What is Fluoride?

Fluoride is a chemical which occurs naturally in many water supplies. It has been proven to reduce dental decay by as much as 80% in children if given in the correct amounts.

Some water supplies are artificially fluoridated to a concentration of one-part fluoride per million parts water (ppm), which is considered to be ideal and the dentists at Barley Mow support water fluoridation on a national scale to reduce the ravages of dental decay.

At the Barley Mow, we have a small but increasing number of children with widespread decay, which would fit with the reduction in the level of natural fluoride in the local water over the last few years from 0.7ppm to 0.2ppm.

Fluoride Supplements

Malmesbury water has a low enough level of fluoride that supplementation is recommended at all ages, and should certainly be considered by the age of 3. 

Please talk to your dentist about what he or she would recommend.

Fluoride supplements in the form of tablets, toothpastes and mouthwashes are available at no charge on NHS prescription for those under 18 years old.

Are There Any Harmful Effects?

In very high concentrations or amounts, fluoride can become toxic.

A much more common effect is fluorosis which can occur if a little too much fluoride is taken in over a period of time. This is only important below the age of 6 as by then, the adult front teeth have formed.

Fluorosis is seen as white flecking or brown mottling on the surface of the teeth. It is not dangerous or harmful to the teeth, but it doesn’t look very attractive and therefore is best avoided if possible.

It is because of the risk of fluorosis that we recommend that only a small pea-sized amount of toothpaste is used when brushing children’s teeth, and that children are encouraged not to swallow toothpaste.

However, it has been shown that minimal or no rinsing after spitting out the excess toothpaste after brushing enhances the effect of the fluoride.

Many other toxic effects are claimed for fluoride but do not stand up to statistical analysis. It is impossible to prove something is safe, but it is easy to prove fluoride massively decreases the incidence of decay in children and adults.

 Other Uses for Fluoride

Teenagers can suffer from an increased risk of decay either because of a poor diet, poor brushing or the presence of orthodontic appliances. Often, it is all three!

Similarly, some of our older patients can see a large increase in decay activity following the use of some medications or after cancer treatment. In many, the reasons are not clear cut and are probably linked to a decrease in saliva quantity and/or quality.

In any case, the decay can be very destructive and troublesome to control.

In both cases we may well recommend the use of additional fluoride delivered as a gel held in custom made trays or as triple-strength fluoride toothpaste.

 Do We Have Fluoride in Our Water?

Our local water supply in Malmesbury is not artificially fluoridated, but there is a natural fluoride level of around 0.2 ppm which is well below the ideal level of 0.7 to 1 ppm.

Patients who live further away from the practice may receive their water from different sources and would be advised to check with their local water supplier.

It is also possible that children may be mainly drinking bottled water, so the fluoride content would need to be checked, as each brand varies in the level of fluoride contained.

The effect of water filters is unclear, but will probably remove some, if not most of the fluoride. Thus, children who drink solely from these filters are at increased risk of decay

 Finding out your fluoride level

Wessex Water and Thames Water both have postcode searches available for the supply area they cover. or you can phone them and enquire. Use the following details to check.

Go to www.wessexwater.co.uk, select the ‘Help and Advice’ tab, and select ‘check your water quality’ box to the right of your screen. 

The fluoride level will be around 2-300, which is divided by 1000 to get parts per million

Go to www.thameswater.co.uk, select ‘Help and Advice’, then select ‘water quality’ down the left.

The aim of this leaflet is to provide basic information on looking after your dentures

There are a number of different types of dentures; initially we will deal with general care, and then some specific details on each type of denture.

It is best to start with the observation that artificial teeth only substitute for the real thing and can never be as efficient as natural teeth.  You have spent a considerable amount of time and money having these new dentures made and like all new things, it will take some time for them to settle in. You must look after them carefully in order to have good service.

Initial Problems

Your dentist will show you how to place and remove your dentures. Be sure you can do this properly before you leave the surgery. Even if you have worn dentures before, your new dentures will almost certainly feel strange at first.  This is because your mouth takes some time to adapt to the new dentures.  When eating, start with soft crisp food, such as lightly cooked vegetables. Take in small amounts and chew slowly, trying to chew on your own teeth rather than the denture where possible.  With full dentures, it can help to chew on both sides at once.

It can also help to practice talking, and one easy solution for this is to read aloud for some time each day. Generally, speech is back to normal within a week.

It is completely normal to get increased salivary flow as your subconscious assumes the dentures are food, which triggers saliva production.  This response settles down within a few days.

In most cases, your dentist will have arranged a review visit. This is to check the dentures are fitting properly, functioning well, and to deal with any other problems you may experience.

Often more than one adjustment may be necessary.

The general advice is that dentures should be removed  before going to bed as this gives your gums a chance to recover. Initially, it can help with new dentures to leave them in place for 24 hours a day for several days, removing them only to clean any remaining teeth and the dentures, This helps your subconscious get used to the feel of the new dentures.

Cleaning

The dentures should be cleaned thoroughly with a soft brush and need to be kept in water overnight to prevent them drying out.  New dentures are highly polished and very slippery; therefore they should be cleaned over a folded towel or a half full basin of water until you are used to them. Both the inside and outside surfaces of the dentures need thorough cleaning.

They are made from acrylic, so aggressive scrubbing will wear them away.  Do not use very hot water, kitchen detergents, abrasives, laundry bleaches, methylated spirit or any antiseptic unless otherwise instructed. Denture cleaners can be used but are not strictly necessary if the dentures are kept clean by mechanical brushing.

If tartar build-up is noted on the dentures, try soaking them each night in a mixture of one part white vinegar and four parts water. This generally helps to remove or soften the tartar.

Repairs

If you break your dentures, please contact the surgery or bring them in so we can see what is required in order to repair them. Generally, it is advised not to attempt a repair yourself, as it is difficult to do it accurately more than once. This can make a proper repair difficult and more costly.

Full Dentures

It can take up to 48 hours for full dentures to properly bed in, so we are not usually concerned about suction problems for the first few days.

Sometimes they also ride up on the harder   areas of gum which show up as sore spots, and   this stops the dentures settling in properly.

If you are finding the upper denture difficult to tolerate then it is one of the few times the dentist will recommend the use of sweets. A boiled sweet or mint held on the tongue will distract the tongue while you are getting used to the feel of the denture.

Denture adhesives can help with upper denture retention, but the narrow width of lower full dentures will unfortunately, generally make adhesives useless.

Partial Dentures

Teeth are normally lost through decay or gum   disease, both of which are caused by the accumulation of bacteria (biofilm/plaque) on the teeth.  The presence of dentures tends to make biofilm accumulate more readily and so it is important that you clean your teeth even more carefully than before to avoid further problems developing. Obviously the teeth should be cleaned without  the denture in place. Sometimes the position, angulation or shape of remaining teeth can make insertion or removal of the denture tricky, but after a few days it usually becomes easier. If not, adjustments can help.

Chrome frame dentures

These usually cause few problems; however, the accuracy of the fit can make locating any problems more difficult. They are also more difficult to adjust where the stainless-steel frame is involved

Similarly, they can be fiddly to place and remove until you have become used to them. Despite the above problems, dentures with a metal frame are usually very successful and can offer a long service life.

The instructions given for cleaning the adjacent teeth for partial acrylic dentures are just as important for partial chrome dentures.

If you use proprietary denture cleansers, please ensure they are compatible with a metal frame.

Immediate Dentures

These dentures are made by the technician guessing the what the shape of the gum will be after the dentist has extracted the teeth.   Coupled with the fact that you are usually partially numb when the denture is fitted, adjustments will usually be necessary the next day.

It is normally recommended that immediate dentures are left in place for the first 24 hours, being taken out only to clean the denture after meals.

The gum will always shrink as it heals, and this means the denture may need refitting, for which there may be an additional charge. Most of the change happens in the first three months after extractions and then slowly continues for the rest of your life

How long will they last?  

The normal service life of dentures varies hugely, as it depends on which types of denture you have, how hard you chew and how adaptive you are to the slow change that occurs.

As a rough guide, full dentures function very well for the first 5 years, and often may need replacing at ten years. They can benefit from a reline of the denture at 3-4 years to improve the fit. Replacing one of a pair is very limiting and is often not advisable.

Partial dentures often need replacing if they begin to fracture frequently as this is an indicator of poor underlying fit, or a problem with repair alignment. Their appearance is often poor by 7-10 years.

Chrome frames often survive very well, but the acrylic teeth wear out and need replacing in 5-10 years.

Severe wear in any denture cannot be rectified without replacement.

Why Do I Need a Crown or Bridge?

 Crowns are required when there is insufficient tooth structure remaining to support a conventional filling. This is usually dictated by one or more missing cusps of molar teeth and large fractures or lost fillings of anterior teeth. Crowns usually cover the entire visible surface of the tooth. Crowns can also be placed to protect cracked teeth.

There are also onlays which cover just the biting surface of the tooth. Their benefit is that less tooth is removed.

Bridges are used to replace missing teeth and can involve either one or both of the teeth adjacent to the gap.

There are various materials available for crowns and bridges. Each has its advantages and disadvantages.

Gold crowns require less tooth tissue preparation but the material is now very expensive.
Porcelain bonded to metal crowns are cheaper but tend to develop a dark line at the crown edge and also look less natural in comparison to other crowns.

All ceramic crowns that contain no metal are presently very strong and offer excellent aesthetics, but can require more tooth removal to achieve this.

Often, the decision is made on the basis of the degree of aesthetics the patient requires and how dark or discoloured the remaining tooth is.

Types of Bridges

 Conventional Bridge

For these, a full coverage crown is prepared on the adjacent tooth or teeth, so there is a need to do substantial reduction to this tooth. The lab technician then makes a crown with a cantilevered blank tooth, very similar to that used in a Maryland bridge. Another design uses a crown at either end of the bridge, so two teeth need preparing.

Maryland or Resin Bonded Bridge (RBB)

It is named after the University of Maryland who pioneered the technique. It relies on using plastics to bond a metal or plastic wing to a tooth.

A bridge unit is made by a dental laboratory to replace the missing tooth with a thin metal or plastic wing that accurately fits the back (palatal or lingual) of an adjacent tooth. The tooth will usually need some adjustment to allow the bite to be correct afterward, but the amount is minimal. The wing is then stuck to the tooth.

In some cases there can be problems with the 'wing' tooth darkening owing to reduced light transmission and an all plastic version is used if this is thought to be likely. It is also possible to make them from ceramic.

Your dentist will discuss with you which bridge type is most appropriate to your individual circumstances.

 What Does the Treatment Involve?

All crowns and bridges involve tooth tissue preparation. Tooth preparation will be done as conservatively as practical.

There are normally two appointments involved with either crown or bridge treatment.

At the first visit the tooth or teeth are prepared and then the dentist will do a 3D scan or take an impression of your upper and lower teeth.

This allows a customised crown or bridge to be created specifically for you. Once the scan is completed satisfactorily, it is sent electronically to a specialist lab.

A shade will also be taken to ensure the best possible match to your existing teeth and a temporary crown(s) or bridge is made and fitted.

In some cases, we ask the patient to attend the laboratory for a shade consultation to ensure the best possible match.

The final appointment is for the crown or bridge to be permanently fitted, using a strong adhesive to ensure maximum strength and adhesion.

This appointment normally lasts for 20 minutes and is scheduled roughly 2 weeks after your scan. This allows plenty of time for the lab to create your new crown/bridge.

Possible Post-Treatment Issues

In general, patients suffer very few issues after crown or bridge treatment. However, a few patients may experience one or more of the following:

Sensitivity of teeth

After the teeth have been prepared or after the crown has been fitted the tooth may become sensitive. It may be mild to severe. Usually there is no to very little sensitivity but if you do get persistent sensitivity please notify us.

Root canal treatment

After being crowned, teeth may develop inflammation or death of the nerve. In most cases this is due to the presenting circumstances of the tooth. It may have been traumatised from an accident, deep decay, extensive fillings or the preparation itself. In this case, the tooth will need root canal treatment and, in some circumstances, referral to a specialist or extraction.

Breakage

Crowns and bridges can chip or break. This is unusual and is not usually due to defective materials or construction unless it occurs soon after placement.

Uncomfortable or strange feelings

This may occur because of the differences between natural teeth and artificial replacements. In the majority of cases, the patient becomes used to the crown or bridge in a matter of weeks.

Aesthetics and appearance

We do our best to get as good an aesthetic result as practicable. Patients will be given the opportunity to observe the appearance of the new crowns and bridges in place prior to final cementation so any adjustments can be readily made.

Longevity of crowns and bridges

There are many variables that determine how long crowns and bridges can be expected to last. Because of this, no guarantees can be made or seen to be made.

We have little control over the pre-existing condition of the underlying tooth, and this is probably the most important factor in survival. Heavily restored teeth may die requiring root canal treatment. Teeth with root canal treatments can become reinfected. Teeth which have had a post fitted to support the crown, can split.

However, despite all the above, the majority of the crowns we supply have a good life span.

The problem

A healthy balanced diet is essential for young children in order for them to grow and develop properly. Diet is also important for the development of healthy teeth.

Most children enjoy sweet sugary foods, but too much sugar in their diets is the major cause of tooth decay that can lead to toothache, fillings and infections.

The problem with sugar is that when you put it in your mouth, the bacteria found in plaque converts the sugar into acid. This acid then starts to dissolve the surfaces of the teeth for over an hour until your saliva neutralises the acid. The tooth will then start to repair itself, but this takes time. Decay starts to happen when the tooth doesn’t have enough time to repair itself before the next hit of sugar arrives, or if the repair systems are compromised.

Acids are often present in many foods, and these soften the teeth allowing them to be rapidly worn away. Decay bacteria flourish in an acidic environment promoted by sugary and acidic foods.

While it is unrealistic to expect children never to eat sugary foods, just by taking a few sensible steps at an early stage it is possible to greatly improve your child’s chances of developing strong, healthy teeth that will serve them well during their childhood and beyond.

So what can I do?

  • Do not sweeten foods and drinks to suit your taste: children are not born with a ‘sweet tooth’!
  • Limit sugary foods to mealtimes.
  • Most children love sweet drinks. Encourage them to drink those containing no added sugar, or that use artificial sweeteners.
  • The acidity of the drink is also relevant, so consider low acidity drinks such as Robinson’s Special R or Ribena Toothkind. Excessive consumption of acidic drinks can lead to permanent erosion of the teeth. Smoothies can be very acidic.
  • Most children love sweets and to expect them never to eat them would be impractical.
  • Eat sweets and chocolate all in burst rather than spreading them out over the day. This limits the number of acid attacks on their teeth during the day.
  • Try to only give sweets at certain times of the week, such as Friday afternoons, Saturdays, or as very occasional treats. Don’t give sweets regularly as rewards (especially for coming to the dentist!) or to keep children quiet.
  • Discourage grandparents and childminders from giving sweets to your children either as rewards or as pacifiers.
  • Consider buying sugar-free sweets particularly those with xylitol, which has been shown to reduce decay.
  • Snacks between meals should ideally contain foods which do not damage teeth. This is covered more fully over the page.
  • Never allow your child to consume sweets or sugary drinks last thing at night after they have brushed their teeth.
  • Brush your child’s teeth twice daily with a children's fluoridated toothpaste
  • Visit the dentist regularly with your children to allow your child to become used to the environment and so any problems can be spotted early on.

By following these simple guidelines, you will greatly improve your child’s chances of growing up with strong healthy teeth  

 

Snack foods for children

Snack foods for children are a difficult area. There are a huge range of products commercially available, many marketed specifically at particular age groups.

Many of these are high in sugars, salt content, acids, and fat, but not usually all at once. It is also fair to say that none of them are toxic.

However, from our standpoint, you are looking to provide snacks for children which can provide essential nutrients for their growth and development, coupled with minimal sugar content and acidity.

Nuts & seeds – these are packed with nutrients and are often available unsalted. They are often available in spreadable ‘butter’ form, often unsweetened and unsalted.

Fruit and vegetables – There is a wide variety of fruit and vegetables available, often in small portions. Choices could include pears, apples, bananas, avocados, watermelon, cantaloupe melon, cherry tomatoes and carrot sticks. Fresh fruit can also be chopped up and mixed into unsweetened yoghurt.

Popcorn – made at home this can be unsalted and unsweetened.

Other possibilities are good quality grilled cocktail sausages and chicken drumsticks, cubed ham or chopped chicken or turkey.

Cheese is interesting because it is high in fat but does have a high calcium content. It seems reverse the effects of sugars if consumed after the sugary snack.

There are many commercial products on the market; It is difficult to generalise as there is such a wide range. However, because products now mostly have nutritional information printed on the packaging, it is now easier for parents to more easily see all the nutritional values contained in food products.

Pay particular attention to food & drinks containing ‘hidden’ sugar, which are often advertised as ‘healthy’. It is worth a quick glance through the labelling to determine how much sugar is present.  Smoothies, sweetened yoghurts, and ‘healthy’ breakfast cereals are particular culprits.

Brushing Your Teeth

Why Clean Your Teeth?

 The two most common dental problems, dental decay and gum disease. are both caused by the action of bacteria on teeth or gums. Bacteria are naturally present in the mouth and are often detectable as a thin (or thick!) sticky film over the teeth especially at gum level. This is referred to as plaque. These bacteria cannot be removed completely - the point of cleaning teeth is to remove as many as possible, and to maintain an environment that discourages the more ‘dangerous’ types of bacteria.

Most people brush their teeth at least once daily, and some more often, but it is usually done in an inefficient manner and too quickly, leaving a lot of plaque behind. Careful cleaning can take a bit longer, but for those patients without serious problems it will not involve too much extra effort.

Thorough cleaning will reduce the risk of decay or gum problems starting, or slow the rate at which they progress. It also produces fresher breath and a ‘cleaner’ feel to the teeth and mouth.

Electric Toothbrushes

 The new designs of mains rechargeable electric toothbrushes have improved brushing immensely. They brush very efficiently and encourage longer brushing times, and are suitable for all ages. The main differences from manual brushing are to move the brush slowly from tooth to tooth, tilted at around 45 degrees, and use a little less force.

There is no reason that children cannot use them.

So How Should I Be Using The Electric Brush?

Brush Type: The commonest problem we see is a brush that is too worn and ‘rounded’ or far too big. There are a huge variety on the market, but the basic things to look for are:

  • Soft or medium bristle ‘stiffness’
  • Compact head slightly smaller in length or width than the diameter of a £1 coin
  • A handle you can hold on to firmly.

Toothpaste: Very little real difference exists between brands despite all the brands available; basically, choose one you like the taste of. Another important factor to consider is if you need a toothpaste to reduce cold sensitivity, or possibly to combat tooth wear. It is recommended to use a toothpaste which contains fluoride. However, non-fluoride options are available, normally in good health food shops.

 Floss type: There are many types on the market. Beginners often find the tapes easier to use as there is more to hold onto. As with toothbrushes the proper technique is more important than the floss you use.

 Frequency: It is better to brush thoroughly once a day than quickly 3 or 4 times. Ideally, for the average set of teeth, brushing should be done thoroughly twice a day for at least two to three minutes. Flossing will take an extra minute or two.

 Timing: Traditionally, it was recommended that the best time to brush was straight after meals. Now, the only definite advice is to brush in the morning before breakfast if it includes acidic foods, and last thing at night after any food or drink.

 Rinsing: It has been shown that not rinsing with water after brushing reduces decay, as the fluoride has longer to act.

Brushing Technique

To clean the outer surfaces of each tooth, tilt your toothbrush at a 45-degree angle against the gumline.

  • Move the brush back and forth, using short, gentle circular strokes.
  • Repeat this motion on the inside, outside and chewing surfaces of your teeth.
  • To clean the inner surfaces of your front teeth, hold the brush vertically and use gentle up-and-down strokes with the front part of the brush.
  • Pay extra attention to the gumline, hard-to-reach back teeth and areas around fillings, crowns or other restorations. Plaque builds up more on the areas of teeth covered by dentures.
  • For fresher breath, brush your tongue too! To do this grab, the tip with a clean facecloth or piece of gauze and scrub the top surface vigorously.

But My Teeth Are Really Sensitive When I Brush Them…

 If your gums are tender and bleed on brushing, you see improvement once you start brushing properly. This may take a couple of weeks to resolve. If they do not, arrange a visit with your dentist or one of our hygienists as professional cleaning or advice may be needed.

If you have cold sensitivity from the necks of the teeth, then this is a bit more of a problem to manage. The hard outer layer of enamel stops at the tooth neck, and a softer material - dentine - is exposed by the gums receding.

Modern diets are often quite acidic compared to the diets of 20 years ago, as they often include fruit juices, fruit, wine, fizzy drinks, etc.

Dentine is easily softened by these acids and can be brushed away exposing the tiny tubules in dentine that are associated with the sensitivity.

Management of the problem focuses on reducing the acid exposure through diet changes, and brushing before the acid consumption, so the softened dentine has a chance to recover. This often means brushing before meals, using a soft brush and a gentle technique.

Anti-sensitivity toothpastes need to be used or applied gently after normal brushing and left to ‘soak in’ They work by trying to block the tubules.

Your dentist can also apply materials to block the tubules, or if the wear is deep enough, place a filling material over the neck of the tooth.

A Few Other Points:

Children are generally only able to use a simple scrub-brushing technique until they are 7 - 10. Assisted parental brushing and supervision on a regular basis is advisable to ensure it has been done properly. Their brushing can also be checked with disclosing tablets.

Patients with dentures need to be particularly thorough brushing not only their dentures to remove all the plaque, but also the areas of gum and tooth covered by a denture, which are more likely to develop gum and decay problems.

Brushing can become more difficult for patients put on certain drug treatments that may make their mouth drier. This is a side effect of very many drugs.

It is also possible for the gums to be directly affected by a few drugs, with one group of blood pressure control drugs being the commonest. If you think this is a possibility, then please discuss it with your dentist.

Page 2 of 2