Advice Sheets
- Teeth bleaching
- The cracked tooth syndrome
- Removable Braces
- Advice for patients after extraction
- Retention Advice
- Your Fixed Brace
- What is a Maryland bridge?
The home bleaching method can whiten teeth discoloured by coffee, tea, tobacco and especially age-related (yellow-brown) darkening.
What to do at home:
After brushing your teeth, a very small amount of the bleaching gel should be placed inside the plastic bleaching trays which are seated slowly over the teeth. Excess gel should be removed with a toothbrush or cotton bud.
The trays should be worn for a minimum of one hour. Remove the trays and rinse with water.
If the bleaching trays are worn only at night, treatment may take 4-6 weeks.
If the bleaching trays are worn during the day as well and the gel changed every 3 hours, maximum whitening will take place in 10 days.
Side effects:
The gel is non toxic but slight irritation of the gums can occur - stop treatment for 2 days. Sensitivity of the necks of the teeth can also occur which is helped by using a fluoride mouthwash together with a desensitising toothpaste such as Sensodyne.
What to expect:
You can expect your teeth to become about one or two shades brighter.
The bleaching process usually needs repeating every two years so keep your individually fabricated trays stored safely.
Symptoms:
If a tooth is cracked it becomes painful with cold liquids and usually but not always is also painful when biting hard foods. This sensitivity can last for months before the tooth actually breaks or treatment is carried out.
Diagnosis:
This is difficult because there is usually nothing wrong to be seen and X-rays cannot show up a hairline crack.
So the diagnosis depends on the information supplied by you the patient together with examination of the tooth under magnification if necessary after the filling is removed - often a tiny black line can be seen running through the middle of the tooth.
Causes:
Teeth weakened by large fillings are at risk and hard foods such as muesli and granary bread may play their part, but almost always the patient has a habit of clenching and grinding the teeth. This increasingly common problem is almost certainly related to our more stressful lifestyles these days. In addition teeth become more brittle as we get older - the cracked tooth syndrome is not seen in young people.
Treatment:
Treatment depends very much on the position and extent of the crack. Frequently with lower molars the crack is on the tongue side and a crown will be successful. Sometimes the crack involves the nerve of the tooth and removal of the nerve (root canal treatment) is needed as well as crowning. This adds considerably to the expense of saving the tooth.
In the upper jaw the crack is often right through the middle of the tooth and extraction is the only option.
Replacement of the tooth with a bridge or implant may be possible and your dentist will advise you.
Can it happen again?
Patients with one cracked tooth will frequently reurn with the same problem in another tooth. Your dentist might suggest making a night guard from thin plastic to cover and protect your teeth from night-time clenching and grinding.
What to expect - On the day of fitting expect extra saliva to form (because your brain thinks the brace is food) but this soon passes off. Learning to speak takes a week – less if you practice reading a book out loud.
The brace may be uncomfortable to begin with but we do not expect you to wear a brace that is digging into your gum – return for adjustment.
Q. Why a removable brace?
A removable brace can fix simple problems such as moving a top front tooth forwards into line with the others.
Fixed braces (‘traintracks’) are used for complicated problems. They are excellent at straightening teeth but removable braces are better at straightening jaws.
So we use expansion plates to widen narrow upper jaws (perhaps caused by years of thumbsucking). You could call this a side to side brace.
We use functional appliances such as twin-blocks to improve teeth that stick out. You could call this a front-to-back brace to improve the profile.
Q. Well do my teeth stick out too far?
Top teeth should normally be in front of the bottom teeth by 2-4mm; this is called your overjet.
Although twinblocks might seem a mouthful of plastic it is a very powerful brace which, if worn fulltime, can reduce an overjet from 10mm to 4mm in a matter of months.
If the teeth themselves are still crooked we follow the removable brace with a fixed brace.
Q. When should I wear my brace?
All braces should be worn day and night because teeth will hardly move at all if the brace is left out.
We recommend taking the brace out for sports and placed in its box for safekeeping. Replacements for lost braces cost approximately £60-00.
Q. Do I eat with my brace in?
Eating with the brace takes more perseverance but you will be rewarded by a quicker improvement in your teeth.
Q. How do I clean my brace?
It is very important to keep your brace clean and this is best done with your toothbrush taking care not to bend any wires. If you cannot brush your brace after every meal then at least rinse it under the tap.
Reception stock a special cleaner for braces called RetainerBrite.
Q. What if the brace breaks?
Sometimes the plastic or wire parts of the brace break. If you are still able to wear the brace do so but if not please telephone for an early appointment. While the brace is out of the mouth undesirable tooth movements occur so repairs are back in less than a week.
To prevent bleeding, avoid for the first 24 hours:
· Mouth washing
· Very hot drinks, hot food and alcohol.
· Exercise
If excessive bleeding occurs:
Apply pressure to the gum by biting on a clean rolled handkerchief. If the socket is between two teeth, constrict the pad so it fits between them.
Bite firmly for 10 minutes, sitting upright.
If in pain:
Paracetamol or ubuprofen may be taken as directed on the instructions. Do not exceed the stated dose, and if you have to take painkillers for more than 24 hours then alternate the paracetamol with the ibuprofen.
If you are taking other medication from your doctor, check with us that there is no interaction.
Avoid aspirin.
After 24 hours, use hot salt mouthwashes:
1. Fill a tumbler with hot water (as hot as possible without risking scalding) and add a teaspoon of salt.
2. Take a large mouthful and tilt the head to the operated side so the solution floods the inflamed area. Hold it there for one minute before spitting out. Repeat until the tumbler is empty.
3. Repeat every two hours.
4. Do not apply heat to the outside of your face, and never use a mouthwash on the same day as the extraction.
Septic socket:
If after a couple of days you start experiencing severe pain and a bad taste you probably have developed a septic (infected) socket. Although very painful this is not serious and your dentist can place a dressing in the socket to relieve the discomfort.
Septic sockets occur much more frequently in smokers, so avoid smoking after an extraction.
Antibiotics have only a very limited role to play and should not be used routinely.
If you have any worries do contact us for advice. The out of hours emergency number can be obtained from the answering machine.
Research has shown that teeth will move back towards their original positions if not retained permanently. This research was carried out by Dr. Little in the United States and his interesting findings are available to you on a separate sheet.
There are two types of retainer available. These are either the clear removable splints which are worn over your teeth, at night times, indefinitely.
Alternatively bonded retainers can be attached to the back of your front teeth and left indefinitely. These retainers consist of a wire fitted to the inside of your teeth where it does not show and attached by means of tooth coloured cement. Unfortunately bonded retainers break from time to time and need replacing. Also a high standard of cleaning is necessary around bonded retainers.
The final decision on the choice of retainer is left to you, the patient. We will of course give you suitable advice because it is upsetting to everyone if the teeth go crooked again after being straightened.
YOUR FIXED BRACE
Q. What is my brace made up of?
Your brace is made up of small brackets glued to your teeth. The brackets are handles used to hold your teeth and straighten them; the archwire that runs through the brackets moves the teeth. We start with the most gentle archwire and gradually move up through five sizes. The archwire is held in place by tiny elastic bands that come in different colours.
Q.Will it hurt?
It is usual for the teeth to be uncomfortable for the first few days after the brace is first fitted - stay with a soft diet and if necessary take one or two tablets of paracetamol or ibuprofen.
Q. What if bits break off?
If one bracket comes off, leave it until your next scheduled visit. If several break off then phone for an appointment to have the brace repaired.
Often as the teeth move the archwire sticks out at the back and if this scratches your cheek come in to to have the end cut off. (ask reception for a packet of wax in case this happens).
Q.How do I clean my teeth?
Since the brace is fixed you cannot remove it for brushing. It is extremely important to spend extra time brushing all around the brace and especially the gums. If the dirt builds up then your gums will bleed a lot (gingivitis) and your teeth will decay.
Reception stocks special brushes and fluoride mouthwashes for daily use.
Q. Will there be marks on my teeth when the brace comes off?
Poor cleaning and too many fizzy drinks can cause permanent decay marks - we cannot emphasise enough the importance of thorough brushing and the use of a fluoride mouthwash.
Q. What about sports?
Contact sports such as rugby present a problem since it is difficult to make a gum shield over the brace. A reasonable solution is to buy a cheap gumshield from a sports shop that can be softened in hot water and moulded over the brace. Reception also stock preformed gumshields.
Q. How long before the brace is removed?
It usually takes about 18 months, occasionally longer, to straighten your teeth. "Traintrack" braces are very good at straightening teeth so that they look better in months but it is important to remember that if the brace is removed too quickly before the teeth have settled into their new positions, then the teeth tend to go crooked again.
Q.So how are the teeth kept straight after the fixed brace is removed?
Usually we make a removable brace called a retainer to wear at nights for at least 12 months.
Sometimes a wire is fixed to the insides of the teeth to hold them straight.
WHAT IS A MARYLAND BRACE?
Q. What is a Maryland bridge?
For many years dentists had to reduce healthy teeth as abutments for fixed bridges. Today, with the Maryland bridge, an ultra-conservative treatment option is available that enables the dental practitioner to replace missing teeth aesthetically, with a minimum of adjacent tooth modification.
Q. How is it made?
After some minor adjustments to the tooth which will support the missing tooth, impressions of the mouth are sent to the laboratory. The dental technician constructs a cast metal wing to fit behind the supporting tooth and attaches to this a false tooth made from porcelain.
Back in the dental surgery this metal wing with its false tooth is carefully cemented in to place with special adhesive.
Q. How long does a Maryland bridge last?
Maryland bridges can last for many years. Occasionally they do come unstuck but they can be recemented again. A single metal wing supporting only one tooth is very reliable and is often used to replace a missing front tooth in teenagers who are too young for implants.
In older patients we often use even long-span Maryland bridges as a temporary means of filling a gap until implant supported bridges can be fitted.
Q. Is there an alternative to metal wings?
Yes, there is a new fibreglass material which is tooth coloured. As this material is perfected it may replace metal in the future.
