Over-brushing is unfortunately a very common problem, and can be surprisingly destructive. There are two problems we see regularly caused by over-enthusiastic brushing; gum recession and V-shaped notches worn into the necks of the teeth (root abrasions). Both can be caused by scrubbing hard, especially with a hard bristled brush. The brusher is usually either in a hurry, or is eagerly trying to get their teeth extra clean unaware of the damage they are causing. If you scrub the front surfaces of your teeth hard and fast you are probably over-brushing. Having a toothbrush with splayed bristles is often a sign.
This picture shows how gum recession can be caused by brushing too hard. It often affects the top side teeth more severely as this is the most comfortable position for hard scrubbing. Recession can sometimes be treated with specialist regenerative gum surgery but is often difficult and results are variable. It is best to try and avoid the gums receding in the first place.
These V-shaped notches in the root result when the gum has receded exposing the root dentine. The root dentine isn't as hard as the enamel and with repeated hard scrubbing it will wear away. This can make teeth sensitive and weaken them. These V-shaped notches can be repaired with tooth-coloured fillings.
How to avoid over-brushing
The best way is to use an electric toothbrush. It is hard to brush too hard with an electric brush. However it is still possible and there are some electric brushes that have a warning light or beep if you are brushing too hard. When using an electric brush don't try and brush as you would with a normal brush. Just hold the brush tucking the bristles into the gum line and slowly move back and forward over a couple of teeth for a few seconds, before moving to the next teeth along. If using a manual brush hold the toothbrush to the bristles are tucking into the gumline. Brush backwards and forwards a few times, not too hard, then flick and drag the brush down the tooth surface pulling the plaque away from the gumline.
Invisalign, the American company who produces invisible braces, have now treated over 3 million patient worldwide. Since their inception in 1999 they have invested a huge amount of money in research and development. The features included in their system are miles ahead of any other invisible brace system I have tried. One of the most exciting developments was a few years ago when they launched their Smart-track material. This is a special kind of plastic, used to make the braces, which has really good elastics properties. I was lucky to hear one of their American plastics research scientists talk about the development of this patented material. I have seen a huge benefit from using this material to treat my cases. The recent news from Invisalign, that following rigorous testing, they are recommending that each set of braces can be changed, rather than every two weeks, now once a week means halving the treatment time for most cases. This really is a game changer. Most cases I treat I complete in 6-12 months. This means going forward I will be completing many cases in 3-6 months!
Almost everyone with crooked teeth would rather have straight teeth. People are put off primarily by four things: the appearance of wearing braces, the time it takes, the discomfort involved, and the cost. Invisalign have pretty much solved three of these problems. The braces are virtually Invisible, far more comfortable that traditional fixed braces, and now we have such short treatment times. Cost may still be a factor for some people. The cost of Invisalign reflects the vast sums that have been, and continue to be spent on research and development, to enable them to produce such a fantastic product. However, having treated many patients of all income levels with Invisalign, the consensus is most definitely that it was well worth it.
The example below shows a case I treated in 12 months. This could now be achieved in 6 months!
For more information on Invisalign or what other options you may have for improving your smile, give me a call, text me or email me using my details on this website, or come and see me for a free consultation.
Myth 1: Root canal treatment is really painful
Almost every time I tell a patient they need a root canal filling they look at me with trepidation and ask "isn't root canal treatment really painful?". I am always happy to put their mind at ease on this one. The vast majority of root canal treatments are completely painless. In fact I have had many patients doze off during root canal work. As long as they doze with their mouth open that's fine by me! The reason this myth exists that a very small proportion of times when a patient comes for root canal treatment they have what we call a 'hot pulp'. This is when the dying nerve is very inflamed and extremely sensitive. In such cases it can be difficult to get the tooth fully numb with local anaesthetic. In such a case the dentist may find the patient experiences pain when they try to open up the nerve chamber. If this happens a dentist would usually open the nerve chamber as much as the patient can tolerate, and then place a paste containing steroid and antibiotics on or into the nerve chamber, with a temporary filling on top. A week later the tooth can usually be treated painlessly. Luckily this doesn't happen very often, and if it does a caring dentist will get the dressing in place with the minimum possible discomfort to the patient and continue a week or so later.
Myth 2: All wisdom teeth extractions are difficult and painful
Luckily this is untrue. This myth relates to the fact that removal of impacted wisdom teeth can be difficult. The procedure itself should not be painful with adequate anaesthetic. However there can be some swelling, bruising and pain afterwards. But all wisdom teeth are not impacted wisdom teeth. If a tooth is impacted it means it hasn't had space to erupt and is buried or partially buried. Therefore in order to remove the tooth if is often necessary to remove some bone around it. It is nearly always lower wisdom teeth that are impacted and rarely upper wisdom teeth. Nearly all upper wisdom tooth extractions and many lower wisdom tooth extractions are of fully erupted teeth and therefore removing them is the same as for any other tooth.
Myth 3: You can't eat before a dental appointment
This myth stems from a confusion between local anaesthetic and general anaesthetic. It is true that you cannot eat before having a general anaesthetic, which is where you are put to sleep in hospital. However, there is no need to avoid eating before having local anaesthetic for dental treatment. In fact it is better to make sure you have eaten. Especially if you are a little nervous, avoiding sugar will mean you end up with low blood sugar and are more likely to feel faint.
Myth 4: Honey isn't bad for your teeth
Children of affluent well educated parents tend to have good teeth. So one day I was surprised when a family of such children came in showing widespread decay. Their mother was being careful to ensure they didn't have sugary drinks or snacks and generally their diet was very healthy. But then it transpired that they were eating a lot of 'grandpa's honey' as their grandfather was a beekeeper. Their mother had no idea that honey is extremely tooth-decay-causing. So watch out for those products and recipes that tell you something is healthy because it has no sugar in, but its been sweetened with lots of honey.
Myth 5: Interdental brushing isn't as important as normal brushing
Very nearly everyone brushes their teeth with a normal electric or manual toothbrush every day. But how many people are as good at brushing with interdental brushes every day? Unfortunately a lot less. Much as you might want them to there is no way those toothbrush bristles are getting all the way between your back teeth. This means plaque that forms here can be left for days and weeks undisturbed if you aren't using interdental brushes or floss. So it is no surprise that most of the gum disease and tooth decay I treat on a day to day basis occurs between the teeth. So stock up on those interdental brushes and make it part of your daily routine.
Many people have phobias of some kind, some are irrational and some are not. I never belittle a dental phobia. I myself have a phobia of spiders yet I know that the harmless spiders we have in this country are unlikely to come near me and even if they did the worst I would experience physically would be a tickly sensation. I respect dental phobias because they are so often founded on something far more rational than my own phobia. So often dental phobias are triggered by a previous bad experience at the dentist. Unfortunately the result of this is avoidance of coming to the dentist. This allows dental problems to worsen to a point where more serious intervention is required. For example a twinge in a tooth can often be fixed with a simple filling. But when a dental phobic puts off coming they are often forced to finally come by the extent of a severe tooth ache which leaves them miserable and in intolerable pain. Not only this but a spreading dental infection can even become life threatening. A tooth will often then require root canal treatment and a crown, or need to be extracted, when an earlier visit would have solved the problem with a simple filling.
The key is to work with each patient individually on their fear, firstly by finding out details of any previous bad experiences and finding out which aspect especially bothers them. Some patients have a fear of injections but don't mind drilling, others are fine with injections but don't like the drilling, whilst some feel panicky about breathing if water from the drill collects in their mouth. Although some patients have a more general fear, I tend to find with most people there is one specific aspect that worries them the most.
I take pride in my injection technique. Usually the most discomfort during an injection is not caused by the needle going it, but by the dentist injecting the anaesthetic solution too fast. A careful slow injection really does help enormously. Many patients tell me they didn't feel the injection at all. For patients who don't like the sensation of the water collecting in the back of their mouth I work closely with my assistant to control the water spray to minimise this. I have patients who like to have breathing breaks every few seconds and am always happy to accommodate this. We can also use a rubber sheet over the tooth that prevents any water at all from going into the mouth.
Another thing I find that has triggered dental phobia for many patients is a brusque manner or rough technique. I can guarantee to always be caring and thoughtful in my approach and gentle in my technique.
I think it is vital to offer patients options, and ensure that we work together to make plans they are entirely happy with. I explain things in a simple manner without using dental jargon. Pictures can be really helpful so I will take photos inside your mouth so you can see the problem I am talking about for yourself. I also take pictures inside the mouth of work I have completed so you can see the quality of my work. I find all these things help patients to feel confident and comfortable in my care.
If phobias are more serious I can offer oral sedation. At the practice we can also offer inhalational sedation (gas and air), and if needed we can arrange IV sedation at another practice. However it is several years since anyone has actually needed to ask me for any of these options.
If you are thinking about fighting that fear and making an appointment you have various options. You are welcome to come for a free consultation, to meet me, have a chat and see the practice. Alternatively you can book in for an hour long new patient assessment and treatment planning appointment. But if even those options are too much to start with you can call me for a chat, or have a chat over email or text. My details can be found on my contact page http://www.drlucynichols.com/contact.html
Here are some sample comments from nervous patients that I have taken from my review page:
"Thank you very much for my sparkling new teeth, for taking care and discussing the process at every step to put me at ease. I was very nervous at first but as the treatment progressed I could feel the tension ease in my shoulders. Yes, to such an extent that I almost fell asleep during an appointment. I am sure I heard myself snore! I was so scared about the tooth extraction and implant that I delayed the process but you were very patient with me and give me time to get used to the idea. Everything went well, hardly any bleeding and after a good nights sleep, all was back to normal. I first went to the Fountain Dental Practice with my nephew who is now 7 years old. The receptionist that day was very friendly and answered all our questions. I felt very comfortable and decided that it was the best place for my treatment and I have not been disappointed. It took me a year to make my first appointment but it has been worth it. Thank you." Merlyn Harris
“I came knowing I needed a significant amount of restorative dentistry. I was very nervous and had resigned myself to some painful dentistry with limited cosmetic improvement. Lucy is very good with nervous patients and put me at ease almost immediately. I found that over the course of the treatment I eventually stopped being intensely nervous before each treatment, something of an improvement for a life-long dentist-phobe." Jen Miller
"I want to thank you all for the care you gave me through my treatment. I walked through your front door a very nervous woman and have walked out a lot braver and contented one owing to your kind approach. It started with your receptionist. Then Dr Lucy and nurse, then on to the hygienist. All so caring. You have made an old lady happy. Thanks to everyone." Hilda Cosnett
Vaping with e-cigarettes has seen an enormous increase in recent years. Whilst it is encouraging news that smoking rates are down, many people are switching to vaping instead so they can continue to feed their nicotine fix.
There is, as yet, very little research on the long term effects of vaping on oral health. I am sure that in time research studies will become available, but until then we have to give our best guess on what the long term effects or vaping our likely to be. The most important issue is the effect of the nicotine in the mouth. Using a nicotine-free vaping liquid to vape rather than smoke as a substitute for the habit of smoking may avoid this. However it is apparent that the majority of vaping liquids contain nicotine.
So what do we know about nicotine and the mouth?
Nicotine causes constriction of blood vessels. This includes that hundreds of tiny blood vessels in our gums. The knock on effect of this is poor blood flow to the gums. When bacteria settle at , and under, the gumline in the plaque on our teeth we rely on antibodies to fight that bacteria. There is only one way for the antibodies to get there; via the bloodstream. So if the blood flow is poor, then the delivery of antibodies to the gums will be poor. So basically not many soldiers have shown up for the fight, and it's likely to be a losing battle.
When nicotine is not present bacteria cause inflammation and that increases blood flow. This may be noticed by bleeding when you brush you teeth. The dentist will also see this and be able to find the exact areas of inflammation by checking all around the gums with a gum probe. When the gums are healthy and the dentist checks with a gum probe the gums will not bleed. If there is inflammation the gums will bleed. However if the nicotine has decreased the blood flow the gums may not bleed. This can therefore mask the signs of gum disease to both the dentist and patient and mean that the gum disease is not picked up until it is at a more advanced stage.
Having had a look at people's own experiences online following a switch from smoking to vaping it seems there is a range of experience. Some people say their gums have been bleeding much more and some say less. I would assume that this depends on the concentration of nicotine in the liquid they are using. If the exposure of the mouth to nicotine is less, then the blood flow will increase and gum disease may no longer be masked. Worryingly I have seen some people suggesting they might start smoking again to stop their gums bleeding. However, if they are being exposed to similar levels of nicotine then the change will be less significant.
Other Chemicals in Vaping Liquid
Changes noticed on switching to vaping will also depend on the other constituents in both the cigarettes being smoking and the vaping liquid switched to, as both cigarettes and vaping liquids contain a range of chemicals which may have many and varied effects on the mouth.
Research also suggests that many vaping liquids do contain carcinogens (cancer causing agents). However we do not yet have enough information to know how significant the long term effects of these carcinogens will be compared to tobacco smoking.
I have seen anecdotal reports from users suggesting that vaping can make their mouth more dry. Saliva is an essential defence mechanism in the mouth. It physically washes away debris, it neutralises acids and as well as diluting acids and sugars. We often see patients with dry mouths. These are elderly patients on a long list of medications for things like high blood pressure and other ailments. They can have quite high rates of tooth decay. These patients don't tend to drink a lot of acidic fizzy drinks. However if you have a younger patient who vapes, with a dry mouth, drinking fizzy drinks, that is a sure recipe for acid erosion attacking the teeth.
So in summary I really feel the jury is out on the safety of vaping from an oral health point of view. If used as a step on the road to quitting then it serve a useful purpose. However, I personally would not recommend long term use of vaping and would questions marketing claims of the safety of these products. We simply don't know enough yet.
Recently there have been some headlines around suggesting you no longer need to floss. This comes as surprise to many people who floss regularly and many dental professionals who advise flossing. So where have these headlines come from and how much attention should we pay to them?
It is true that the evidence from research for flossing is weak. This does not necessarily mean that flossing is not beneficial, but may mean that the right studies have not been conducted in the right way to demonstrate the benefits. The aim of flossing is to remove plaque from between the teeth in an effort to prevent tooth decay and gum disease. It is quite clear that there is no way that normal toothbrush bristles can penetrate all the way between the back teeth which are broader and wider than the front teeth, so inevitably plaque will be left there after brushing. In my opinion, the best way to remove this plaque is with interdental brushes, and if you look beyond the headlines, most of the recent articles acknowledge this. These brushes are like tiny bottle brushes that you insert between the teeth. When you remove the brush you can easily see the plaque that the brush has picked up and dragged out. It is my feeling that floss might move the plaque around a little but does not pick it up and remove it in the same way as these interdental brushes. However, some people prefer to floss, or find the gaps between the teeth too small for using interdental brushes. In that case I advise flossing before normal brushing. The aim in this case is to move the plaque out from between the teeth so it can be brushed away with the normal brush.
I am quite sure it is no coincidence that the majority of tooth decay and gum disease I diagnose and treat occurs between the back teeth where the tooth brush bristles cannot reach. I was quite concerned to see these headlines. Knowing that many people don't read beyond the headline, I and many other dentists are concerned that people may be misled into thinking that cleaning between the teeth is not important. This is not the case at all and all dentists I know feel strongly about the importance of cleaning between the teeth. So if you can, use interdental brushes once daily, and if not then it's still well worth flossing before brushing.
Silver fillings have been used worldwide very successfully for decades and many people have several silver fillings in their mouths. These types of fillings are usually made of an alloy of silver, mercury copper and tin. They are cheap, easy to place, hard wearing, and the silver ions exert an antibacterial effect which can help inhibit further tooth decay in the cavity.
There are three main reasons why people consider replacing their old silver fillings; poor appearance, concerns over mercury toxicity and age of the fillings and I will consider each of these in turn.
1. Appearance - the ideal fillings material will of course of safe, easy to use, hard wearing, affordable, and tooth coloured. The tooth coloured alternative to silver fillings is a kind of plastic resin material called composite. Composite technology has come on enormously over the years. In the past there were concerns that composite fillings were not as hard wearing or long lasting as silver fillings, but there is no reason why a good quality, well placed composite filling used in the right situation should not give many long years of service. They are usually more expensive, partly due to material cost, and partly because they do take a little longer to place than silver fillings. However, the results can be very pleasing cosmetically and some patients are keen to move on from their old silver fillings to more cosmetic tooth coloured fillings. However it must be borne in mind that drilling out an old silver filling that is especially deep, or close to the nerve of the tooth carries a small risk of irritating the nerve. This may only be temporary but if the nerve does not settle then root canal work can become necessary. However this is very rarely a problem and if you would like to replace any old silver fillings with tooth coloured fillings you can discuss with your dentist first if any of them are especially deep, and decide together what would be the best option for you.
2. Mercury toxicity - high levels of mercury are indeed toxic to humans. However the level of exposure from silver fillings is very low, and if you eat a lot of seafood you are likely to be exposed to more mercury through your seafood consumption than through your silver fillings. Large scale studies have failed to identify convincing evidence of harm caused to individuals from having silver fillings. (Dentists are exposed to far higher mercury levels than their patients.) The exception to this is in rare individual cases of allergy to components of silver fillings. However an absence of evidence to conclusively prove harm from mercury in dental fillings is not the same as conclusive proof that mercury in dental fillings is always safe. It is possible that some people are more susceptible to mercury toxicity than others and some smaller studies due suggest possible benefits to some individuals from having their silver fillings removed. However, due to general concerns regarding the environmental impact of industrial mercury processing, many countries are phasing out silver fillings. As tooth coloured fillings materials continuously improve silver fillings are gradually being superseded.
3. Age of the fillings - as silver fillings get very old they gradually start to deteriorate. It's not unusual to see silver fillings that have been in place for 20 or 30 years. After such long periods of time they start to appear corroded and pitted on the surface and the edges start to degrade. At this stage the fillings often no longer form a good seal for the cavity and there is often decay underneath the fillings. Fortunately due to the antibacterial effects of the silver ions this decay progresses very slowly. However at this stage the fillings are really reaching the end of their useful life and it is worth considering replacing them.
If you would like to discuss replacing your silver fillings then feel free to contact me, or come and see me at The Fountain Dental Practice for a free consultation.
Over the years there has been a shift in attitudes and many people are now less likely to accept having crooked front teeth. Whilst crooked front teeth are unsightly they are also more difficult to clean around and can lead to uneven wear and chipping of the teeth. So straightening crooked teeth isn't entirely cosmetic.
Patients who request straightening of their teeth are often in their 20s , 30s or 40s. However some much older patients ask to have their teeth straightened and there is no age limit to straightening teeth. The benefits of a more attractive smile and teeth that are easier to keep clean can be enjoyed by a 70 or 80 year old too. Many patients had braces when they were teenagers, but without lifelong nighttime retainer use teeth often relapse towards their original position. Those who have never had braces often find their teeth crowd up at the front as they get older. This aging effect is caused by a slight shrinkage of the jaw bone. Keeping your teeth straight helps keep you looking young!
There are several options for straightening teeth. Many adults are more concerned about straightening misaligned front teeth, than they are about correcting bite issues which would involve a more lengthy comprehensive orthodontic treatment. Aligning the front teeth can often be achieved in a treatment time of around 6 months, sometimes even quicker. There are various methods available including removable invisible braces, and fixed 'train'track' braces. Fixed braces can now be tooth coloured so they look quite subtle. In the teeth straightening section of this website you can see a video of me explaining how the Invisalign system works. You can also see lots of before and after photos of cases I have treated with different appliances. In the review section you will see lots of reviews of patients describing their experiences of having these types of treatment.
If you would like more information about teeth straightening then please get in touch with me via this website, on my email email@example.com, by calling me or texting me on 07740367589 or you can book a free consultation with me at the Fountain Dental Practice, New Malden.
I am pleased to announce I am now practising laser dentistry. I recently invested in a 810nm soft tissue diode laser. This really is a great piece of kit for a dentist to have, making dentistry more fun for the dentist and better for patients too!
I bought it as a replacement for my old electrosurgery unit. Electrosurgery works by using an electric current to heat a fine metal tip. The tip can cut gum tissue and it stops bleeding as it goes, cauterising the tissue. It is a very useful tool in dentistry, but a laser does this and much more.
Lasers can be used in a similar way, the laser fibre can be heated so it cuts and cauterises tissue. However, in doing this the affects is more superficial than with electrosurgery and there is less tendency to cause damage to deeper tissues. This results in less pain after the procedure and faster healing. Another advantage is the ability of the laser to disinfect the tissue, killing bacteria. This also improves healing. It is relatively painless to cut gum tissue with a soft tissue laser and it can often be done with minimal anaesthetic, sometimes only anaesthetic numbing gel. Following the procedure healing is fast and relatively painless with no need for stitches, and minimal or no bleeding. The laser can be use to trim excess gum tissue around partially erupted wisdom teeth that cause repeated gum infections, to improve gum contour at the front of the mouth for cosmetic reasons, to trim the gum back to access tooth decay under the gum, or to allow more tooth to work with when a tooth is badly broken down. Unlike electrosurgery lasers can also be used around metal crowns and implants.
Lasers can also be used in a completely different way, with a non cutting tip, where the laser energy is used for disinfection, pain relief and to stimulate tissue regeneration and healing. They can be used to kill bacteria in gum pockets in areas of gum disease, in infected root canals during root canal treatment, and to kill bacteria on the surface of a painful mouth ulcer and stimulate healing, and to increase blood flow and cause an analgesic effect to painful jaw joints.
I have been using my laser for a few weeks and have been amazed at how beautifully tissues have healed and how little pain my patients have experienced following procedures. I am gradually increasing the range of procedures I use my laser for and monitoring the results. I know I certainly enjoy having access to this fantastic piece of equipment and I think it brings great benefits to my patients too.
It's always important to look for a dentist who keeps up to date and embraces new technology if you want to get the best care possible. I work hard to do this because it is fundamental to my ethos to be able to offer the very best for my patients. If you would like any more information on dental lasers or any other aspects of dentistry please do contact me via the website, or come in and see me for a free initial consultation to have a chat at my lovely practice in New Malden.