Your frequently asked questions answered

Your appearance is one reason. Another is that the gap left by missing tooth can mean greater strain on the teeth at either side. A gap can also mean your ‘bite’ is affected, because the teeth next to the space can lean into the gap and alter the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes both decay and gum disease.

This depends on the number of teeth missing and on where they are in the mouth. The condition of the other teeth also affects the decision. There are two main two ways to replace the missing teeth. The first is with a removable false tooth or teeth – a partial denture. The second is with a fixed bridge. A bridge is usually used where there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth.

Bridges are usually made of a precious metal base. If the bridge will show, porcelain is then bonded to the base. Sometimes, there are other non-precious metals used in the base to reduce the cost.

You need to clean your bridge every day, to prevent problems such as bad breath and gum disease. You also have to clean under the false tooth every day. Your dentist or hygienist will show you how to use a bridge needle or special floss, as a normal toothbrush cannot reach.

There are other options, such as using a combination of crowns and partial dentures that are well disguised. You can also have teeth implanted, ask your dentist for more information.

Yes, there are different types of bridge which use different fixing methods. Your dentist will choose the most effective and conservative bridge for your personal situation. Remember that it’s as important to care for your remaining teeth as it is to replace the missing ones.

Dental hygienists are specially trained to work with the dentist in giving care to patients. They play an important role in dental health care and are mainly concerned with gum health, showing people correct home care and applying preventive materials to the teeth and gums.

The hygienist’s main role is to professionally clean the teeth for the patient. This is usually called scaling and polishing. However, perhaps their most important role is showing the patient the best way to keep the teeth free of plaque. The hygienist will work with your dentist to provide care tailored to your needs.

Regular professional cleaning combined with your home care will help keep your mouth healthy. A clean and healthy mouth will improve your appearance, help you to keep your teeth and give you fresh breath.

This is what the training of the hygienist is all about. Carefully removing the deposits that build up on the teeth (tartar) and teaching you how to prevent it reforming again, will go a long way to slowing the progress of gum disease. By discussing your diet, and recommending other preventive measures, your tooth decay can also be slowed down.

Children can benefit from having their teeth polished. The hygienist can also apply fluoride gels and solutions to help prevent decay. The permanent back teeth can also benefit from having the biting surfaces sealed. This is done by applying a special plastic coating to the biting surface soon after they come through. Adults can also benefit from having fluoride applied. They can also have anti-bacterial gels and solutions applied under the gum to kill the bacteria causing gum disease. Another very important part of the hygienist’s work is giving regular instruction and advice on home care. The hygienist may also suggest giving up smoking, as this will reduce staining. Recent research has also shown that smokers have more gum disease and lose more teeth than non-smokers.

Some dentists will carry out this type of work. However, many now recognise that the hygienist has been specially trained to carry out scaling and polishing and can spend longer with you. They are also expert at teaching you how to look after your teeth and gums. Often the hygienist will spend a number of appointments getting the gums healthy ready for the dentist to restore the teeth with crowns and fillings.

A Scaling and polishing is usually pain-free. However, if you do have any discomfort the hygienist can use anaesthetic creams, or give you some local anaesthetic. It is important that you let the hygienist know at the time so they can help with your pain. You can have the treatment under the NHS or privately. It is important to find out the cost before you start, by getting a written quotation. Some practices will have a price list displayed at reception giving a guide to the prices charged for the service. Under the NHS rules, the government fixes the price.

You can do a great deal to help yourself and the hygienist, as you are in control of your mouth between visits to the practice. Your hygienist will have shown you how to remove plaque with a toothbrush and fluoride toothpaste. You will also have been shown how to clean between your teeth with floss, tape or little brushes. There are many products now available, and your hygienist will recommend those that are best for you. Cutting down the amount of sugar in your diet, and the number of times that you eat during the day, can help to reduce decay. Your hygienist can help you by looking at your decay problem, your diet and by making some recommendations for you to consider.

A dental implant is a titanium metal rod which is placed into the jawbone. It is used to support one or more false teeth. In practice, both the false teeth and their supporting rod are known as ‘implants’.

Implants are a well-established, tried-and-tested treatment. 90 per cent of modern implants last for at least 15 years.And yes you can still have Implants if you have some of your own teeth. You can have any number of teeth replaced with implants – from one single tooth to a complete set.

It depends on the state of the bone in your jaw. Your dentist will arrange for a number of special tests to assess the amount of bone still there. If there is not enough, or if it isn’t healthy enough, it may not be possible to place implants without grafting bone into the area first.

Placing the implants requires a small operation. This can be carried out under local anaesthetic with sedation or with a general anaesthetic. You will not feel any pain at the time, but you may feel some discomfort during the week following the surgery. This is usually due to having stitches in place, and the normal healing process.

No. The implants need to bond (integrate) with the bone after they have been placed. This takes at least 3 months in the lower jaw and 6 months in the upper jaw. If you are having one, two or three teeth replaced, you will have a temporary restoration in the meantime. If you have complete dentures, then you can wear them throughout the healing period once they have been adjusted after the surgery.

It takes about 12 months from the initial assessment to the time when the artificial teeth or dentures are finally attached to the implants. However, if only the lower jaw is involved then it may only take around 5 months. A lot depends on how complicated your treatment is. Your dentist will be able to give you a timetable once the surgery has been done.

Cleaning around the teeth attached to the implants is no more difficult than cleaning natural teeth. However, there may be areas that give you problems and you’ll be shown methods to help.

Yes, if you don’t care for them well enough. If you keep them clean, and don’t smoke, then you should not have any problems.

Most artificial teeth attached to implants can only be placed and removed by the dentist. However, if you have complete dentures fixed to the implants by bars, then you’ll be able to take them out for cleaning.

No, unless you’re only having a single tooth replaced. Normally, five or six implants are used to replace all the teeth in one jaw, as each implant can usually support two teeth. For a few missing teeth, two or three implants may be used.

This happens very rarely. If the implant becomes loose during the healing period or just after, then it is easily removed and healing takes place in the normal way. Once the jaw has healed, another implant can be placed there. Or, the dentist can make a bridge, using the implanted false teeth that have ‘taken’.

A veneer is a thin layer of porcelain made to fit over the front surface of a tooth, like a false fingernail fits over a nail. Sometimes a natural colour ‘composite’ material is used instead of porcelain.

Veneers make teeth look natural and healthy, and because they are very thin and are held in place by a special strong bond (rather like super-glue) very little preparation of the tooth is needed.

Veneers can improve the colour, shape and position of teeth. A precise shade of porcelain can be chosen to give the right colour to improve a single discoloured or stained tooth or to lighten front teeth (usually the upper ones) generally. A veneer can make a chipped tooth look intact again.The porcelain covers the whole of the front of the tooth with a thicker section replacing the broken part. Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.

A natural-coloured filling material can be used for minor repairs to front teeth. This is excellent where the tooth supports the filling, but may not work so well for broken tooth corners. There will always be a join between the tooth and the filling material. Crowns are used for teeth that need to be strengthened – either because they have broken, have been weakened by a very large filling, or have had root canal treatment.

Veneers should last for many years, but they can chip or break, just as your own teeth can. Your dentist will tell you how long each individual veneer should last. Small chips can be repaired, or a new veneer fitted if necessary.

Some of the shiny outer enamel surface of the tooth may be removed, to make sure that the veneer can be bonded permanently in place later. The amount of enamel removed is tiny and will be the same as the thickness of the veneer to be fitted, so that the tooth stays the same size. A local anaesthetic (injection) may be used to make sure that there is no discomfort, but often this is not necessary. Once the tooth has been prepared, the dentist will take an ‘impression’. This will be given to the dental technician, along with any other information needed to make the veneer. The colour of the surrounding teeth is matched on a shade guide to make sure that the veneer will look entirely natural.

A veneer takes at least two visits; the first to prepare the tooth and to match the shade, and the second to fit it. Before bonding it in place, your dentist will show you the veneer on your tooth to make sure you are happy with it. Bonding a veneer in place is done with a special adhesive, which holds it firmly on the tooth.

Because the preparation of the tooth is so slight you will probably not need a temporary veneer. The tooth will look very much the same after preparation, but will feel slightly less smooth.

Only minor adjustments can be made to the veneer after it is fitted. It is usually best to wait a little while to get used to it before any changes are made. Your dentist will probably want to check and polish it a week or so after it is fitted, and to make sure that you are happy with it.

Dental occlusion is another name for the way your teeth meet when your jaws bite together.

The letters TMJ are short for of ‘temporo-mandibular joint’, which is the joint connecting your lower jaw and your skull. The movement in this joint lets you open and close your mouth and chew from side to side.

If your teeth don’t fit together properly, you can have problems not only in your teeth themselves, but also the gums, the temporo-mandibular joint or the muscles that move your jaw. These problems are called ‘occlusal’ problems.
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Teeth
Teeth that are out of line, heavily worn or constantly breaking, fillings that fracture or crowns that work loose may all be signs of occlusal problems. Your teeth may also be tender to bite on or may ache constantly.
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Gums
Loose teeth or receding gums can be made worse by a faulty bite.
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TMJ
Clicking, grinding or pain in your jaw joints, ringing or buzzing in your ears and difficulty in opening or closing your mouth could all be due to your teeth not meeting each other properly.
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Muscles
If your jaw is in the wrong position, the muscles that move the jaw have to work a lot harder and can get tired. This leads to muscle spasm. The main symptoms are continual headaches or migraine, especially first thing in the morning; pain behind your eyes; sinus pain and pains in your neck and shoulders. Sometimes even back muscles are involved.

See your dentist. He or she may be able to help you or may refer you to a specialist who deals with occlusal problems. Depending on the problems you are having, it can be possible to spot the signs of an occlusal problem. Various muscles may be sore when tested, or the broken and worn areas of your teeth will show you are grinding your teeth – a common sign of an incorrect bite. If your dentist suspects that your problems are due to an incorrect bite, he or she may help to diagnose the problem by supplying a temporary soft nightguard or hard plastic appliance that fits over your upper or lower teeth. This appliance needs to be measured and fitted very accurately so that when you bite on it, all your teeth meet at exactly the same time in a position where your muscles are relaxed. You may have to wear this all the time or, just at night. If the appliance relieves your symptoms then your bite may need to be corrected permanently.

Tooth Adjustment (equilibration)
Your teeth may need to be carefully adjusted to meet evenly. Changing the direction and position of the slopes that guide your teeth together can often help to reposition the jaw.

Replacement of teeth
The temporo-mandibular joint needs equal support from both sides of both jaws. The chewing action is designed to work properly only when all your teeth are present and in the correct position. Missing teeth may need to be replaced either with a partial denture or bridgework.
Replacement is not usually done until a diagnosis has been confirmed by using an appliance and this has fully relieved the symptoms. Relief in some patients is instant: in others it can take a long time.

Medication
Some drugs can help in certain cases, but this is usually only temporary. Hormone replacement therapy may also help some women.

Diet and Exercise
As with any joint pain, it can help to put less stress on the joint. So a soft diet can be helpful, as can Corrective exercises and external heat. Physiotherapy exercises can often help, and your dentist may be able to show some of these to you.

Relaxation
Counselling and relaxation therapy may help in some cases. These techniques help the patient to become more aware of stressful situations and to control tension.

You may find that you clench or grind your teeth, although most people who do aren’t aware of it. Sometimes can be caused by anxiety, but generally most people clench their teeth when they are concentrating on a task – housework, gardening, car mechanics, typing and so on.You may wake up in the morning with a stiff jaw or tenderness when you bite together. This could be due to clenching or grinding your teeth in your sleep. Most people who grind their teeth do it while they are asleep and may not know they are doing it. If you suffer from severe headaches, or neck and shoulder pain, you may not have linked this with possible jaw problems. Or you may keep having pain or discomfort on the side of your face around your ears or jaw joints or difficulty in moving your jaw. These are all symptoms of TMJ problems. If you are missing some teeth at the back of your mouth, this may lead to an unbalanced bite, which can cause uneven pressure on your teeth.Together, all these symptoms are called ‘TMJ syndrome’.

If your teeth are too far out of line or in a totally incorrect bite position, it may be necessary to fit an orthodontic appliance to move them into a better position.

Up to 1 in 4 people may have some symptoms. Both men and women are affected equally, although women tend to seek treatment more often than men. The symptoms can often start with the menopause or other hormonal changes. Many people have imperfect occlusion and missing teeth, yet never have symptoms because they adjust to their problems. Occasionally, in times of increased stress and tension, the symptoms may appear and then go away immediately.

Or, your teeth and gums may be affected straight away and instead of headaches, you may suffer:

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  flattened, worn teeth
  

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  broken teeth, fillings and crowns
  

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  loose teeth
  

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  continual sensitivity of your teeth to temperature change
  

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  toothache with no apparent cause
  

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  If you think you have any of these problems, ask your dentist
  

A dental implant is a titanium metal rod which is placed into the jawbone. It is used to support one or more false teeth. In practice, both the false teeth and their supporting rod are known as ‘implants’.

Implants are a well-established, tried-and-tested treatment. 90 per cent of modern implants last for at least 15 years.And yes you can still have Implants if you have some of your own teeth. You can have any number of teeth replaced with implants – from one single tooth to a complete set.

It depends on the state of the bone in your jaw. Your dentist will arrange for a number of special tests to assess the amount of bone still there. If there is not enough, or if it isn’t healthy enough, it may not be possible to place implants without grafting bone into the area first.

Placing the implants requires a small operation. This can be carried out under local anaesthetic with sedation or with a general anaesthetic. You will not feel any pain at the time, but you may feel some discomfort during the week following the surgery. This is usually due to having stitches in place, and the normal healing process.

No. The implants need to bond (integrate) with the bone after they have been placed. This takes at least 3 months in the lower jaw and 6 months in the upper jaw. If you are having one, two or three teeth replaced, you will have a temporary restoration in the meantime. If you have complete dentures, then you can wear them throughout the healing period once they have been adjusted after the surgery.

It takes about 12 months from the initial assessment to the time when the artificial teeth or dentures are finally attached to the implants. However, if only the lower jaw is involved then it may only take around 5 months. A lot depends on how complicated your treatment is. Your dentist will be able to give you a timetable once the surgery has been done.

Cleaning around the teeth attached to the implants is no more difficult than cleaning natural teeth. However, there may be areas that give you problems and you’ll be shown methods to help.

Yes, if you don’t care for them well enough. If you keep them clean, and don’t smoke, then you should not have any problems.

Most artificial teeth attached to implants can only be placed and removed by the dentist. However, if you have complete dentures fixed to the implants by bars, then you’ll be able to take them out for cleaning.

No, unless you’re only having a single tooth replaced. Normally, five or six implants are used to replace all the teeth in one jaw, as each implant can usually support two teeth. For a few missing teeth, two or three implants may be used.

This happens very rarely. If the implant becomes loose during the healing period or just after, then it is easily removed and healing takes place in the normal way. Once the jaw has healed, another implant can be placed there. Or, the dentist can make a bridge, using the implanted false teeth that have ‘taken’.

Root canal treatment (also called endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury. If the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess. If root canal treatment (RCT) is not carried out, the infection will spread and the tooth may need to be taken out.

The aim of the treatment is to remove all infection from the root canal. The root is then cleaned and filled to prevent any further infection. Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits to your dentist.At the first appointment, the infected pulp is removed. Any abscesses, which may be present, can also be drained at this time. The root canal is then cleaned and shaped ready for the filling. A temporary filling is put in and the tooth is left to settle.The tooth is checked at a later visit and when all the infection has cleared, the tooth is permanently filled. A local anaesthetic is used and it should feel no different to having an ordinary filling done.

In the past, a root filled tooth would often darken after treatment. However, with modern techniques this does not usually happen. If there is any discolouration, there are several treatments available to restore the natural appearance.

Root canal treatment is usually very successful. However, if the infection comes back the treatment can be repeated.

Yes. However, it is better to restore the tooth with a crown to provide extra support and strength to the tooth.

Root-treated teeth should be treated just the same as any other tooth. Remember to clean your teeth at least once a day, preferably with a fluoride toothpaste. Cut down on sugary snacks, and keep them only to mealtimes if possible. See your dentist for regular check-ups.

Tooth whitening can be a highly effective, yet very simple way, of lightening the colour of teeth without removing any of the tooth surface. It cannot make a colour change, but lightens the existing colour.

In a live tooth the dentist applies the whitening product using a specially made tray which fits into the mouth like a gum shield. The chemical is then activated using heat, or heat and light combined. The active ingredient in the product is normally hydrogen peroxide or carbamide peroxide. If the tooth has been root treated, the canal, which previously contained the nerve, may be reopened and the whitening product is put in. In both cases, the procedure needs to be repeated until the right shade is reached.

First of all you will need 2 or 3 visits to your dentist. Your dentist will need to make a mouthguard and will need to take impressions for this at the first appointment. Once your dentist has started the treatment, you will have to continue the treatment at home. This will mean applying the bleach regularly over 2-4 weeks for 30 minutes to 1 hour at a time. However, some newer products can be applied for up to 8 hours at a time, which means that a satisfactory result can be obtained in as little as 1 week.

Everyone is different; and just as our hair and skin colour varies, so do our teeth. Some teeth have a yellowish tinge, some are more beige – very few are actually ‘white’. Teeth also yellow with age can become stained on the surface by food and drinks such as tea, coffee and blackcurrant. Calculus (tartar) can also affect the colour of the teeth. Some people may have staining inside their teeth. This can be caused by certain antibiotics or tiny cracks in the teeth, which take up the stain.

Over-the-counter kits are not recommended as they contain only a small amount of hydrogen peroxide which makes the product less effective. Some also contain mild acids, while others are abrasive. Although these products are cheaper, whitening is a complicated treatment procedure and should only be carried out by a dentist after a thorough examination and assessment of your teeth. It is very important to follow the instructions your dentist gives you, and to make sure that you go for any follow-up appointments recommended.

Whitening can only lighten your existing tooth colour. For a change to specific chosen shade veneering is another option. Whitening also works on natural teeth. It will not work on any type of ‘false’ teeth. This includes dentures, crowns and veneers. If dentures are stained or discoloured, it may be worth visiting the dentist and asking him or her to clean them. Stained veneers, crowns and dentures may need replacing. Again, ask your dentist.

There are now several whitening toothpastes you can buy. Although they do not affect the natural colour of the tooth, they are effective at removing staining and therefore improving the overall appearance of the tooth. Whitening toothpaste may also help to keep up the appearance, once teeth have been professionally whitened.

Treatment results may vary depending on the original shade of the teeth. Teeth will tend to darken slightly over time. The effect lasts for around 1 to 3 years, although sometimes it can last longer. Some people find that their teeth are sensitive for the first few days after treatment, but this wears off after a short while.