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Jul 28 20

Emergency Dental Treatment: Everything you Need to Know

by Dr Jay Padayachy

As the COVID-19 pandemic is rapidly spreading throughout the world, many dentists had to discontinue seeing patients or offering dental services. So, you may not have been able to go for a regular check for a while.

But what if you have a dental emergency? Is it safe to go to the dentist, or should you wait until things have settled down? How to find a dentist offering emergency services around you? This article provides everything you need to know about dental emergencies and their management during COVID-19.

Emergency Dentist During Coronavirus Lockdown

Imagine having severe pain in one of your teeth during the lockdown. What would you do? Typically, you would simply call your local dental practice and book an emergency appointment. But things are different now. Dentists now must use additional protective measures to minimize the chances of COVID-19 infection.

You may not recognise your dental team when you 1st see them as their faces will likely be covered behind masks, eye wear and face shield, as well as wearing full-length gowns.

Some dental practices are charging £25 for the additional personal protective equipment required, as a gratitude for patient’s loyalty, some practices (such as ours) are waving all PPE fees for practice members.

Is it safe to go to the Dentist During COVID-19 Pandemic?

The British Dental Association offers several guidelines to the dentists to ensure the safety of their team and the patients. First, it may not be necessary for you to visit the dentist for every dental emergency. In some cases, your dentist may guide you over the phone to manage the situation.

Secondly, for situations that do require visiting the dentist, dentists nowadays use additional personal protective equipment (PPE) – such as gowns, face shields, caps, etc. – to ensure the safety of their team and yourself by preventing the spread of the coronavirus.

Virtually all dental restorative procedures generate an aerosol, which carries considerable risk for transmitting coronavirus infection. Therefore, dentists must take additional measures to minimize the risk of infection from aerosol-generating procedures (AGPs) for routine dental treatment. Most modern dental practices are now equipped with high-grade vacuum machines that prevent the aerosol from staying in the room for prolonged durations, thereby reducing the fallow time.

What Qualifies as a Dental Emergency?

A dental emergency is any potentially life-threatening situation that requires immediate medical or dental treatment to alleviate severe pain, stop bleeding or manage severe infection.

A chipped tooth, broken orthodontic wire, dislodged filling or crown that has come out does not qualify as a dental emergency.

When should I go to A&E with Tooth pain?

Dental emergencies must never be taken lightly as they can be life-threatening. If you are having any of the below-mentioned problems, then you must visit your nearest hospital emergency, primary care facility, or dentist for immediate treatment. Some of the common dental emergencies include:

  • Uncontrolled bleeding
  • Severe toothache
  • Cellulitis or bacterial infection
  • Facial trauma or injury

What Will An Emergency Dentist Do?

When visiting your dentist for emergency treatment, please bear in mind that you may still have to wait for some time before you’re called in. This is because you’re dentist has to disinfect the dental room after the previous patient leaves. In the meantime, you may be asked to wait in the car outside.

When you’re called, your dentist will first perform a clinical examination to guage the extent and nature of the emergency. Management of dental emergencies usually requires treatment of the underlying cause. For example, a toothache may arise due to a variety of reasons, such as a fractured tooth or an abscess. Your dentist will first diagnose the problem and then recommend an appropriate treatment.

Some people are afraid of the dentist, finding any excuse not to set foot into the dental care practice – even in the case of emergencies. Thanks to modern techniques dentistry can now be made very comfortable and sometimes even relaxing. Dentists rely on advanced relaxation techniques using anesthesia, sedation dentistry so that their patients feel comfortable and relaxed while their dental work is being done.

Why Do My Teeth Hurt?

Teeth can hurt due to many reasons. Some of the common reasons for having a toothache include:

  • Teeth cavities
  • Something stuck between two teeth
  • Fractured or chipped teeth
  • Dental abscess
  • Periodontal inflammation
  • Toothache due to an abnormal or imbalanced bite
  • Temporomandibular joint (TMJ) problems
  • Pericoronitis – a painful condition in which the soft tissues surrounding an impacted tooth get inflamed.

Your dentist will first ascertain the cause of your toothache and then proceed to provide pain relief. Please note that unless there is severe and uncontrollable pain or severe bleeding that these do not constitute a dental emergency.

How to Get Rid of Toothache?

To relieve tooth pain, you must know what is causing it. If you are having severe pain in one of your teeth and you cannot see your dentist right away, or you’re too afraid of the dentist – either because of a bad experience or because of dental anxiety – there are ways in which you can relieve some kinds of toothache at home.

The best thing to do while you’re waiting to book an appointment with your dentist is to take over-the-counter pain medication. A painkiller not only reduces pain and inflammation but will also help calm down nervous patients or those having a dental phobia.

Can Toothache Cause Headache?

Several dental problems can cause a headache. An improper bite can lead to temporomandibular joint disorders (TMDs) and cause headaches. Similarly, the nerves that innervate the teeth are connected to other parts in the heat. Sometimes, pain in one of your teeth can be “referred” to other areas and may cause a headache.

If you wake up every day having sore teeth and a headache, it might be because of night-time tooth grinding. Finally, a headache can also occur because of an underlying sinus infection.

Whether you require emergency root canals or dental fillings, the key to minimizing damage in an emergency is to seek expert help as soon as possible.

Mar 20 20

Visiting the dentist during the Covid-19 outbreak

by Dr Jay Padayachy

We would like to reassure all our patients that most dentists are fully aware of all current government advice for healthcare professionals.

You will appreciate that as a dental practice we work in an environment where the prevention of the spread of a whole range of infections is woven into everything that we do. Clinical sterilisation and disinfection procedures will continue at our normal high standard as a routine. We have also increased the disinfection of non-clinical areas, door handles, bathrooms and public areas in the practice.

Before attending the practice for your next appointment we would be grateful if you would review the most up to date government guidance – just click the link https://www.nhs.uk/conditions/coronavirus-covid-19/

Keep Your Dentist in the Loop

We will contact you the day before your appointment to check you are fit and well.

If you have flu-like symptoms, a fever, or a recent sore throat or cough, please contact us to postpone your appointment.

If you are self-isolating or have been diagnosed with Covid-19, please contact the practice to postpone your appointment.

Let’s All Keep Safel

When you visit, you will be asked to use an alcohol hand sanitiser and you may have your temperature checked at reception.

You will be asked to rinse with Peroxyl mouthwash prior to your treatment.

You’ll notice that we’ve removed some non-essential items in the reception area including papers, magazines, kids books and toys. They will return once this is all over.

Please forgive us if we don’t shake hand, don’t think we are being rude!

Please also try not to bring family members to appointments, as this will increase the number of people in the lounge area.

At this time of uncertainty, your safety is our highest priority. As a team, we are doing everything we possibly can to remain fit, well and able to work so that we can continue to provide or usual high standard of dental care for you whilst safeguarding your health, and our and our families health.

Thank you for your support in keeping everyone safe.

Feb 4 20

Cosmetic Dentistry for Crowded Teeth

by Dr Jay Padayachy

” I want to fix my smile but don’t know where to start”…

… is this a question you’ve ever asked? This blog post is written particularly if you want to understand more about cosmetic dentistry for crowded teeth, so let’s get started.

What problems do crowded teeth cause?

  1. Cosmetic and confidence reducing
  2. Increased risk of dental decay developing

The most obvious problem is one of cosmetics, not many people like the idea of having very crooked, rotated or crowded teeth, most people want to enjoy a straight smile as it is perceived as beautiful.… However, did you know that there are also oral health benefits from treating crooked teeth?

Everyday a biofilm layer builds upon the surface of your teeth, if this is not removed daily then it can harden off to form that nasty creamy coloured tartar in between your teeth. In this tartar the bacteria lurk and as they digest the sugars in your food they excrete acid and it is this acid which can lead to dental decay… And ultimately to tooth loss if it is not treated.

Cleaning in between teeth is easier if the teeth are straight

In order to keep the bacteria to a minimum, it’s important to clean your teeth daily, however, crooked teeth are more difficult to clean than straight teeth. We should be using floss or an interdental brush/stick to clean in between their teeth each day, this is far easier if the teeth are straight and in-line as it makes the floss or brush easier to get through.

How do braces work on crowded teeth

Braces are usually one of the preferred options to treat crooked teeth as they maintain as much natural tooth structure as possible.

This basic principle of tooth movement can often be seen in people that suck their thumb, they very often have protruding top teeth, the constant pressure on the roof of their mouth and inside of the teeth pushes them forwards. This same principle applies to braces, all that is required to move teeth is a constant pressure in the correct direction and the teeth will move.

Crowded teeth can be rotated by using different springs which push on one side and pull on the other side of the tooth thereby rotating it.

Complex spring mechanisms pushing and pulling at the same time

How to fix overcrowded teeth without braces

There are a few cosmetic alternatives to braces and crooked teeth can indeed be fixed without braces using one of 4 options:

  1. Cosmetic recontouring – sometimes it’s possible to reshape and re-contoured teeth to make them look more attractive. Very often people dislike the pointed canines (eye teeth) or perhaps don’t like the rough edges on the tips of their teeth. With some delicate trimming your dentist can re-contour these areas to look more beautiful.
  2. Dental bonding – minor crowding can often be treated this way, this is where a very small amount of tooth coloured resin is applied to the surface of the tooth, the raising built the tooth forwards into the correct alignment.
  3. Dental veneers – slightly crowded teeth can be treated with veneers, they work in the same way as bonding, by building the tooth forwards in to alignment however, veneers are made from a high-strength dental porcelain and are therefore often considered more durable than dental bonding.
  4. Dental crowns – sometimes the teeth are so broken down or require too much adjustment to accept dental veneers, in these instances crowns are used (caps). A crown covers the entire surface of the tooth with that tooth being reduced to a stump prior to having a crown placed on top. A crown can then be made in any shape, position or colour.

Cosmetic recontouring, dental bonding and dental veneers are usually only used on front teeth.

Do I need to have teeth extracted before braces

Not necessarily. However if teeth are crooked it can often mean that there is not enough space in your mouth for all of the teeth to be in a natural alignment. If this is the case then sometimes a dentist will remove the 1st premolar on either side, this gives space for the crooked teeth to be the rotated and spread out evenly in your smile.

In very rare situations patients have additional teeth, called supernumeraries, these are teeth in addition to the regular 32 teeth which adults usually have.

The only way to find out for sure is to have a consultation with a dentist and then diagnostic planning undertaken.

Can veneers be used for overlapping teeth

Most of the time, yes. However, teeth are often crooked and overlapping because there’s not enough space in the jaw for them to all be in an equal alignment. If the same number of teeth take up the same space and are straight then they can look very narrow, this would be required in order to fit them into the space but would look rather strange.

However, it is true that sometimes mildly overlapping teeth can indeed be straightened with veneers.

For this reason, orthodontics is sometimes preferred, along with extraction of a couple of teeth to make more space.

What are the most affordable cosmetic dentistry options?

Don’t confuse affordability with cheapness! Cheap is not always best and the saying that “if you buy cheap then you buy twice” is often so true.

This doesn’t mean to say that all treatments are expensive, sometimes amazing cosmetic dentistry results can be achieved with a small amount of dental bonding to reshape and straighten teeth, coupled with teeth whitening to whiten them and make a brighter smile.

In more complex cosmetic cases with additional complex treatments prices do tend to rise. In these instances it’s good to ask a dentist if they offer finance.

Many dentists offer 0% finance over an extended period of time helping make cosmetic dentistry more affordable.

Jan 21 20

13 interesting questions and answers about dental crowns

by Dr Jay Padayachy

Lots of people have dental crowns to restore broken down teeth, they are an extremely common component in modern day dentistry. We are often asked a multitude of questions about crowns so decided to put the top 13 of them into this article… Do let us know what you think.

Do dental crowns come with any kind of guarantee or warranty?

Most dental crowns would come with a simple assurance that they are free from defects, any problems with guarantees arise when it’s necessary to work out how a crown broke. Crowns, and indeed teeth, are not designed to do anything except eat and chew. People can often use their teeth to open bottles and packets and some decide to chew matchsticks all day long.

So long as you respect the fact that you have a dental crown, look after it and your natural teeth and it is free from any manufacturing defect it should last for many years.

Can a dental (teeth) crown last forever and is it worth it?

It is possible for a dental crown to last the rest of your life, indeed if it is well looked after and is not subject to extreme impact then it probably will. The average dental crown lasts for 10 years. The most common reasons that a dental crown needs to be replaced are:

  • Fracture, particularly if it is a porcelain crown
  • Aesthetics. Over the years your natural teeth may darken making a crown look lighter.
  • Gum recession. As we age the gums recede making our teeth look longer, hence the expression “long in the tooth”. This gum resorption can expose the tooth/crown margin which can stand out looking grey.
  • Underlying tooth decay. Your tooth underneath the crown can still decay, particularly around the margins. This decay can then mean that the underlying tooth structure needs to be removed which necessitates removal of the crown and hence, often remaking.

How to take care of my dental crown?

Crowns don’t need any special type of care. Looking after your oral health is important for any kind of dental care routine, simply clean your teeth twice per day with a pea sized amount of toothpaste, ensuring you clean in between them at least once a day with floss or an interdental brush.

Even though you have false tooth in place you still need to clean your teeth and look after your gums to prevent gum disease and further oral health problems.

What is a dental crown?

A crown is a full surface covering which covers the whole of your crowned tooth. It is used in situations where a large amount of tooth structure has been damaged or lost. In order to rebuild the tooth to its full-size crowns are used.

Why do some dental procedures cost so much? Like crowns, etc.?

Dental procedures often cost so much for a variety of reasons:

  • The complexity of the treatment. Some treatments are extremely complex and take many years for the dentist to train to be able to do.
  • The location of the surgery. Dental surgeries are often located in convenient locations in the middle of high streets, this kind of location often has a high cost.
  • Manufacturing and production costs. Some treatments, like crowns are made by a dental laboratory. These crowns cost a considerable amount of money, especially if a quality dental lab is used.

Why do dentists always want you to get a crown?

If a tooth is slowly breaking down there are a few options. It’s possible to use a dental filling or dental inlay. The problem is that if a considerable amount of tooth has broken down you could have a dental filling and then the final part of the natural tooth breaks, you are then in a situation where you keep having fillings which get bigger and bigger, continuously having to go back to the dentist.

Sometimes, your dentist is able to see that the tooth is breaking down to such a degree that this process becomes very costly in terms of money and time, for that reason a dental crown may be prescribed at the beginning, to save you all of this extra cost.

What are alternatives to dental crowns?

If you have a natural tooth which has broken down to the point at which a dental filling or inlay can no longer work then the only real alternative to a dental crown is to have the tooth removed. Clearly this is not a good alternative as it means you then have a space which can mean the bite is altered as the surrounding teeth drift.

Unfortunately, if you wish to keep as many teeth as possible then a crown may be the only option if you have lost a lot of natural tooth structure.

What should be done if a dental crown falls off?

The first thing to do is to retain a lost Crown. You can buy temporary adhesive in many good-quality pharmacies, this can be used in an emergency to fit the Crown back again temporarily.

In order for the crown to be fitted back permanently you will need to visit a dentist. A dentist will then remove any of the hardened cement/blue on the inside of the crown, once this has been done the crown can be refitted

Are dental crowns painful?

Not usually. You will always have a local injection prior to having any form of invasive dental work undertaken. A good tip is to ask your dentist to use a topical anaesthetic gel beforehand, this is a small amount of gel placed onto a cotton wool bud which sits for a couple of minutes on the gum on the site where the injection will be given. This number is the gum so that you can’t even feel the needle.

After you have had a crowns fitted you may find there is some mild sensitivity for a few days, this is simply because the tooth is settling down again after having all of the work done and is usually nothing to worry about.

What are the pros and cons of dental crowns versus bridge?

This is a question which often get asked but is actually a non-question. A dental Crown replaces a single tooth yet a bridge replaces multiple teeth. There are therefore no pros and cons of dental crowns versus bridge as they have completely different outcomes.

The only time a dental crown is used as a single replacement of a missing tooth is when it is used as a restoration on top of a dental implant.

Why are dental crowns recommended after a root canal?

Dental crowns are not always recommended necessarily after a root  treatment. It is possible to have a root canal treatment without a crown. Sometimes a root canal is required as the decay has got so bad that it has affected the nerve and/or blood supply of the tooth. If the decay has also affected the part of the tooth which you see and it has broken down then often a root canal will be combined with a dental crown.

If however the bulk of the tooth remains unaffected then you can have a root canal treatment without having a permanent crown fitted afterwards

What is the best dental crown to get for back teeth?

Crowns on front teeth are usually focused around aesthetics, crowns on back teeth usually focus around strength and functionality, although in both instances all criteria count.

Crowns for the front teeth usually include ceramic crowns, these have no metal and can often look the most beautiful. Porcelain fused the metal crowns or full metal crowns made out of a range of metal alloys can often be stronger, these can be used for back teeth although it is usually considered they don’t look quite as good.

The process of having the crown is exactly the same, the dentist prepares the tooth, takes an impression and sends to a dent laboratory they make the crown, once manufactured the dentist fits the new restoration over a prepared tooth.

What is the best dental crown material?

There are a range of different crown materials including precious metal, porcelain bonded crowns and all ceramic crowns. Each material is used in a different situation dependent upon the look and strength.

The type of crown used will depend upon where it is going to be in your mouth.

The weakest material is acrylic or composite, this is usually what your temporary crown will be made from.

The strongest material is often considered to be a precious metal alloy such as a gold alloy, however this is often not desirable, particularly at the front of the mouth.

Porcelain bonded to metal alloy crowns are amongst the most common materials, this type of ground has been around for many years and has an extremely long track record and pedigree.

Summary

Dental crowns are a routine dental treatment often necessitated after dental decay or traumatic loss of tooth structure. Crowns can look extremely natural and blend in with your other teeth harmoniously. They can also last many years, sometimes a lifetime if well looked after.

Dec 20 19

A Mini Smile Makeover – what is it?

by Dr Jay Padayachy

Very many people are looking to improve or enhance their smile by making their teeth brighter, whiter, straighter or by rebuilding broken down teeth.

However for a variety of factors, including cost and convenience among other things some people are now opting for the reduced mini smile makeover rather than a full smile makeover.

This article takes a look at mini smile makeovers, what’s in them, what’s included and how treatment differs to a full smile makeover.

The term smile makeover usually refers to a combination of the following aspects of cosmetic dentistry:

  • Straightening crooked teeth.
  • Whitening dark or yellow teeth.
  • Restoring broken down, chipped or damaged teeth.

A full smile makeover will include a range of treatments including teeth whitening, dental crowns/veneers and orthodontics… A mini smile makeover is a much reduced version of this full smile makeover treatment.

Before we go into the full details of the mini smile makeover, let’s look at a full smile makeover, we can then see the advantages and disadvantages of a mini smile makeover and compare them.

Stage 1 of a smile makeover – Aligning crooked teeth.

In a full smile makeover this can be done using a variety of techniques, including but not always limited to:

  • Orthodontics to move, rotate and twist teeth back into straighter alignment. Different orthodontic options are available such as rapid orthodontics with the Inman aligner or invisible orthodontics using Invisalign.
  • Veneers or crowns to rebuild teeth and also realigned them. One of the problems with veneers is that they cannot bodily move a tooth like orthodontics can, veneers are usually only suitable for teeth which are twisted but in the correct position.
  • Bonding, this is a minimally invasive approach where a small amount of tooth coloured resin is placed over the surface of the tooth, very similar to veneers it cannot bodily move a tooth to make it more aligned, it simply builds up a part of the tooth which is too far back to make it look straighter from the front.

Stage 2 of a smile makeover – Whitening dark teeth.

The method of whitening depends upon how dark teeth are in the first place and if there are any other associated problems which need to be treated at the same time e.g. broken down teeth or rotated teeth.

Your dentist will always prefer to maintain as much natural tooth structure as possible and so the simplest option is usually to whiten dark teeth with either teeth whitening or air abrasion

Air abrasion involves using a very fine sand which is gently blasted over the surface of the tooth. Whilst this doesn’t actually whitening the teeth themselves, it is incredibly efficient at removing surface stains, particularly tea, coffee, red wine or smokers stains. It is a simple and pain free treatment which can often be provided in approximately 30 min.

If the tooth needs to be whitened itself then teeth whitening will usually be the preferred treatment.

This could be rapid teeth whitening in the dental practice or home whitening undertaken using a night time bleaching tray and gel.

If the teeth are particularly dark then traditional tooth bleaching may not be sufficient to whiten the teeth to the desired colour, in this case teeth whitening can be used in conjunction with either bonding veneers.

The natural tooth is whitened to provide a light base for of veneer which fits over the surface. The veneer can then be made in the ideal colour, usually much lighter or whiter than the original tooth shade.

Stage 3 of a smile makeover – Rebuilding broken down or damaged teeth

The final stage of cosmetic dentistry smile design is to think about restorative options. Your dentist will have already considered aligning the teeth and orthodontics and whitening the teeth with either teeth whitening or air abrasion… But what about the teeth that are damaged or broken down?

This is where the final stage of treatment options comes into play, usually this will include bonding, veneers or crowns.

Bonding involves the dentist placing a small amount of tooth coloured resin over the surface of teeth, this can be particularly useful for chipped teeth or teeth with small surface pits.

If the tooth is more broken down or more heavily damaged/discoloured then veneers may be considered. A porcelain veneer fits over the surface of the tooth, completely covering any damaged natural tooth and restoring any broken down areas.

Sometimes a tooth is so broken down or damaged that a veneer is not adequate, in this case a full coverage crown will be used. This covers the entire part of the tooth which you see, including the tongue side and biting surfaces. A crown can therefore be made in any colour and any shape making it a perfect component of cosmetic dentistry.

Which option should I go for?

This is where a smile makeover really comes into its own, your cosmetic dentist will look at each tooth in turn as well as your entire face and smile, they will then come up with a treatment plan that suits the outcomes you have defined. Very often the best cosmetic dentists we use a combination of all treatments available in order to give the best smile.

What is a mini smile makeover?

A mini smile makeover simply takes the simplest and most convenient options available to your dentist to deliver the quickest and most cost effective smile makeover possible. Typically a mini smile makeover includes:

  • Air abrasion to remove any surface stains from the teeth, this may be enough if your teeth are nicely aligned and a good shape.
  • Teeth whitening. The whitening process can usually be undertaken in either a 30 min appointment at the dentist or over a couple of days at home by wearing bleaching trays at night.
  • Dental bonding. This will be done in the dental practice and usually takes anywhere between 30 min and a couple of hours depending on how many teeth are having the bonding process.

Am I suitable for a mini smile makeover?

A mini smile makeover is not suitable for everyone, it can only be used for patients who:

  • Have mildly crooked or rotated teeth.
  • Don’t have complex dental health issues.
  • Don’t want to replace any missing teeth.
  • Don’t wish to change the way their teeth bite together (occlusion).
  • Want a simple fix to a relatively nom-complex problem.

How much does a mini smile makeover cost?

Typically the cost of a mini smile makeover is:

  • New patient consultation, from £59
  • Teeth whitening, from £277
  • Bonding, from £135 per tooth

So let’s say you had 2 teeth which were rotated and were suitable for bonding, you wanted to brighten your smile and have these teeth aligned it would cost, from £606.

We hope you have found this blog post useful .

Download your FREE guide to Cosmetic Dentistry today…
“Your complete guide to confidence with a perfect smile”

A special report containing all you need to know about cosmetic dentistry.

Find out:
  • The costs and lowest price alternatives
  • Your options and choices for treatment
  • Are you suitable for treatment?
  • How can you have straighter teeth WITHOUT braces?
  • What happens if you smoke?
  • How safe is teeth whitening?

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Oct 17 19

Do You Brush Your Teeth after Using Whitening Strips?

by Dr Jay Padayachy
Do You Brush Your Teeth after Using Whitening Strips?

Many people wish to improve the appearance of their smile, this can include a range of treatments from straightening crooked teeth to replacing missing teeth to rebuilding broken down teeth through to whitening dark teeth.

It’s also popular for people to want to discover ways to do these without visiting the dentist, or at least keeping visits to the dentist to a minimum. In this blog post we will have a look at teeth whitening strips and answer a few questions you may have about this home teeth whitening option.

What are the options to whiten teeth?

There are a range of options to whiten dark teeth, some of them can be done at home whilst others will require a visit to a dentist. Understanding this can help us make the best decision about whitening strips.

Teeth Whitening without a Dentist

The following items can typically be bought over the counter:

  • Teeth whitening toothpastes – these can start the process at home, there is very little active whitening agent within the toothpaste as this is restricted in law, these toothpastes typically use a slightly more abrasive compound, this is then more effective at removing surface stains.
  • Teeth whitening pens – these can often be purchased in chemists and other similar shops, most typically they are simply a slightly translucent white paint which covers the front surface of the tooth temporarily. They can often be good to whiten teeth for a single occasion but the results will be very temporary. Other whitening pens do contain an active whitening agent so it’s important to check which type is on offer prior to purchase.
  • Teeth whitening strips – Whitening strips will have an active ingredient to actively whiten your teeth, however, it’s important to know that for safety reasons the amount of this active ingredient is quite dramatically reduced compared to what you can have when it is prescribed by a dental professional.

Teeth Whitening With a Dentist

The following options can whiten teeth to a greater degree than is possible without visiting a dentist:

  • Home teeth whitening kit – this involves visiting the dentist to have a dental impression taken, from this impression a highly accurate custom fitting whitening tray will be made. This tray fits precisely over the surface of your teeth, this helps to keep the whitening gel exactly in place and prevent it from touching the sensitive gums. The whitening gel is placed inside the tray and is then worn for a couple of hours each day or possibly overnight. The whitening gel contains hydrogen peroxide bleaching agent to lighten the colour of theteeth.
  • In office whitening – this involves the dentist in the office/surgery placing the whitening gel over the surface of the teeth and then applying a high-powered light to speed up the whitening process. The dentist will ensure that there is an isolating agent put over the gums of the teeth to prevent the gel coming into contact with them.

Should I brush my teeth before whitening trays

It is advisable to wait 20 minutes after eating before brushing the teeth, this is to give the surface of the teeth time to recover from any acid attack which occurs each time anything is eaten or drunk. This is particularly true if this was acidic food & drink.

The same applies with teeth whitening. We recommend that a delay of 20 minutes is taken after eating before teeth brushing and starting the whitening process.

It is important that any food debris or surface plaque is removed from the teeth prior to whitening, this is why we recommend cleaning teeth before starting the daily whitening routine at home.

Do whitening strips work well on yellow teeth?

They can do. Whitening strips typically have a hydrogen peroxide (the active whitening ingredient) percentage of around 6.5% whilst teeth whitening prescribed by a dentist can, in some circumstances use concentrations up to 40%.

This typically means that teeth whitening at the dentist is quicker and may be able to whitening the teeth more than whitening strips.

One of the reasons that the concentration is lower in whitening strips is because hydrogen peroxide can burn the delicate soft tissue/gum area, for home use this is why the concentration is lower. However, when the dentist is involved they would take measures (such as providing a close fitting custom bleaching tray, or isolating the gum during surgery whitening) to ensure that the hydrogen peroxide stays well away from the gums.

Can I eat after whitening?

It is indeed eat after any form of whitening, one may however find that there is some sensitivity for a few hours after the whitening trays are taken out, avoiding very hot or very cold food and drinks may be advisable. This sensitivity should settle down quite quickly. With whitening strips some people notice that the sensitivity is lower due to the lower concentration of active hydrogen peroxide ingredient.

Do you brush your teeth after using whitening strips?

We recommend that with any form of whitening that teeth are brushed beforehand. This is to ensure that any plaque (this sticky surface layer on your teeth) is removed and that any whitening agent present in the strips or gel gets the closest contact with the teeth.

We don’t advise brushing immediately after whitening as the teeth maybe a little more sensitive for a couple of hours. The sensitivity will usually be lower with whitening strips then it is with any other form of whitening, however the whitening process will take longer due to the lower percentage of hydrogen peroxide active ingredient.

Are there any negative side effects from teeth whitening?

The most common side effect from teeth whitening is sensitivity. Some people find that using a sensitive teeth toothpaste can help to alleviate this. It may be advisable to begin using a sensitive teeth toothpaste a couple of weeks prior to beginning whitening to give the teeth time to build up resistance and prevent tooth sensitivity.

Another quite serious side effect from teeth whitening can be burning to the gums. Teeth whitening at the dentist is controlled carefully to ensure that the whitening agent does not touch the gum, this is done with a very closely fitting tray which is custom-made exclusively for you. Without this tray the gel would come into contact with the teeth.

Finally, another side-effect may be that the teeth don’t get whiten but that the tartar which builds up between your teeth gets whitened instead. This happens when the tartar is not removed between the teeth prior to beginning the whitening, therefore the whitening agent cannot actually touch the teeth and can only whiten the tartar.

This is why visiting a dentist for whitening is the only legal way to ensure you get the brightest smile. A dentist will ensure that all of the oral health requirements are met prior to beginning whitening, this includes:

  • Gum recession which can exacerbate dentine hypersensitivity
  • Gum disease which could lead to bleeding and damage to the gums
  • Cracked tooth check, cracked teeth can become ultrasensitive if whitening is undertaken.

They will undertake a full assessment to ensure the gums are not bleeding (which could then get mixed into the bleaching gel) and that there isn’t any tartar in between the teeth which would prevent the teeth whitening fully.

Should you have any further questions about teeth whitening in Watford please do feel free to contact us, we are at your service.

Sep 24 19

Can invisalign fix protruding front teeth

by Dr Jay Padayachy

There are often a variety of questions that people ask about Invisalign, can it fix an overbite, crowding, crooked teeth and indeed, what can Invisalign NOT fix.

This article is dedicated to answering this great array of questions including, can Invisalign fix protruding front teeth?

What is Invisalign?

Invisalign versus conventional braces
Can you spot which one of these patients is wearing braces?

Invisalign is an orthodontic system which utilises modern computer assisted technology to create clear aligners. These clear aligners sit over your teeth and put a small amount of pressure in the design direction in order to move them.

At the beginning of your treatment planning the software will calculate how many aligners you need and how often you will need to change them, typically this is every 2 weeks.

How long does it typically take for Invisalign to align teeth?

At the beginning of your treatment planning stage you will have your teeth scanned into a computer, your teeth can then be moved on the computer to the ideal location and the computer then calculates how long it will take for this movement to occur to close the gaps and straighten your crooked teeth.

Some treatments can be completed in one year however that average is usually 2 years. It all depends on how much tooth movement is required.

Can Invisalign fix overbite


Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. medical-dictionary.thefreedictionary.com/overjet

An overbite is when the top teeth stick out, often when the mouth is closed. Strictly speaking this is actually called an overjet however many people refer to it as an overbite. Often called buck teeth or protruding front teeth. An overbite may have either dental or skeletal causes.

  • Dental causes. This is where the teeth only are in the wrong position.
  • Skeletal causes. this is where either the lower jaw is underdeveloped or the upper jaw is overdeveloped.

Typically Invisalign is able to fix dentally caused overbite much better than skeletal caused overbite. The good news is that most overbites are caused simply by teeth being in the wrong position, severe buck teeth overbites may require orthognathic surgery in conjunction with an orthodontic treatments such as Invisalign.

Can Invisalign fix crowding

In many instances teeth are crowded because of an underdevelopment of the jaw, this leaves not enough room for the teeth to sit in their natural alignment. For this reason, in order to fix crowding there may sometimes be a requirement to remove a tooth to create enough space. Very often the tooth that is removed if the 1st premolar. This then gives enough space to move all of the teeth and straighten them to fix crowding.

In this regard, yes Invisalign can fix crowding.

Can Invisalign push front teeth back

Invisalign can indeed push front teeth back so long as there is enough space for these teeth to move into. If there are gaps behind the protruding front teeth then these gaps will be taken up as the front teeth push back. If there are no gaps and not enough room to push the front teeth back then extraction of a premolar tooth may be required.

Can Invisalign fix protruding upper front teeth

And so on to the main question about whether Invisalign is able to fix protruding front teeth. The answer is definitely yes, although there needs to be room for these front teeth to be moved back into.

If you only have a couple of protruding front teeth, for example 2 front teeth then you may also like to consider dental bonding or other treatments.

The 2 front teeth may look as though they stick out however it may be because the lateral teeth either side of them are actually retruded and not far forwards enough. if this is the case then the teeth either side of the 2 front teeth can be built forwards using dental bonding, this can stop the 2 front teeth from looking as though they stick out.

This can often be a cheaper and quicker option than orthodontics, please speak to your dentist about whether this could be one of your treatment options.

Can you get Invisalign for only the bottom teeth?

Invisalign is suitable for orthodontic treatment on the upper and lower teeth at the same time, just the others or just below is. However most commonly Invisalign is used for the other teeth because it is these which are more visible, however if you are just concerned about straightening lower teeth then Invisalign can also work well to give a straighter smile.

What can Invisalign not fix?

Invisalign is great to fix cosmetic orthodontic issues, straightening, rotating and moving the front teeth is what it is ideally suited for.

More complex orthodontic procedures such as widening your jaw, moving back teeth and correcting extreme malocclusion may be more suitable for specialist orthodontic procedures or other types of orthodontic brace.

Jul 29 19

Dental Sedation Questions and Answers

by Dr Jay Padayachy
dental sedation questions and answers

Many people have some level of dental anxiety, phobia or fear and would like to have sedation whilst having treatments. This is absolutely understandable and clearly, having dental sedation comes with a whole range of questions.

In this article we talk about some of the most common questions and answers with dental sedation.

What type of anesthesia is used for dental work?

There are a few different types of sedation and they typically fall into one of 3 categories:

  1. Intravenous (IV). This is where drugs are given to you directly into your bloodstream, often called Twilight sedation as you will have no recollection of the treatment yet you will just about be awake.
  2. Inhalation/Gas and air. Often called happy gas or happy air, the nitrous oxide mix is provided via a small nasal mask so that you breathe in the sedation drugs.
  3. Tablet. Usually given in advance so that the patient can take tablets a few hours before the treatment, the tablets typically have a calming effect.

How safe is dental sedation

Modern dental sedation is incredibly safe. Sedation will always be provided by specially trained dental professionals.

One of the big advantages of gas and air sedation is that the effects of nitrous oxide wear off incredibly quickly, so if you find you have a negative reaction you simply stop breathing gas and the effects wear off fast.

Dental sedation comes with slightly higher risks to people who are obese or have obstructive sleep apnoea, this is because the airway is more likely to become blocked.

There have been some studies which show that nitrous oxide inhalation sedation tends to deplete the body’s store of vitamin B12. For people with vitamin B12 deficiencies this could be potentially dangerous.

Can I eat before dental sedation

You should follow the guidelines given to you by your dentist prior to having sedation however the recommendations are.

  • Intravenous sedation (IV sedation). Because this is not a full general anaesthetic like you would have in hospital it is not necessary to fast prior to having your intravenous sedation, we recommend that you have a light meal for your appointment.
  • Inhalation sedation. You can eat and drink as normal before having inhalation sedation.
  • Tablet/oral sedation. You can eat and drink as normal before having tablet/oral sedation.

You should however avoid alcohol prior to any form of sedation. Alcohol can react badly to some of the drugs used and will also impair your ability to follow instructions.

Who is a candidate for sedation dentistry?

Anyone that is anxious or nervous of the dentist can be a candidate for some form of dental sedation. If you are apprehensive about your appointment and/or treatment then simply speak to your dentist.

You are unlikely to be refused sedation however patients who are obese or have obstructive sleep apnoea may be advised that sedation is not for them due to the increased risks of the airway becoming obstructed.

Should I be scared of the dentist?

It is absolutely understandable that people are apprehensive of visiting the dentist, we appreciate that you may be concerned about any discomfort and understand that many people feel out of control.

The first stage to overcoming any form of anxiety is to let your dentist know, be very clear and specific about what your concerns are, is it:

  • Anxiety about the pain?
  • Fear of a particular treatment?
  • Anxiety over the dentist doing something that you haven’t agreed to?
  • Feeling out of control?
  • Worried about how much or this is going to cost?
  • Fear of being in an enclosed space?

If your dentist knows what you are scared about then they can take action to help, they will be able to:

  • Give topical anaesthetics via a little gel placed on some cotton wool prior to having needle injections, this numbs the gum so that you can’t feel the needle at all.
  • Explain all treatments fully before starting so that you know exactly what is going to happen.
  • Provide a full treatment plan which highlights what treatment will be done at any given appointment.
  • Agree a simple stop signal, this is usually raising a hand, the dentist can then stop treatment, give you a rest for a moment and allow you to set up if appropriate.
  • Provide all costs of treatment in advance, including any necessary payment plans to ensure you are completely happy and relaxed.

Even if all of the above is taking care of there are times where you may still feel anxious, nervous or scared, if this is you then dental sedation may be the perfect answer, in conjunction with everything already mentioned.

Should I ask my dentist for sedation?

Absolutely yes, if you feel this will help then ask your dentist for sedation. Not every dental practice of visitors standard so you may need a referral to another practice or your regular dentist may be able to bring in another suitably trained dental professional to help.

Is there any alternative to anesthesia in dentistry?

Another great question that we get asked lots. Many dental practices are able to help you relax in a variety of ways, some I just naturally relaxing environments and some dentists use alternative techniques such as hypnosis.

Are relaxed calming environment which helps you to slow down your heart rate and gently understand what will happen throughout any treatment, we feel, is an incredibly important way of helping you relax at the dentist and have alternatives to anaesthesia.

However, we would almost always use some form of local anaesthesia to ensure that any treatment site is totally numb prior to undertaking any treatment.

Can I get my wisdom teeth removed without anesthesia?

We would always recommend having a local anaesthesia to numb the area where the teeth will be extracted, however you may also opt to not have any form of sedation such as relative analgesia (inhalation sedation) or intravenous sedation.

Wisdom teeth often have a smaller root system than other back teeth and so are usually relatively simple to extract

How much does it cost for sedation dentistry?

The cost of sedation will vary depending upon the service provider and the length of treatment. Typically sedation is provided on a per hour basis. Many treatments can be performed in less than an hour although some may be considerably longer, for example full mouth dental implants. Sedation is usually provided at around £300 per hour

Jun 13 19

How to Get Straight Teeth without Braces

by Dr Jay Padayachy

Do you have crooked teeth?

Perhaps you are embarrassed to smile or find it difficult to eat?

You may even have jaw joint problems as a result of crooked teeth?

If any of these apply to you then you may be wondering about your options and want to ask the question, how to get straight teeth without braces!

If you have crooked teeth there are really only two ways to treat them:

  • Move the teeth physically.
  • Add something to the front of the tooth to make the front of the tooth aligned and give the illusion of straight teeth

Moving the teeth physically includes various orthodontic options and adding something to the front of the tooth can be done with various cosmetic dentistry techniques.

Even the orthodontic options offer solutions to crooked teeth without traditional braces, so read on to find out your options.

Why do teeth grow crooked?

There is a natural balance in your mouth Between your tongue pushing out and the cheeks pushing in. This natural balance in forces is called the neutral zone. As a baby grows and turns into a child and then adult various factors come into play which can affect this neutral zone.

  • Thumb or dummy sucking. This puts pressure on the roof of the mouth which can move the bone physically during growing. This can mean the teeth come through in the wrong position, often spaced with buck teeth.
  • Poor posture. The muscles of your head, face and neck are all interconnected, poor posture such as continuously leaning forwards or having the mouth continuously open can affect the muscles and fine balance of the neutral zone. This can mean that the pressures from the muscles around the face do not exert on the teeth and they come through crooked.
  • Developmental issues. Occasionally either the top or lower jaw can develop too big or too small. If it is too big then the teeth will tend to be spaced, if it is too small then the teeth will tend to be crowded or crooked.
  • Poor eating habits. We use our tongue considerably during eating. It gets forced against the roof of our mouth which can, over time, move the bone and space the teeth out.

If your teeth are extremely crooked or you need to correct the bite it may not be possible to straighten teeth without braces, however, slightly crooked teeth can often be treated without braces.

How important are straight teeth in society?

Research has shown that a beautiful smile doesn’t only make you more attractive to others; it can even improve your job prospects! A coy ‘hand over the mouth’ approach may work among friends but like it or not, in a one-to-one interview that smile is just going to show.

People want straight teeth for a variety of reasons

  • Socially wanting to look good at parties with friends
  • Before going away on holidays – Happy holiday snaps become more amazing
  • Boosting their self-confidence that brings out the best in them
  • Dating – I know I will enjoy more talking to someone with a nice, bright smile
  • Comments from friends & family making them feel self-conscious – I have had people requesting whitening because of comments from their grandchildren.
  • Wanting to look more youthful – we all love to look and feel young all the time.

How to close the small gap between my front teeth?

Small gaps between the front teeth can often be closed with dental bonding. This involves applying a thin layer of tooth coloured resin to the front side of your teeth. Bonding in this way can look extremely natural and close the gaps completely, all without braces.

Dental veneers can also be used, this can also adjust the shape and colour of the teeth at the same time.

Notice this case below, there is a small gap between the front teeth of this patient, after dental veneers the gap has completely gone, the teeth are whiter, brighter and better shape also.

Closing gap between front teeth without braces

How to get fake teeth instead of using braces

So long as your teeth are not too crooked then it is possible to get fake teeth by way of bonding, veneers or dental crowns in order to straighten teeth instead of using braces.

However, most dentists will prefer to maintain as much healthy tooth structure as possible. Veneers and dental crowns may involve removal of otherwise healthy tooth structure in order to accept the new (and straighter) veneer or crown.

Whenever healthy tooth structure is removed there will be a joint between the natural tooth and the fake tooth (veneer or crowns), this joint will always be a weak point and susceptible to bacteria gathering. This could lead to increased chances of decay in this area.

Careful consideration to this fact should always be taken when deciding whether you want to have faked teeth (veneers, crowns or bonding) instead of orthodontic braces.

There are also a range of “snap on dental veneers” which are available through online retailers. These are only adding onto the outside of your teeth and can only be worn for short periods of time. We are also extremely concerned about the fit of these products, if they do not fit then they will rub on the gums, this can then lead to inflammation and the gums actually receding.

These snap on instant smiles can also look extremely unnatural as they will, by their very nature, be very big and protruding.

Orthodontics without visible braces

There are also a range of orthodontic treatments which are possible to have which do not have invisible braces. This means you can have straight teeth with no one else knowing you are having treatment!

This means you can look as though you were having straight teeth without braces, the following treatments make this possible:

  1. Clear orthodontic braces. These types of braces are made using completely clear plastic aligners. These are virtually imperceptible whilst being worn.
  2. Tooth coloured brackets and wires. Whilst it is possible to see these close-up they often go unnoticed in normal society distances from each other, they involve conventional orthodontic technology of brackets and wires but instead of them being metal train track types they are tooth coloured which makes them blend in better.
  3. Lingual orthodontics. This type of orthodontic brace fits on the inside of your teeth (tongue side). This means that from the front the braces are completely invisible meaning you get straighter teeth without the look of braces.

Clear orthodontic braces

The almost invisible option

This type of orthodontic brace involves the use of a series of clear aligners. When they are being worn they are virtually imperceptible. One of the most popular types of clear orthodontic brace like this is Invisalign.

The system uses advanced CADCAM technology to computer design each aligner. Each aligner moves your teeth small amount towards their final destination. You wear each aligner for approximately 2 weeks and have around 26 aligners for a standard treatment. More complex treatments may require a longer time period.

Invisalign versus conventional braces

Can you spot which one of these patients is wearing braces?

Tooth coloured brackets and wires

The option for more crooked teeth

This option includes conventional type braces on the front of your teeth by using clear brackets and tooth coloured wires. One of the most popular treatments of this type is known as Six Month Smiles. Whilst you may notice these braces when viewed close-up people generally don’t notice them when viewed from a distance, in fact many celebrities have been known to wear this type of orthodontic brace and it completely bypass the press and media!

Mar 22 19

Fluoride toothpaste & your baby’s teeth

by Dr Jay Padayachy

Fluoride toothpaste and baby teeth

It’s often thought that there is no need to look after your children’s teeth because they are going to lose them at some point! This isn’t particularly great advice for a range of reasons:

  • Habits form very young. If your young child does not look after their teeth then this habit is likely to go through to adulthood,  their permanent teeth are then at risk.
  • The risk of other diseases. If your child does not look after their teeth and they develop excessive caries then the bacteria can travel around their body causing other health problems.
  • The adult teeth risk being affected also. Your child adult teeth fixed immediately underneath their baby teeth, if an abscess forms around the baby teeth then the bacteria in this abscess can begin to attack their underlying adult teeth also.

So, yes, it’s incredibly important to look after your children’s teeth… Here’s some more advice.

Should I use toothpaste on my baby’s teeth?

Yes, however always use a dedicated children’s toothpaste. The outer surface of our teeth, known as the enamel is made up primarily of minerals. Over time, teeth require remineralisation in order to keep them strong. Fluoride has been shown to help with this remineralisation process which is why it is added to toothpaste. However there is a limit on the amount of fluoride that we should use, especially when our bodies are small, for this reason toothpaste manufacturers make a children’s toothpaste with a lower dose of fluoride.

When should you start brushing your child’s teeth?

Ideally you should start brushing your child’s teeth before they have any! Keeping their gums clean and free of bacteria is also really important. Regularly allowing your baby to experience the sensation of a toothbrush in their mouth also gets and used to what it feels like, making them less likely to object to teeth cleaning when their teeth finally come through.

You can read more teething advice here.

Is it bad if I use a natural, fluoride-free toothpaste?

The general advice we always give is to use a fluoride containing toothpaste. Fluoride helps the remineralisation process of your teeth and without it you stand a higher chance of developing tooth decay. The same principle applies to children.

How to care for my baby’s new teeth?

A checklist of ways to look after your baby teeth is as follows:

  1. Allow a baby to get used to a toothbrush before any teeth come through.
  2. When the teeth finally come through, use a grain of rice sized amount of fluoride containing children’s toothpaste.
  3. When your child reaches three years old then use a piece sized amount of fluoride containing children’s toothpaste.
  4. Supervise your child is cleaning until they are released 7 years old.
  5. Clean your children’s teeth from behind. If they are a baby then sit them on your knee facing away from you, if they are a toddler then stand behind them.
  6. Clean all tooth surfaces, remember the cheek side, tongue side and biting side on the upper teeth and lower teeth.
  7. Brush in a circular motion. Your child will have 20 primary teeth and it’s important to ensure they are clean each day.
  8. Encourage your child to spit out excess toothpaste but do not rinse with water as this will wash away the fluoride. Whilst fluoride is added to the drinking water in many places around the UK it’s still important to apply topically to prevent cavities.

As an adult, why shouldn’t I use children’s toothpaste?

The quantity of fluoride in the toothpaste is designed specifically for the average body size. Because the child is much smaller than an adult the fluoride dose is much smaller in children’s toothpaste. This would mean that if you used children’s toothpaste as an adult you would not be having the correct amount of fluoride on your teeth which could lead you to be more susceptible to tooth decay.

What is the cause of a baby’s tooth decay before two years?

The primary cause of any tooth decay, leaving out any congenital disorders, is poor oral hygiene. in the year to 2018 26,111 children aged between 5 & 9 were admitted to hospital as a result of tooth decay.

In total 44,047 children under the age of 19 were admitted to hospital, that’s more than children admitted for acute tonsillitis, viral infections, asthma, abdominal and pelvic pain!

Some of the primary causes include:

  1. Children not cleaning their teeth at least twice per day.
  2. Consumption of too much sugar with out adequate cleaning afterwards.
  3. Drinking sugary drinks from bottles with teats.

In summary, it is that adults responsibility to ensure that children keep their sugar consumption in check whilst ensuring that their children clean their teeth adequately each day.

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