrition and meal plan. However do consider your dental health. Not only will it prevent unwanted tooth discomfort, it will help save you unnecessary time at the dentist and lessen the chance of needing comprehensive dental work that may need to be maintained for life.

We recommend seeing your dentist regularly as they are trained to be able to identify early signs of erosion. If you don’t have a current dentist use the search function of www.fillinggaps.co.nz or ask us to help find the right one for you!

All Dental Topics,Dentures

Dentures

3 Aug , 2015  

Who can make dentures?

A dentist. prosthodontist or a clinical dental technician can take impressions and make dentures. A clinical dental technician requires a patient to have
obtained an oral health certificate (a tooth and gum warrant of fitness) from a dentist or dental specialist
before a denture of any form can be started. There is no point in building a house on a poor foundation as it will never last.

What types of dentures are there?

Dentures are either called complete (full) or partial depending on how many teeth need replacing. A complete denture replaces all the teeth, while a partial denture replaces the missing teeth and is secured by the remaining teeth.

A denture improves speech, appearance, eating function and supports facial muscles.

Are there different types of complete denture?

Complete dentures are made when all your natural teeth have been removed. 

Complete dentures are called “conventional” or “immediate” depending on when they are made and positioned into the mouth.

Immediate dentures are inserted directly after the removal of the natural teeth. To undergo an immediate denture procedure, your dentist will take impressions of your upper and lower jaws, record your bite, smile line and desired toothcolour and shape. The impressions with then be sent to a laboratory for construction of your immediate denture. The advantage of immediate dentures is the patient does not have to go without teeth or denture during the healing period. The disadvantage of this option is the bone and gums shrink over time, particularly during the first 6 months of tooth removal. The change in shape of the bone and gums often requires immediate dentures to be rebased or relined to fit properly, and in some cases complete new dentures need to be remade.

Conventional dentures can then be made once the tissues have healed, ideally 3-6 months if going without dentures for this long is an option for the patient.

Over dentures are removable dentures that slots over a few remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture either with a filling, a root canal, and or crown.

Are there different types of partial dentures?

Partial dentures are often an affordable option when a few teeth are missing. There are 2 types of partial dentures; an all acrylic denture or an acrylic denture which is supported by metal framework. Partial dentures use metal clasps or precision attachments to gain support and retention from your natural teeth. Crowns with precision attachments on your natural teeth can enhance the fit of a partial denture and are often more aesthetic than metal clasps. However partial dentures with precision attachments generally cost more than those with metal clasps. Removable dentures were once the primary way to replace missing teeth, more and more people are using dental implants or bridges as a fixed treatment alternative.

How do I get used to my denture?

Complete and partial dentures take time to get used to. Everyone adapts differently so be patient as your mouth with get used to wearing it. Initially there can be sore spots where the denture is rubbing or pressing on the gum. Your dentist or technician can adjust these denture pressure areas for you. As sore spots heal the gums become tougher and more resilient. For complete and partial dentures that are not immediate dentures, the best approach is to wear the denture for small periods of time slowly increasing to wearing all day. This allows the gums to toughen up without causing you too much discomfort. For the health of your gums it is best to not sleep with your dentures in.

Alternatively for immediate dentures it is best to try keep the dentures in place for the first 72 hours taking the dentures out only to rinse after each meal. Swelling is most prevalent in the first 72 hours of tooth removal so taking a denture out for a long period of time may mean it is difficult to reinsert. After the first 72 hours it is advised to remove the dentures at night.

Chewing can be a steep learning curve depending whether you have a partial or full denture. For a full denture it is important to try and keep the denture balanced as you eat. Try up and down chewing as opposed to left and right movements as this can cause the denture to tilt. Eat small pieces of soft foods and chew on both sides of your mouth to prevent the denture from tipping and irritating your gums. Hard and sticky foods are best avoided. As you get used to chewing with denture you can progress to firmer foods until you can return to your normal diet. Continue to chew food using both sides of the mouth at the same time and be careful with sharp, hot or hard foods.

Speech can initially be altered and pronouncing certain words will take practice. If your dentures “click” while you`re talking, try to speak slowly. If your dentures slip when you smile, laugh or cough, re-position the dentures by softly biting down and swallowing. If your speech does not improve after a few weeks consult your dentist or dental technician.

How do you care for a denture?

Never force the partial denture into position by biting down as this can bend or damage the clasps.

When handling the denture stand over a sink of water or towel so if you were to drop it it won’t be damaged. After every meal rinse the denture and brush the denture daily with a denture brush (soft bristles) to remove food debris and plaque. Look for denture cleansers at the pharmacy or supermarket. Mild dish-washing liquid to cleanse dentures is acceptable however other house cleaners and abrasive toothpastes should be avoided.

Keep your denture moist to avoid it losing its shape. Place your denture in a soaking solution or water over night. However, if the plate has metal attachments, they could be tarnished if placed in soaking solution. Even with full dentures, you need to maintain excellent oral hygiene. Still brush your gums, roof of your mouth, and tongue with a soft toothbrush before you put in your dentures to clean off plaque and stimulate circulation in the mouth.

Maintain a balanced diet to keep a healthy mouth.

Will I need further adjustments?

Once teeth have been removed your jaw bone and gums change shape slowly each year. The most dramatic change is during the first year, however each subsequent year there is still a small change. As soon as a denture feels loose it is time to consult your dentist or dental technician for a reline or re-base. Loose dentures can cause various problems, including sores or infections, loss of confidence, discomfort.

Avoid using DIY kits to reline your dentures as this damage the plate beyond repair and provide a poor result.

If your denture becomes loose, cracks or chips, or if one of the teeth come off, see your dentist or dental technician. Often denture repairs are easily carried out, most within 48 hours. 

Inevitably your dentures will loosen overtime and will require relining, re-basing or complete remake. To reline or re-base a denture, the denture some of the denture base is ground away, an impression is taken with the denture and more acrylic is added to the base. Dentures may need to be replaced if they are markedly loose, bulky in areas they no longer should be and the denture teeth are worn or unaesthetic.

What is a denture adhesive?

If a denture fits well but occasionally slips out of place then an adhesive can trialed. Adhesives are not the solution for very loose dentures. Adhesives can enhance denture retention, however the disadvantage is cleaning the adhesive off. Apply adhesives sparingly, too much adhesive prevents the adhesive from working well.

To find a dentist or clinical dental technician near you visit www.fillinggaps.co.nz

General Dentist,Prevention and saving money,Tooth whitening

Hydrogen Peroxide

31 Jul , 2015  

Hydrogen peroxide, H2O2, oxidises into water and oxygen when it reacts with certain chemicals. This makes it a very effective cleaning agent in some cases and why it is commonly found in first aid kits to clean cuts and as an additive in household cleaners and detergents. it seems that some believe you can swish a low strength H2O2 solution around the mouth as a teeth whitener.

 

Studies have shown that when used sparingly hydrogen peroxide can assist in whitening teeth over a very long period of time, usually over a year of weekly use. therefore, it will not be as effective as whitening toothpastes, which often contain H2O2 anyway, or professional whitening services available from dentists.
However, H2O2 can be useful in cleaning toothbrushes. By rinsing or storing your toothbrush in a low strength H2O2 solution the debris that builds up on a toothbrush can be washed away. Therefore, while responsible use of H2O2 in an oral regimen is unlikely to be harmful, we would recommend the use of whitening toothpaste and mouthwashes and professional whitening services.

For more information on home whitening remedies, please see:

Should I brush with…?

To find a dentist in your area, please see

www.fillinggaps.co.nz

Prevention and saving money,Tooth whitening

Charcoal and Teeth Whitening

31 Jul , 2015  

Activated charcoal, the ingestible version of charcoal, seems to be growing in popularity as a method of tooth whitening at home. The rationale behind this is that activated charcoal attracted to a group of found compounds called tannins which are prevalent in staining foods like coffee, as such it binds with stains and makes them easy to remove.

 

However, charcoal is naturally very adhesive and that natural adhesiveness could actually be a problem for teeth. Currently the long term effects of charcoal use have not been explored but a material that is too abrasive can wear away at the enamel of the tooth and cause oral health problems.

 

Essentially the jury is still out on the long term effect of activated charcoal on the teeth. what is clear is that it is definitely not a miracle whitener, it may whiten your teeth over time but its abrasiveness could damage enamel. Therefore, if you are going to use it, do not brush with charcoal, simply dab it on your teeth and rinse it out, as the brushing may exacerbate the negative effects of charcoal’s natural abrasiveness.

Therefore, we would recommend for some research to be conducted but if it is used remember that it is not a replacement for brushing your teeth with toothpaste, flossing and regular dental check ups.

For more information on home whitening remedies, please see:

Should I brush with…?

General Dentist,Gum problems,Hygiene treatment,Prevention and saving money

Fluoride

31 Jul , 2015  

Fluoride and particularly water fluoridation where the chemical fluoride is added to water supplies seems to be a frightening prospect for some. However, the vast majority of dentists, and the Ministry of Health agree that fluoride is a very valuable tool in promoting oral health.

 

Fluoride strengthens your teeth by preventing demineralisation of the surface of teeth. Essentially,demineralisation is where a biofilm called ‘plaque’ occurs and creates acid which removes calcium from the tooth. This process if left unchecked leads to cavities. Fluoride helps by adding strength to tooth enamel which makes it more difficult for the tooth to be demineralised. Furthermore, studies have shown that fluoride actually can contribute to remineralisation of teeth, or the reattachment of minerals from enamel.

 

The Ministry of Health has conducted a number of studies of fluoride and its effect on oral health. The general findings of those studies are that people that live in fluoridated areas have generally less tooth decay than those not in fluoridated areas. Furthermore, it has been found that fluoride can have substantial benefits for the oral health of children. For instance, the Ministry of Health has found that 5 year olds living in fluoridated areas had 30% less decay than those living in other areas.

 

The main concern present in criticisms of fluoride use and fluoridation is that over exposure can lead to enamel fluorosis. This is a developmental condition of tooth enamel and in most cases simply results in white streaks appearing on the teeth. However, this condition only occurs upon overexposure to fluoride. In a very carefully controlled system of fluoridation, like the one practiced here in New Zealand, the likelihood of that occurring is very low.

 

Therefore, due to the low risks and very substantial benefits you can find fluoride in most toothpastes, mouthwashes and also in very small, controlled amounts in water supplies around New Zealand.
For more information, including the actual research papers referred to in this post, please see: http://www.health.govt.nz/our-work/preventative-health-wellness/fluoridation

Tooth anatomy

Tooth anatomy

27 Jul , 2015   Video

What structures make up tooth anatomy?

A tooth can be divided into two main sections; a crown (top third of the tooth) and of roots (lower two thirds of the tooth). A tooth can be thought of like an onion with layers. In the upper third of a tooth, the outer layer is the white hard enamel, next layer in is a yellow softer layer known as dentine and the center of the tooth is the pulp chamber which houses the tooth’s blood supply and nerves. In the lower two thirds of the tooth, the outer layer is root dentine followed by the root canal which extends down from the pulp chamber. The root(s) of a tooth is surrounded by cementum and periodontal ligament and finally the jaw bone. Please see the attached image of tooth anatomy.

Tooth anatomy.

 

To find a dentist or dental specialist near you please visit www.fillinggaps.co.nz.

 

 

 

 

 

Gum problems

Bleeding gums

26 Jul , 2015  

Why are my gums bleeding when I brush and floss?

If there has been no tooth trauma, then bleeding gums is usually a symptom of gum disease. Gums bleed in response to the presence of bacteria on teeth as the body sends more blood containing immune cells to fight the bacteria. Bleeding gums are often accompanied by swollen red gums, tenderness, and bad breath (halitosis). Often there is no pain associated with the early stages of gum disease. Early gum disease is often reversible and easily treated by a dentist or dental hygienist by performing a dental clean (scale and polish).

Often people think they are causing their gums to bleed by flossing. However, it is quite the opposite, the gums are bleeding because they are not flossing frequently enough. We recommend you see your dentist and dental hygienist and follow our prevention guidelines to help prevent bleeding gums.

What causes bleeding gums?

  • Seldom, bleeding gums are a symptom of other problems with your mouth or body. Bleeding gums are usually a good sign that you have gum disease, however other causes of bleeding gums can also result from:

  • Brushing too hard

  • A vitamin deficiency

  • Bleeding or clotting disorders
  • Taking blood thinners or other medications

  • Dentures that don’t fit

  • Hormonal changes during pregnancy, resulting in pregnancy gingivitis

  •  Mouth sores

  • Other medical problems, including diabetes, heart disease, leukemia or scurvy

It is important that you don’t self diagnose as only a dentist or medical professional can diagnose the causes of bleeding gums and offer the right treatment.

To find a dentist or dental hygienist near you visit www.fillinggaps.co.nz.

Dental toothache

Sedation

20 Jul , 2015  

What types of sedation are used in dentistry?

 

Dental toothache

Pain relief

13 Jul , 2015  

How does pain relief (analgesics) work?

Toothache results from pain transmitted from damaged (inflammed) tissues along nerve fibres to the brain. Analgesics work to interfere with this pathway. Analgesics can:

–Affect the central component and the emotional aspects of pain, the brain’s perception of pain (e.g. opioids and antidepressants)

–Work at the site of injury to decrease the pain associated with an inflammatory reaction (e.g. non-steroidal anti-inflammatory drugs)

–Alter nerve conduction (e.g. local anaesthetics)

–Modify transmission (e.g. opioids and some antidepressants)

What pain medications can be used for toothache?

Opioids

– Work at various points of the pain pathway and diminishes the brain’s perception of pain.

– Side effects: Respiratory depression, nausea and vomiting, constipation, fatigue, dependence.

– These medications require a prescription:

  • Codeine phosphate tablet (15-60mg) four times a day, maximum 300mg daily
  • Tramadol capsule (50mg) or slow release tablet (100mg), 50-100mg every four times a day, maximum 400mg daily

Non steroidal anti-inflammatories (NSAIDs)

– NSAIDs work at the site of tissue damage to decrease inflammation.

– Avoid this medication if known hypersensitivity to NSAIDs, some asthmatics (9-20%), taking warfarin, have a bleeding disorder, prone to gastrointestinal ulceration and bleeding, have a serious acute infection.

– These medications can be purchased over the counter without a prescription:

  • Naproxen Sodium (Synflex) tablet (275mg), take 275mg three to four times daily for maximum 1375mg daily
  • Diclofenac (Voltaren) tablet (25 – 50mg) two to three times a day for maximum 450mg daily.
  • Ibuprofen (Neurofen) tablet (400mg, 200mg), take 400 to 600 mg three to four times daily for maximum 2400mg daily.
  • Ibuprofen suspension 100mg/5ml, the dosage is calculated per weight (kg) of the patient. Best to contact your dentist or GP for the most accurate dosage calculation. Ibuprofen for children is not recommended below the age of 6 months, and Paracetamol should be used in the first instance for children. Seek medical advise before giving Ibuprofen to children under the age of 12 months.

Paracetamol

– Paracetamol is an analgesic as well as an antipyretic (reduces fever). Paracetamol acts to block the pain signal centrally to the brain.

– Adverse reactions are rare if taken in recommended dosage. Not following the recommended dosage can result in liver damage.

– Paracetamol does not require a prescription and can be purchased over the counter.

  • Paracetamol tablet (500mg), adult dose 500-1000mg four times daily maximum 4000mg daily.
  • Paracetamol suspension 120mg/5ml and 250mg/5ml, the dosage is calculated per weight (kg) of the patient. Best to contact your dentist or GP for the most accurate dosage calculation.

Can I use a combination of pain relief medications?

Yes, this is called multimodal analgesics (a combination) in which more than one method or modality for controlling pain is used. Using a combination of medications which operate through different mechanisms or at different sites along the pain pathway can be very effective in controlling pain.

Maxigesic is an over the counter medication which contains Paracetamol (500mg) and Ibuprofen (150mg). 1-2 Maxigesic tablets can be taken every 4-6 hours with maximum 8 tablets daily. Paracetamol blocks the pain signal centrally to the brain’s cortex while Ibuprofen blocks the pain transmission at the site of the tissue damage.

Panadeine is an over the counter medication containing Paracetamol (500mg) and Codeine (8mg or 15mg) depending whether it is the plus version of the product. 1-2 Panadeine tablets are taken every 4-6 hours with maximum 8 tablets daily. Paracetamol blocks the pain signal to the brain while codeine works centrally to diminish the brains perception of pain.

Another effective way to combine medications is take a different medication at different times. Each medication takes time to reach its most effective level before tapering away as it is metabolised. The idea is to have the second medication peak as the first mediaction is tapering away thereby creating a “blanket” effective. For example:

  • Ibuprofen 4oomg, after 3 hours take 1000mg paracetamol, after a further 3 hours take 400mg Ibuprofen and so on.
  • Ibuprofen 400mg, after 3 hours take Panadiene, after 3 hours take 400mg Ibuprofen and so on.

Why did my dentist recommend I take two Ibuprofen before my tooth removal?

Your dentist was considering pre-emptive analgesia which is the administration of one or more analgesics prior to a noxious event. Pre-emptive analgesia attempts to prevent peripheral and central sensitisation of nerves, minimizing post-injury pain.

To find a dentist for more definitive pain relief visit www.fillinggaps.co.nz.

Composite filling

Composite filling

13 Jul , 2015  

What is a composite filling?

A composite filling, or tooth-coloured filling, provide good durability and resistance to fracture in small to medium size fillings that need to withstand moderate pressure from the constant stress of chewing. They can be used on either front or back teeth. They are a good choice for people who prefer that their fillings look more natural. 

Composites cost more than amalgam due the increased procedure duration and increased cost of the material.  It generally takes longer to place a composite filling than it does for a metal filling because composite fillings require the tooth be kept clean and dry while the cavity is layered in increments and cured with a UV light. Composite fillings are layered in increments as there is small dimensional shrinkage on curing.

Tooth-coloured fillings are now used more often than amalgam or gold fillings, largely due to aesthetics. In a society focused on a white, bright smile, people tend to want fillings that blend with the natural colour of their teeth. 

Dental fillings do not last forever. Some studies show that composite fillings can be less durable and need to be replaced more often than amalgam fillings. If a large tooth coloured filling lasts for only 1-2 years then your dentist may recommend a crown.

What is the cost of a composite filling?

The cost of a composite filling depends on size of the filling and the dentist’s expertise. Most dentists price fillings depending on the number of tooth surfaces the filling covers. For example a filling on the biting surface of a tooth is a one surface filling. A filling that covers the whole tooth is a 5 surface filling. Dentist’s fees also vary if they add reinforcing materials (pins, fibre-reinforced) or spend time layering the filling with different colours and stains for aesthetic purposes.

To find a dentist near you who provides composite fillings please visit www.fillinggaps.co.nz.