Resources

Daily Brushing
Let us start with the obvious: twice daily brushing with a soft brush and a gentle brushing technique. It is important to spend plenty of time making sure ever tooth/molar is cleaned on every side. Use a small amount of fluoride toothpaste. About a pea size quantity is more than enough. Do not rush it and do not use brute force. If you are wearing out your brushes rapidly you are doing damage to you gums and jaw bone. This will result in the gums gradually receding and, over time, the root surface eroding away. It is essential that the borderline between tooth and gum is cleaned thoroughly but make sure you do it gently.

What helps a lot is to brush your teeth in a systematic way, for example, start on the outer upper surfaces of your right-hand molars and slowly work your way to the upper left. Then switch to the inside and slowly do the inner surfaces of the upper teeth. Then the chewing surfaces which completes the upper jaw. Give the lower jaw the same systematic treatment. By working your way through this sequence you avoid missing certain parts of your mouth completely every time you brush. We see it a lot so beware.

Floss your teeth once a day properly
This means that every contact point between your teeth will need to be accessed twice: once for each tooth. If you are unsure about the right technique please ask for a demonstration when you are in the surgery. Not flossing means you are leaving approximately 20% of the plaque behind exposing you to gum disease and tooth decay.

Avoid sticky and sugary foods
What is crucial is to understand how tooth decay arises. Whenever you eat or drink something containing sugar, the bacteria that make up the dental plaque can use this sugar and turn it into acid. It is this acid that actually decays the tooth. Your teeth have got the best chance if we can eliminate the plaque and reduce the sugar intake to a minimal number of times per day. This last point is important as it is the frequency of the sugar intake that is the clue here, not the quantity of the intake. A diluted low sugar drink still contains sugar and will eventually do harm if drunk often enough throughout the day.

Also, if you have eaten or drunk something acidic, do NOT brush your teeth immediately afterwards as you will rub away the demineralised enamel. Leave it for approximately 20 minutes to give your saliva the chance to remineralise.

Avoid abusing your teeth
ike tearing plastics, prying open bottles or biting your nails. Although this may sound very obvious, it is frightening how often damage is done this way. You might even go as far as listing eating toffee and crackling under the tooth abuse heading.

Mouth Guards
Protect your teeth with a custom made mouth guard when playing sports. A mouth guard works only if it fits well because it transfers a sharp local impact onto a larger surface thereby giving the teeth more chance to survive the trauma. If the mouth guard does not fit, you will not get that transfer of pressure/impact and teeth are more likely to get damaged.

6 Monthly Check-up
Attend for your 6-month examination regularly. If we can diagnose problems early they are much easier and cheaper to fix.

Every time you eat or drink anything sugary, your teeth are under attack from acids for up to one hour. This is because the bacteria in your mouth will use these sugars and produce harmful acids as waste products. It is therefore important to limit the number of times sugar passes through your mouth. The frequency of the sugar intake is more important than the quantity. In other words, if you really must eat/drink something sweet, make sure you do it all at once and do not spread it out though the day in many small quantities. All sugars can cause decay and sugar can come in many different forms like sucrose, fructose and glucose to name just three types. All these sugars can harm your teeth. Many processed foods have vast quantities of sugars hidden in them so it is well worth checking on the list of ingredients. It is worth remembering that the phrase 'no added sugar' does not mean that the product is sugar free. It simply means that the manufactures have not added any extra sugar.

Dental Erosion
Acid foods and drinks can be just as harmful to your teeth. The acid erodes the enamel, exposing the dentine underneath. This can make the teeth sensitive and unsightly. In order to assess the acidity of any food or drink we must find out what the 'pH value' of the food is. This is a relatively simple figure where a value around 7 is safe and any pH below that becomes increasingly hazardous for your teeth. They will literally dissolve if you go low (read acidic) enough! Although the principal of the pH figure is straightforward, finding out what the pH of your food and drink is unfortunately much harder. Below is a short list of a few safe and some outright dangerous things:

Still mineral water: pH=7.6
Milk: pH=6.9
Cheddar cheese: pH=5.9
Lager: pH=4.4
Orange juice: pH=3.8
Fizzy drinks including carbonated mineral water: pH=3.0
Cola: pH=2.5
Red wine: pH=2.5
Vinegar / Lemon Juice: pH=2.0
Stomach acid: pH=1.0
Battery acid from your car: pH=0

After having consumed something acidic do NOT brush you teeth straight away afterwards as the acids will have demineralised your enamel. If you give your saliva approximately 20 minutes, these demineralised surfaces can re-mineralise. If you brush immediately, you will remove this weakened, demineralised layer and strip your teeth through erosion much quicker.

Snacking
It is better for your teeth and general health if you eat 3 meals a day instead of having multiple snacks as the latter gives the bacteria far more opportunity to harm your teeth. If you do need to snack between meals, choose foods that do not contain sugar. Fruit does contain acids, which can erode your teeth however, as long as you eat them in sensible quantities and avoid the really acidic ones like lemons they are healthier than most other foods and strongly recommended in all the dietary advice that comes out regularly from research. Good savoury snacks are cheese, nuts and raw vegetables like carrots. If you really must snack on something sweet then confectionery containing Xylitol are the best option.

Sugar-free chewing gum
Chewing gum makes your mouth produce more saliva, which helps to cancel out the acid in your mouth after eating or drinking. It has been proven that using sugar-free chewing gum after meals can prevent tooth decay but do not chew it for prolonged periods as fillings can wear out quicker if you chew excessively.

Tooth brushing
It is important to brush your teeth really well, twice a day with a fluoride toothpaste. The best times are just after breakfast and just before you go to bed. This is better than brushing 3, 4 or even more times a day as the net result is almost invariably that you end up brushing badly all those times, missing out on the same areas over and over again. Brush twice and floss just before bedtime is the gold standard.

Many headaches and jaw problems originate in the dental occlusion. This is another name for the way your teeth meet when your jaws bite together. Another closely related term is the TMJ. The letters TMJ are short for temporo-mandibular joint, which is the joint connecting your lower jaw and your skull. The movement in this joint lets you open and close your mouth and chew from side to side. Up to 1 in 4 people may have some symptoms. Both men and women are affected equally, although women tend to seek treatment more often than men. If your teeth do not fit together properly, you can have problems not only in your teeth themselves, but also the gums, the temporo-mandibular joint or the muscles that move your jaw. These problems are called ‘occlusal’ problems. Teeth that are out of line, heavily worn or constantly breaking, fillings that fracture or crowns that work loose may all be signs of occlusal problems. Your teeth may also be tender to bite on or may ache constantly. Loose teeth or receding gums can be made worse by a faulty bite.

TMJ
Clicking, grinding or pain in your jaw joints, ringing or buzzing in your ears and difficulty in opening or closing your mouth could all be due to your teeth not meeting each other properly.

Muscles
If your jaw is in the wrong position, the muscles that move the jaw have to work a lot harder and can get tired. This leads to muscle spasm. The main symptoms are continual headaches or migraine, especially first thing in the morning; pain behind your eyes; sinus pain and pains in your neck and shoulders. Sometimes even back muscles are involved.

You may find that you clench or grind your teeth, although most people who do are not aware of it. Sometimes can be caused by anxiety, but generally most people clench their teeth when they are concentrating on a task - housework, gardening, car mechanics, typing and so on. You may wake up in the morning with a stiff jaw or tenderness when you bite together. This could be due to clenching or grinding your teeth in your sleep. Most people who grind their teeth do it while they are asleep and may not know they are doing it.

If you suffer from severe head aches or neck and shoulder pain, you may not have linked this with possible jaw problems. Or you may keep having pain or discomfort on the side of your face around your ears or jaw joints or difficulty in moving your jaw. These are all symptoms of TMJ problems. If you are missing some teeth at the back of your mouth, this may lead to an unbalanced bite, which can cause uneven pressure on your teeth. Together, all these symptoms are called ‘TMJ syndrome’. Depending on the problems you are having, it can be possible to spot the signs of an occlusal problem.

Various muscles may be sore when tested, or the broken and worn areas of your teeth will show you are grinding your teeth - a common sign of an incorrect bite. If your dentist suspects that your problems are due to an incorrect bite, he or she may help to diagnose the problem by supplying a temporary soft night guard or hard plastic appliance that fits over your upper or lower teeth. This appliance needs to be measured and fitted very accurately so that when you bite on it, all your teeth meet at exactly the same time in a position where your muscles are relaxed. You may have to wear this all the time or, just at night. If the appliance relieves your symptoms then your bite may need to be corrected permanently.

Tooth Adjustment (equilibration)
Your teeth may need to be carefully adjusted to meet evenly. Changing the direction and position of the slopes that guide your teeth together can often help to reposition the jaw.

Replacement of teeth
The temporo-mandibular joint needs equal support from both sides of both jaws. The chewing action is designed to work properly only when all your teeth are present and in the correct position. Missing teeth may need to be replaced either with a partial denture or bridgework. Replacement is not usually done until a diagnosis has been confirmed by using an appliance and this has fully relieved the symptoms. Relief in some patients is instant: in others it can take a long time.

Medication
Some drugs can help in certain cases, but this is usually only temporary. Hormone replacement therapy may also help some women.

Diet and Exercise
As with any joint pain, it can help to put less stress on the joint. So a soft diet can be helpful, as can corrective exercises and external heat.

Relaxation
Counseling and relaxation therapy may help in some cases. These techniques help the patient to become more aware of stressful situations and to control tension.

Everybody has had halitosis or bad breath at one time or another and we have all been in a situation where we want to run away from the person we are talking to because their breath is so strong. There are a number of causes of bad breath and many can be prevented:

Morning Breath
Saliva acts as a natural cleanser to wash away food particles in our mouths. When we sleep, our saliva production decreases and bacteria forms when food particles remain, causing morning breath. Although it is almost impossible to totally prevent, morning breath can be reduced by thoroughly flossing around all of your teeth and rinsing forcefully for 20 seconds then take 2 minutes to brush all of your teeth and again rinse forcefully for 20 seconds. Flossing is a must because 30% of the tooth surface is not cleansable by a brush and contrary to some mouth wash claims, rinses alone are not adequate to remove this plaque. Cleaning your tongue before bed will help. A good brushing and rinsing in the morning should get rid of any traces of morning breath.

Dry Mouth
Medications may have a side effect of causing dry mouth as does breathing through your mouth instead of your nose. The bacteria grow quicker in a dry mouth. Some people breathe through their mouth while they sleep. The following can also lead to dry mouth: dieting, exercising, intake of alcohol or the use of an alcohol based mouth rinse and the grand daddy of them all, smoking.

Bacteria
The most common cause of bad breath is bacteria. Anaerobic bacteria digest plaque that we do not remove. The bacteria grow and produce waste products known as volatile sulphur compounds on the surface of the tongue, throat, teeth and periodontal pockets. These waste products cause gum disease and bad breath. Gum disease is a bacterial infection of the gums and ligaments that support the teeth. This leads to bone loss and deep pockets in between the teeth and gums. These are not easy to clean. Many bacteria live in these pockets and require aggressive cleaning therapies to reduce bad breath. Signs of gum disease are red or swollen gums, bleeding gums, loose teeth, pus drainage and pain when chewing. Breath odour that will not go away even after proper flossing and brushing is usually the result of a lot of bacteria in the mouth, throat, sinuses or lungs. These bacteria combine with proteins from dental plaque, food debris and cells, producing acids and compounds that cause smelly breath.

Dental Problems
Tooth decay and gum disease can cause some nasty breath problems. Many people are not aware of dental problems until a considerable amount of damage has occurred. A dentist can recognise these potentially damaging problems early and provide early treatment, the dentist can also diagnose other problems which cause bad breath such as impacted teeth, cavities, gum disease, etc.. That is why it is so important to visit your dental office regularly, every 6 months, to have your teeth checked by your dentist for decay and periodontal, (gum), disease and professionally cleaned by your dental hygienist or dentist. It is necessary to maintain proper oral hygiene at home by doing the following:

• Brush at least twice a day for a minimum of two minutes each time, especially just before bed
• Floss every night at bedtime and rinse thoroughly with water after flossing
• Brush your tongue (or use a special tongue scraper) after each brushing from the back to the front
• Chew sugar-free gum and drink plenty of water to hydrate your body
• Use an alcohol-free, sulphur reducing mouth rinses containing chlorine dioxide which neutralize the sulphur compounds as opposed to an alcohol based mouth rinse which will make matters worse by drying your mouth out and in the long term can contribute to the bad breath problem

What we eat
As we all know, the ever-popular onions, garlic and spices that we eat add to the flavour of our food, but tend to stay with us in the form of bad breath for several hours. Also, what we don't eat can affect our breath as well; dieting, fasting and skipping meals can cause unpleasant breath odour, so it is important to eat a balanced diet and drink plenty of water during the day. Dairy products increase the bacterial production of volatile sulphur compounds. Acids in coffee and soda decrease oxygenation allowing the bacteria to grow faster and produce more offensive volatile sulphur compounds

Other potential causes
While gum, mints and mouthwashes may mask bad breath, they are only temporary measures. If chronic bad breath is a problem, it is best to explore other possible underlying causes such as sinusitis, allergies/intolerances, diabetes, kidney failure, Hiatus Hernia, stress, alcohol, prescription drugs or hormonal changes.

Dry mouth or xerostomia is an extremely common symptom presented by patients. It is a condition that may have long or short-term effects on you. It is caused by the salivary glands in your mouth not working in the way they should normally.

Dry mouth may be a symptom of stress or the result of medication you are taking and can therefore be short-term. Smoking can also cause dry mouth. In the long-term a dry mouth may be irreversible caused by medical treatments such as radiotherapy or by a medical condition such as diabetes or rheumatoid arthritis. Dry mouth can have a dramatic effect upon a patient. You will experience difficulty in every day functions such as talking, eating, swallowing and sleeping.

If you are a denture wearer you may find it uncomfortable, and find that it does not fit very well. You will probably feel thirsty most of the time and dry mouth will affect your sense of taste. You may also feel a burning sensation in your mouth and develop cracked lips. Natural saliva production is essential to your oral health as it washes away debris and plaque which cause tooth decay and your gums may be swollen, sore and sometimes they may bleed.

Dry mouth frequently causes bad breath in sufferers. If your dry mouth symptoms have an identifiable cause, such as medication, it may be possible to rectify the problem – for these types of reason your symptoms may be short-term. Temporarily, sucking sugar-free sweets or an ice cube can relieve dry mouth but is important to introduce a method of sustained moisture. This can be done with moisture gels or saliva substitutes like the products from the companies Biotene and BioXtra. These products will not only relieve the dry mouth feeling but supplement the protective elements in the saliva by releasing enzymes. These specialist products are available as a gum, mouthwash, toothpaste, moisturising gel, gel mouth spray and sucking tablet. Used daily they will help keep the dry mouth moist, comfortable and healthy.

The early signs of mouth cancer can often be seen. When these changes are found early there is a very good chance of a cure. So be aware of changes in your mouth and check regularly for the changes listed below. If they last longer than three weeks, report them to your doctor or dentist without delay. Try to come for a check-up at least once a year, preferably twice. Early treatment is simpler and more effective and many people can be cured Look for the following changes. They may not be painful but you should still see your doctor or dentist if they last longer than three weeks.

The most common signs of cancer

• an ulcer or sore in your mouth or on your tongue
• a red or white patch in your mouth
• an unexplained pain in your mouth or ear
• an unexplained lump in your neck
• a sore or painful throat
• a croaky voice or difficulty swallowing

If you notice any of these changes and they last longer than three weeks, tell your doctor or dentist without delay. Usually they are not caused by cancer but it is better to play safe. Sometimes the early signs of mouth cancer do not cause pain or discomfort but they can be seen. So it is important to check your mouth for any of the changes. From time to time, spend a few moments in front of the mirror looking in your mouth. Check your tongue, gums, lining of your cheeks, lips, under your tongue and the roof of your mouth. But remember your dentist can easily check the parts you cannot see. Dentists have special training to help them identify health problems and are often the first to spot early changes in their patients.

As part of a regular examination, dentists check for the early warning signs of mouth cancer. They will refer patients with suspect changes to hospital for further tests. If you are over 40, smoke, chew tobacco or betel nut or drink heavily, ask your dentist to check your mouth once a year. It is important to visit the dentist regularly even if you no longer have your own teeth.

Lifestyle Choices
Our lifestyle choices have a big effect on our risk of mouth cancer. The most important causes of mouth cancer are: smoking tobacco (cigarettes, cigars, pipes), regularly drinking large amounts of alcohol and chewing tobacco or betel nut.

People who use tobacco and drink too much alcohol have the highest risk of mouth cancer. Up to three-quarters of mouth cancers are caused this way. The best thing is to stop completely. Help is available - talk to your doctor or call Quit-line on 0800 00 22 00 . Nicotine replacement products help many people to stop using tobacco. You can buy them at your local chemist, or ask your doctor if you can have them on prescription. Mouth cancer is more common in men than women and is rare in people under 40. If you drink alcohol, try to follow these guidelines:

• Women should drink less than two units of alcohol each day
• Men should drink less than three units of alcohol each day

Many alcoholic drinks contain more than one unit:

• A pint of premium lager, beer or cider (5% vol) contains three units
• A standard 175ml glass of wine (11-12% vol) contains two units
• A double measure of spirits (40% vol) using the35ml measure contains three units

Try to eat at least five different portions of fruit and vegetables every day. Increase the amount of red, yellow and orange fruit, salads and green vegetables in your diet.

As we gradually move towards a more advanced age, it is a well known fact that out body starts to complain about the many years of service it has done. With our teeth however there is a lot that can be done and it is really not the case that we inevitable will loose teeth as we age.

What particular problems may be involved?
Some gum recession may occur as you get older and exposed root surface will erode gradually because it is very soft compared to the enamel. We will be able to advise you on the best brushing methods to keep these problems under control and may advise a fluoride rinse to deal with possible sensitivity. The eroded surfaces can be neatly protected by putting composite filling material into the eroded root. This restores the shape of the tooth but more importantly, protect the root surface from eroding further.

Normal cleaning may become more difficult if your manual dexterity is reduced or if your eyesight is less than perfect. Again particular help and advice will be needed for the best aids to use – a magnifying mirror preferably with a built in ring light and an electric toothbrush are often the answer.

If you have lost one or more teeth and find it difficult to get on with your dentures, there are other solutions available like upgrading from plastic dentures to metal based dentures, or even better, to bridges. We can discuss all these options with you on your examination day.

Some people take regular medication which makes their mouths dry. Saliva helps to protect teeth against decay so if you have less saliva than usual ask your dentist for advice. Alternatively, special products including artificial saliva are available over the counter in most chemists.

Should I expect to have problems with my gums?
Gum problems are caused by a build up of bacteria called dental plaque, which forms constantly on the teeth and gums. It is important to remove this plaque in order to avoid gum inflammation. If the plaque is not removed the gum inflammation will in time, affect the bone under the gums which supports the roots and your teeth may gradually become loose.

How do I know if I have gum disease?
As it is often painless many people may be unaware that they have gum disease. Some common signs are: gums that bleed when brushed, teeth that are loose, receding gums and bad breath. Not everyone has all these signs. You may have only one.

Can I still get tooth decay?
Yes. The same dental plaque which causes gum inflammation can cause decay, particularly when combined with sugary food and drinks. There is a particular risk of decay at the gum edge when there has been some gum recession as the neck of the tooth is not protected by enamel. To minimise the risk thoroughly remove the plaque from your teeth and dentures twice a day with a fluoride toothpaste. Avoid food and drinks containing sugar in between meals. Sugar is most harmful to teeth if consumed frequently throughout the day.

In the practice we take complaints very seriously and try to ensure that all our patients are pleased with their experience of our service. When patients complain, they are dealt with courteously and promptly so that the matter is resolved as quickly as possible. This procedure is based on these objectives. Our aim is to react to complaints in the way in which we would want our own complaint about a service to be handled. We learn from every mistake that we make and respond to patients' concerns in a caring and sensitive way.

The person responsible for dealing with any complaint about the service which we provide is Maarten Tonsbeek, our Complaints Manager. If a patient complains on the telephone or at the reception desk, we will listen to their complaint and offer to refer him or her to the Complaints Manager immediately. If the Complaints Manager is not available at the time, then the patient will be told when they will be able to talk to the dentist and arrangements will be made for this to happen. The member of staff will take brief details of the complaint and pass them on. If we cannot arrange this within a reasonable period or if the patient does not wish to wait to discuss the matter, arrangements will be made for someone else to deal with it. If the patient complains in writing the letter or email will be passed on immediately to the Complaints Manager.

If a complaint is about any aspect of clinical care or associated charges it will normally be referred to the dentist, unless the patient does not want this to happen. We will acknowledge the patient’s complaint in writing and enclose a copy of this code of practice as soon as possible, normally within 3 working days.

We will seek to investigate the complaint within 10 working days of receipt to give an explanation of the circumstances which led to the complaint. If the patient does not wish to meet us, then we will attempt to talk to them on the telephone. If we are unable to investigate the complaint within 10 working days we will notify the patient, giving reasons for the delay and a likely period within which the investigation will be completed. We will confirm the decision about the complaint in writing immediately after completing our investigation. Proper and comprehensive records are kept of any complaint received.

If patients are not satisfied with the result of our procedure then a complaint may be made to:

The Dental Complaints Service: 020 8153 0800 or info@dentalcomplaints.org.uk or the General Dental Council: 020 7167 6000 or www.gdc-uk.org