Research has shown that the SLS in toothpastes negates the action of chlorhexidine, the active ingredient in Corsodyl mouthwash and gel for at least 30 minutes after the toothpaste is used and up to 2 hours later. So, to get the best effect the two need to be separated in time by 1-2 hours.

SLS is caustic but is partially inactivated by many of the other components of toothpastes.

In some people it appears to be active enough to trigger oral ulcers. For this reason, we will often recommend a trial of SLS free toothpastes to see if it helps those with this problem.

SLS Free toothpastes

SLS = sodium lauryl sulphate is a common detergent found in many toothpastes, among other products.

Too the best of our current knowledge, this list is accurate; however, always read the product label to be certain.

Zendium                                     Unilever. The whole range is SLS free

Sensodyne                                 the whole range is SLS free

Oral B                                         Gum & Enamel repair

Oranurse                                    SLS and flavour & colour free. The taste is ‘interesting’!

Corsodyl

Taylors 32                                  the whole range is SLS free. Available online

Dentalux                                     available from Lidl

Colgate                                       Sensitive Pro-relief Repair & Prevent

Many others are available, including store-brands that are cheaper than name brands. We advise reading the ingredient list carefully. There are also a number of natural alternatives available via health food stores and online. Please check they have fluoride in, so you don't substitute one problem for another

The aim of this leaflet is to describe in broad outline the treatment the Barley Mow can provide if you have gum disease.

Dentists Role

Your dentist has an overall supervising role in management of gum problems.  It is their responsibility to diagnose the problem and arrange suitable treatment and monitor it’s progress, with input from the hygienists.

Hygienists Role

Hygienists undergo an extensive training course that covers oral hygiene education, dietary advice, smoking cessation, anti- sensitivity advice, cleaning of the teeth, and polishing. They can administer local anaesthetics, topical medications and prescribe their own treatment plans.

They have an important role in treating the other main dental disease: decay.

Oral health educators Role

Oral health educators (OHE) are involved in oral hygiene education, dietary advice, and smoking cessation. 

They do not provide ‘hands-on’ treatment. The main benefit from seeing an oral hygiene educator is that they primarily focus on your oral hygiene without feeling any pressure to provide treatment.

Gum Disease

Around 15% of the population are very susceptible to gum problems, 15% are very resistant, and the rest are somewhere in the middle.

Disease severity is affected by how well you brush, smoking history, diabetes and general health.

We cannot repair the damage from gum disease: only stabilise it, so early intervention and ongoing maintenance is very important.

 

The most common gum problems are: 

Minor gum problems - Marginal Gingivitis

These mainly cover swollen, red and bleeding gums where there has been no loss of bony attachment.  Pocket probing depths are normal or slightly increased because the gum is enlarged.  Marginal gingivitis responds well to thorough cleaning and improved oral hygiene measures, such as tooth brushing and flossing.  It is routinely treated because it is known to be the starting point from more serious gum problems.

Moderate gum problems - Early Chronic Periodontitis

Once bony attachment has been lost from around the tooth by the initial attack of gum disease, deeper pockets are created. The disease process can continue uninterrupted in the pockets and between teeth.  Alternatively, marked recession can occur. Often, there is active disease between the teeth where oral hygiene is more difficult, which can cause biofilm to accumulate.

Treatment ideally consists of thorough cleaning by a hygienist and provision of excellent oral hygiene by the patient at home.  Regular ongoing maintenance at 4-6 monthly intervals is usually required as the situation requires monitoring. The more difficult areas need professional assistance

.

Serious gum problems - Widespread Chronic Periodontitis

Once gum disease progresses, there can be extensive pocketing, and areas of bone loss from between teeth, and often is increased tooth mobility. Severe cases will often exhibit ongoing gum infections or spontaneous loss of teeth.

Ideally, treatment consists of very thorough hygienist treatment, high-quality oral hygiene at home, and regular ongoing maintenance at 3-4 four monthly intervals.  After a suitable period of time, generally 6—12 months, the areas that have not resolved will be retreated on an ongoing basis.

A specialist referral may be thought useful in some cases.

Smoking

Moderate and serious gum problems can be difficult if not impossible to treat adequately where the patient continues smoking.

However, we accept that stopping is difficult and will provide ongoing maintenance in any case.

The Bottom Line

Long-term studies have shown that the thoroughness of the oral hygiene measures the patient undertakes daily at home are the best predictor of tooth survival. Given this, the importance of good oral hygiene cannot be emphasised too much.

Present treatment protocols are moving towards getting the homecare right in the first instance, to ensure the hygienists active cleaning has the maximum effect.

Generally speaking, no matter how brilliant your dentist and hygienist are, if you do not look after your teeth at home thoroughly and effectively, the treatment will probably not succeed as well as it might. Without the patient taking a pro-active approach, treatment may not achieve any improvement.

Referral

This is probably a suitable point to mention that there are specialists who deal in gum problems (periodontists). 

Regrettably there are none available locally: Bristol, Bath, Cheltenham and Swindon are the nearest and we have a list of them and their websites & locations available on request. However, referral is always an option worth considering if your problems are serious enough.

Generally, the practice would like to see if they can resolve the problem in 12 to 18 months before this option is considered, but if the patient prefers, it is possible to refer when the problem is first diagnosed.

How we use your personal data

At Barley Mow Dental Care we are committed to protecting your personal data.

We will use your sensitive personal data for the purposes of providing our services to you or if we need to comply with a legal obligation. Our legal ground of processing this data is your explicit consent and provision of Dental treatment

We will use your non-sensitive personal data to (i) register you as a new patient, (ii) manage payments, (iii) collect and recover monies owed to us (iv) to manage our relationship with you, (v) send you details and reminders of your treatment and appointments.

Our legal grounds for processing your data are in relation to points (i) to (iv) above are for performance of a contract with you and in relation to (iii) and (v) above, necessary for our legitimate interests.

We will not share your details with third parties for marketing purposes.

Disclosure of your personal data

We may have to share your personal data with (i) service providers who provide IT and system administration support, (ii) professional advisors including lawyers, bankers, auditors and insurers (iii) HMRC and other regulatory authorities (iv) to other professionals for the purposes of discussing your treatment

We require all third parties to whom we transfer your data to respect the security of your personal data and to treat it in accordance with the law. They are only allowed to process your personal data on our instructions.            We will, in most cases, reply within one month of the date of the request unless your request is complex or you have made a large number of requests in which case we will notify you of any delay and will in any event reply within 3 months.

If you wish to make a Subject Access Request, please send the request to the practice or email  us  marked for the attention of the Data Compliance Officer.

Data security

We have put in place security measures to prevent your personal data from being accidentally lost, used or accessed in an unauthorised way, altered or disclosed. We also limit access to your personal data to those employees, agents, contractors and other third parties who have a business need to know such data. They will only process your personal data on our instructions and are subject to a duty of confidentiality. We have put in place procedures to deal with any suspected personal data breaches and will notify you and any applicable regulator where we are legally required to do so.      

 

Data Deletion

In certain circumstances you can ask us to delete your data. See the section entitled ‘your rights’ below for more information.

We may anonymise your personal data so that you can no longer be identified from such data, for research or statistical purposes. In these cases we may use this information indefinitely without further notice to you.

Data retention

We will only keep your personal data for as long as is necessary to fulfil the purposes for which we collected it. We may retain your data to satisfy any legal, accounting, or reporting requirements for 11 years or until you turn 25.

You have the right to ask us to delete the personal data we hold about you in certain circumstances. See section 6 below.

Your rights

You may chose to exercise certain rights in relation to your personal data that we process. These are set out in more detail here:

https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/

In relation to a Subject Access Right request, you may request that we inform you of the data we hold about you and how we process it. We will not charge a fee for responding to this request unless your request is clearly unfounded, repetitive or excessive, in which case we may charge a reasonable fee, or decline to respond.

Keeping your data up to date

We have a duty to keep your personal data up to date and accurate; therefore, from time to time we will contact you to ask you to confirm that your personal data is still accurate and up to date.

If there are any changes to your personal data (such as a change of address) please let us know as soon as possible by writing, or via email to This email address is being protected from spambots. You need JavaScript enabled to view it..

Complaints

We are committed to protecting your personal data, but if for some reason you are not happy with any aspect of how we collect and use your data, you have the right to complain to the Information Commissioner’s Office (ICO), the UK supervisory authority for data protection issues (www.ico.org.uk).

We would be grateful if you would contact us first if you do have a complaint so that we can try to resolve it for you.

How can Smoking affect your mouth and teeth?

By now even the most hardened smoker realises that smoking is bad for your general health. They just hope it won’t happen to them.

However, many of our patients have no idea that smoking can also impact on the health of their teeth and gums.

In most cases, smoking will cause staining of the teeth which can become permanent. Smoking also makes the severity of gum disease worse, which can lead to tooth loss. Smoking is the main causative factor in mouth cancer.

Staining

The nicotine and tar content of cigarette smoke can cause the teeth to discolour generally, and any areas that are not brushed perfectly will accumulate surface stain.  Long-term smokers often have badly discoloured teeth where the stain has penetrated the tooth structure.

Taste & smell

The taste & smell senses of smokers are materially affected by smoking, but this recovers within weeks of stopping.

Implants

The failure rate of dental implants and any dental surgery increases markedly when the patient is a smoker.

Gum disease

Around 15 % of the population appear to be genetically very susceptible to getting severe gum (periodontal) disease. A further 70% are moderately susceptible to some degree.

Smoking appears to have a number of negative effects that alter how people respond to gum disease.

Smoking decreases the blood flow to the gums, probably due to the nicotine and carbon monoxide content. This reduces their ability to heal, so any disease process that starts, such as gum disease, will progress more readily and cause more damage.
The reduction in blood flow also reduces the amount of bleeding from gum edges on brushing that might otherwise warn the patient that they have gum disease. This can make early detection and treatment difficult.

Smokers also have reduced activity of white blood cells, causing a decrease in normal defence systems against plaque bacteria. This allows more tissue damage to occur.

Patients who smoke also generate more bacterial plaque and hard deposits around their teeth, and this plaque is the main cause of gum disease. Research shows smokers are 2.5 to 6 times more likely than non-smokers to lose teeth early.

In many cases, our normal treatment regimes for gum disease are ineffective when the patient continues smoking, most likely due to the reduced capacity for healing caused by smoking.

Smoking and Cancer

Most people are aware of the association between smoking and lung and throat cancer. However, smoking is strongly associated with the development of oral cancer, with smokers being four times more likely to develop oral cancer. The figure jumps to a person being ten times more susceptible to oral cancer if the smoking is combined with the consumption of spirits. High alcohol content mouthwashes are also implicated.

There are around 4000 cases a year of oral cancer in the UK, primarily in men and the over 50’s. It is the eleventh most common cancer in men, and sixteenth in women. It is as common as cervical cancer. The survival rate is poor – 50% at five years - as it is often detected late. It is believed that the risk of oral cancer returns towards normal 5-10 years after smoking stops.

 Please bear in mind that the average dentist will only ever detect two to three oral cancers in a practising lifetime, so don’t panic too much!

All our dentists routinely scan the mouth for any problems at each dental examination.

Smoking and Children

Smoking during pregnancy doubles the incidence of cleft lip & palates and increases the incidence of low birthweight babies.

 Smoking parents are also associated with an increased risk of cot death, plus increased rates of asthma and respiratory disease in their children.

Reasons for Quitting

  • Pregnant women: Increased risk of low birthweight and foetal death
  • Long-term smokers: Increased risk of heart disease, cancer and stroke
  • New smokers: Easier to stop now than later
  • Any smoker: Save money and feel healthier
  • Fresh breath for yourself, benefitting others around you

Organising Quitting

  • Set a date for quitting and stop entirely on that day
  • See your GP or practice nurse for advice and assistance, as this increases the success rate markedly
  • Call the smoking helpline: 0800 169 0169
  • Get friends and family involved to help.
  • Plan ahead so that any problems that may arise can be dealt with
  • Have “substitutes” to smoking arranged, such as gum or exercise

Practical Advice

Arrange a follow-up appointment, preferably within 1-2 weeks of quitting. This may fit in with a subsequent dental appointment or a visit to the hygienist.  Patients may also be referred to local smoking cessation services and helplines.  This is important since studies show that people are twice as likely to successfully quit with regular follow-ups than without. Even with routine contact, most smokers will make three or four attempts to quit before they finally succeed; it is important to understand that relapse is perfectly normal. At the same time, patients should not be put off trying to quit again and again if necessary.

To help smokers overcome nicotine cravings, the following “Four Ds” can help reduce the urge to smoke:

  • DELAY: Don’t act on the urge to smoke by opening a pack or lighting a cigarette because even after a few minutes this urge will reduce
  • DEEP BREATHS: Take three deep, slow breaths in and out
  • DRINK WATER: Sip it slowly and enjoy the taste
  • DO SOMETHING ELSE: Take your mind off smoking by doing some exercise, listen to music or talk to a friend

The purpose of this leaflet to discuss the risks and benefits of endodontic or root canal treatment (RCT).

Teeth are the hardest substance in your body but have live tissue inside them. Trauma or irritation from decay will cause inflammation, and as the tissue is unable to expand, severe toothache can result.

If the pulp tissue then dies, it can become infected, which will then give rise to a dental abscess. Teeth can have a varying number of roots ranging from 1 to 4, and occasionally more. They are all different shapes and sizes.

Endodontic treatment aims to remove all the organic debris from inside a tooth and then fill the space.

It is a technically demanding treatment and requires skill and training of a high-level from the dentist.

What are the Options if I have an Abscess or Severe Toothache?

If you have a tooth that in the dentist's opinion needs root filling, there are a variety of options:

  • Do nothing: antibiotics will resolve an abscess for usually 2 to 3 months: however, they do not reach the bacteria inside the teeth and so the abscess will recur.
  • Extract the tooth: this is reliable but if the tooth is important for chewing or appearance it can be difficult to replace. While it can be costly to root fill a tooth, it can be more expensive to replace it in other ways such as a bridge, denture or implant. At the same time if the tooth is so badly damaged it cannot be reliably restored then it is better off extracted, and an alternative solution pursued.
  • Endodontic treatment: as detailed above this has a relatively good success rate but will only work reliably if enough of the bacteria can be removed from the inside of the tooth, and then the tooth can be sealed against further bacterial contamination. Bacteria are very small (in the region of 2/1000 of a mm) so it is impossible to guarantee success.

What Can Cause Problems with the Treatment?

Endodontic treatment becomes more difficult to perform successfully for the following reasons:

  • More difficult on multi-rooted teeth
  • the length of time the tooth has been contaminated with bacteria
  • if the tooth has developed internal cracks
  • if the canals are severely curved or heavily calcified or sclerosed (backfilled)
  • Tooth location: the further back in the mouth the tooth is

A wide variety of problems can arise during treatment which can decrease the likelihood of success. The most common are:

  • The dentist may not be able to locate all the canals
  • An instrument can fracture in the tooth
  • the tooth can be perforated
  • the canal can become blocked

In some cases, it may be advisable to refer you to a specialist to undertake or complete the treatment. You can always ask to be referred if you wish.

Minor Problems During Treatment

There can be problems of a transient nature associated with the treatment.

It is quite common for the tooth to be slightly tender after treatment and occasionally there can be pain and swelling, although in most cases this will resolve without intervention. The temporary dressing that is placed in the tooth between appointments is important to prevent bacterial recontamination of the inside of the tooth. If you feel it is failing, then an urgent appointment is advisable.

To avoid further bacterial contamination of the tooth during treatment, it is nearly always done with a ‘rubber dam’ in place, which is a thin sheet of rubber stretched over the tooth to keep your saliva out of the tooth and isolate the area.

We usually take at least one or two x-rays during treatment to assess the shape of the tooth and the root structure; the x-ray is also used to assess the final root-filling.

Longer Term Problems

Another factor to consider is the prognosis of the tooth in the future.
It is pointless doing a root filling if the tooth cannot be rebuilt properly; at the same time, doing a root filling damages the tooth further as more tooth structure has to be removed.
All teeth that have been root treated should receive protective full coverage restorations, crowns or onlays in the medium term to avoid bacterial leakage and catastrophic fracture of the remaining structure.

The evidence shows that root-filled teeth with crowns or onlays survive far better than those without.

A survey in America looked at 1.4 million root filled teeth in 1.1 million people over eight years. The study found that 97% were still in place at the end of eight years. The 3% of teeth that had need of further treatment had usually required it in the first three years. 85% of the teeth that were extracted had not been protected against mechanical failure of the remaining tooth structure.

Another UK study using NHS data showed that a crown on the tooth gave better survival no matter how good or bad the root filling was on x-ray.

The charge for root fillings includes around £30-40 to cover the cost of the single use instruments we use. It is also for the time and expertise we spend doing the treatment - there is no guarantee of a positive result, but we do the best we can to ensure a successful outcome.

Success Rates

Studies have shown that in simple cases with no pre-existing infection, success rates can be as high as 96%. This drops to 86% where infection has been present for some time. Where retreatment is involved, success can be as low as 68%.

Success is higher in teeth that are crowned, and poorer overall in molars, single standing teeth and where the root-filled teeth are used to support a denture or bridge.

The main points are:

  • Root fillings work very well in many cases, but not all
  • If the tooth is very broken down, it may not be worth doing
  • If a tooth needs root filling, antibiotics will not ‘fix’ it
  • Root filled teeth are usually heavily filled and will often need crowns or onlays in the medium term to avoid mechanical failure.
  • Root filled teeth are more unreliable if single-standing or if they are used to hold up bridges or dentures as they are under more stress.
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