Ask the Dentist

You must take you daughter to a dentist promptly as her teeth are black with decay & she has pain. Choose a dentist who is good with young children or consider a specialist paedodontist. Otherwise you may need to be referred to the children's department of a teaching hospital. It sounds that there is too much sugar in her diet & not enough brushing carried out by her parents (not your daughter). Alter her diet straight away, removing sweet drinks, foods, confectionery, cakes & biscuits .Brush her teeth twice daily with fluoride toothpaste & consider fluoride drops or tablets prescribed by the dentist to strengthen the teeth & stop this high decay rate in her first teeth & hopefully her adult teeth later.

If you are in pain & have a bad taste or smell from the extraction sites, you have to return to your dentist & may need antibiotics.

I'm not sure what "irritating a capillary/turn into itself " means. If the tooth is vital i.e. the nerve is alive ,it sounds as though you have an inflamed nerve under the crown. If so, it is either reversible or irreversible. If irreversible & you are still in pain, you may need root canal treatment (removing the nerve of the tooth)either by drilling through the crown or by removing the crown. Discuss this with your dentist & ask for a treatment plan & estimate of the choices offered. Alternatively consider going elsewhere for a second opinion.

The gingiva is the medical term for the gums & the pointed part in between the teeth is called the papilla.Sounds like the papilla has become detached & you have a form of gingivitis which frequently occurs without pain.You would need to provide more information for me to explain fully,for example do your gums bleeed on brushing,do you floss or use interdental brushes or do you have bad breath?These are some of the signs of gingivitis.I prefer bonded wire retainers to plastic removable orthodontic retainers.The teeth may have moved or the retainer is impinging on the gingiva causing it to become detached.the best advice is for you to see your dentist promptly.

Nothing to worry about. There is a range between early & late tooth eruption & he seems to be in the normal range. Sometimes teeth are congenitally missing but at your son's age he probably won't be able to have X-rays & there is no treatment anyway until much older. I would recommend that you take him to your dentist for a check up when you go & ask your dentist these questions.

It depends on the type of gingivitis, the severity, your age & causative factors. Generally, if your gums are bleeding on brushing & you have gum pockets no more than 4 or 5 mms you should go to your dentist & receive advice & a diagnosis on the type of gingivitis you have, then have a gingivitis programme with your dentist & hygienist. This could be 2 to 4 appointments of deep scaling to remove calculus deposits from under & above the gums, 1 to 1 advice on tooth brushing, flossing, a mouthwash & use of interdental brushes. The aim is to control the soft bacterial plaque deposits from reforming, massage & brush the gums so you obtain natural or "biological" healing & the gums will stop bleeding.You will always be susceptible to gingivitis & need to have regualar visits every 3 months to the hygienist for monitoring & cleaning until the gingivitis has gone & does not return.

I would be concerned about the symptoms you describe & ask for more information about the diagnosis & the cause. Your dentist should give you a written treatment plan & estimate so you know what's going on. You will probably need oral antibiotics, root canal treatments & crowns. If not, 1 or more teeth may need to be removed.

Orthodontic treatment for adults is not usually available on the NHS for minor tooth movements.Private treatment with a specialist orthodontist can often be paid for over a period of months interest free & treatment can also take from 6 to 18 months depending on the severity of the case.The teeth should be held in position with bonded wire retainers otherwise they can move again.

Not exactly.An implant abutment is usually screwed to an implant & a fixed crown ,bridge There is a system called Locator which is used to fix a removable overdenture to implants.The "female" part of the Locator is an abutment which is connected to the implant,the other "male" part is embedded in the removable denture .This enables the accurate placement of the overdenture which snaps onto the impants,giving greater security & superior dual retention of the removable denture.The locator is available in different sizes & retention levels,allowing some movement or pivoting of the denture There are some small maintenance issues including replacement of parts of the retention system when they become less retentive or wear over time. Locators are made by Zest & can be incorporated into Straumann implants.

It can be difficult to fully diagnose caries(decay) on an X-ray. It depends on the type of X-ray. If it is digital, it is viewed on a computer & can be blown up & there are ways of seeing decay better. When the dentist drills the cavity it is often larger than seen by eye & if it has destroyed a lort of the tooth the decay may have entered the nerve,hence the need for a pulpotomy. The prognosis for the tooth is quite good, but depends on the state of the nerve, the technique used & how the tooth was finally filled. All is not lost though if the tooth flares up, it could have a root canal treatment later & a crown.have a close look at your child's brushing, flossing & dietary intake of sugars.

No toothpaste can rebuild lost enamel.The cause or diagnosis of your tooth surface loss (lost enamel or tooth wear) is important. It could be from over-brushing, grinding your teeth, too much acid in your diet or from acid regurgitation from the stomach, sometimes caused by a hiatus hernia or a combination of these factors. These should be considered & controlled before considering treatment. As you say over the counter tooth whitening systems generally don't work & some have high acidic contents. It may be possible to whiten your tetth with minimal sensitivity with the right technique, but not if you have lost a lot of enamel. Veneers may be the only solution but there are composite resin bonded veneers or porcelai with the latter being the most expensive. Most important is the diagnosis then a detailed plan of prevention then appropriate planned treatment.

An abscess is an infection in the bone & is usually due to the nerve dying in a tooth. It can be chronic ie low grade & long term. Antibiotics may reduce the abscess but won't get rid of it completely. The only correct solution is root canal treatment (RCT) or sometimes removing the tooth. However many people have chronic abscesses they don't know about as there are no symptoms & an Xray has not been taken of the ends of the tooth roots.After the RCT the tooth will be fragile & may need reinforcing with a post & core build up & a crown long term. It should be re-Xrayed at a later date to ensure the abscess & infection has gone.

Using any dental oral hygiene tool needs a 1 to 1 demonstration You should return to your dentist or hygienist to be shown how to use the Dentocare interspace brush.But the idea is to massage the gum firmly & gently backwards & forwards.How you should use it also depends on the gum problem & how severe it is & the cause of the problem.

You don't need to worry about offending your dentist, but you do need to be out of pain. This probably means having the impacted wisdom tooth removed. If your dentist is reluctant to remove the tooth ask for a full X-ray of the tooth & jaw - an orthopantomograph or OPG which is a view of both upper & lower jaws & all teeth. Then a diagnosis should be made & a treatment plan effected. You may need to be referred to a hospital to a maxillofacial surgeon for an opinion & removal of this tooth & possibly other wisdom teeth either with local anaesthetics (injections) or a general anaesthetic. After having the tooth/teeth removed, you may like to consider adult orthodontics to straighten the teeth which have moved. If so, make sure after treatment the teeth are retained with a bonded wire to stop them moving again.

You should be shown which design, make & size of interdental brushes & floss to use by your dentist or hygienist. They will measure your gum pockets & gingivitis & the gaps in between your teeth. They will recommend which size of brush for different parts of your mouth & monitor how well you use them.

As I understand,the same filling materials are available on the NHS & privately.However a purely private dentist is more likely to use the best & more expensive materials & you are likely to be paying more for more clinical time .Also you can not have white fillings in your molar teeth just to replace silver(amalgam ) fillings because you do not like the look of the fillings or are unhappy with fillings containing mercury. Some dentists are in "mixed "practice & work both in the NHS & privately.
It is generally accepted that the techniques required for large white composite fillings in molar teeth is more difficult than amlgams. You may consider obtaining a second opinion from a private 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.