Preventative Dentistry » Oral Health Advice

• BARKINGSIDE DENTAL CARE- ORAL HEALTH ADVICE

  Why is brushing important?

  Daily brushing and cleaning between your teeth is important because it removes plaque. If the plaque isn't removed, it continues to build up, feeding on the bits of food left behind and causing tooth decay and gum disease.

  How do electric or 'power' toothbrushes work?

  A power brush has an oscillating rotating or vibrating head, which provides a large amount of cleaning action with very little movement needed from the user, although you do need to position the brush correctly.

  Do electric toothbrushes clean better?

  Tests have shown that power toothbrushes are more effective at removing plaque. Those with heads that rotate in both directions ('oscillating' heads) are the most effective. Everyone can use a power brush. They are particularly useful for people with limited movement of the arm or hand, such as disabled or elderly people, who often find that using a normal toothbrush does not allow them to clean thoroughly.

  Power brushes can also be better for children as they may be more likely to brush regularly because of the novelty of using a power brush. Discuss the idea with your dental team to find out if you would benefit from using a power brush.

  How should I brush?

  Brushing removes plaque and bits of food from the inner, outer and biting surfaces of your teeth.

  Here is one way to remove plaque – discuss with your dental team which is the best for you:

  Place the head of your toothbrush against your teeth, then tilt the bristle tips to a 45-degree angle against your gumline. Move the brush in small circular movements, several times, on all the surfaces of every tooth.

  Brush the outer surface of each tooth, upper and lower, keeping the bristles angled against your gumline.

  Do this again, but on the inside surfaces of all your teeth.

  To clean the inside surfaces of your front teeth, tilt the brush vertically and make several small, circular strokes with the front part of the brush.

  Brush the biting surfaces of your teeth.

  Brush your tongue to help freshen your breath and clean your mouth by removing bacteria.

  How often should I brush my teeth?

  Be sure to brush thoroughly with a fluoride toothpaste last thing at night and at least one other time during the day. If you regularly keep getting discomfort or bleeding after brushing you should see your dentist.

  How do I know if I have removed all the plaque?

  You can stain the plaque with special dye, which you can paint onto your teeth with a cotton bud, or you can use special disclosing tablets. You can get these from your dental practice or pharmacy.

  The stain is harmless and will show any areas of your mouth which need better brushing. Look particularly at where your teeth and gums meet. Further brushing will remove the stained plaque.

  How often should I change my toothbrush?

  Worn-out toothbrushes cannot clean your teeth properly and may damage your gums. It is important to change your toothbrush every two to three months, or sooner if the filaments become worn. When bristles become splayed, they do not clean properly.

  Should I use a fluoride toothpaste?

  Yes. Fluoride" helps to strengthen and protect teeth, which can reduce tooth decay in adults and children. All children up to three years old should use a smear of toothpaste with a fluoride level of no less than 1000ppm (parts per million). After three years old they should use a pea-sized amount of toothpaste that contains 1350ppm to 1500ppm.

  Some children's toothpastes only have about half the fluoride that adult toothpastes have. They only give limited protection for the teeth. If your children are under 7 you should keep an eye on them when they brush their teeth and encourage them not to swallow the toothpaste.

  What sort of toothpaste should I use?

  As well as regular family toothpastes, there are many specialised toothpastes. These include tartar control for people who get tartar build-up, and a choice of toothpastes for people with sensitive teeth. 'Total care' toothpastes include ingredients to help fight gum disease, freshen breath and reduce plaque build-up. 'Whitening' toothpastes are good at removing staining to help restore the natural colour of your teeth, but are not strong enough to change the natural shade of the teeth.

  Some children's toothpastes only have about half the fluoride that adult toothpastes have. They only give limited protection for the teeth. If your children are under 7 you should supervise them when they brush their teeth. Encourage them not to swallow the toothpaste and to just o have a clean and healthy mouth you need to use the correct dental-care products. Ask your dental team to tell you what choices there are and to give their recommendations.

  How much toothpaste should I use?

  You do not need to cover the head of your brush in toothpaste. Children under three should use a smear, and children over three, a pea-sized blob of toothpaste. Remember to spit out after brushing and do not rinse, so that the fluoride stays on your teeth longer.

  Should my gums bleed when I clean in between my teeth?

  Your gums may bleed or be sore for the first few days that you clean between your teeth. This should stop once the plaque is broken up and the health of your mouth has improved. If the bleeding does not stop, tell your dental team. It may be that you are not cleaning correctly, or that your teeth and gums need a more thorough clean by your dental team.

  How should I clean between my teeth?

  You can clean between your teeth with an 'interdental' brush or dental floss. Cleaning in between your teeth removes plaque and bits of food from between your teeth and under your gumline - areas a toothbrush can't reach. When flossing or using interdental brushes, keep to o have a clean and healthy mouth you need to use the correct dental-care products. Ask your dental team to tell you what choices there are and to give their recommendations. o have a clean and healthy mouth you need to use the correct dental-care products. Ask your dental team to tell you what choices there are and to give their recommendations.

  Should my gums bleed when I clean in between my teeth?

  Your gums may bleed or be sore for the first few days that you clean between your teeth. This should stop once the plaque is broken up and the health of your mouth has improved. If the bleeding does not stop, tell your dental team. It may be that you are not cleaning correctly, or that your teeth and gums need a more thorough clean by your dental team.

  Interdental

  Interdental brushes come in various sizes. It may be helpful to ask your dentist or hygienist to show you the correct sizes for your mouth.

  Hold the interdental brush between your thumb and forefinger. Gently place the brush through the gap between your teeth. Do not force the brush head through the gap. If the brush splays or bends then it is too big - you will need a smaller brush head for this space.

  Flossing

  Break off about 45 centimetres (18 inches) of floss, and wind some around one finger of each hand.

  Hold the floss tightly between your thumbs and forefingers, with about an inch of floss between them, leaving no slack. Use a gentle Use a gentle 'rocking' motion to guide the floss between your teeth. Do not jerk the floss or snap the floss into the gums.

  When the floss reaches your gumline, curve it into a C-shape against one tooth until you feel resistance.

  Hold the floss against the tooth. Gently scrape the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth.

  Don't forget the back of your last tooth.

  When flossing, keep to a regular pattern. Start at the top and work from left to right, then move to the bottom and again work from the left to right. This way you're less likely to miss any teeth.

  Are 'oral irrigators' useful?

  Oral irrigators use a stream or jet of water to remove plaque and bits of food from around your teeth. They can be particularly helpful if you wear an orthodontic appliance ('brace') or a fixed bridge that is difficult to clean, or if you find it difficult to use interdental brushes or floss

  Should I use a mouthwash?

  A fluoride mouthwash can help prevent tooth decay. Your dental team may recommend an antibacterial mouthwash to help control plaque and reduce gum disease. If you find that you are regularly using a mouthwash just to freshen your breath see your dental team, because bad breath can be a sign of unhealthy teeth and gums or of poor general health.

  Can my diet help?

  Many people think that it is a high level of sugar in your diet that causes decay, but this is not true. It is how often you have sugar in your diet, not the amount, that causes problems. It takes up to an hour for your mouth to cancel out the acid caused by eating and drinking sugar. During this time your teeth are under attack from this acid. It is therefore important to limit the number of attacks by having sugary foods and drinks just at mealtimes. Chewing sugar-free gum and drinking water after meals or snacks can also help to cancel out the acid more quickly.

  As well as causing decay, sugary fizzy drinks, fruit juices, sports drinks, and wine can be acidic - which can also cause dental erosion. This is when the acid in foods and drinks gradually wears away the hard enamel coating of the tooth. This may lead to the tooth being sensitive.

  How should I clean my dentures?

  It is just as important to clean dentures as it is to clean your natural teeth. Food can become caught around the edges of dentures and clasps, and the food can rot if you do not clean them thoroughly.

  You should keep a separate toothbrush for cleaning your dentures. The general rule is: brush, soak and brush again. Clean your dentures over a bowl of water in case you drop them. Brush your dentures before soaking them, to help remove any bits of food. Soak the dentures in a specialist cleaner for a short time and then brush the dentures again. Brush them like you would your natural teeth. Make sure you clean all the surfaces of the dentures, including the surface which fits against your gums. If you notice a build-up of stains or scale, have your dentures cleaned by your dental team. Most dentists still recommend a small- to medium-headed toothbrush.

  I have implants, do I have to do anything special?

  Your dental team or oral surgeon will tell you how to care for your implants after surgery. It is very important to make sure you clean them regularly and thoroughly to prevent gum disease and possible infection. Follow the instructions your dental team or oral surgeon gives you.

  Why should I visit the dental team regularly?

  t is always better to prevent problems rather than have to cure them when they happen. If you visit your dental team regularly you will need less treatment and they will spot any problems earlier, making any treatment easier.

  How do I look after my bridge?

  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 –super floss , as a normal toothbrush cannot reach.

  How often should I clean my dentures?

  It is important to treat your dentures like you would treat your natural teeth. You should keep them as clean as possible so that you don't lose any more teeth, or have inflamed gums or bacterial and fungal infections. We usually recommend that you clean them thoroughly at least once a day, and after eating if you need to.

  How should I clean my dentures?

  Dentures may break if you drop them. Always clean your dentures over a bowl of water or a folded towel in case you drop them.

  To clean your dentures, the general rule is: brush and soak every day. Brush your dentures first, to help remove any bits of food. Use a non-abrasive denture cleaner, not toothpaste. Be careful not to scrub too hard as this may cause grooves in the surface.

  Make sure you brush all the surfaces of the dentures, including the surface that fits against your gums. This is especially important if you use any kind of denture fixative.

  Soak your dentures every day in a denture-cleaning solution. This will help remove any plaque and stubborn stains that are left. It will also t will also help to disinfect your dentures, leaving them feeling fresher. Always follow the manufacturer's instructions.

  If you notice a build-up of stains or scale, have your denture cleaned by your dental team.

  Is there anything I should avoid?

  It is important not to use any type of bleaching product to clean your dentures. Bleaching can lead to weakening of the dentures as well as making them look unsightly. Do not use very hot water to soak your dentures. Again, it can weaken the dentures causing them to break.

  What should I do if my denture has a soft lining?

  Some people have sensitive gums and may need a softer lining made for their dentures. If you have one of these special linings, it is important to check with your dental team before using any cleaning products or fixatives, as some products can damage the lining.

  What if I have a metal denture?

  Some cleaning products can damage metal dentures, so talk to your dental team about how to clean them. If your denture has clasps, you need to take particular care when cleaning to avoid damage.

  Should I remove my dentures at night?

  Don't keep your dentures in overnight unless there are specific reasons for you to keep them in.

  Can my dental team clean them?

  Some people get a build-up of tartar on their dentures just as they would on their natural teeth. If plaque is not removed properly, it can react with your saliva and harden into tartar. As with your own teeth, you will not be able to remove this tartar completely by yourself, and eventually it can make the denture uncomfortable and unsightly. Your dental team will be able to remove this tartar using a professional cleaning machine.

  What can I do about staining?

  Like natural teeth, dentures can pick up staining every day. This is especially true if you smoke, or drink a lot of tea, coffee or red wine. In most cases you should be able to remove this staining with regular cleaning. However, more stubborn stains may take a little more cleaning, which your dental team should be able to help with.

  Do I still need to see the dentist?

  It is important to visit your dental team regularly even if you don't have any of your natural teeth. Dentists do not check just your teeth, but also the soft parts of the mouth, including the tongue and cheeks. These examinations are just as important, so the dental team can spot any infections, mouth conditions or even mouth cancer at the earliest stages. Your dental team will be able to tell you how often you should visit.

  CONCLUSIONS :

  Good dental health begins with you. By following these simple tips you can keep your mouth clean and healthy:

  Brush your teeth for two minutes, last thing at night and at least one other time during the day, using fluoride toothpaste.

  Spit toothpaste out after brushing and do not rinse.

  Use a toothbrush with a small- to medium-sized head.

  Use a toothbrush with soft to medium, multi-tufted, round-ended nylon bristles.

  Consider using a power toothbrush.

  Use small, circular movements to clean your teeth.

  Change your toothbrush regularly, and at least every 3 months.

  
  
  

  CHILDREN

  How Do I Help My Children Care for Their Teeth and Prevent Cavities?

  Teaching your child proper oral care at a young age is an investment in his or her health that will pay lifelong dividends. You can start by setting an example; taking good care of your own teeth sends a message that oral health is something to be valued. And anything that makes taking care of teeth fun, like brushing along with your child or letting them choose their own toothbrush, encourages proper oral care.

  To help your children protect their teeth and gums and greatly reduce their risk of getting cavities, teach them to follow these simple steps:

  • Brush twice a day with a fluoride toothpaste to remove plaque-the sticky film on teeth that's the main cause of tooth decay.
  • Floss daily to remove plaque from between your teeth and under the gumline, before it can harden into tartar. Once tartar has formed, it can only be removed by a professional cleaning.
  • Eat a well-balanced diet that limits starchy or sugary foods, which produce plaque acids that cause tooth decay. When you do eat these foods, try to eat them with your meal instead of as a snack-the extra saliva produced during a meal helps rinse food from the mouth.
  • Use dental products that contain fluoride, including toothpaste.
  • Take your child to the dentist for regular checkups.
  What Brushing Techniques Can I Show My Child?

  You may want to supervise your children until they get the hang of these simple steps:

  • Use a pea-sized amount of a fluoride toothpaste. Take care that your child does not swallow the toothpaste.
  • Using a soft-bristled toothbrush, brush the inside surface of each tooth first, where plaque may accumulate most. Brush gently back and forth.
  • Clean the outer surfaces of each tooth. Angle the brush along the outer gumline. Gently brush back and forth.
  • Brush the chewing surface of each tooth. Gently brush back and forth.
  • Use the tip of the brush to clean behind each front tooth, both top and bottom.
  • It's always fun to brush the tongue!
  When Should My Child Begin Flossing?

  Because flossing removes food particles and plaque between teeth that brushing misses, the sooner your child masters how to use floss and becomes a daily routine the better. In the USA, the advice is from 4 years. By the time they reach age eight, most kids can begin flossing for themselves.

  What Are Dental Sealants and How Do I Know if My Child Needs Them?

  A dental sealant creates a highly effective barrier against decay. Sealants are thin plastic coatings applied to the chewing surfaces of a child's permanent back teeth, where most cavities form. Applying a sealant is not painful and can be performed in one dental visit. Your dentist can tell you whether your child might benefit from a dental sealant.

  What Is Fluoride and How Do I Know if My Child Is Getting the Right Amount?

  Fluoride is one of the best ways to help prevent against tooth decay. A naturally occurring mineral, fluoride combines with the tooth's enamel to strengthen it. For most children the proper use of fluoride toothpaste will be sufficient to help prevent decay. For children at high risk of dental decay and without access to fluoridated water, milk, or salt, your child's dentist may suggest using fluoride drops or mouthrinse in addition to a fluoride toothpaste.

  How Important Is Diet to My Child's Oral Health?

  A balanced diet is necessary for your child to develop strong, decay-resistant teeth. In addition to a full range of vitamins and minerals, a child's diet should include plenty of calcium, phosphorous, and proper levels of fluoride.

  If fluoride is your child's greatest protection against tooth decay, then frequent snacking may be the biggest enemy. The sugars and starches found in many foods like biscuits, sweets, soft drinks and even some savoury snacks are food for bacteria in dental plaque and are converted to acids. These acids attack the tooth enamel and can lead to cavities.

  Each "plaque attack" can last up to 20 minutes after a meal or snack has been finished. Even a little nibble can create plaque acids. So it's best to limit snacking between meals.

  What Should I Do if My Child Chips, Breaks or Knocks Out a Tooth?

  With any injury to your child's mouth, you should contact your dentist immediately. The dentist will want to examine the affected area and determine appropriate treatment.

  If your child is in pain from a broken, cracked or chipped tooth, you should visit the dentist immediately. You may want to give an over-the-counter pain reliever to your child until his/her appointment. If possible, keep any part of the tooth that has broken off and take this with you to the dentist.

  If a tooth is completely knocked out of the mouth by an injury, take the tooth to your dentist as soon as possible. Handle the tooth as little as possible-do not wipe or otherwise clean the tooth. Store the tooth in a cup of fresh milk until you get to a dentist. It may be possible for the tooth to be placed back into your child's mouth, a procedure called reimplantation.

  
  
  

  SPECIAL NEEDS

  Who needs special-care dentistry?

  Everyone needs to be able to have dental care. However, some people need special facilities or services to have this care provided. People with physical disabilities may have problems getting into the surgery or even into the dental chair. People with learning disabilities may become overanxious at the thought of going to the dentist or may need extra reassurance. People suffering from severe medical problems may need extra precautions or care. Dental teams are able to take account of all these things when providing dental care.

  Who can provide treatment?

  Many dentists will happily treat people with special dental needs in their surgery. However, some people find it hard to get to the surgery and so other arrangements may be made by the practice: for example, home visits and special health centres. Some people need a specialist service. The local Community Dental Service or some health centres will also help people needing specialist care and may be able to offer possible treatment alternatives, such as sedation or general anaesthetic.

  How do I arrange specialist care?

  Usually the patient's dentist or doctor is responsible for referring them to the clinic best suited to their needs. Normally, the dentist or doctor will write a referral letter and send it, with any hospital lett

  What do the dental team need to know?

  The dental team will need to know the patient's medical history and about any medicines they are taking, any anxieties they may suffer from , need of an interpreter . This includes any inhalers and regularly prescribed medicines from the doctor. The dental team will also need to know the name of the family doctor and hospital consultant, and about any recent operations and allergies the patient may have.

  When is the best time to be treated?

  Some patients prefer to be seen at certain times of the day depending on their needs. For instance, evening appointments may not be suitable for patients who tire easily or may spend the day worrying. Some patients rely heavily on routine and may need regular appointments at the same time.

  How accessible are treatment clinics?

  Practices should offer facilities for wheelchair users, including access to the practice, and ground-floor surgeries. If wheelchair access is particularly important, contact the surgery and ask if this is something they are prepared for. Some clinics have specially adapted surgeries for patients with mobility problems.

  What about children's dental treatment?

  Children with learning disabilities or other medical conditions may be referred to a specialist dental service by their doctor or dental team. It is important to take children to see the dentist at an early age. A low-sugar diet is also important, as they may be more likely to have tooth decay due to having problems with brushing and through taking medication. Make sure they have fizzy drinks, and sugary foods and drinks, just at mealtimes, and in moderation.

  Is there anything to make brushing easier?

  For some people, moving their arms or hands can be a problem, which makes effective cleaning difficult. It is important to reach all the areas of the mouth to clean effectively. A toothbrush with a small to medium head size with soft to medium bristles is usually recommended. There are special handgrips and other adaptations which can be fitted to manual toothbrushes to make them easier to hold.

  In some cases, electric or 'power' toothbrushes are recommended for people with mobility problems. They are also helpful to people with learning difficulties as they can be a novelty and therefore encourage brushing. The dentist or dental team will be able to offer advice and practical help on brushing and general mouth care.

  Is sedation available?

  Intravenous sedation (an injection) is an effective way of treating most nervous patients. The drugs given can relax and calm the patient, so treatment can be carried out with the dental team and patient still able to talk to each other. There are certain things that affect a patient's suitability for this type of sedation. These include weight, age and medical condition. This would all be discussed during the consultation. Sometimes the patient would need to be referred to a specialist clinic for this treatment.

  What other help is available?

  Relative Analgesia (RA) can also help patients get through their treatment more easily. Here, nitrous oxide and oxygen are breathed in through a nosepiece. It is the safest and simplest form of sedation and is often the one most suitable for both children and people with special needs. However, this is not appropriate for everyone - especially people with limited understanding, cerebral palsy or multiple sclerosis.

  In some cases, the dental team prefer to use other ways of calming the patient. These can include simply talking, visiting the practice to meet staff, or even hypnosis. These can all be effective in making the patient less anxious.

  How often should I visit the dental team for care?

  It is important to visit the dental team regularly. This would normally be every six months, but some people need to visit less often and others more often. The dental team will be able to tell you.

  The dentist may also recommend appointments with a dental hygienist, who will remove plaque and tartar from the teeth and offer advice on how to brush effectively and keep your mouth clean and healthy. The dental team may also offer advice to care givers about the dental care of others. It is very important to build a relationship between the dental team, the patient and their care giver. This can help greatly with people who have severe learning difficulties. Short but regular appointments seem to work better at building trust between the patient and the dental team than long appointments at irregular intervals.

  What toothpaste should be used?

  It is recommended that children up to three years old use a toothpaste that contains at least 1000ppm (parts per million) of fluoride. Over the age of three, a toothpaste that contains 1350 to 1500ppm of fluoride is recommended. If the dentist thinks that the patient is particularly at risk of tooth decay, they may prescribe a toothpaste or fluoride varnish which contains a higher level of fluoride to offer more protection.

  What treatment might I have to pay for?

  Special treatment may be available under the National Health Service (NHS) or might have to be paid for privately, depending on the practice. It is important to ask for an after treatment plan check-up and an estimate of charges at the time of the check-up. This will avoid confusion over payment later. NHS treatment is free for people getting benefits. If the patient is on a very low income, but does not claim any benefits, they may get help with charges by filling in an HC1 form. You can get this from either the dental practice or a doctor's surgery. You may also be able to get help towards eye tests among other things.

  The Community Dental Service will provide most treatment for free. However, there will be a charge for any private treatment carried out. In some cases treatment needing laboratory work, such as dentures, bridges and crowns, will also be charged for.

  
  
  

  Mouth care for people with dementia

  Maintaining good oral health is essential to your overall well-being. Daily care can help stop problems like painful cavities and infections before they arise, and helps avoid pain when eating, drinking and communicating. People living with dementia have a high rate of tooth decay and gum disease. This may be because they find it difficult to perform their normal daily activities, and require some support to keep up with their oral hygiene routine. Others may not be able to express that they have a toothache and leave problems untreated. It's important that people living with dementia receive the help they need to keep their teeth and gums clean and free of debris so that they can maintain their self-esteem and avoid pain and infections.

  Sugar and oral health Sugar can cause tooth decay, especially when it's frequently eaten. If you are caring for someone with dementia, try to avoid giving them too many sugary foods, both between meals and at mealtimes.

  Tooth friendly foods and snacks include:

  • vegetables
  • bread with sugar-free spreads
  • savoury crackers and cheese
  • pitta bread with hummus or guacamole
  • rice cakes
  • fresh fruit
  • oatcakes
  • plain yoghurt.

  Drinks that are labelled sugar-free may still be damaging to health if they are acidic. Water is the best drink to consume to avoid damaging teeth. Milk and unsweetened tea and coffee are good to have in moderation.

  Caring for teeth and gums Everyone should have their mouth cleaned twice a day, so make sure that the person living with dementia continues to do this and help them if they are unable or reluctant to do it themselves. You may want to make brushing your teeth an activity you do together so that you can prompt, observe, and help them if needed. If you need to brush the person's teeth for them, you could try:

  • supporting their jaw to keep their teeth together to help clean the front of the teeth
  • encouraging the person to open wide to help you clean the inside and chewing surfaces of the teeth
  • using a toothbrush with a small head and medium bristles; a child's toothbrush may be easier to use
  • using a pea-sized amount of toothpaste containing no less than 1450ppm fluoride (look on the tube or box to find out how much fluoride is in your toothpaste)
  • using gentle, circular movements, paying extra attention to the area where the tooth meets the gum
  • encouraging the person you're helping to spit out the toothpaste rather than rinse it out. The fluoride in the toothpaste will continue to protect their teeth
  • replacing the toothbrush when it begins to show wear or every three months.
  Wearing dentures

  Many people living with dementia will have dentures. It's crucial that the dentures are kept clean and are replaced if they become loose. If someone has recently received dentures to replace lost teeth, they may need support in forming new cleaning habits. You might like to try the following with the person living with dementia:

  • encouraging them to clean their dentures twice daily or do it for them if they are unable
  • use a soft-bristled brush if there are no natural teeth for a gentler clean
  • encouraging them to clean their remaining teeth or gums before they go to bed
  • speaking to a dentist about getting a second set of dentures made. Your dentist can advise on having the person's name printed on the dentures
  • making sure you speak with staff at any new care setting to let them know the person has dentures and ask where they can store them safely
  • making sure the dentures are cleaned over a bowl or sink of water so that they won't break if you drop them
  • cleaning dentures with a special denture brush and denture paste or non-perfumed liquid soap and water to remove all food and plaque deposits. Don't rely on overnight tablet cleaners in water as these are not as effective
  • making sure they take their dentures out overnight
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