How does sugar affect our teeth?

It is a well known fact that sugar consumption is the primary reason cavities form in teeth. But how does this process occur and what can you do to minimise its effects?

Sugar (in all its different forms), is used by our bodies to fuel metabolic processes. The same sugar is used by the billions of bacteria in our mouths as their energy source, and if readily available they will use it to grow and multiply. A waste product of all this sugar use by these bacteria is acid, and it is this acid which dissolves tooth structure and causes decay.

Drinks such as coke have the double effect of containing sugar as well as acid, and therefore are even more damaging to teeth.

Steps you can take to minimise sugar related tooth decay

1. reduce your sugar intake! The most obvious way to reduce the effects of sugar is to reduce sugar itself. Whilst even more complex carbohydrates will be converted to simple sugars by enzymes in your mouth, reducing further intake will lead to less tooth decay

2. timing your sugar intake . We recommend that if you do want to consume a soft drink or sweet, have it after a meal when your mouth already is in an acidic state from the other food you have consumed. This will lead to just one acid ‘attack’ on your teeth as opposed to multiple if snacking on sugary food or drink.

3. drink tap water after a meal. Drinking tap water will help reduce the acidic load in your mouth and also provide flouride to remineralise the areas of your teeth that have been dissolved by the acid.

4. clean your teeth properly! Toothbrushing and flossing are by far the most effective way to reduce the amount of bacteria in your mouth. The plaque and tartar on your teeth are filled with the bacteria that cause all the ill effects in our mouths.

6 easy steps to keep your smile looking great.

When it comes to a great smile, the basics are often all you need. With the recent lockdowns happening it’s important to take the right steps whilst at home. Here are 6 easy steps to take all year round.

1. Use a soft bristled toothbrush with fluoridated toothpaste twice a day for 2 minutes each time.

2. Flossing at night to remove the plaque between your teeth that brushing won’t reach.

3. Avoid smoking in all forms.

4. Eat nutritious whole foods as opposed to processed

5. Avoid sugary food and drinks.

6. Stay hydrated, drink at least 2L a day of fluoridated water.

The Rule of Two

When it comes to basics in oral hygiene and maintenance, there is a simple rule of 2 which can be applied to the vast majority of the population.

How long do you need to brush your teeth for ? 2 minutes

How many times a day? 2 times

How many times a year should you see your dentist for a check up and clean? 2 times (once every 6 months).

If applied properly, and short of any unexpected accidents, the average patient will require minimal if any restorative work on their teeth during the course of their life.

Literature shows us that dental plaque forms almost as soon as food enters your mouth. Now for a window of about 24-36 hours, this film will be soft and easily removed with your toothbrush and floss. Left any longer than that it will start to calcify, meaning it will use the ‘good’ ions in your saliva (that teeth use to strengthen themselves), to harden and once this has happened, it has turned into tartar (calculus). Calculus cannot be removed by your toothbrush and requires a scale from your dentist. By brushing twice a day you give yourself 2 opportunities to remove all the plaque off your teeth before it becomes tartar.

2 minutes (or sometimes up to 3 ) is the ideal duration of a toothbrushing session, it enables you to spend 1 minute on the upper teeth and 1 minute on the lower. With proper technique you should be able to cover all teeth with sufficient time.

6 months in a year can pass very quickly, but if there’s an issue in your mouth, 6 months can be the difference between having a simple quick fix to requiring something like an extraction or root canal. Also tartar that is left on your teeth is a continual irritant that causes gingivitis (or in severe cases periodontitis), and needs to be removed in a timely manner to prevent irreversible gum and bone recession.

Dental Implants to improve your uncomfortable denture

There is often a great deal of confusion about what a dental implant is. Traditionally, a single dental implant was used to replace a single missing tooth. When a patient is missing a large number of teeth, the assumption is that there will be so many implants that need to be placed that its just not financially possible. They are then left with no option but to use traditional dentures, which are often times either bulky, move too much or both. This is most apparent with lower full dentures.

What a large number of patients are not aware of is that dental implants do not have to have a SINGLE tooth attached to them, rather they can be used to anchor in your existing dentures. As little as 2 dentures on the lower jaw can make that loose and uncomfortable denture turn into an extremely stable and less bulky set of teeth. With upper full dentures, while the are able to stay retentive on their own accord, they do require the entire roof of the mouth (palate) to be covered which increases its bulk significantly. With implants the entire palate portion can be removed, drastically reducing the size of the denture. This also has the added benefits of a smaller denture to clean, less surface for plaque to build up, and giving the soft tissue on your palate a to be ‘free’ to prevent possible candida infections.

If you or a loved one is struggling with their dentures we at the Dental Surgery - St Marys would be happy to assess your condition and discuss how we can help get you eating and smiling comfortably again!

Wisdom Tooth Extraction and Sedation.

Dental anxiety is one of the main reasons people avoid seeing their dentist. Unfortunately without routine examinations and cleans, this ultimately leads to more extensive and costly treatment.

Undoubtedly one of the most difficult procedures to sit through would be having wisdom teeth removed, and in many cases the removal of these teeth cannot be avoided. Whether they are impacted, have cavities in them, or causing pain, a majority of the time the only way to fix these issues is to have these teeth removed.

Some patients are able to have these teeth removed just under local anaesthetic (numbing injection). The benefits of having this is minimal after effects of the anaesthetic, you are able to drive and have no loss of cognitive function once the procedure is over. Its the same anaesthetic you would get if you had a simple filling or deep clean done. However you will feel a lot of pushing and pressure, and to some patients this is too much to bear even though it is not ‘painful’.

If you require stronger sedation there is IV sedation which is medication that results in a ‘twilight’ effect. You are not completely asleep, however the medication means you are completely relaxed. Once the procedure is finished you will have little to no recollection of the treatment. It is what we recommend for those patients would are apprehensive about being completely awake. We are able to offer this service in our rooms, so no extra costs are involved unlike a day surgery where G.A is involved.

G.A is where the patient is put completely to sleep. It requires a day surgery and a more extensive list of pre-op steps to carry out. If a patient would prefer to see a specialist oral maxfacs surgeon to remove their wisdom teeth, this is often conditions under which they will operate. We are able to provide a referral to one of the friendly surgeons in the region if the patient so wishes or we deem it necessary.

If you require wisdom teeth removal we are able to offer all four wisdom teeth extracted with IV sedation for $2400. Please contact us for any further enquiries.

Dental Work and Pregnancy

“Can I have dental work done while I’m pregnant?” 

Did you know, that doctors in training are informed that if a pregnant woman requires a chest X-Ray, that the radiation dose to the foetus is so insignificant that the risks of misdiagnosis and not assessing the lungs and heart properly far outweigh any risk of the low dosage of the xray!

The foetal radiation dose of a chest radiograph is 0.001 rads. If we compared that to a dental radiograph, the foetal dose is even smaller at 0.0001 rads (that’s 1/10th the exposure!)

Key messages for patients regarding dental treatment and pregnancy:

1. Ideally women considering pregnancy should try their best to ensure any major dental work is undertaken PRIOR to pregnancy if possible.

This can help prevent women forming misled correlations of any adverse pregnancy events with any pre-birth events or dental work done. In other words, peace of mind for the expecting mother.

1. All routine and emergency dental treatment is indicated at any time during pregnancy.

2. Dental imaging should be used when required!

Untreated dental infections can trigger pre-term birth and result in overwhelming maternal infection.

1. Pregnant women from 28 weeks onward need careful positioning in the dental chair.

Lying back at this stage of pregnancy can be uncomfortable and can sometimes lead to low blood pressure. Placing a small pillow under one side of your back while in the chair can help minimize this. 

1. In the third trimester, avoid using and NSAID (anti-inflammatory) drugs. These can have serious adverse affects on the baby. For dental pain relief, paracetamol is recommended.

Hopefully this helps clear some of the myths and fears associated with pregnancy and dental treatment! At all times, treatment is based on the individual and often requires communication with other healthcare professionals in charge of your welfare. Prevention and planning is always key.

Digital Dentistry is now here at Dental Surgery - St Marys

One of the simplest procedures carried out in daily dental practice is the dental impression. It is completely painless and takes only a few minutes to complete. However for many patients with an exaggerated gag reflex, this simple undertaking is actually their most dreaded thing about going to the dentist.

Everything in todays age is going digital. Dentistry is not any different. Where we used to take analogue impressions with alginate and putty we now have the ability to take the same moulds with a digital intraoral scanner.

Where the scanner is most useful is for those impressions to make a new crown or bridge, as these moulds were traditionally taken with a high accuracy putty (PVS) that required a longer time in the mouth to set. With the use of an intraoral scanner, we can perform the same ‘mould’ in the same time or less, but without the discomfort and messiness involved in using the putty. It also eliminates the chance of the mould being distorted and having to retake it.

Some procedures the scanner can be used are ,

-for orthodontic (braces) analysis

-for mouthguards

-for occlusal splints (nightguards)

-whitening trays

-crowns, bridges and implants.

We at the Dental Surgery - St Marys are always on the lookout for new technology and innovations to make our patients as comfortable as possible, as well to as deliver the best quality dentistry.

What to do and What Not to Do after a Tooth Extraction.

For many of us, a tooth extraction or extractions will be the most invasive medical procedure we will undergo whilst being completely awake. Whilst modern anaesthetics will take all the discomfort out of the actual procedure, once it has worn off there are a number of things you need to do to ensure the area heals as quickly as possible.

The first 24 hours are primarily concerned with pain relief and bleeding control. The blood clot that forms straight after the extraction is fragile and needs time to establish itself into the wound. So

DO NOT rinse or gargle with anything for 24 hours, swallow your saliva even though it may taste like blood.

DO NOT drink anything hot, keep drinks cold to cool

DO NOT spit

DO NOT do any exercise and rest as much as you can.

DO NOT drink alcohol , and do not smoke for at least 48 hours.

DO take analgesics such as paracetamol, ibuprofen or a combination of the two, whilst the area is still numb from the anaesthetic. This will take effect as the numbness wears off and will prevent a sudden onset of pain. Ibuprofen will limit the swelling and help with ongoing pain.

DO still brush your other teeth, taking care around the wound. Leaving plaque behind will increase the bacteria in the area and the likelihood of a subsequent gum infection.

DO contact the surgery if bleeding continues and you find your mouth filling up with blood. A steady stream/trickle of blood is to be controlled with more gauze and firm pressure for 10 mins at a time. If your dentist is closed head to the hospital emergency room.

After 24 hours, the clot will be established and you can now rinse salt water to irrigate the gum and remove any debris that may make its way into the wound.

DO rinse with salt water twice a day starting 24 hours after the extraction.

DO continue to use pain relief if required. A wound in the bone takes much longer to heal than one in soft tissue so pain relief may be required for up to a week in some patients.

If pain should all of a sudden presents after a few days and/or a foul taste and odour develops, and especially if you have a history of smoking, you should contact your dentist in case a dry socket has developed. Whilst a dry socket is self limiting, your dentist should check to ensure it’s not some other sort of infection that requires attention.

Following these simple steps will ensure that your recovery is as quick and painless as possible.

The truth about charcoal toothpaste

Anyone on social media will tell you there are endless advertisements and influencers promoting the use of charcoal toothpaste to whiten their teeth. In this blog we will discuss the truth about charcoal toothpaste, namely does it work and what risks are involved when using it.

Activated charcoal has the ability to absorb dirt and impurities. It is commonly used in water filtration systems and food poisoning for this very reason i.e. to remove toxins. So in theory applying it to your teeth should do the same thing right? The companies that market these toothpastes state they will remove impurities and stains from your teeth making them whiter.

The truth is there are no studies to prove these claims, or whether charcoal toothpaste is indeed safe to be used on your teeth. What we do know however is that charcoal toothpaste is very abrasive, and if you have surface stains from things such as smoking, red wine, or tea, the toothpaste will be effective in removing these. However if used everyday, it will start to wear your enamel away (think sandpaper to a piece of timber), and if worn through enough your teeth will start to look darker as the dentine (the 2nd layer of the tooth) starts to show. This also in turn can cause sensitivity and tooth ache. The charcoal may also make its way into fine crevices in the teeth that will be difficult to remove. Finally, Fluoride is often missing from these toothpastes, and using them will not help remineralise teeth or prevent cavities.

Our message when asked about these toothpastes is if you’re wanting to whiten your teeth, the best way is using custom made trays and whitening gel. This in combination with fluoridated sensitive toothpaste will give you the best results with the least discomfort. There simply isn’t enough clinical data on whether charcoal toothpaste is safe, and until such research is done we can’t recommend it use.

Dental Pain

“I have a toothache, what needs to be done to fix it?”. This is an all too common question we are confronted with on a daily basis. The answer depends on a combination of different factors i.e.the type of pain felt, the duration of onset, things that make it worse/better, whether it disturbs sleep just to name a few.

Generally speaking a sharp, sudden and short lasting pain that can be isolated to a tooth is a better sign than a long lasting ache that is more in a general area rather than a single tooth. A short lasting pain in a tooth is more characteristic of a ‘reversible pulpitis’, that is, an inflammation in the nerve that can be removed with treatment.

A long lasting pain is characteristic of an ‘irreversible pulpitis’, that is, inflammation in the nerve that cannot be removed and will eventually lead to the nerve dying and an infection forming. This type of pain is more of a dull ache in nature, spontaneously starts and wakes one up from their sleep. Because the inflammation in the nerve cannot be removed, the only way to treat this pain is to remove the nerve itself (root canal treatment), or the entire tooth.

Pain can also present from the gums, and if left long enough will start to effect the teeth. This is because all the tissues are joined together, and the same nerves innervate them. Gum pain and infections if left long enough can affect the teeth through their roots and cause tooth pain.

The sinus’ can also cause pain due to the location of the upper molar roots. Sometimes these upper molar roots are part of the wall that forms the sinus and so any sinus infections can present as tooth ache.

Finally other pathology from cysts, tumours, infections of the bone, or any other tissues of the mouth can be referred to the teeth, and other times toothache can be referred to other structures. Ear ache is a common presentation in lower molar pain when it has become chronic.

Diagnosis of pain is complex at the best of times. A combination of your symptoms, the signs we clinically detect, the information gathered from clinical tests and imaging are all used to ensure the correct treatment is carried out.

The toothbrush, a simple device but a not so simple choice.

There are literally hundreds of different toothbrushes being marketed at any one time, all promising to deliver a superior clean and improve the users oral health. Manual, electric, oscillating, sonic, floss action.….for a device that is basically used to scrape plaque and food off your teeth there is no shortage of options to win over the consumer. So which is best and why?

At dental school we are taught that a manual toothbrush, with a small head and soft bristles, combined with daily flossing and fluoridated toothpaste is the gold standard for keeping those pearly whites and gums healthy (when used correctly and for the adequate amount of time). Being human however means we will make mistakes in our technique which can lead to ongoing problems. Electric toothbrushes either use an oscillating (spinning left and right) or sonic (rapid side to side vibration) to increase the 'cleaning power’ of the toothbrush. The idea behind them is to take out a lot of human error in brushing technique and having the brush do the work.

Between the two styles of brushes there are various other features such as bluetooth, pressure sensors, different cleaning modes, travel cases. Whether these are helpful to the patient is really based on the individual. What we are really interested in is which style is more effective at plaque removal, and if they’re actually better than manual toothbrushes.

A study (https://www.cochrane.org/CD002281/ORAL_poweredelectric-toothbrushes-compared-to-manual-toothbrushes-for-maintaining-oral-health) has found that electric toothbrushes are superior to manual ones in cleaning, regardless of the type. The difference however between oscillating and sonic is less clear, with studies showing slightly better plaque reduction with oscillating type brushes, but a difference so small that this may not be of any significance in the real world.

Our advice? We have always preferred the oral b oscillating style toothbrushes. The smaller brush head enables easier access to those back teeth. However if you use a sonic toothbrush and its working for you, theres no compelling evidence for you to change.

Just remember that no amount of brushing will substitute for flossing, and this is true for electric toothbrushes also.

Dentures...or implants?

A question we often encounter from patients is ‘which is best, dental implants or a denture?’. This question is loaded with so many different factors to consider, but we will go through the common ones in this blog.

Dentures:

A denture, whether it be a partial or complete one, is a prosthetic device which is designed to replace anything missing, from a singe tooth to all of a patients teeth. It can be made of acrylic, cobalt chrome, a thermoplastic nylon or a combination of these. It is removable, and needs to be taken out of the mouth to be cleaned and maintained.

A staple for many years and even today, dentures have the main benefit of being cost efficient when replacing multiple missing teeth, and requiring little to no drilling of the existing teeth (in the case of a partial denture). The main cons of a denture are the added bulk of the base which the denture teeth are attached to, the removable aspect means constant removing and placing back in, retainers (‘hooks’) to hold in the denture may be visible, and the possibility of losing /breaking them when not in the mouth. With full dentures, the lower complete denture is well known to be hard to manage initially, and is always loose and moving.

Implants:

A dental implant is technically just the titanium fixture ( ‘screw’ ) that is surgically placed into the bone of where a tooth used to exist. When used to replace a single tooth, the attached tooth to the implant is called an ‘implant crown’.

If multiple implants are placed, and a row of teeth are made to attach to these, this is called an ‘implant bridge’. The popular ‘all on 4’ procedure uses 4 implants to which a long bridge of teeth (the entire row) is attached to.

Implant crowns and bridges are fantastic substitutes for real teeth, as they are fixed into the mouth, do not require work to be done on neighbouring teeth, do not add any bulk and basically feel like a natural tooth. The main drawbacks of implants for some people is cost (especially if requiring multiple implants), the surgery itself and the time taken to complete a case,

Implants can also be used to help hold a denture in place. Instead of a tooth being attached to the implant, components that ‘click’ together can be put onto the implant and denture to help hold it in place. This is done on partial dentures where existing teeth aren’t sufficient to hold it in place, or in complete dentures (especially lower dentures) where there is nothing for the denture to grip onto.

So which is right for you?

It all depends! There is no right or wrong answer, and depending on your circumstances and clinical assessment some options may be more suited. A discussion with your friendly dentist is a good first step in establishing which options are actually viable for you individually and the fine details involved.