DENTISTSECRETS Q & A MAY 2010

Thankyou to everyone that has asked us about their dental care. We do apologise that we are unable to answer your questions personally, and we apologise if your questions have not been answered in this Q&A. Please keep reading future editions as we aim to answer all of the important dental queries that you send to us in due course.

(Please note that your questions will be rewritten, not only for brevity in these issues, but to make some questions more easy to understand for other readers ).

Dentistsecrets guarantees strict confidentially for all information received.

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Q1 I recently changed dentist as my old dentist retired. In the past, I have always had to take antibiotics before dental treatment. My old dentist was really strict on this because I have a heart murmur. She told me that the antibiotics were needed to protect my heart. I went to a new dentist last week and they say I don’t need to take antibiotics even though they plan to take out a tooth next time. I have pointed out that in their health questionnaire I have filled in about the heart murmur. This new dentist says I don’t need to worry. Should I just get antibiotics from my doctor before I go?

A. No

Recent research has shown that some of the medical conditions that were previously thought to put the heart at risk of infection following some dental procedure are no longer a worry.

Uncomplicated heart murmurs are no longer considered to put the heart at risk of infection after dental procedures and antibiotic cover before treatment is NOT recommended. If you have no other medical condition or complication, your new dentist is right NOT to be prescribing unnecessary doses of antibiotics for you.

But………….

As you have not provided us with a full medical history, we recommend that you should confirm this advice with your doctor or even your cardiologist so that you can be sure before you undergo any dental treatment

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MY SON’S BABY TOOTH IS LOOSE AND I CAN SEE THE ADULT TOOTH ALREADY GROWING INTO HIS MOUTH. WILL THIS CAUSE PROBLEMS FOR HIM LATER?

DO I NEED TO GET THIS BABY TOOTH TAKEN OUT?

HE HAS NOT BEEN TO A DENTIST YET.

IT IS QUITE COMMON FOR A BABY TOOTH TO STILL BE QUITE FIRMLY IN THE MOUTH WHEN THE ADULT TOOTH IS ALREADY BEGINNING TO ERUPT. IT USUALLY DOES NOT NEED ANY TREATMENT.

BUT……….

IF HIS ADULT TEETH ARE ERUPTING, NOW COULD BE A GOOD TIME FOR YOUR SON TO HAVE HIS TEETH CHECKED BY A DENTIST:

1. TO CHECK THAT TEETH ARE ERUPTING CORRECTLY

2. TO CHECK IF HIS ADULT TEETH WOULD BENEFIT FROM PREVENTATIVE TREATMENTS THAT COULD PROTECT THEM FROM FUTURE DENTAL DISEASE.

PLUS………..

IT IS USUALLY EASIER FOR A CHILD TO GET USED TO A DENTIST AND THE DENTAL ENVIRONMENT WHEN YOUNG, BEFORE THEY NEED TO UNDERGO ANY ACTUAL TREATMENT.

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Q3.

I have been given an appointment to have all of my wisdom teeth out. I have had no trouble from them.

Why do I have to have them out?

Sorry, this impossible to answer without seeing your x-rays or your teeth.

BUT……..

1. Wisdom teeth quite regularly cause problems because there is often insufficient room in the mouth for them to erupt fully.

They can partially erupt into the mouth and become prone to a painful infection that is known as pericoronitis.
Some partially erupted wisdom teeth may decay, or may cause decay in the tooth in front because you are unable to clean it thoroughly.

2. Wisdom teeth need to be taken out when they are partially erupted, not going to erupt fully into the mouth and are causing recurrent painful infections.

3. Wisdom teeth need to be removed if there is untreatable decay.

Wisdom teeth do NOT have to be extracted simply because they are not going to erupt.

They only need to be removed to prevent future problems.

Ask your dentist the reason they are recommending you have these teeth out to put your mind at ease that it IS necessary. Your dentist may be acting to prevent problems in the future that you are not yet experiencing.

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Q4.

MY DENTIST SAYS I HAVE GUM DISEASE AND WANTS ME TO START TREATMENT THAT MAY TAKE YEARS. THIS IS GOING TO BE EXPENSIVE AND, TO BE HONEST I AM NOT BOTHERED ABOUT THE LOOK OF MY TEETH. THEY DON’T HURT, WHY CAN’T THEY BE LEFT AS THEY ARE? IS MY DENTIST JUST DRUMMING UP WORK?

“GUM DISEASE” CAN BE USEDTO MEAN:

1. GINGIVITIS (A REVERSIBLE INFLAMMATION OF THE GUMS.)

2. PERIODONTITIS (WHERE THERE IS PROGRESSIVE DESTRUCTION OF THE TISSUES WHICH ATTACH THE TEETH TO THE JAW.)

IN IT’S EARLY STAGES “GUM DISEASE” RARELY CAUSES PAIN OR PROBLEMS.

IT IS IMPORTANT TO TREAT GUM DISEASE BECAUSE:

1. LEFT UNTREATED, IT WILL CONTINUE TO PROGRESS AND YOU WILL BEGIN TO GET PAIN AND POSSIBLY LOSE TEETH.

2. UNTREATED PERIODONTAL DISEASE HAS BEEN LINKED TO AN INCREASE IN STROKES, HEART ATTACKS AND DIABETES.

RECENT EVIDENCE BELIEVES THAT PERIODONTAL DISEASE MAY ALSO INFLUENCE MANY OTHER SYSTEMIC DISEASES.

IF YOU HAVE MORE ADVANCED GUM DISEASE, TREATMENT OFTEN DOES TAKE A LOT OF DENTAL VISITS OVER A LONG PERIOD OF TIME. IT ALSO REQUIRES EFFORT FROM YOU.

IF YOU DO HAVE GUM DISEASE - NO, YOUR DENTIST IS NOT JUST “DRUMMING UP WORK”– THEY ARE ACTING IN YOUR BEST INTERESTS TO PROTECT YOUR DENTAL AND ALSO YOUR MEDICAL HEALTH.

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Q5.

The skin in the corners of my mouth keeps going red and splitting, no matter what I seem to do. It looks bad and can get sore. What do you recommend I try to get rid of this?

A. Any complaint that shows no sign of healing that has been present for some time should be checked. See a dentist who will be able to identify what is causing this.

It is important that you see a dentist for diagnosis and treatment advice.

My dentist recommended that I start chewing gum because I need a lot of fillings.

Why?

SUGAR-FREE chewing gum CAN be good for your teeth. Chewing sugar-free gum increases the amount of saliva (spit) in your mouth which helps the health of your mouth by:

1. helping wash away sticky deposits on the teeth

2. helping reduce acid attack by reducing the acidity in the mouth.

Chewing sugar-free gum physically helps clean deposits off the teeth through the chewing action.

If you are chewing gum, you are less likely to snack on sugary foods that will increase your chances of tooth decay

So, chewing after meals can be helpful to reduce your chances of more tooth decay.

But, always make sure that the chewing gum you are using IS sugar-free.

AND please remember…………….

Chewing sugar –free gum is NO substitute for thorough tooth brushing.

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I chipped my front tooth some months ago. It now seems to be going a greyish colour. What can I use to whiten this tooth?

If you broke your tooth a while ago and:

1. HAD NO DENTAL TREATMENT, then the tooth discolouring could indicate that your tooth is dying. If this is the case, although you may be having no pain from the tooth at the moment, you could be developing what is called a chronic abscess.

You need to see a dentist for treatment of this, as a chronic infection above the tooth can become acute at any time, and those symptoms may include:

- extreme pain

- swelling of the gums or face

The longer you delay treatment, the darker your tooth may become. As you are obviously intending to keep this tooth, as your appearance is a concern, root canal treatment –which could be necessary to save your tooth - if carried out sooner rather than later is more likely to be successful.

There is nothing that you can do yourself to improve this colour.

2 IF YOU HAD YOUR TOOTH ROOT FILLED when it

broke and it is discolouring now; this is not uncommon.

Your options to restore its colour include:

Internal bleaching - This is carried out by your dentist. Bleach is sealed inside the tooth for a time to improve the colour. The disadvantage of this is that the tooth is quite likely to darken again.
A more permanent option could be to cover the tooth surface with a veneer of plastic or porcelain. The disadvantage of this is that it will be expensive( but the colour will not change).
The discoloured tooth can be trimmed down and covered with a crown (cap). The disadvantage of this is that you lose more tooth structure and again it will be expensive.

All options to improve your tooth colour effectively need to be carried out by a dentist.

No whitening products that you can buy commercially will match your tooth colour to its’ original shade and match your tooth to the neighbouring teeth.

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Q8.

I have been to the dentist numerous times for pain when eating sweet things and for extremely sensitive teeth. I’ve been told that I have very thin enamel - which explains the intense pain when even the dentist’s vacuum tube is used. They can see no holes. What is the best way to deal with this issue? I do my best to look after my body and not getting any help is making me anxious.

Without examining you or seeing x-rays, it is impossible for us to give you a diagnosis of the cause of your sensitivity. Your dentist has examined you and found no decay/holes, and you don’t need fillings.

So…………..

The first thing you need to find is the cause of your “thin enamel”. Wear and loss of enamel can be caused by many things - and this is covered in detail in the issue “Stop Paying for Dental Treatment“.

Briefly, some possible causes are:

1.You may be brushing too hard and wearing away areas of enamel - this is usually seen as darker notches along the gum edges of the teeth and may need to be treated by your dentist either with de-sensitising agents or by sealing the wear with filling material.

2. You may be losing enamel through acid erosion if your diet contains too much acidic food such as citrus foods.

3. You may be grinding your teeth - which can cause excessive wear to the biting surfaces which results in loss of enamel cover

These last two causes are harder to fix - but still possible - thin, painful enamel can be covered and sealed with modern dental materials - but you need to fix the cause rather than just treating the wear, so that you stop its progression and recurrence. But again, desensitising agents can help in many cases.

“Sensitive toothpastes” such as Sensodyne and Colgate’s range are also quite effective at stopping the symptoms of tooth sensitivity in mild cases of enamel wear, but you do need to be able to identify the cause to prevent it from becoming a problem in the long term.

Our advice to you is to return to the dentist and rather than just accepting that you have “thin enamel”, ask why. The dentist will be able to identify where the wear is and so be able (by asking you too) to identify the cause. Desensitising toothpastes will help in the short term, but you need to be able to change whatever is causing it, to actually fix the problem.

Hopefully (as you know from your dentist that you do not have holes/decay), this will help you - you may be able to recognise what is causing your problem from this answer, but do seek help and advice if not.

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AND FINALLY…………….

Far from being a product of the modern world, toothpaste has been used by people to keep their teeth clean as long ago as the Ancient Egyptians (around 5000 years ago). It was made from the powdered ashes of ox hooves and egg shells mixed with myrrh and pumice.

Tasty!!!

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