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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.

Feb 14 19

What are teeth made of?

by Dr Jay Padayachy

What are teeth made ofSometimes when we think about dental health it’s a good idea to consider exactly what teeth are made of, this allows us to understand more about how our dental health is impacted by our habits and what we eat.

We going to break this blog post down into two sections, firstly we will look at the basic biology and an anatomy of the tooth, in the second section we will then look at how this anatomy can be compromised and what you can do to look after it.

The basic anatomy of a human tooth

A Tooth Diagram – showing all aspects of the tooth

A tooth diagram

What are human teeth made of?

A tooth consists of three parts:

  1. The crown. This is the part above the gum which you see.
  2. The neck. This is the section of the tooth where the crown meets the root.
  3. The root. This is the section of the tooth which anchors it into the bone and it is not normally seen.

Within these three parts there are principally three biological sections:

  1. The enamel. This is the hard outer layer of the tooth, it is the hardest substance in the human body. It protects the tooth and is 96% hydroxyapatite mineral, this is a crystalline form of calcium phosphate. The remaining 4% is made up of organic material and water. This highly mineralised content gives the enamel its characteristic quite/translucent appearance.
  2. The dentine. This is a slightly softer in part of the tooth surrounding the sensitive root canal which contains the nerve the blood supply. The dentine consists of 45% hydroxyapatite mineral with 33% organic material and 22% water. The organic material gives the dentine slightly yellow colour.
  3. The blood vessels and nerves. These are the living tissues in the tooth and feed the it keeping it alive, they also provide proprioception to your brain so that you can feel what is going on. The blood vessels are held in the dental pulp.

The whole tooth is held in place by a soft cushioning mechanism called a periodontal ligament.

Are teeth made of bone?

No. In contrast to teeth which are made up primarily of the mineral hydroxyapatite, bone is mostly made of collagen and is a living growing test you. Collagen is a protein which gives the soft framework to the bone whilst calcium phosphate is the mineral which provides additional strength to this softer framework. It is the combination of collagen and calcium which provide the strength and flexibility of bones.

The uses of each type of tooth

The 32 teeth in your mouth are broadly broken down into 2 areas:

  • Incisive biting, for example biting into an apple.
  • Chewing and grinding.

The sharper and more knife like teeth are towards the front of the mouth, as we move towards the back of the mouth, where we are able to get far more pressure on them from grinding, they become larger so that we can distribute the pressure over a larger surface area, thereby making them more efficient. Back teeth also have much larger groups enabling us to put larger amounts of pressure to grind our food.

Right at the back of our mouth we have wisdom teeth, in modern-day humans these seem to cause many problems, often being impacted. It is for this reason that wisdom teeth are often removed.

There doesn’t seem to be any evidence to suggest that our more pointed canines are there to tear meet. In actual fact they are more likely to be a throwback to our ancestors millions of years ago.

Looking after the anatomy of a tooth

Why do I have black lines on my teeth?

Black lines on teeth have a few different causes:

  • Poor oral hygiene. If the natural anatomy of your tooth has lines and bridges then these can fill with plaque, if this is not cleaned off regularly then it can become dark, particularly if you have habits such as eating very strongly coloured foods or smoking.
  • The tooth dying. If the tooth dies then the blood supply is reduced and the tooth have a tendency to go black.
  • Root canal treatment. A root canal treatment can sometimes cause the tooth to look darker than it did originally, this is because the blood supply will have been removed from inside the tooth.
  • An old dental crown. Some dental crowns have metal inside them, towards the gum line this can begin to look black as the gum recedes during the natural ageing process.

What are the best way to take care of your teeth?

Taking care of your teeth is actually relatively simple, just follow this simple advice:

  1. Clean your teeth twice per day (morning and evening).
  2. For adults use a pea sized amount of fluoride toothpaste.
  3. Clean in between your teeth once per day using either dental floss or an interdental brush or stick.
  4. Use a fluoride mouthwash after meals and never directly after cleaning your teeth. Mouthwash contains less fluoride and toothpaste, if you brush your teeth and then use mouthwash you will actually rinse off some of the helpful fluoride.
  5. Visit your dentist regularly. Your dentist is able to spot the very early warning signs of any dental disease, such as softening of the enamel in the pits and fissures of your teeth. You won’t be open to spot this yourself and if you leave these areas then decay can develop.
  6. Visit your hygienist regularly. Your dental hygienist will be able to clean your teeth on a regular basis and evaluate your own oral hygiene routine, making suggestions about how you could clean your teeth better.

Why do humans have carnivorous teeth?

In actual fact we don’t. Canines are usually considered the carnivorous teeth, yet some of the largest canines in the animal kingdom along to herbivores… Gorillas and hippopotami both have extremely large canines and yet are both herbivores. Canines are usually used in the animal kingdom for fighting and it’s probably this fact which means that modern-day humans still have slightly more pointed teeth as a throwback to our ancestors. Long canines have also been shown to be used by gorrillas as a display to fend off other gorillas… Something which humans don’t really need to do any more!

What chemical element make up teeth?

A tooth is broken down into many parts, each have a unique composition:

  • The enamel in a is the hardest part of the tooth, it is made of an extremely hard mineral called calcium phosphate. The enamel is relatively clear although it does have a slightly blue/grey tint.
  • The dentine is a slightly softer layer underneath the enamel, This is the part of the tooth which gives it the most colour. the dentine is 45% mineral hydroxylapetite, 33% is organic material and the remaining 22% is water. The dentine is not as little as the enamel due to the reduced amount of mineralised content.
  • The pulp is the inner part of the tooth, it is extremely soft and provides the living section of the tooth carrying the blood vessels.

The process of tooth decay can only be reversed or stopped by removing the decay altogether and then filling the void with a hard wearing filling material. If you have tooth decay it is unfortunately not possible to reverse it at home as it will need to be removed and filled.

The best thing you can do at home is to prevent the tooth decay in the first place by following good oral hygiene routine.

Jan 22 19

Everything you need to know about dental crowns

by Dr Jay Padayachy

Everything you need to know about dental crowns

Dental crowns have been in common use since the 1960s when the techniques to manufacture them were first understood, Nowadays, with better preventive techniques crowns aren’t used quite so much but they still play a key part of many dental treatments. We’ve found that many patients can often be confused about types and uses of tooth crowns so we thought we would write an extensive article to answer all of your questions.

What is a dental crown?

A tooth crown

In simple terms, a dental crown is a full replacement for everything you see on your tooth above the gum. They are usually used when the natural tooth has become severely broken down and can no longer be restored with either fillings or inlays. Your crown will fit over your natural tooth which the dentist will prepare and reduce to a stump. So long as you have high quality crown then it will blend in with the remainder of your teeth and no one will know you have one fitted.

Which crown is better for front teeth?

Light shining through Crown

A crown which allows the like to shine through will look best at the front

For front teeth it is usually aesthetics which take the priority, function and strength are still important however. For the highest athletics it is better to use a more translucent material which allows the light to shine through the crown, a porcelain crown is often the best choice. This allows a more natural appearance than having a crown which has metal inside. For this reason the best crown for a front tooth will be some form of metal free crown.

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

Full-back teeth it is usually function and strength which are a priority over aesthetics. Your back teeth are capable of exerting extreme pressure and therefore strength is a priority. Modern zirconia crowns can be extremely strong as well as aesthetic, however very often classic porcelain fused to metal or indeed full metal crowns are still preferred for back teeth.

What are Zirconia Dental Crowns?

Zirconia is the common name for zirconium dioxide, this is effectively sand or ceramic and it is what makes beautiful white beaches look very white. Zirconia has been used for many years in hip replacement surgery as the body does not reject it and it has little or no wear. Zirconia is also able to allow the light to shine through making crowns made from the material extremely lifelike. Zirconia is one of the most biocompatible materials it’s possible to use due to the fact it does not react with anything.

What is the best dental crown material?

The best types of dental crowns will always be selected, but this will differ depending on your clinical situation. The two criteria which are usually used to decide which crown material you should have are:

  1. Aesthetics. Especially important at the front. Very often metal free or crowns are chosen.
  2. Strength. Especially important at the back. Crowns containing metal, such as porcelain fused metal crowns are often chosen however modern advances in technology means zirconia crowns are approaching the same strength.

How long will a tooth crown last?

A tooth crown will last thousands of years… So long as it is not put under any stress and is left alone! So actually the question should be how long will the tooth crown last in MY mouth? The things which affect how long the tooth crown last are:

  • Failure and/or fracture.
  • Gum recession exposing the Crown margin.

You can reduce the chance of failure and/or fracture by ensuring that you look after it. Only use crowns for eating and chewing, not opening bottles! Also, be aware that a common way to fracture ceramic crown is to knock it with a ceramic mug whilst drinking.

You can reduce the chance of gum recession by ensuring that you maintain good oral health and have a regular visit to the dentist to ensure that your gums are in the best condition possible.

Why is palladium not used in dental crowns?

Palladium is used in crowns occasionally however it is falling out of favour for a few reasons:

  • It is a precious metal and therefore expensive, there are lower cost alternatives which offer similar advantages.
  • It is a precious metal and therefore open to fluctuations in price depending upon what the stock market is doing, more stable pricing materials are available.
  • It is metal and therefore does not allow the light to travel through like a natural tooth, this can sometimes make a crown with metal alloys such as those containing palladium look not as good as an all ceramic crown.

What is the typical cost for a dental crown?

The price will vary depending on the type of crown, you should expect to pay anywhere between £300 to more than £1000 per tooth, depending upon where you visit the dentist. Understanding dental prices can be quite difficult so it’s good to speak to your dentist beforehand.

What are alternatives to dental crowns?

If you only have a small amount of damaged tooth then a dental inlay or filling may work, other filling materials are also a possibility. If however there is a large amount of tooth to restore then there really isn’t any alternative to a dental crown, if you want to keep the tooth.

Doing nothing is always an option and should always be considered, if you need to have a tooth restored then doing nothing could lead to additional dental health problems in the future or possibly losing the tooth completely.

How to take care of my dental crown?

You should take care of a tooth crown exactly the same as you would a natural tooth, ensuring you clean it twice per day for 2 min with toothpaste. You should then clean in between the crown and the next tooth with either floss or an incidental brush, just like you do natural teeth, this ensures you keep those difficult to reach areas clean as well. One of the weak areas of a crown is where it joins your natural tooth, often under the gum margin, this area needs to be kept particularly clean.

What is the process for putting on dental crowns?

The process for having crowns is as follows:

  1. Diagnosis that a crown is required, a treatment plan should be produced with all options including prices.
  2. Agreement of the treatment plan. Any root canals or root canal treatment will be done first.
  3. Preparation of the tooth. This involves removing any decayed or broken down tooth and preparing it to be the correct shape to accept the new crown. You will receive a numbing anaesthetic beforehand.
  4. Fitting a temporary crown. This will be made chair side by the dentist at the time of preparation, you wear this temporarily crown for two weeks whilst the final and definitive crown is made.
  5. The final crown is manufactured by a dental technician.
  6. The fitting appointment. You will have a numbing anaesthetic, the temporary crown will be removed, the final crown will be checked for fit, aesthetics and function. If everything is okay the permanent crown will be fitted using a special dental cement material.

We hope you have found this blog post useful, what other questions do you have about crowns?

 

Dec 10 18

Understanding a private dentist price list

by Dr Jay Padayachy

Private dentist price list

Any good dental practice will understand that fees and prices are a major factor in the decision-making process by which dentist to visit. That’s why we have decided to tackle this issue head on, we hope that by the end of this blog post you will have more information about private dentist prices in the UK, why those fees and prices are as they are and how to make the best choice.

Whenever you have a treatment undertaken you should always have a fully itemised treatment plan in advance, the question we recommend you ask your dentist is:

What is included in treatment?

Things which may get left out of your budget in a treatment plan could include:

  • X-rays. Always ask if x-rays are included in any treatment, particularly in a dental health assessment. Some practices offer an initial dental health consultation for new patients which do include x-rays, others don’t, so it’s important to find out beforehand.
  • Follow-up appointments. After complex treatments you may need a series of follow up appointments, think about treatments such as dental implants or orthodontics. Does the fee includes all of these appointments?
  • Retainers. When you have orthodontics you may need retainers after the treatment to ensure your teeth stay in a new position, some practices include a couple of retainers in the treatment fee whilst others include retainers for life. It’s important you find this information out before going ahead with treatment.
  • Sedation. If you are particularly anxious or nervous and think you may require sedation then find out if this is included. Almost certainly inhalation sedation or intravenous sedation will not be included but it’s worth asking about oral sedation.

A good private dentist price list will include everything and not have any hidden extras.

What are the best options for paying for dental fees?

Most private dentists in the UK will offer a range of different ways to pay for the treatment. This could include:

  1. Paying for the entire treatment in one go and enjoying a small discount, often around 10%.
  2. Staged payment for each treatment, particularly useful for expensive treatments over a long period of time.
  3. Finance. Many practices offer 0% finance over one year and then interest-bearing finance thereafter.
  4. Membership plans. Practices offer membership in exchange for a monthly fee. The membership comes with certain benefits including discounted appointments and usually includes routine hygiene and dental appointments.
  5. Bupa Dental plans are also covered by some practices.

Why choose a Private Dentist instead of an NHS dentist?

Many people wonder what is the difference between NHS and private? NHS treatments typically cover the most basic level of care. An NHS dentist is actually still a Private dentist but has a contract to deliver a certain number of Units of Dental Activity (UDA) to the local primary care trust, in the bidding process each bidder for these UDA’s will place their bid, the trust will then decide which provider wins the contract.

The contract will include the total number of UDA’s that must be delivered within the contract period. Each type of treatment has a different number of activities attributed to it.

This is potentially an unstable system, if, towards the end of the contract period the dentist has not achieved the number of UDAs required then there may clawback where the local trust claws back any money paid to the dentist, on the face of it this seems fair but sometimes the target number of UDAs set by the trust is unachievably high, this can leave dentists in a very difficult situation, short of cash and then possibly unable to invest. The flipside to this is if patients come in which needed lots of treatment, in this scenario the dentist may use up their UDA allocation, no matter what treatments patients need the dentist will not be paid for them. This may result in dentists closing their books to NHS patients when the required number of UDAs have been delivered.

Private dentistry avoids all of this. You get exactly what you need, when you need it!

Because the amount that an NHS dentist often get paid for each unit of activity they have a tendency to want to keep treatment very basic and quick, this means treatments may not be as complex or personalised as private dental treatments. High-quality private treatments overcome this problem by giving the dentist the freedom to operate at whichever level they wish.

Where can I get affordable dental treatment?

Affordable treatment is, without doubt a touchy subject. It is also rather subjective. After all, what is affordable? Many people would be happy to spend £5000 on a new car or £2000 on holiday but would not want to spend the same amount of money on their teeth.

Your teeth are used 24 hours a day, 365 days a year, they allow you to eat, smile and chew with confidence. Having great teeth is an investment in yourself!

Having said that, there are ways to make dentistry more affordable.

The advent of private membership plans has made dentistry much more affordable. These plans can bring complex treatments like dental implants or root canal work down by about 5%. Paying for treatments booked in advance can also pay dividends, dental practices can offer up to 10% discount for treatments booked in this fashion. Many practices also offer finance, this is often 0% if the entire treatment is paid off within a year.

The key to finding affordable dental treatments is to speak to your dentist, don’t be afraid to let them know exactly how you feel, what your concerns are… This allows them to come up with the best price list and dental charges for you.

 

Oct 24 18

Dental implants abroad, what you need to know

by Dr Jay Padayachy

The full cost of dental implants can often run into many thousands of pounds and it is for this reason that people seek cheap dental implants abroad. This article is dedicated to providing information and advice for those patients interested in dental tourism from the perspective of a UK dentist.

What are the reasons Dental tourism occurs?

With the NHS struggling to cover a wide variety of dental treatments it’s left to private dentistry to fill this gap. Cosmetic dental treatments and particularly dental implants are very rarely available on the NHS which means patients will need to pay the full rate for any treatment they have. Dental treatments in the UK can seem relatively inexpensive but this is mainly due to the fact we are used to paying virtually nothing on the NHS.

With anything we buy we are always looking for value, so if we purchased a brand new BMW car for £5,000 that would be excellent value and most people might jump at the chance. Equally a brand new 5 bedroom house for £30,000 would be excellent value and again many would purchase due to the extreme value offered.

So it’s not about the definitive amount, rather the value that can be achieved from spending this amount.

Dental implant prices often begin much lower than £5000 but could approach £30,000 for a full set of dental implants. A car will almost certainly wear out after a few years, and we don’t even use a car 24 hours a day. A new set of teeth supported on dental implants are used all day everyday and will certainly last much longer than a car making them good value.

Unfortunately this value is not always fully recognised and people seek to have the cheapest dental implants possible… Which often means not such good value!

Why are dental implants are expensive in the UK?

The easiest way to understand this is to look at the components of a dental implant treatment in the UK to discover where each of the costs lay:

  • Initial consultation. Your dentist will want to have an initial consultation with you, this may involve CT scans, x-rays and consultations with more specialised dentists. Prior to this detailed dental initial consultation some practices may offer a free consultation .
  • Planning. Once you have decided to go ahead a full and detailed treatment plan will have to be done, this is very often provided by a dental laboratory in conjunction with the dental implant surgeon. With the highest quality comes the ability to use computer assisted diagnostics and planning, this means the dental implant is placed in exactly the right place and avoidance all of the vital nerves and blood vessels supplying your teeth.
  • Dental implant placement. After the planning stage the placement will go ahead, this will often involve the whole team including nurses, surgeons, dentists and technicians.
  • The dental implant surgery. As well as providing the practical skills your dental implant will be placed in a sterile surgical environment, as you may know this kind of facility is very expensive to run and maintain.
  • Dental implant training. Of course you will want to know that the person placing your dental implant has had the best training and continues to do so, the training courses for dental implants can be very expensive and will need to be undertaken by all of the dental professionals involved.
  • The dental implant itself. The dental implant itself will be made from high-grade medical titanium, implants are very often computer milled meaning they have tolerances of a few microns.
  • The trans-mucosal element. This is an abutment which connects the dental implant itself to your final restoration, this could either be a Crown, Bridge or denture.
  • The restoration. This is the only part of the dental implant you will actually see a it is the part that provides your new smile and enables you to eat and chew again with confidence.
  • Post operative care. After the implant is placed there will be a time of healing during which you will need to visit the dentist a few times.

As you can see, there are many elements which make up the price of the dental implant, if any of these are compromised in order to provide a cheaper dental implant than the value of the implant may be reduced and you may not receive the quality of service you expect, or indeed receive the most cost-effective treatment.

How to choose the right clinic and dentist for a dental implant

Here are our top questions to ask any clinic you are looking for:

  • What experience do you have? Ask how many dental implants they have placed in the previous year, this will give you an idea of the level of experience.
  • What do your patients say about you? Ask to see reviews by current patients, look for reviews specifically by patients that have had dental implants.
  • What dental implant system do you use? Whilst we don’t expect you to have heard of the dental implant systems if you know which system your dentist is using you will be able to do further research. Ensure that the implant system used is one of the major brands and not a cheap copy.
  • What are your qualifications? In the UK we have a list of dental specialists, these specialists have additional Masters level training. Some dentist also have additional training at postgraduate level in order to place dental implants.
  • What a professional bodies do you belong to? Ask about voluntary and compulsory membership. In the UK dentists have two comply with the Care Quality Commission and the General Dental Council regulations and are regularly audited. A foreign dental clinic may only have voluntary membership or comply to voluntary schemes this may not be as high standard as the compulsory ones in the UK.
  • What other options are there? If your dentist only offers you dental implants you may like to consider the possibility that they are not seeing the bigger picture. There are other alternatives such as bridges, dentures and sometimes doing nothing may be the best option.

How to save on full mouth reconstructions

There are often many ways to save on a full mouth reconstruction. It’s not always necessary to place multiple dental implants. Modern techniques such as All-on-4 allow your dentist place only 4 dental implants and then placed either a fixed bridge or removable denture over the top. Dentures are often a cheaper option and can provide a good way to save on full mouth reconstructions.

Some final advice

Most dental practices really do appreciate that  UK dental work can be relatively expensive, to help finance options are often available, similar to when you purchase a car. Please do let your dental practice know that you would like to find out about finance options and making treatment more affordable, there are very often ways that they can help. So don’t forget, being prepared to be open about the cost with the UK dentist may be the best option rather than travel abroad for dental implants, in order to ensure high-quality treatment.

 

Jul 30 18

Bruxism – Are You at Risk?

by Dr Jay Padayachy

Bruxism

Bruxism – a cause of enamel degradation and tooth wear. What causes it, how to stop it and how to treat it.

With the stress of modern day living more people are finding they have enamel degradation and tooth where from bruxism. This article is dedicated to helping those people and to helping you find a solution to teeth grinding /bruxism.

How do you diagnose bruxism

The first signs of bruxism will be noticeable by you at home:

  • tenderness in and around the jaw muscles
  • possible headaches
  • visible signs of tooth wear and erosion resulting in Chipping or flat edges on the front teeth

Your dentist will be able to confirm the diagnosis of bruxism by:

  • checking for additional tooth wear towards the back of your mouth where you can’t see yourself
  • checking for the signs of underlying tooth and bone damage using x-rays
  • checking the condition of other teeth for visible signs of abrasion

What is the treatment for bruxism

The treatment for bruxism is usually done in stages:

  1. understanding why you are grinding your teeth
  2. physical mechanisms and barriers to stop you grinding your teeth e.g. mouth guards
  3. drug therapies such as non-steroidal anti-inflammatory drugs like Ibuprofen to relieve pain and reduce any swelling

Understanding why you are grinding your teeth

This is the first stage in treating bruxism, if the underlying cause is stress then this will need to be addressed. If the underlying cause is something physical e.g. dental malocclusion then this can be treated with equilibration (selective and careful tooth grinding by the dentist to remove any cuspal interferences).

Bruxism mouthguards

Mouthguard can help you stop your bruxism by keeping your teeth apart. They usually fit on the lower teeth and will be custom-made for you. The surface of the mouthguard usually flat and smooth meaning your top teeth can’t lock together with your lover teeth.

This has a double effect, not only can’t your teeth meet to actually grind but the muscles around the head, face and neck will relax to then natural position. This relaxing of the muscles can also help relieve headaches caused by bruxism

Sleep bruxism

Exact causes of sleep bruxism are not actually known although there has been research which linkage to factors such as anxiety, alcohol, cigarettes smoking and stress. However, sleep bruxism is considered sleep related movement disorder and because of this if you have sleep bruxism you are statistically more likely to suffer from other sleep disorders such as snoring and possible sleep apnoea.

Can bruxism go away

Bruxism can go away depending upon its causes. If the bruxism is caused by anxiety, alcohol, cigarettes or stress then clearly reducing these factors will help with the bruxism.

There may also be other physiological causes of bruxism which, unless treated mean that the bruxism won’t go away.

Other common questions and answers about bruxism

Is it bad to grind your teeth

We all grind out teeth a little bit, after all that’s what they are therefore, to enable us to grind food into small enough chunks to eat. Teeth grinding only becomes a problem when it affects things like tenderness in around the jaw muscles, headaches and tooth and bone loss. Your dentist will be able to diagnose the extent of any teeth grinding and let you know whether it is a problem for you.

How do you relax your jaw

 

How do I stop clenching my teeth in my sleep

If your intention is to rely entirely on home remedies to stop clenching your teeth in your sleep then you have two primary ways of doing this:

  1. understand the cause of your teeth clenching and treat that, is it anxiety, alcohol, stress or cigarette smoking perhaps?
  2. Consider taking over-the-counter ibuprofen, this is a non-steroidal anti-inflammatory and can help to reduce pain and swelling. Always follow your doctor’s instructions and the labels on any medication.

How would you know if you grind your teeth and night

It’s not such an infrequent occasions that patients tell us the first thing they know about grinding their teeth and night is that their partner tells them… It can be a rather loud grinding noise!

Other symptoms of night time grinding could be you wake up with headaches or pain around the jaw joint or muscles in your jaw.

Is teeth grinding a sign a sleep apnoea

Teeth grinding is not a sign of sleep apnoea but the two conditions are link in that they are both sleep related movement disorders. There is no causal link between the two conditions but there may be other links worth investigating.

Can you get headaches grinding your teeth

Yes, you most certainly can get headaches from grinding your teeth, this is because the muscles which put your jaw together connect high up around the side of your head. If these muscles are under tension from grinding then this can be translated into headaches.


This blog post was written by Senova Dental Studios in Watford

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