This month my blog is a bit different. After I posted my blog last month I was contacted by Elizabeth from www.reviews.com. She told me that she herself had recently changed to an electric toothbrush due to brushing too hard, and that her team had recently carried out a review of electric toothbrushes. She asked if I would reference it in my blog. I had a look at the link and I was so impressed at what a thorough, accurate and informative review it was that I said I wanted to devote a whole blog article to it.
In order to carry out the review her team sought advice from the American Dental Association, and the Cochrane Collaboration (an independent global network of researchers); two great sources of unbiased high quality advice. They then tested and reviewed 70 models of electric toothbrush. Yes 70! I didn't know there were that many models out there. Her team must have the cleanest teeth going right now!
From the initial 70 they came up with a short list of the top 7 models. All of these models are Oral B and Philips Sonicare brands. I whole heartedly agree with their findings and these are the two brands I always recommend to patient. These two brands have carried out by far the most research and product development of all electric toothbrush manufacturers. I have used both myself and found both to be excellent.
The review highlights some of the most important features. I agree that quad pacers are very important. This is a timer feature that gives a buzz every 30 seconds allowing you to ensure you devote adequate time to each area, upper right, upper left, lower right, lower left, with the total recommended brushing time of two minutes. Long battery life is another of their most important features and for convenience this is really important. Luckily battery life time has improved with successive models. The risk with a short battery life is that you keep finding it's flat so resort back to using a manual toothbrush. Small head is another highlighted feature. A smaller head allows you to access all areas properly. I tend to find cheap toothbrushes, electric and manual, often have heads that are too large. Pressure sensors are really useful for those who tend to brush too hard. Though if you brush too hard with an electric brush you are really missing the point as you don't 'brush' as such with an electric toothbrush. You hold it over the teeth and the motor does all the work.
The review correctly points to evidence from the Cochrane Collaboration that electric toothbrush use is linked to lower plaque levels and less gum inflammation. There is no doubt in my mind that for most patients, an electric toothbrush will aid better oral hygiene.
I really can't recommend this review enough. It gives such detailed and useful information that is of relevance to everyone in an easy to read and easy to understand format. So please do check it out at https://www.reviews.com/best-electric-toothbrush/
Dental erosion is the loss of tooth enamel caused by acid attack. Enamel is the hard, protective coating of the tooth, which protects the sensitive dentine underneath. When the enamel is worn away the dentine is exposed which can lead to pain and sensitivity.
Erosion usually shows up as hollows in the back teeth, thinning, or shortening of the front teeth and blunting of the sharp biting edges. Every time you eat or drink something acidic the enamel on your teeth becomes softer for a short while. The saliva slowly neutralizes the acid. However, until this happens your teeth will be more easily worn away, especially by brushing.
Causes of dental erosion
• Carbonated/fizzy drinks, fruit juice, fruit squash, herbal tea, sports drinks.
• Holding acidic drinks in the mouth, or swishing the drink in your mouth before swallowing.
• Dry wines, lager, alcopops, mixers.
• High alcohol intake, especially if this is linked to acid reflux or vomiting.
• Pickles, vinegar, fresh fruits, yoghourt, spicy food.
• Chewable or dissolvable vitamin C tablets.
• Recreational drug use, especially where acidic drinks are consumed, while the user has a dry mouth as a result of the drug, and especially if the user also grinds the teeth at this time.
• Acid vapours arising, for example, from batteries, fertilisers, chemical processing etc.
• Acid in vapours from swimming pools (this can affect competitive swimmers).
• Any medical condition causing vomiting.
• Voluntary regurgitation of food from the stomach back into the mouth, before re-chewing and re-swallowing. (This is called rumination).
• Stomach acid coming into the mouth due to hiatus hernia or reflux disease. (You may not know you have this; signs may include heartburn, indigestion, stomach pains, an acidic or metallic taste in the mouth, or they may be no symptoms at all. Silent reflux often occurs if you have a large meal and alcohol shortly before going to bed at night).
If you grind your teeth you may make the tooth wear worse.
If you have a dry mouth there will be less saliva in your mouth to neutralise the acids.
Some people are more prone to acid erosion than others. Research suggests this is because some people have a higher mineral content in their saliva than others which is more effective at neutralising acids.
Advice for preventing further dental erosion
Limit acidic products. No more than two acidic drinks a day, ideally less if you are prone to erosion.
Drink acidic drinks quickly, rather than sipping them, and consider using a straw.
Have some cheese or milk, or sugar free gum after an acid attack, to help neutralise the acid.
Wait for an hour after an acid attack to brush your teeth, or brush your teeth before having the acid at breakfast.
Switch to vitamin C capsules if using chewable or dissolvable vitamin C.
Reduce alcohol intake.
Avoid large meals just before going to bed.
See your GP if you think you may have a relevant medical problem.
So, the sad day has come, where you've had to have a tooth out at the dentist. What are the options for replacing the missing tooth?
A dental implant is a titanium screw fixed into the jaw done. They are typically around 8-12mm long and 3-5mm wide. Usually the implant will need around 3 months to 'take' in the jaw bone before a tooth is fixed on top.This means the bone needs to grow into the screw threads so the implant is stable enough to support a tooth used in the bite. After 3 months, moulds of the teeth are taken and a tooth is made in the laboratory to fit on top of the implant. Often a 3D scan will be done first to make sure there is enough bone in 3 dimensions to place the implant. If not, some bone grafting may be required.
Dental implants are the most expensive option for replacing a missing tooth but have enormous advantages. They are fixed so you don't have to worry about taking it in and out. They do not require the teeth either side to be drilled, nor do they rely on the health and longevity of the teeth either side. They are a single tooth solution for a single tooth problem.
As a mother of three I know how tough it can be to do the best thing for your children all the time. Children will nearly always want the unhealthy options and after endless whining and tantrums it’s easy to give in. I don’t like to go overboard on either sugar or artificial sweeteners but a little of each won’t do any harm. There are some great sweet shops on the internet where you can get sugar free versions of all the old sweet shop favourites.
Tooth decay is caused by sugar. The best way to prevent it is by limiting the amount of sugar your child has in what they eat and what they drink. Here are some suggestions.
Disclosing tablets can be used after brushing to show any areas of plaque that have been missed. Using disclosing tablets is good fun for children and helps them to gain an interest in looking after their teeth.
Mouthwash and flossIt is a good idea for children to use a fluoride mouthwash but only when they are old enough to rinse and spit properly. When they are old enough to manage they should start flossing
Visiting the DentistChildren should visit the dentist for a check up every 6 months. As per guidelines from the Department of Health they should also have an application of fluoride varnish applied at the dentist once every 6 months.
Never mention your own fears of visiting the dentist when your children are in earshot. This will seriously affect you child’s own attitude and a worried child may be very uncooperative.
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.