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Caution with Paracetamol in Dentistry

As it can be so uncomfortable, dental pain often requires over-the-counter analgesics. Paracetamol is regularly a drug of choice: it is cheap, readily available and comes with minimal side effects. Despite being such a common and easily purchasable drug, accidental paracetamol overdose remains one of the highest causes of both acute liver failure and liver transplants in the UK.

Through a similar mechanism to non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, paracetamol can relieve the symptoms of pain, fever and headaches. Though its route of action is less well understood than regular NSAIDs, it is accepted that paracetamol is able to inhibit pathways in the body that lead to the release of prostaglandins, the chemical attributed to these symptoms.

Adverse Effects of Paracetamol

Tooth ache is inflammatory in nature. The anti-inflammatory effect of paracetamol is not as potent as NSAIDs but comes with a lower incidence of gastro-intestinal bleeding, nausea and blood thinning. Despite this, it seems to work just as well as NSAIDs in treating inflammatory tooth ache, possibly due to the effect it has on the central nervous system (1).

Once taken into the body, paracetamol is mostly metabolised by the liver. Initially it is conjugated with glucuronic acid to allow it to be excreted by the kidneys but this pathway is limited and can be exhausted by as little as 8 tablets of paracetamol (1). The remaining drug is converted into a toxic by-product that quickly reacts with a molecule called glutathione so the two can be excreted harmlessly in the urine (2). However, once this final mechanism of protection is used up, the toxic by-product begins to damage the cells of the liver.

Symptoms of paracetamol toxicity varies according to the time of presentation. Early presentation may often include nausea and vomiting; late presentation can show signs of jaundice, impaired consciousness and haemorrhage (2). The toxicity can be treated with acetyl-cysteine, which acts as a paracetamol antidote, but many people still die from paracetamol overdose due to late presentation (2). While incidence of accidental overdose is lower than non-accidental overdose, its mortality rate is often higher due to a decreased awareness about long-term damage and a later presentation in hospital (3).

Some people are more at risk of paracetamol toxicity than others; additional drugs being taken, such as anti-TB medication, and a number of conditions (particularly those damaging to the liver like hepatitis C) can all increase the risk. However, the two most dangerous risk factors in the average patient are often the belief that an over-the-counter drug is relatively harmless and how easy an overdose can be when paracetamol tablets are taken alongside paracetamol-containing medicaments like Lemsip, Night Nurse and Beechams.

The way forward with reducing the harm associated with paracetamol is through further patient education: a great number of people won’t read the precautions on drug instructions so the information needs to come from medical professionals (GPs and dentists) who see the patients taking these drugs and who often prescribe them. It is also the responsibility of professionals to identify the patients who are at a higher risk of paracetamol overdose due to their reliance on it for dental pain relief.

(1) Nayyer, N.V., Byers, J. and Marney, C. (2013) Identyfying adults at risk of paracetamol toxicity in the acute dental setting. BDJ. 216(5): 229-235
(2) Ferrer, R.E., Dear, J.W. and Bateman, N. (2011) Managing paracetamol overdose. BMJ. 342
(3) Craig, D.G., Bates, C.M., Davidson, J.S. et al (2011) Overdose pattern and outcome in paracetamol-induced acute severe hepatotoxicity. Br J Clin Pharmacol 71(2): 273-82

Posted in: General Dentistry

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The benefits of private orthodontics

There was a time when orthodontics may have been regarded as treatment available only to children. These days orthodontic treatment is widely available to people of all ages and is becoming more and more common amongst adults, with many of them opting for a new, aesthetic styles of braces.

When considering having orthodontics, there may sometimes be the option of private or NHS treatment and it can be different to decide which choice is right for you. Discussed here are some of the differences in private and NHS treatments.

the benefits of private orthodontics birmingham
Orthodontic Braces
 

Private vs NHS Orthodontics

  • Cost

    Undoubtedly, the cost of private orthodontics is greater than NHS orthodontics. As with all NHS treatments, the patient pays only a reduced fee while the rest is shouldered by the NHS. For children under 18, this fee is completely waived.

  • Ease of Adult Treatment

    The NHS only allows the treatment of those with considerable oral discrepancies (either cosmetic or functional). Initially all adults and children need an examination to see if they are able to have orthodontics on the NHS. While it is relatively common to fulfil the criteria as a child, adult treatment on the NHS is very difficult to find and is often reserved only for special cases, which are then treated in a dental hospital.

    By selecting private treatment, all options will be available to you. The difficulty involved in finding an NHS dentist who can treat adult patients at a reduced fee is eliminated.

  • Waiting Lists

    Waiting lists are often considerable in NHS practices, with adults and children waiting a year or more for treatment because of the sheer number of patients. Most private orthodontic practices will be able to begin your treatment within only a short while of your initial consultation.

  • Aesthetics

    In terms of fixed braces (ones that cannot be removed), the NHS is only able to offer standard metal brackets and wire. However, you will be able to choose the colour of the elastics that hold the wire in place; many children like to change the colours during each visit. In private practice there are many more options available: white brackets with aesthetic wires are a popular option amongst adults and children, especially those involved in theatre work and public speaking. Lingual braces (that sit on the inside surface of the teeth rather than the outside) are also becoming increasingly popular as they are practically invisible, as are invisible removable braces such as Invisalign.

  • Appointment Types and Times

    Many NHS practices that treat children often work to a very tight schedule due to the numbers of patients they treat. Appointment times are less flexible and some NHS practices are known to only allocate each child a 5 minute slot, not nearly allowing enough time to form any sort of relationship with the patient or answer any questions. Private practices are more likely to allow for longer, more personal appointments with a greater flexibility of time and date.

Find Out More About Private Orthodontics

To find out more about the type of private orthodontics offered by Scott Arms Dental Practice, visit our orthodontic page or call our receptionist team at 0121 357 0500

Posted in: Orthodontics

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Severe pain following a tooth extraction

Some degree of discomfort can be expected following a tooth extraction and this is often managed with the use of common analgesics, such as ibuprofen and paracetamol. However, sometimes when pain becomes particularly severe following an extraction, a condition called ‘dry socket’ can be suspected.

Dry Socket after tooth extraction
Dry Socket
 

Dry socket occurs when the bone from an extraction site becomes exposed to the oral environment. In most extraction sites a blood clot forms and protects the socket and promotes healing; this blood clot can be lost or broken down, compromising the health of the underlying bone. It is a relatively common complication of tooth extraction, with an incidence rate of anywhere between 0.5-30% depending on the nature of the extraction: non-surgical extractions can cause dry socket in approximately 1% of cases, where surgical extractions have been quoted to cause dry socket in up to 30% of cases.

Risk factors for dry socket

While dry socket can occur in any extraction site, there are some situations where there is a greater risk. These include:

  • Extraction sites near areas of infection
  • Smoking
  • Frequently rinsing the mouth or spitting after an extraction
  • Playing with the extraction site
  • Oral contraception
  • Having a wisdom tooth removed

As instructed by your dentist, following a tooth extraction you should keep the area as undisturbed as possible. Ceasing smoking, alcohol and heavy exercise around the time of a dental extraction is recommended. Using mouthwash or spitting for 48 hours after the extraction is advised against, but gentle salt-water rinses from 24 hours can help keep the area clean.

Symptoms of dry socket

  • Severe pain initiating 2-4 days after the extraction
  • Pain radiating to the ear or temple
  • A bad smell originating from the mouth
  • A bad taste
  • Visible bone in the extraction site

What to do if you think you have dry socket

If you suspect you are suffering from dry socket the most important thing to do is to make an emergency appointment with the dentist. The dentist will be able to clean the site and place a medicated dressing inside that can help ease the pain and promote healing. Other than taking analgesics, unfortunately there is very little else that can be done once dry socket has occurred and it can take between 10 and 40 days to fully heal. Regular trips to the dentist over that period for medicated dressing may be necessary and continued use of gentle warm salt rinses. Avoiding food that is likely to leave particles behind that can get caught in the extraction site is also a good idea.

If you suspect you have dry socket, contact Scott Arms Dental Practice now to arrange an appointment on 0121 357 5000

Posted in: Emergency Dentist, General Dentistry

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Receding Gums – Causes and Treatment

Gum recession is a hugely common problem with approximately 50% of the population showing signs of receding gums. This figure only increases with age yet few people are aware of what causes gum recession and how to avoid it.

The aetiology of gum recession is often multi-factorial, but the consequence is generally the same; gum pulling away from the natural margin of a tooth crown exposes the root, causing sensitivity, decay risk and often an unpleasant appearance.

periodontal treatment for receding gums
Receding Gums
 

Overzealous Tooth Brushing

Overzealous tooth brushing is often the culprit in localised recession (which affects only a few teeth). It is mostly the upper canines (pointed, fang-like teeth) that are affected in cases of aggressive brushing. Connecting the front teeth to the chewing teeth at the back though their angular positioning, canines are sometimes considered the ‘corners’ of the mouth and are consequently subject to increased pressure during tooth brushing. The thin layer of gum and bone overlying the bulbous root of the upper canines is easily worn away from continual rubbing, unable to regrow.

Gum Disease

In cases of generalised recession (which affects a larger area of the mouth), a history of periodontal disease can be expected. During active stages of the disease, combinations of host-parasite interactions destroy the vital tissue surrounding teeth. Despite the underlying bone thinning, the overlying gum tissue remains plushy and swollen due to active infection. Only when the disease is arrested will the gums shrink down to match the new bone levels.

Unfortunately this side effect of successful periodontal treatment can come as a surprise. During the active stages of the disease, the gums often remain at a cosmetically acceptable level but then shrink once the issue is resolved. However, arresting the degradation of underlying tissue as soon as possible is often the only way to save the teeth and a reduced gum height is usually accepted as a small price to pay.

Other causes of gum recession are less common. Genetics can play a part in a person’s susceptibility to gum disease, which often results in recession. Life choices are also a factor: tongue and lip piercings can rub the gum they have most contact with, causing it to thin and eventually disappear. Emotional and mental status also has a role: clinical depression can result in poor oral hygiene, which may lead to periodontal disease and recession. Similarly, gingivitis artefacta, a very rare type of injurious behaviour, involves picking or scratching at the gums and is often associated with psychological issues.

Periodontal Treatment

Treating gum recession is complex. Very thin oral tissues intended to overlie slim segments of bone are difficult to regain. Gum surgery is an option in some cases and usually involves the removal of a thin section of healthy tissue from an oral donor site (like the palate) and attaching it to a receiving site. While these operations can be wonderfully successful, their longevity needs to be considered for each case. In instances of generalised gum recession following periodontal disease, full-mouth reconstruction (with either donor tissue or prosthetics) is rare, expensive and often unpredictable.

Prevention

A better way to deal with gum recession is perhaps by both preventing it from occurring and treating it symptomatically. Having regular dental checks and maintaining good oral hygiene are often adequate to reduce the risk of gum recession, though removing piercings and visiting a doctor with any psychological concerns are also both important.

Symptomatic relief is generally found through the application of sensitive toothpaste to the areas of exposed dentine. Painful gums should be cleaned gently (a single-tufted brush can be advantageous in these situations). There are also products on the market available to soothe gum pain.

If you are concerned about gum recession or want to know more about treatment and relief options, book an appointment with your dentist today on 0121 357 5000.

Posted in: General Dentistry, Periodontal Disease

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The Latest Tech for Treating Gum Disease

With nearly 50% of the population suffering from it, gum disease is one of the most prevalent diseases in the country. The most common form of the disease, chronic periodontitis, mostly affects adults over the age of forty and is characterised by the loss of bone, gum and other surrounding structures responsible for anchoring teeth into their sockets. Triggered by the invasion and multiplication of particular bacteria, chronic periodontitis is a slowly progressing disease involving complex interactions between host and parasite. The natural progression of the disease results in the loss of the tooth as there is nothing left to hold it into the mouth, regardless of the health of the tooth itself.

Periodontal disease is very complex and not completely understood. Studying it and isolating all the different bacteria involved has proved very difficult. Consequently, the aetiology of periodontal disease is not black and white. However, there are correlations between the prevalence and severity of the disease with a number of risk factors including genetics, smoking, oral hygiene and even the presence of some systemic diseases.

Unusual cases aside, most instances of periodontal disease arise when bacteria are given time to flourish, multiply and encourage the invasion of further, more pathogenic, bacteria. Located deep inside the natural pockets around all teeth, these bacteria slowly begin to destroy the tissue. Products released from this continual destruction kick the host immune system into action. Interestingly, in situations where the disease continues to flourish (when the immune system is not capable of combatting all the bacteria) the host defences appear to exacerbate the situation, further destroying local tissues in a bid to both access the bacteria and destroy them. Maintaining good oral hygiene undoubtedly reduces the risk of periodontal disease, as the immature bacteria are constantly removed before they have a chance to grow more dangerous.

With periodontal disease awareness growing, some of the most expensive dental law cases arise from the failure to recognise and treat the disease early on. These days, screenings for periodontal disease are carried out in every routine examination and more patients understand the condition that once may have gone undiscussed.

Treating chronic periodontal disease requires comprehensive oral hygiene instruction, along with the eradication of any risk factors such as smoking. Cleaning above the gum line is always carried out and once it can be seen that the patient is able to achieve a high standard of oral hygiene the next stage of treatment can begin.

Root surface debridement (RSD) is the term given for the manual removal of bacteria and their debris from the below the gum line. During periodontal disease, tissue that would once have been attached to the tooth becomes destroyed, creating a pocket around the tooth. After anaesthesia is achieved, small instruments can be inserted into the pockets so that the bacteria and debris can be removed, allowing the tissue to once again reattach. Generally the combination of RSD, oral hygiene instruction and risk factor removal are adequate to arrest the disease and allow the mouth to return to health.

In some circumstances, the gums around the odd tooth may not respond to standard periodontal treatment despite compliance and efficiency. Designed ‘because every tooth matters’, PerioChip is a biodegradable chip impregnated with chlorhexadine digluconate that, when used as an adjunct to standard periodontal treatment, has been shown to more than double the chance of success.

Periochip for treating gum disease

Chlorhexadine digluconate might ring a bell; it is the active ingredient used in the popular product, Corsodyl. While Corsodyl is effective at improving gum health in early periodontal disease, even if it were able to saturate the deep pockets associated with severe disease it would be washed out again momentarily. PerioChip, containing the same chemical, can be inserted into the pocket where it will remain until it biodegrades in seven days. Popular amongst periodontists, PerioChip is the only biodegradable, antimicrobial product available in the UK and, because it contains only antibacterials and not antibiotics, there is no danger of bacterial resistance.

For more information on periodontal disease and PerioChip, visit www.periochip.com.

Posted in: Periodontal Disease

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Dental Implant Questions for March 2014

    1. Can I have more than one dental implant placed at a time?

      Yes, you can have multiple dental implants placed at once, regardless of which jaw they are in. In fact, having adjacent implants placed at the same time is arguably advantageous, as the healing site is not interrupted.

      For nervous patients requesting sedation, it is best to have both implants placed at the same time to save the need for further sedation.

    2. Can I work after having my implants placed?

      After having the implants placed your jaw may feel tender. Different people respond differently to the treatment, but generally we recommend taking the rest of the day off and relaxing, especially if you have had conscious sedation. Some patients may find they need the next day off work as well if their work is particularly strenuous. For the majority of jobs, a single day off to recover from the treatment is all that is necessary.

    3. Which is the best dental implant system to go for? Different dentists offer different ones.

      There are a number of commonly used systems in the UK, each with their benefits. Most of the popular companies are all high tech and state of the art and dentists generally choose, and stick to, the one that they find most usable, usually after product demonstration.

      Biomet 3i, Straumann, Nobel Biocare, Camlog and Astra-Tech are all amongst the more successful. Don’t worry too much about the system offered, and look for an experienced dentist who you like the sound of.

    4. Can dental implants come out if they get knocked?

      Unlike real teeth, which are held into the bony socket via a connection of soft tissue fibres, dental implants are connected directly to the jawbone. Consequently it is extremely unlikely that any knock could loosen a healthy implant as there are no fibres to damage.

      If you have knocked your implants and are concerned that they may have come loose, book an appointment with your implantologist as soon as possible.

    5. Why are dental implants so expensive?

      Learning to place dental implants can take up to a number of years, even after a 5-year degree in dental surgery. It is also an expensive course to complete. Furthermore, dental implants are made from state-of-the-art materials with a variety of expensive implements to place and maintain them.

      Once the dental implant itself has been placed, the crown that sits on top of it is made from fine-quality porcelain, zirconia or another material that has been tailor-made by a trusted laboratory.

      Often included in the cost of dental implants is a consultation including x-rays and even CT scans, a timeframe for guarantee, post-operative maintenance appointments and possibly conscious sedation.

      To help cover the costs of implants many companies offer interest-free funding over a number of months, Denplan coverage and dental implant insurance.

    6. Can children have dental implants?

      Dental implants are not placed in children for a number of reasons: the jaws don’t stop growing until the late teenage years and not all teeth are through until around the age of 13 (not including wisdom teeth). Dental implants should only be placed when the bone underneath is sufficiently dense, clear of unerupted teeth, and in a jaw that has finished growing with a developed, stable occlusion (bite).

      In some situations, parents know that their child will need dental implants from an early age. X-rays during childhood can show that some adult teeth may never develop. Generally it is recommended for the child to wait until 18 to have the dental implants placed, but orthodontics might be recommended in the mean time to maintain the spaces needed for implant placement.

    7. Can I have my dental implants taken out if I don’t want them in the future?

      Because dental implants are fused to the bone, removing them can be very difficult. It is possible to have them taken out, but requires a careful procedure usually followed by bone augmentation if the socket needs filling. However, there would be very few situations where a dental implant would need to be removed; even if all other teeth were lost, current dental implants would prove very useful in stabilising a denture.

    8. Can dental implants be added to in the future in case I need more teeth taken out?

      If you need natural teeth removed adjacent to a healthy dental implant, an extra dental implant can be placed and the structure above the current dental implant (e.g. crown) can be removed. A new impression will be taken of the two implants together and a custom-made prosthesis can be fabricated. This can either be two separate crowns or a joint structure.

Adding to a dental implant is generally not a problem provided the surrounding tissue is healthy.

  • Can I postpone having a dental implant until the future and have a bridge in the meantime because it is cheaper? Will I still be able to have the implant?

 

Without a tooth to house, alveolar bone (the bone that forms the tooth socket) shrinks away. Consequently, if left too long, the bone may deplete so much that a dental implant can no longer be placed because not enough is there to attach it to.

If you choose to have a bridge now to replace the gap, there is a possibility that you either won’t be able to have a dental implant in the future or its longevity may be compromised. Generally, bone can be well maintained if the lost tooth was between two other healthy teeth, but more might be lost if this is not the case.

If you can’t afford the implant right away, best to try and get it placed within a few years to avoid too much bone loss. However, new systems are being developed that allow implant placement in areas of shallow bone, so worries about bone loss may one day be a thing of the past.

  • Do I have to have a dental implant for every tooth needing replacement?

    No, this is not necessary. Two implants are often sufficient to replace a few adjacent teeth and roughly six implants are adequate to reconstruct a single jaw.

    The ‘all-on-four’ technique allows the replacement of all teeth in an arch using only four implants and is offered in a number of dental surgeries for the right cases.

  • I lost my teeth because of gum disease. If I get dental implants will they get gum disease too?

    It is possible that your genetics may predispose you to gum disease, in which case your implants may suffer from a similar condition called ‘peri-implantitis’. However, with excellent oral hygiene the risk can be dramatically reduced. Cleaning the implants twice a day with an antibacterial toothpaste and using TePe brushes, floss or SuperFloss every day is recommended for the home routine. Regular visits to a hygienist is also very important, along with maintenance checks with your implantologist to ensure the implants are still healthy.

  • Will magnets stick to my dental implants?

    No, because implants are made from titanium, which is not a magnetic metal. Magnetic materials are made mostly from iron, cobalt or nickel.

 

Posted in: Cosmetic Dentistry, Dental Implants, Replace Missing Teeth

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West Midlands Emergency Dentists

Same Day Emergency Dental Service

Offering both emergency and general dental treatment, the Scott Arms Dental Practice sees and treats one of the highest number of emergency treatment patients in the West Midlands area. Having once been the official out-of-hours emergency contact for the Birmingham Dental Hospital patients, Scott Arms have over two decades worth of emergency management and specialise in same-day appointments with fast and effective pain relief.

Open all Year Round – Including Christmas

Open 365 days a year to treat any dental emergency, Scott Arms is a consistent provider of immediate treatment. Emergency appointments are available on the same day up until 11:00pm. We also operate a help-line which runs 24 hours over the weekend: our highly-trained nurses and are experienced at offering dental advice and can book you in for the first appointment of the following day at any time of night.

Dental Emergencies

The following are all described as dental emergencies by the West Midland Emergency Dentists:

Dental emergencies most commonly involve toothache, though Scott Arms Dental Practice is experienced at dealing with and treating all of the above.

Emergency Dental Advice

If you are suffering from toothache and aren’t available to see us, feel free to call one of our nurses for advice. Furthermore, below you will find some common alleviating home remedies to help ease the discomfort:

  • Take standard pain medication such as ibuprofen. Co-codamol is often recommended as it contains both paracetamol and codeine, which can both be taken alongside ibuprofen for thorough pain relief. A successful way of incorporating all these drugs to maximum effect is to stagger their use. Always read the leaflet provided before taking any of these medications as they are not appropriate for everyone.
  • Both Aleve (naproxen sodium) and Tylenol (acetaminophen) have been suggested as particularly effective against pain of dental origin. As before, always read the leaflet before consuming any medication.
  • Warm salt-water rinses are always recommended for soft-tissue injuries. Swollen gums, irritated soft tissues, painful wisdom teeth, abscesses and previous extraction sites can all usually be eased by a gentle rinse with warm salt water.
  • If you can’t see a dentist until the next morning, sleep with an extra pillow at night. Having the wound slightly higher will reduce the blood flow to the area, limiting inflammation.
  • Clove oil can be used directly on a sore tooth to help ease pain.
  • Difflam can be bought at a number of pharmacies and is effective at easing any soft tissue pain. Be sure to read the label and use appropriately.
  • Ice/heat compress – wrapping either ice cubes or a heated press in a blanket and applying it to the face in the area of pain can often help. Sometimes you will know whether hot or cold will be most alleviating. Hot presses are often recommended for muscular pains, such as those associated with jaw joint pain, while cold presses may be better at easing tooth ache. Don’t use the pack for more than ten minutes at a time to avoid injury.
  • Vanilla extract (not essence) can help ease tooth ache when applied to the tooth in question. It contains a low level of alcohol, which provides a numbing effect. The scent is often thought to be calming too.

Call Now for Emergency Dental Treatment

To make an appointment for West Midlands emergency treatment or to receive dental emergency advice, call 0121 357 5000, available until 11pm Mon-Thurs and 24 hours Fri-Sun.

Posted in: Emergency Dentist

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Could your early morning headache be linked to your teeth?

Are headaches linked to health?

Headaches are so common that many people experiencing them choose not to seek medical advice, regardless of the severity and frequency of the headaches. Most people either put no thought into the cause of their headache, accepting it as a nuisance of life, or believe it has been triggered by stress. While headaches are often caused by anxiety, a surprising number of headaches are actually linked to a dental imbalance.

There are a number of different types of headache, including migraines and sinus headaches, but the most common headache, and the one most often linked to dental imbalance, is the tension headache. This headache is characterised by a mild, throbbing pain of variable duration and frequency. Tension headaches don’t often stop a person from carrying out a daily task and over-the-counter painkillers are often sufficient to treat them. The most probable cause is muscle tension, triggered either from stress, anxiety, lack of sleep, or overexertion to name a few. But dental pain can also be a leading cause of muscle tension and is therefore just as likely to be a key factor in the initiation of these types of headaches.

A dental condition that often exists alongside tension headaches is temporomandibular joint dysfunction (TMD), a complex condition encompassing dysfunctions associated with the jaw joint and muscles relating to it. An estimated 40% of the population suffer from this and 4% suffer to such an extent that treatment is required.

A leading cause of TMD is bruxism, a parafunctional (not normal) activity involving excessive clenching or grinding of the jaw. Its effects are usually visible on examination and make reaching a diagnosis relatively easy. The most common signs are horizontal ridges along the inside of the cheeks, a scalloped tongue and worn teeth. In instances where the bruxist clenches the jaw but doesn’t grind, diagnosis can be more difficult as worn teeth are not present.

Because bruxists use their jaw muscles a lot more than usual, headaches are likely. This is often noticed in the early mornings after a poor night’s sleep: bruxists may spend the majority of the night with a clenched jaw.

Another possible dentally-related cause of headaches, unrelated to bruxism and TMD in the sense that the headache is not due to muscle tension, is referred pain. This is a type of pain sensed at a site away from the stimulus. The pain experienced during toothache is sensed by a nerve that has many branches throughout the face. It is possible that the pain can be referred to the head, much like how a heart attack is often felt in the shoulders and arm rather than the chest.

Treating a dental-based headache requires finding the root of the problem. If the issue is due to referred pain, the culprit tooth should be treated. Dentists will always eliminate the likelihood of tooth decay/damage as the cause of tension headaches before progressing to treat a more serious condition like TMD.

TMDs can have many causes and finding the right one is important in pain management. If the TMD is initiated from bruxism, treatment can involve stress-counseling and hypnotherapy, though the primary treatment plan usually includes the making of a splint for nightly use. The splint (often known as a Michigan splint or a stabilisation splint) is a plastic guard worn over of the upper teeth. It protects the teeth from further damage and opens the bite enough to attempt to reduce the episodes of grinding.

Because the awareness of dental-related headaches is on the rise, more research is going into their management and treatment. An interesting device, known as a Sleep Clenching Inhibitor (SCi device), has been developed to do exactly what its name suggests! It is a small, tailor-made block that sits comfortably between your front teeth at night to stop grinding and helps relax the jaw muscles, similarly to a splint.

If you think your headaches are caused either by your teeth, jaw or bite, speak to one of our dentists who will be able to offer you a full assessment and discuss treatment options.

Posted in: General Dentistry

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Investments in your oral hygiene

oral hygiene

The dental aisle in the supermarket is one that is constantly growing. The choices are extensive and offer little guidance to aid the confused shopper. Toothbrushes come in a range of shapes and sizes, toothpastes make exciting claims and even the simplicity of interdental cleaning has been eradicated with the introduction of numerous alternatives to standard floss.

Summarised here are a few new products receiving praise for their innovation. Shop around and try toothpastes and brushes that work for you, suited to your particular dental needs.

Toothbrushes

Manual or electric? Large or small head? Standard tufts or a mix of materials? To keep things simple, just remember that the better you are at brushing, the less complex your toothbrush needs to be. If you have the manual dexterity to practice a near-perfect brushing technique then a small-headed manual toothbrush with even bristles is all you need. However, the percentage of the population who practice what is known in the profession as the ‘modified bass technique’ (the gold standard of brushing) is small. Many toothbrushes have been made to combat this problem.

If you know that your technique is a bit all over the place then you are better off selecting a more exciting toothbrush with criss-crossing bristles designed to reach the areas you might be missing. These toothbrushes may improve your plaque control, but the easiest way for a person with a questionable technique to reach maximum cleanliness would be via an electric toothbrush. While still recommended for everyone, electric toothbrushes are particularly successful amongst those who are unsure if they are brushing their teeth correctly: pressure and movement are decided for you and all you need to do is hold the brush in the right place for the right time.

One electric toothbrush, consistently voted in the top 10 of electric toothbrushes since it was brought to market, is the Oral B Triumph 5000. While there are many other very good electric toothbrushes, the Oral B 5000 seems to tick all the boxes. It has 5 modes, one of which is designed for sensitive teeth and gums, a SmartGuide system that tells you how long you have been brushing for and when to move on to the next quadrant of your mouth, a sensor to visually warn you when you are brushing too hard and a variety of toothbrush heads.

The Oral B Triumph 5000 claims to break up plaque through series of oscillating movements, rotation movements and pulsation. The innovative introduction of pulsation to the electric toothbrush helps to break down plaque that is not in contact with the toothbrush itself. Oral B is so confident in their product that they are now offering a full refund within 30 days for anyone who doesn’t like their Triumph 5000 brush.

Interdental cleaning

Most people are aware that brushing alone is not enough to properly clean your mouth, though for many of us flossing remains a fiddly nuisance that gets deprioritised. The best thing to do is find a technique that is less likely to be a chore; there are plenty to choose from.

TePe brushes are a very successful alternative to floss. Those who find floss too fiddly often get on well with TePe brushes. They are small brushes that can be held between your thumb and forefinger and have a small bristle attached that can slide in between the teeth. They come in a variety of sizes.

Floss picks and dental sticks are also both viable options, but more recently an exciting new form of interdental cleaning has come to market: Water Pik seem to have their fingers in a number of pies – not only do they monopolise the oral health market in terms of water-based interdental cleaning, but they also specialise in sinus health and shower heads. Their water-based medicinal products seem to know no bounds.

Not only do the Water Pik water flossers look sophisticated, they have managed to provide a fuss-free method of interdental cleaning. The water flossers work by shooting a pressurised stream of water through the teeth to disrupt and dislodge the plaque biofilm. Because they are so easy to use they are especially beneficial for those with limited manual dexterity. They are also highly recommended for people with considerable periodontal pocketing around their teeth (caused by severe gum disease) that require alternative methods of cleaning.

If you are having difficulty finding the right oral hygiene instruments for you, speak to one of our hygienists or dentists next time you visit: they will be able to suggest the most suitable brushes for you and show you how to use them.

Posted in: General Dentistry

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Resin-bonded bridges

a resin bonded bridge

Resin-bonded bridges (or Maryland bridges) are one of the treatment options available for the replacement of a single missing tooth. Made from an aesthetic, white material, the false tooth locates into the space of the absent tooth and is held in place by a metal wing connected to the back of either one or both of its neighbours. The wings are attached to the adjacent teeth using a small amount of bonded filling material.

While resin-bonded bridges are a viable option for long-term tooth replacement in certain cases (where the abutment teeth involved are healthy, unfilled and in an area of low stress) they are usually used for short-term space management. Because resin-bonded bridges are very conservative to place they are often used in the interim between having a tooth extracted and having a dental implant fitted. The adjacent teeth take the load from the false tooth, which stops the healing extraction site from experiencing pressure. The protection that the false tooth provides the extraction site though coverage can also reduce healing time and increase comfort.

Because resin-bonded bridges are only cemented on to the back of other teeth they cannot withstand the pressures that normal teeth can. When put under too much pressure, or left in the mouth too long, resin-bonded bridges may de-bond (lose attachment). For this reason we recommend only using the resin-bonded bridge as a mechanism of tooth replacement and socket protection for a maximum of three months. At this time the extraction site will have healed adequately for the placement of the permanent implant and the resin-bonded bridge can be removed.

In some situations, a resin-bonded bridge may not be the most appropriate way to replace the missing tooth until the dental implant can be placed. For these patients the site can either be left uncovered or a temporary denture can be made; the denture would consist of a pink acrylic material that engages the other teeth in the arch with a protruding false tooth that can slot into the extraction site.

How to look after your temporary resin-bonded bridge:

  • Avoid eating hard food in this area.
  • Brush the bridge gently at morning and night with a soft-bristled toothbrush.
  • Use SuperFloss to clean the gum under the bridge as instructed by your dentist – this will not be recommended within the first few days of extraction as it could damage the healing process.
  • If the bridge falls out or becomes lose, call the practice on 0121 357 5000 to be fitted in that day for an emergency appointment where the dentist will reattach the bridge for you. While the materials we use to cement these temporary bridges in place are strong, there is small possibility that the bridge may come lose.

Posted in: Dental Bridges, Replace Missing Teeth

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