Ask the Dentist

It is not true that fillings accelerate recession. Gum recession has many causes including overbrushing, gingivitis or periodontitis (gum disease) & having thin gums & thin bone below the gums. Pain on biting is not usually caused by gum recession.

The symptoms are likely to be sensitivity or pain with cold air, hot & cold drinks & sweet food such as chocolate. Go back to your dentist & have any fillings checked & Xrayed in the area you had pain & have a filling replaced if necessary.

You don't mention how old you are & how much the gums have receded. Ask the dentist to record the amount of recession & monitor it over the next year or two. Ask the hygienist to check your brushing technique & floss your teeth daily. There should be no bleeding gums on brushing or flossing.

Alcohol is a well established cause of & definitely increases the risk of mouth cancer according to the World Health Organisation .

However,combining smoking with drinking alcohol increases the risk even more.Drinking 6 units of alcohol a day triples the risk of oral cancer compared to non drinkers.

In 2008 a study in the Australian Dental Journal suggested that a mouthwash with a high alcohol content could cause mouth cancer.

One of the biggest selling mouthwashes world wide has a staggering amount of alcohol in the region of 21.6 to 26.9 %.The company also now sells "Zero" a mouthwash which is alcohol free.

In 2009 the American Dental Association said that the available evidence did not support the connection between oral cancer & alcohol containing mouthwashes.

The science is not clear but there is no disputing the figures of 5000 cases a year of mouth cancer in the UK.

I do not recommend mouthwashes with alcohol.They are often too strong & unpalatable & I do not recommend them mainly because of the alcohol content..There are plenty of good mouthwashes which are alcohol free.

Swelling & discomfort in a wisdom tooth is usually caused by a localised infection to the gum over the tooth which is pushing through as it tries to "erupt" into the mouth.The tooth may be part through & trapping food & bacteria which causes the infection.It can be very painful & a bit like teething.

You should go to your dentist & have Xrays taken of all your wisdom teeth on 1 Xray called an OPT or orthopantomograph.This should indicate the position of the wisdom teeth & whether it would be easy to remove them.Make sure you are using HOT salt mouthwashes about 3 times a day.You may also need antibiotics to help control an infection.

Implants are a very successful long term replacement for missing natural teeth, but there are so many questions you need to ask & receive understandable answers.

For example :

1. How many implants have you placed & restored & over what length of time?
2.What is your success rate & how do you deal with failures?
3.Which system do you usually prefer & why?
4.Do you place the implants & restore them ?if not who does?
5.Will I need a fixed bridge held by implants & have I got enough bone quantity & quality?
6.Will I need a CT scan to assess the bone quantity & quality?
7.Do I need sedation?
8.How long will the treatment take & what will I wear after  the bridge  has been removed & I'm waiting for the implants to "integrate" with the bone?
9.How experienced are the technicians you use in implants ?

After an examination you should be offered a treatment plan & estimate covering different options. It is then that you can ask more questions about the look, design, materials & aftercare.

More experienced dentists are likely to use one of the better systems which have been established for many years & have a good track record of success. These companies are at the leading edge of research & development & are likely to offer guarantees on their products. Base your decision on "informed consent" ie carry out your own research. Most implants are made of the purest medical grade titanium as are the posts (abutments) & screws.The crowns or bridges are usually made of porcelain fused to metal.Sometimes the abutments & crowns are made in zirconium which is a hard all ceramic material & can offer a better appearence on the front teeth.

Your options include having a new better fitting denture made, having the current denture relined or consider having implants fitted & either an "overdenture" which you can remove but snaps into & is supported by the implants or a fixed bridge on implants which cannot be removed by you. Go back to your dentist & ask for more information on these alternatives and if they are not helpful ask around & find a new dentist.

The best cleaner is soap & water with a small headed toothbrush,cleaned over a sink .Avoid soaking in proprietary denture cleaners which can cause the metal (usually chrome cobalt ) to tarnish

The night mouthguard was probably fitted not only to stop you damaging your teeth but also to stop you grinding your teeth & overworking your jaw joints & muscles.This can cause muscle spasms,fatigue ,joint clicking,facial pain & some headaches.However,I would think that neck pain & headaches are outside the remit of a dentist & you should visit your doctor.

It would not be unprofessional to ask your dentist to clean your teeth.However good hygienists often spend longer & are better at routine cleaning than many dentists whose time should be spent on more complex dentistry.Personally I clean the teeth on about 6 patients who have either gum problems or extensive crown & bridegework & prefer me to clean ther teeth.We have 3 hygienists who are very sympathetic,caring & highly skilled in educating patients to prevent & control dental disease & are gentle but thorough in applying their skills. If your dentist does not want to clean your teeth you could consider finding a hygienist elsehere who would.

Waterpiks are not bad at dislodging large soft deposits such as food between the teeth but my patients find them messy & less effective than other aids at removing the tenacious biofilm of bacteria called plaque. For this a combination of small interdental brushes (Tepes or Interprox Plus) or Glide Floss Piks are easy to use when you have been shown how .

It's impossible to comment on 2 partial dentures without seeing them, the accuracy of the fit & the health of your mouth. It is possible to make fine dentures which fit the teeth, gums & the bite well but the patient cannot adapt easily & does not like wearing a removable denture. Everyone is different in their ability to wear dentures. I warn all patients that they may not be able to adjust to having a large "foreign body " in their mouth & explain that it is easier to adapt to fixed bridges or implants as they are non removable & act like natural fixed teeth.

There are different types of dentures & you may get on better with a different design & materials which is better made.However,before spending more money on another denture consider implants or bridges .

I’ll assume that you already clean your dentures daily with a denture brush followed by soaking in a cleaning fluid intended for this purpose. As this is does not appear to be doing the job you could try using a whitening toothpaste such as Janina, which contain mild abrasive agents that are effect in removing tobacco stains from natural teeth. You may also wish to try the Curaden Weekly Denture Cleaner, I gather it is very effective but don’t have any information specifically on tobacco stains.

One final point to consider in respect of your daily denture cleaning regime and that is to pay attention to the instructions on the cleaning product you use. For example dentures should not be soaked in Sterident overnight as the bleach within this product will damage the surface of the denture, resulting in the surface becoming porous and allowing stains to penetrate into the ‘teeth’. For overnight soaking use a bleach free cleaning product like SECURE® Denture Cleaning Tablets.

Yes I do but it does not mean dental implants cannot be placed to replace missing teeth.

Bisphosphonates are prescribed usually for osteoporosis, the prevention of skeletal fractures in susceptible patients, the treatment of bone disorders & the treatment of bone cancers often in connection with breast or prostate cancer & myeloma. Reports of nasty infections of the jaws known as Bisphosphonate associated osteonecrosis of the jaws (BON) first surfaced in 2003. Bisphosphonates are drugs administered either intra venously (IV) or orally with the IV group being much stronger than the oral group. They stay in the bone for a long time even if the medication is discontinued & a patient can face a lifetime risk of BON.

BON can affect both jaws but the bone infection can also occur without bisphosphonates. The precipitating events include extractions, oral surgery, gum treatment & implant placement. There are also other predisposing factors e.g. diabetes, other medications, alcohol consumption & smoking. Dental implants are not recommended for patients on IV but if necessary treatment should be carried out in a hospital with IV antibiotics.

All patients on bisphosphonates should maintain excellent oral hygiene & see their dentist & hygienist regularly to prevent the need for unnecessary treatment.

It would be unlikely that an irrigator on its own would help if you have 40% bone loss from advanced gum disease (periodontitis). In fact it could cause damage if your gums have deep pockets and are bleeding. You need specialist help from a dentist, hygienist & periodontist. The type of periodontitis should be correctly analysed, a programme of deep scaling & customised advice in oral hygiene provided & possibly antibiotics prescribed. The success of the treatment is re evaluated .After 3 to 6 months decisions should be made on the resolution of the disease & what further treatment may be required.

We all use interdental brushes differently so it is impossible to put a timescale on it. As with your toothbrush it is time to change once the integrity of the brushes has been lost. It is certainly the case that the smaller brushes with ultra thin wires will not last as long as the large ones, due more to the buckling effect on the wire rather than necessarily the bristles themselves.

Yes, though what these mouthwash do is to remove surface stains rather than bleach the teeth. If the discolouration is within the dentine i.e. below the enamel a mouthwash will have no effect, in this instance bleaching is the only option.

There are 2 main types of gum disease, gingivitis & periodontitis. Gingivitis is very common in the UK with up to 80 % of adults suffering with this problem, but most of them don't know they have it.The most common symptoms are bleeding gums on brushing & halitosis (bad breath).The disease is caused by bacteria in plaque a sticky biofilm which adheres tenaciously to the teeth near the gums. Periodontitis is a more advanced form of gum disease with gum recession, long teeth, deep gum pockets where bacteria eat away at the bone, eventually leading to losing teeth.

Your dentist is partially right in advising you that antibiotics won't cure the disease but may have ommitted "not on their own ". I utilise antibiotics either by mouth or injected into the gums as part of a gum programme of deep cleaning below the gums & helping the patient to achieve the highest standards of oral hygiene. Antibiotics don't work on their own as there are a multitude of bacteria & other factors causing the diseases. All antibiotics don't kill all bacteria & don't work for example on smoking, a major cause of gingivitis.

More information: Main symptoms and treatments of gum disease

There are a number of important issues in your question. Firstly I assume the space exists between your upper central incisor teeth. Also ,your gums are healthy & you have always had the gap. If that is the case ,you could have bonding or veneers to close the space .Bonding is a reversible treatment whereby the enamel (outer surface) of each tooth is cleaned & etched ,then composite resin filling material is moulded & bonded to the teeth to close the space. The colour of your teeth are matched & the bonded resin cannot be detected .

I have placed many of these restorations , they last for many years & involve little if any drilling of the teeth.Alternatively ,as in your case the teeth are crooked , there is a space & perhaps the shape & colour of the teeth could be improved. Porcelain veneers should be considered especially If the teeth are either large or badly positioned. The enamel is usually reduced by about 1 mm, impressions are taken & temporary veneers are fitted. The dental technician makes the thin but strong veneers, the temporaries are removed about a week later & the permanent veneers bonded to the enamel.I have patients with porcelain veneers which were fitted over 15 years ago & still look natural.

The patients generally forget about their veneers other than brushing & flossing them . Veneers are an irreversible treatment & it is important that detailed planning is carried out before starting treatment .This could include waxing up the teeth on a model for you to look at & "mocking up" temporary veneers .These snap on for you to take home & show your partner or family. When happy you can go ahead with treatment, copying the temporaries.Sometimes combination treatments are advisable. You may not be happy with the colour of your teeth & should whiten them first before fitting veneers or bonding.

Braces should also not be completely discounted especially as new treatments include braces on the inside that don't show. To produce a perfect smile ,a combination of gum treatments ,whitening ,braces & veneers may be necessary. Make sure you see a dentist who works closely with specialists before embarking on changing your smile & ask to see before & after photographs of other completed cases.

You could try Flossing is not absolutely necessary to maintain optimal dental health, but some form of cleaning between your teeth is. Plaque, a microscopic living biofilm of bacteria sticks tenaciously to the teeth & gums in the tiny gap where the gums & teeth join. When we eat or drink, sugars are broken down by the bacteria & the acid produced attacks our teeth & gums, causing caries (tooth decay) & gingivitis (gum disease).To prevent these common dental diseases it is important to remove the plaque daily. Tooth brushing alone is not enough. Flossing with floss held on your fingers can be mastered if you are coached by a hygienist ,even if you find it difficult. However, there are other alternative products. Some people prefer flossers or floss picks which are plastic devices with floss built in & glide easily between the teeth. My patients prefer Glide Floss Picks which are very well designed & easy to use. Otherwise there are many interdental brushes which are easy to use, but again it is important to be shown the right brushes by a hygienist for your mouth & how to use them. With a healthy low sugar diet & optimal dental hygiene it is possible to prevent fillings & have healthy gums.

Food should not get caught by fixed bridges and I would be concerned as this could cause; gingivitis (gum disease), caries (decay), bad breath, failure and ultimately loss of the bridge. One of the most likely causes could be the design of the bridge. Ideally there should be cleanable gaps between the bridge retainers & the pontics or false teeth. Before I fit a bridge I make sure the technician constructs it to my design, taking the cleaning into account. After fitting the bridge, I show the patient how to clean it on a daily basis. This includes flossing the front & back of the bridge, cleaning in between the individual teeth with interdental brushes and below the pontics with either Superfloss or floss threaded underneath with a floss threader. Otherwise, food & bacteria get caught & break down causing the problems mentioned. There are many of these bridge products available but you should be shown by your dentist or hygienist which ones fit your bridge, how to place them and use them correctly. Your dentist will assess your individual dexterity before advising you, which is better than trial and error. If the problem persists and is more to do with the bridge design, you should have the bridge examined, x-rayed, the problem diagnosed and consider having the bridge replaced with individual crowns and implants. These would act as individual natural teeth and can be cleaned easily with regular floss. Consider taking a second opinion from a dentist experienced in crowns, bridges & implants.