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Dental decay happens when the enamel and dentine of a tooth become softened by acid attack after you have eaten or drunk anything containing sugars. Over time, the acid makes a cavity (hole) in the tooth. ‘Dental decay’ is the same as tooth decay and is also known as ‘dental caries’.
Dental decay is caused by plaque acids that gradually dissolve away the enamel and dentine of the tooth. Decay damages your teeth and may lead to the tooth needing to be filled or even taken out.
Plaque is a thin, sticky film that keeps forming on your teeth. It contains many types of bacteria.
Enamel is the hard, protective outer coating of the tooth and is the hardest part of the body. It does not contain any nerves or blood vessels and is not sensitive to pain.
Dentine lies under the enamel, forming most of the tooth, and it can be very sensitive to pain. Dentine covers the central ‘pulp’ of the tooth.
The pulp is a soft tissue which contains blood vessels and nerves and is in the middle of the tooth.
Decay happens when sugars in food and drinks react with the bacteria in plaque, forming acids. Every time you eat or drink anything containing sugars, these acids attack the teeth and start to soften and dissolve the enamel. The attacks can last for an hour after eating or drinking, before the natural salts in your saliva cause the enamel to ‘remineralise’ and harden again. It’s not just sugars that are harmful: other types of carbohydrate foods and drinks react with plaque and form acids. (These are the ‘fermentable’ carbohydrates such as the ‘hidden sugars’ in processed food, natural sugars like those in fruit, and cooked starches.)
Snacking between meals on sugary or acidic foods and drinks can increase the risk of decay, as the teeth come under constant attack and do not have time to recover. It is therefore important not to keep snacking on sugary foods or sipping sugary drinks throughout the day.
In the early stages of dental decay there are no symptoms, but your dentist may be able to spot a cavity in its early stages when they examine or x-ray your teeth. This is why you should visit your dentist regularly, as small cavities are much easier to treat than advanced decay.
Once the cavity has reached the dentine your tooth may become sensitive, particularly with sweet foods and drinks, and acidic or hot foods.
As the decay gets near the dental pulp you may suffer from toothache. If the toothache is brought on by hot or sweet foods this may last for only a few seconds. As the decay gets closer to the dental pulp the pain may last longer and you may need to take painkillers – paracetamol or ibuprofen – to control the pain. You must visit your dentist straight away as the tooth is dying and you may develop a dental abscess (gumboil) if it is not treated.
Toothache is a sign that you should visit a dentist straight away, as it is a warning that something is wrong. If you don’t do anything, this will usually make matters worse and you may lose a tooth that could otherwise have been saved.
The biting surfaces of the teeth and the surfaces between the teeth are most likely to decay, as food and plaque can become stuck in these areas. But any part of the tooth can be at risk.
If the decay is not too serious, the dentist will remove all the decay and restore the tooth with a filling. Sometimes the nerve in the middle of the tooth can be damaged. If so, the dentist will need to out root canal treatment by removing the nerve and then restoring the tooth with a filling or a crown. If the tooth is so badly decayed that it cannot be restored, the dentist may have to take the tooth out.
No. In the very early stages of decay, your dentist may apply a fluoride varnish onto the area. This can help stop further decay and help ‘remineralise’ the tooth. However, it is important to follow the cleaning routine your dentist or hygienist suggests, using fluoride toothpaste to prevent decay starting again.
The best way to prevent dental decay is by brushing your teeth thoroughly twice a day with fluoride toothpaste, making sure that you brush the inner, outer and biting surfaces of your teeth. Children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). Three-year-olds to adults should use a toothpaste that contains 1350ppm to 1500ppm of fluoride. Using ‘interdental’ brushes, or dental floss or tape also helps remove plaque and food from between your teeth and where they meet the gums. These are areas an ordinary toothbrush can’t reach.
As each of the adult molars (back teeth) appears, and if the tooth is free from decay, a ‘fissure sealant’ can be used to protect the tooth. The sealant is a plastic coating that fills all the little crevices in the tooth surface, creating a flat surface that is easier to clean. This is called a ‘pit and fissure sealant’. Adults can also have this treatment if the teeth are free from decay. Your dentist will discuss whether this is right for you.
Visit your dentist regularly, as often as they recommend, and have sugary and acidic food and drinks less often. Avoid snacking between meals to limit the times your teeth are under attack from acids.
Chewing sugar-free gum for up to twenty minutes after a meal can help your mouth produce more saliva, which helps to cancel out any acids which have been formed.
Your dentist will show you what areas you need to take most care of when cleaning. They will also show you how to brush and floss correctly.
Having sensitive teeth can mean anything from getting a mild twinge to having severe discomfort that can last for several hours.
It can also be an early warning sign of more serious dental problems.
Many people suffer from sensitive teeth and it can start at any time. It is more common in people aged between 20 and 40, although it can affect anyone from teenagers to people over 70. Women are more likely to be affected than men.
The part of the tooth we can see above the gum is covered by a layer of enamel that protects the softer dentine underneath.
If the dentine is exposed, a tooth can become sensitive. This usually happens where the tooth and the gum meet and the enamel layer is much thinner.
Here are some causes of sensitivity.
Toothbrush abrasion – brushing too hard, and brushing from side to side, can cause enamel to be worn away, particularly where the teeth meet the gums. The freshly exposed dentine may then become sensitive.
Dental erosion – this is loss of tooth enamel caused by attacks of acid from acidic food and drinks. If enamel is worn away, the dentine underneath is exposed which may lead to sensitivity.
Gum recession – gums may naturally recede (shrink back), and the roots will become exposed and can be more sensitive. Root surfaces do not have an enamel layer to protect them.
Gum disease – a build-up of plaque or tartar can cause the gum to recede down the tooth and can even destroy the bony support of the tooth. Pockets can form in the gum around the tooth, making the area difficult to keep clean and the problem worse.
Tooth grinding – this is a habit which involves clenching and grinding the teeth together. This can cause the enamel of the teeth to be worn away, making the teeth sensitive.
Other causes of pain from sensitivity may be:
A cracked tooth or filling – a crack can run from the biting surface of a tooth down towards the root. Extreme temperatures, especially cold, may cause discomfort.
Tooth bleaching – some patients have sensitivity for a short time during or after having their teeth bleached. Talk to your dentist about this before having treatment.
You are more likely to feel the sensitivity when drinking or eating something cold, from cold air catching your teeth, and sometimes with hot foods or drinks. Some people have sensitivity when they have sweet or acidic food and drink. The pain can come and go, with some times being worse than others.
There are many brands of toothpaste on the market made to help ease the pain of sensitive teeth. Use the toothpaste twice a day to brush your teeth. You can also rub it onto the sensitive areas.
These toothpastes can take anything from a few days to several weeks to take effect. Your dentist should be able to advise you on which type of toothpaste would be best for you.
You may find that hot, cold, sweet or acidic drinks, or foods like ice cream can bring on sensitivity, so you may want to avoid these. If you have sensitivity when brushing your teeth with cold water from the tap, you may need to use warm water instead. It is important you do not avoid brushing your teeth regularly as this could make the problem worse.
Yes, if you have tried treating your sensitive teeth for a few weeks and have had no improvement.
During an examination the dentist will talk to you about your symptoms. They will look at your teeth to find out what is causing the sensitivity and to find the best way of treating it.
The dentist may treat the affected teeth with special de-sensitising products to help relieve the symptoms.
Fluoride gels, rinses or varnishes can be applied to sensitive teeth. These can be painted onto the teeth at regular appointments one or two weeks apart, to build up some protection. Sensitivity can take some time to settle, and you may need to have several appointments.
If this still does not help, your dentist may seal or fill around the neck of the tooth, where the tooth and gum meet, to cover exposed dentine.
In very serious cases it may be necessary to root-fill the tooth.
•Brush your teeth twice a day for two minutes with a fluoride toothpaste containing at least 1350ppm (parts per million) of fluoride. Use small circular movements with a soft- to medium-bristled brush. Try to avoid brushing your teeth from side to side.
•Change your toothbrush every two to three months, or sooner if it becomes worn.
•Have sugary foods, and fizzy and acidic drinks less often. Try to have them only at mealtimes.
•If you grind your teeth, talk to your dentist about the possibility of having a mouthguard made for you to wear at night.
•If you are thinking about having your teeth bleached, talk to your dentist about sensitivity before starting treatment.
•Visit your dentist regularly, as often as they recommend.
Every time you eat or drink anything sugary, your teeth are under acid attack for up to one hour. This is because the sugar will react with the bacteria in plaque (the sticky coating on your teeth) and produce harmful acids. So it is important to cut down on how often you have sugary foods, which will limit the amount of time your teeth are at risk.
Acidic foods and drinks can be just as harmful to your teeth. The acid wears away the enamel, and will leave the dentine uncovered. This is called ‘dental erosion’, and makes your teeth sensitive and less attractive.
A diet that is rich in vitamins, minerals, and fresh fruit and vegetables can help to prevent gum disease. Gum disease can lead to tooth loss and cause bad breath. The diagram below shows you what you should eat as part of a healthy and balanced diet.
Tooth decay damages your teeth and leads to fillings or even extractions. Decay happens when sugar reacts with the bacteria in plaque. This forms the acids that attack the teeth and destroy the enamel. After this happens many times, the tooth enamel may break down forming a hole or ‘cavity’ into the dentine. The tooth can then decay more quickly.
All sugars can cause decay. Sugar can come in many forms, for example: sucrose, fructose, maltose and glucose. These sugars can all damage your teeth.
Many processed foods have sugar in them, and the higher up it appears in the list of ingredients, the more sugar there is in the product. Always read the list of ingredients on the labels when you are food shopping.
When you are reading the labels remember that ‘no added sugar’ does not necessarily mean that the product is sugar free. It simply means that no extra sugar has been added. These products may contain sugars such as those listed above, or the sugars may be listed as ‘carbohydrates’. Ask your dentist if you aren’t sure.
Some foods and drinks are more acidic than others, and some are acidic enough to attack your teeth directly. The acidity of a product is measured by its ‘pH value’.
The pH values of some food and drinks are listed below. The lower the pH number; the more acidic the product. Anything with a pH value lower than 5.5 may cause tooth erosion. ‘Alkalines’ have a high pH number and cancel out the acid effects. A pH value of 7 is the middle figure between acid and alkali.
•vinegar pH 2.0
•red wine pH 2.5
•cola pH 2.5
•pickles pH 3.2
•grapefruit pH 3.3
•orange juice pH 3.8
•lager pH 4.4
•cheddar cheese pH 5.9
•celery pH 6.5
•milk pH 6.9
•breadstick pH 7.0
•mineral water (still) pH 7.6
•walnut pH 8.0
•carrots pH 9.5
It is better for your teeth and general health if you eat 3 meals a day plus no more than two snacks, instead of having lots of snack attacks. If you do need to snack between meals, choose foods that do not contain sugar. Fruit does contain acids, which can attack your teeth. However, this is only damaging to your teeth if you eat an unusually large amount. Try to limit dried fruit as it is high in sugar and can stick to your teeth.
If you do eat fruit as a snack, try to eat something alkaline such as cheese afterwards. Savoury snacks are better, such as:
The main point to remember is that it is not the amount of sugar you eat or drink, but how often you do it. Sweet foods are allowed, but it is important to keep them to mealtimes.
To help reduce tooth decay, cut down on how often you have sugary foods and drinks and try to choose sugar-free varieties.
Sweets and chewing gum containing Xylitol may help reduce tooth decay.
Sugary foods can also lead to or worsen a range of health problems including heart disease and being overweight.
Still water and milk are good choices. It is better for your teeth if you drink fruit juices just at meal times. If you are drinking them between meals, try diluting them with water and rinsing your mouth with water after drinking. Drinking through a straw can help the drink go to the back of your mouth without touching your teeth.
Diluted sugar-free squashes are the safest alternative to water and milk. If you make squash or cordial, be sure to dilute the drink 1 part cordial to 10 parts water. Some soft drinks contain sweeteners, which are not suitable for young children – ask your dentist or health visitor if you aren’t sure.
Fizzy drinks can increase the risk of dental problems. If they contain sugar this can cause decay and the acid in both normal and diet drinks can dissolve the enamel of your teeth. The risk is higher when you have these drinks between meals.
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. However, it is important to use only sugar-free gum, as ordinary chewing gum contains sugar and therefore may damage your teeth.
It is important that you brush your teeth last thing at night and on at least one other occasion with a fluoride toothpaste. The best times are before breakfast and last thing at night before you go to bed.
Eating and drinking naturally weakens the enamel on your teeth, and brushing straight afterwards can cause tiny particles of enamel to be brushed away. It is best not to brush your teeth until at least one hour after eating.
It is especially important to brush before bed. This is because the flow of saliva, which is your mouth’s own cleaning system, slows down during the night and this leaves your teeth more at risk from decay.
Children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). Three-year-olds to adults should use a toothpaste that contains 1350ppm to 1500ppm of fluoride.
It is recommended that children go to the dentist with their parents as soon as possible. You should then take them regularly, as often as your dentist recommends. This will let them get used to the noises, smells and surroundings and prepare them for future visits. The earlier these visits begin, the more relaxed the child will be.
First or ‘baby’ teeth have usually developed before your child is born and will start to come through at around 6 months. All 20 baby teeth should be through by the age of two-and-a-half.
The first permanent ‘adult’ molars (back teeth) will appear at about 6 years, behind the baby teeth and before the first teeth start to fall out at about 6 to 7. The adult teeth will then replace the baby teeth. It is usually the lower front teeth that are lost first, followed by the upper front teeth shortly after. All adult teeth should be in place by the age of 13, except the wisdom teeth. These may come through at any time between 18 and 25 years of age.
All children are different and develop at different rates. The diagram to the right gives an idea of where the adult teeth come through.
Cleaning your child’s teeth should be part of their daily hygiene routine.
•You may find it easier to stand or sit behind your child, cradling their chin in your hand so you can reach their top and bottom teeth more easily.
•When the first teeth start to come through, try using a children’s toothbrush with a small smear of toothpaste.
•It is important to supervise your child’s brushing until they are at least seven.
•Once all the teeth have come through, use a small-headed soft toothbrush in small circular movements and try to concentrate on one section at a time.
•Don’t forget to brush gently behind the teeth and onto the gums.
•If possible make tooth brushing a routine – preferably in the morning, and last thing before your child goes to bed.
•Remember to encourage your child, as praise will often get results!
Fluoride comes from a number of different sources including toothpaste, specific fluoride applications and perhaps the drinking water in your area. These can all help to prevent tooth decay. If you are unsure about using fluoride toothpaste ask your dentist, health visitor or health authority. All children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). After three years old, they should use a toothpaste that contains 1350ppm to 1500ppm.
You can check the level of fluoride on the packaging of the toothpaste. You should supervise your children’s brushing up to the age of 7, and make sure they spit out the toothpaste and don’t swallow any if possible.
There are many different types of children’s toothbrushes. These include brightly coloured brushes, ones that change colour, ones with favourite characters on the handle, and some with a timer. These all encourage children to brush their teeth. The most important point is to use a small-headed toothbrush with soft, nylon bristles, suitable for the age of your child.
Toothache is painful and upsetting, especially in children, and the main cause is still tooth decay. This is due to too much sugar and acid, too often, in the diet.
Teething is another problem which starts at around 6 months and can continue as all the baby teeth start to come through. If your child needs pain relief, make sure you choose a sugar-free medicine. Remember to check with the doctor or pharmacist that you are being prescribed sugar-free medicines at all times. If the pain continues then contact your dentist for an appointment.
The main cause of tooth decay is not the amount of sugar and acid in the diet, but how often it is eaten or drunk. The more often your child has sugary or acidic foods or drinks, the more likely they are to have decay. It is therefore important to keep sugary and acidic foods to mealtimes only. If you want to give your child a snack, try to stick to vegetables, fruit and cheese. Try to limit dried fruit as it is high in sugar and can stick to the teeth.
It is also worth remembering that some processed baby foods contain quite a lot of sugar. Try checking the list of ingredients: the higher up the list sugar is, the more there is in the product. Sometimes, on labels, sugar is called fructose, glucose, lactose or sucrose.
Thorough brushing for two minutes, twice a day, particularly last thing at night, will help to prevent tooth decay.
Children can sense fear in their parents, so it is important not to let your child feel that a visit to the dentist is something to be worried about. Try to be supportive if your child needs to have any dental treatment. If you have any fears of your own about going to the dentist, don’t discuss them in front of your child.
Regular visits to the dentist are essential in helping your child to get used to the surroundings and what goes on there. A child can be much more anxious if it is their first visit to a dental practice. Pain and distress can happen at any time and it is important to prepare your child with regular visits.
You may notice that your gums become sore and swollen during pregnancy, and they may bleed. This is due to hormone changes in your body. This means that you must keep your teeth and gums clean and visit your dentist regularly. You may also need appointments with the dentist for thorough cleaning, and advice on caring for your teeth at home.
Yes. There should be no problems with routine treatment. If you are not sure what your treatment would involve, talk about all the options with your dentist. Health experts often advise that you do not have amalgam fillings replaced until after your baby is born.
As a general rule, dentists prefer to avoid dental x-rays during pregnancy if possible. However, if you need root canal treatment you may need to have an x-ray. Even if you are suspecting pregnancy, please disclose this to the dentist so that they can take the necessary precautions.
There is no truth in the rumours about pregnancy causing tooth problems through a lack of calcium, or that you will lose one tooth for each child.
Smoking and drinking in pregnancy can lead to an underweight baby and also affect your unborn baby’s dental health. An underweight baby has a greater risk of having poor teeth because of the tooth enamel not being formed properly. It is worth remembering that the adult teeth are already growing in the jaws below the baby teeth when your baby is born. So some babies whose mothers smoke and drink in pregnancy will have badly formed adult teeth too.
When you are pregnant you must have a healthy, balanced diet that has all the vitamins and minerals you and your baby need.
You need to have a good diet so that your baby’s teeth can develop. Calcium in particular is important to produce strong bones and healthy teeth. Calcium is in milk, cheese and other dairy products.
Women who suffer from morning sickness may want to eat ‘little and often’. If you are often sick, rinse your mouth afterwards with plain water to prevent the acid in your vomit attacking your teeth. Try to avoid sugary and acidic foods and drinks between meals. This will protect your teeth against decay.
Your baby should start teething at around 6 months old and will continue until all 20 baby teeth come through. At around 6 years old, the adult teeth will begin to appear. This will continue until all the adult teeth, except the wisdom teeth, have come through at around 14 years old.
Most children do suffer some teething pains. Babies may have a high temperature when they are teething and their cheeks may look red and be warm to the touch.
There are special teething gels that you can use to help reduce the pain. There are some that contain a mild analgesic (painkiller). You can apply the gel using your finger, and gently massage it onto your baby’s gums.
Teething rings can also help to soothe your baby. Certain teething rings can be cooled in the fridge, which may help. But, as teething pains can vary, it is best to check with your dentist or health visitor.
It is best to discuss this with your dentist first, but you could take your baby to your own routine check-ups. This can help the baby to get used to the surroundings. Your dentist will be able to offer advice and prescribe medicines for teething pains, and will be happy to answer any questions you may have. The baby’s own check-ups can start any time from about 6 months or from when the teeth start to appear.
Breast milk is the best food for babies, and it is recommended that you just give your baby breast milk during the first six months of its life.
At six months old, babies can start eating some solid foods. You should still keep breast feeding, or give breast milk substitutes (or both), after the first six months.
There needs to be more research to see whether, in some cases, the natural sugars in breast milk cause tooth decay in babies. However, it is widely accepted that breast milk is the best food for your baby. If you keep your baby’s teeth clean, tooth decay is unlikely to be a problem.
When feeding with a bottle, you must sterilize the bottle properly. Some breast milk substitutes do contain sugar and you should clean your baby’s teeth after the last feed. Try to leave an hour after the feed before cleaning your baby’s teeth. Never add sugar or put sugary drinks into the bottle. Milk and water are the best drinks for teeth. Bottle feeding with drinks containing sugar can lead to ‘bottle caries’ (tooth decay). A baby is not born with a sweet tooth and will only have a taste for sugar if it is given it at an early age.
Early weaning from the bottle can help stop your baby from developing dental problems. Try to get your baby to drink milk or water from a special cup by the time they are about 6 months old, or when they are able to sit up and can hold things on their own.
Savoury foods such as cheese, pasta and vegetables are better than sweet foods. Food that doesn’t contain sugar is better for your baby’s teeth. Ask your health visitor for more advice about a balanced diet for your baby.
If your child has a drink in between meals it is important to give them only water or milk instead of sugary or acidic drinks, which can cause decay.
Fluoride does help to strengthen teeth. However, as fluoride is naturally found in some water supplies, it is important to ask your dentist whether your baby needs supplements. If so, supplements can start at about 6 months.
Babies are obviously not able to clean their own teeth, and children will need help to make sure that they clean them properly until they are about 7 years old. As soon as teething has started you should start cleaning your child’s teeth.
As soon as the first baby teeth begin to appear you should start to clean them.
At first you may find it easier to use a piece of clean gauze or cloth wrapped around your forefinger. As more teeth appear, you will need to use a baby toothbrush.
Use a smear of fluoride toothpaste and gently massage it around the teeth and gums.
It can be easier to clean their teeth if you cradle your baby’s head in your arms in front of you.
As the child gets older it may be difficult to do it this way, but you can gradually give more responsibility for cleaning their teeth to the child. It is important to clean teeth twice a day with a toothpaste that contains at least 1000ppm (parts per million) of fluoride. After 3 years old, use a toothpaste that contains 1350ppm to 1500ppm.
Check with your dentist or health visitor if you are unsure about how to look after your baby’s teeth.
If you can, avoid using a dummy and discourage thumb sucking. These can both eventually cause problems with how the teeth grow and develop. And this may need treatment with a brace when the child gets older.
If your baby needs a dummy, there are ‘orthodontic’ soothers or dummies that reduce the risk of these problems. So if your baby does want to use a dummy, make sure you choose an orthodontic one.
Never dip your baby’s dummy or teething ring into fruit syrups, honey, fruit juices or anything containing sugars, particularly at bedtime. The harmful sugars and acids can attack your baby’s newly formed teeth and cause decay.
If your child damages a tooth, contact your dentist straight away. A damaged tooth will often discolour over time.
If the damage happens outside normal opening hours, your dentist will have emergency cover. Phone the surgery anyway to find out who to call.
Being ‘afraid of the dentist’ may mean different things to different people. It will probably help if you work out just what it is that worries you most.
Maybe the sounds and smells bring back memories of bad experiences as a child, or the thought that having treatment will hurt.
The good news is that more and more dentists now understand their patients’ fears, and with a combination of kindness and gentleness can do a great deal to make dental treatment an acceptable, normal part of life.
Dental techniques have improved so much over the last few years, that modern dental treatment can now be completely painless. Despite this, most people still feel a little nervous at the thought of going to the dentist.
If you have not been to see a dentist for some time, you will probably find that things have improved a lot since your last visit. The general attitude is likely to be more relaxed, the dental techniques and safety procedures will be much better, and the equipment will be more up to date.
Many dentists today offer some form of treatment for nervous patients. The first fear to deal with is the fear of admitting to other people that you are afraid of dental treatment. If you can discuss it with your friends or colleagues you are likely to find someone else who has similar problems, and who may be able to recommend a dentist to you. A dentist who is personally recommended by another nervous person is usually a very good choice.
Yes. This means that they should be used to dealing with nervous patients regularly.
As someone who is nervous about dental treatment, you need to be looked after by a dental practice that will take special care of you. You may need to travel some distance, but it will be worth the effort when you are no longer afraid.
Years ago it was normal for people to need fillings every time they went to their dentist, but things have changed for the better now. With the help of your dentist and hygienist, the aim now is for healthy teeth and mouths that stay healthy. Using a fluoride toothpaste will help to strengthen your teeth and prevent decay. Therefore, you may be surprised at how little treatment you need.
Teeth are for life and can last a lifetime if they are looked after properly. If you can get your mouth into good shape, with the help of the dentist and dental hygienist, you should need less treatment and there will be less for the dentist to do in the future.
It is important to keep up your regular visits to the dentist, not only to monitor tooth decay, but also to help prevent gum disease.
Once your mouth is healthy, your visits to the practice will often just be easy sessions for checking and cleaning.
It may be helpful for you to see the practice before you arrange an appointment. Call in to speak to the receptionist, and see what the atmosphere is like. Do the other people there look cheerful and happy? Does it give you a feeling of confidence? Perhaps you could meet the dentist and have a look around the practice as a visitor.
Your first appointment should just be for a consultation. See it as an opportunity for you to ‘interview’ the dentist, receptionist and dental nurse, and have a chat about what to expect next.
Make sure that the practice knows you are nervous, so that they can help you.
Tell your dentist what it is that you particularly dislike about dental treatment. If you think you know the reason, tell your dentist what may have caused your fear.
Many people are scared of the local anaesthetic injection needed to numb the tooth. Again, be sure to tell the dentist that this is something that bothers you. There are anaesthetic gels that can be applied to the area of the gum to be injected. This gel numbs the gum so that you cannot feel the needle.
Book appointments at a time of day when you feel at your best, and when you do not have any other commitments to worry about. Allow plenty of time so that you can get to the practice in a relaxed frame of mind – arriving in a rush will only make you feel more nervous. It is usually best to have something to eat before you go, so there is no chance of you feeling faint while you are in the chair.
People often feel better if a friend comes with them to the practice. Think about what would suit you best. A reassuring and capable friend is often a great help.
Listening to music is also a good way to help you relax. Some practices have it playing in the treatment rooms, but the best way is to take a personal stereo so that you can have your own choice of music.
Take things one step at a time. Discuss any proposed treatment with your dentist, and decide what you feel you can cope with. This may be no more than an examination with a dental mirror first. If you succeed with that, you may feel you could have your teeth polished next, possibly by a dental hygienist. Don’t be afraid to say when you have had enough – there is usually no reason to hurry through the dental treatment.
Thinking hard about something other than the treatment is a good distraction. Try to solve a puzzle in your mind, or perhaps work out a plan for each day of next year’s holiday. Or give yourself something tricky to do – try to wiggle each toe in turn, without moving any of the others.
Agree with your dentist a sign that means ‘stop now – I need a break’ before the treatment is started. Usually you can just raise your hand, and the treatment can be stopped for a few minutes until you are ready to start again. Once you know that you can control the situation you will feel more confident.
There are various methods available, and it will depend which methods the practice is experienced with and which you feel would help you most. Relaxation techniques can often be learned from specialist teachers or at home and can be very useful in controlling anxiety. (See our leaflet ‘Tell Me About Relaxation & Sedation’)
Many practices offer several types of sedation, including inhalation (‘gas and air’) and intravenous (by injection).
Other practices offer hypnosis and relaxation techniques. You would learn these techniques, which would allow you to gain control over your feelings of distress or fear.
Counselling is another way of dealing with feelings of anxiety. This is usually carried out by a member of the practice team, in a room away from the surgery. You would be encouraged to discuss your fears so that they may be dealt with and overcome.
General anaesthetics are now only rarely available for routine treatment. If a general anaesthetic is needed, patients are referred to a hospital where the necessary safety equipment is available.
As you get to know and trust your dentist, hygienist and other members of the practice you will find your fears begin to lessen. In time you will gain control over your fears, and dental care can become a normal part of your life.
There may be an extra charge for some sedation and relaxation techniques on top of the normal cost of treatment. It is always recommended that you get a written estimate before starting treatment.
Lots of small signals can show that you have bad breath (also called halitosis). Have you noticed people stepping away when you start to talk? Do people turn their cheek when you kiss them goodbye?
If you think you might have bad breath, there is a simple test that you can do. Simply lick the inside of your wrist and sniff – if the smell is bad, you can be pretty sure that your breath is too.
Or, ask a very good friend to be absolutely honest, but do make sure they are a true friend.
Bad breath is a very common problem and there are many different causes.
Persistent bad breath is usually caused by the smelly gases released by the bacteria that coat your teeth and gums.
Bits of food that get caught between the teeth and on the tongue will decay and can sometimes cause an unpleasant smell. So correct and regular brushing is very important to keep your breath smelling fresh.
However, strong foods like garlic, coffee and onions can add to the problem.
The bacteria on our teeth and gums (plaque) also cause gum disease and dental decay. One of the warning signs of gum disease is that you always have bad breath or a bad taste in your mouth. Again, your dentist or hygienist will be able to see and treat the problem during your regular check-ups. The earlier the problems are found, the more effective the treatment will be.
Bad breath can also be caused by some medical problems. Dry mouth (xerostomia) is a condition that affects the flow of saliva. This causes bacteria to build up in the mouth and this leads to bad breath. Dry mouth may be caused by some medicines, salivary gland problems or by continually breathing through the mouth instead of the nose. Older people may produce less saliva, causing further problems.
If you suffer from dry mouth, your dentist may be able to recommend or prescribe an artificial saliva product. Or your dentist may be able to suggest other ways of dealing with the problem.
Other medical conditions that cause bad breath include infections in the throat, nose or lungs; sinusitis; bronchitis; diabetes; or liver or kidney problems. If your dentist finds that your mouth is healthy, you may be referred to your family GP or a specialist to find out the cause of your bad breath.
Tobacco also causes its own form of bad breath. The only solution in this case is to stop smoking. As well as making your breath smell, smoking causes staining, causes loss of taste and irritates the gums. People who smoke are more likely to suffer from gum disease and also have a greater risk of developing cancer of the mouth, lung cancer and heart disease.
Ask your dentist, pharmacist or practice nurse for help in quitting. If you do stop smoking, but still have bad breath, then you need to see your dentist or GP for advice.
If you do have bad breath, you will need to start a routine for keeping your mouth clean and fresh.
Regular check-ups will allow your dentist to watch out for any areas where plaque is caught between your teeth. Your dentist or hygienist will be able to clean all those areas that are difficult to reach. They will also be able to show you the best way to clean your teeth and gums, and show you any areas you may be missing, including your tongue.
To keep your breath fresh, you must get rid of any gum disease and tooth decay, and keep your mouth clean and fresh. If you do have bad breath, try keeping a diary of all the foods you eat and list any medicines you are taking. Take this diary to your dentist who may be able to suggest ways to solve the problem.
•Brush your teeth and gums last thing at night and on at least one other occasion with a fluoride toothpaste. Children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). Three-year-olds to adults should use a toothpaste that contains 1350ppm to 1500ppm of fluoride. Don’t forget to clean your tongue as well.
•Cut down on how often you have sugary food and drinks.
•Visit your dentist regularly, as often as they recommend.
•Floss your teeth – brushing alone only cleans up to about 60 percent of the surface of your teeth. There are other products you can buy to clean between your teeth (they are called ‘interdental brushes’).
•Use a mouthwash – some contain antibacterial agents that could kill bacteria that make your breath smell unpleasant. If you continue to suffer from bad breath visit your dentist or hygienist to make sure that the mouthwash is not masking a more serious underlying problem.
•Chew sugar-free gum – it stimulates saliva and stops your mouth drying out. A dry mouth can lead to bad breath.
Take them out at night to give your mouth a chance to rest and clean them twice a day. Clean them thoroughly with soap and lukewarm water, a denture cream or a denture-cleaning tablet. Use a denture brush kept just for the purpose. Remember to clean the surfaces that fit against your gums and palate. This will make sure your dentures are always fresh and clean, and avoid the plaque build-up on the denture that may cause bad breath.
Most mouthwashes only disguise bad breath for a short time. So if you find that you are using a mouthwash all the time, talk to your dentist. Some mouthwashes that are recommended for gum disease can cause tooth staining if you use them for a long time. It is important to read the manufacturer’s instructions or ask your dentist about how to use them.
The chances are we all know someone who has bad breath, but very few people feel brave enough to discuss the problem. It is obviously a very delicate matter to tell someone they have bad breath. There is always the risk that they will be offended or embarrassed and may never speak to you again! However, bad breath may be the result of any number of problems. Once the person knows they have bad breath, they can deal with whatever is causing it. You could try talking to their partner or a family member, as the bad breath may be caused by a medical condition which is already being treated.
You may like to leave this leaflet where the person in question is likely to see it. Or you could try a more subtle approach, for instance asking if the person has been eating garlic lately!
Other medical conditions that cause bad breath include infections in the throat, nose or lungs; sinusitis; bronchitis; diabetes; or liver or kidney problems. If your dentist finds that your mouth is healthy, you may be referred to your family GP or a specialist to find out the cause of your bad breath.