Preventative Dentistry

Tartar, otherwise known as calculus, is hard, mineralised deposits which form on tooth surfaces when plaque is not regularly removed (see plaque) (hyerplink to tooth decay, what is tooth decay). It appears white to yellow-brown in colour and can often be found in between teeth, where people have failed to clean using floss or interdental brushes. It is especially troublesome to remove when it builds up and if left can encourage bacteria to collect which can lead to gum disease (hyperlink to gum disease).

The good news is that your dentist, dental hygienist and therapist can demonstrate how to remove plaque thoroughly and prevent further tartar formation. If tartar has already built up on your teeth, you may be advised to have a professional clean called a scale and polish.

Most oral diseases can be prevented and managed with healthy behaviours such as a balanced diet and effective cleaning of the teeth and gums. Our dentists will help you to improve your oral health by providing tailored advice and by teaching you skills to improve your oral hygiene. There are several steps that can be taken to improve your oral hygiene and these include:

Effective toothbrushing using a fluoride toothpaste

Brushing teeth physically removes plaque and prevents gum disease and tooth decay. Fluoride in toothpaste is effective against tooth decay.

All tooth surfaces should be cleaned twice a day, last thing at night and at another time of the day. Excess toothpaste should be spat out and you should not rinse after brushing.

Thorough toothbrushing should take at least 2 minutes. An egg timer or a toothbrushing app such as Brush DJ can be helpful to assist you in the length of time you should be brushing your teeth.

Manual and electric toothbrushes are effective at removing plaque. Hold the brush at a 45 degree angle so that the bristles can clean around the gum line.

Inter-dental (interproximal) brushes should be used to clean between teeth twice a day. They should fit snugly between your teeth and you may need different sizes depending on how large or small the gaps are between your teeth.

Healthier eating and a reduction in sugar intake.

Stopping smoking and tobacco use.

Reducing alcohol consumption.

Visit your dentist regularly for preventative care and advice.

Just like in hospitals where there are doctors and nurses, you may come across dentists, dental hygienists and dental therapists in dental practices. Dental hygienists and dental therapists fall under the category of Dental Care Professionals (DCP) and they are qualified to carry out particular aspects of dental care. They have different qualifications and scopes of practices within dentistry.

Dental hygienists help patients maintain their oral health by preventing and treating periodontal disease. They are able to :

Take a history, examine, diagnose and treatment plan patients within their competence.

Take and interpret radiographs.

Provide dental hygiene treatment and undertake scale and polishes and root surface debridement.

Apply topical fluoride and fissure seal teeth.

Dental hygienists cannot restore teeth, carry out root canal treatment or extract teeth.

Dental therapists have a similar scope of practice to dental hygienists; however, they are able to carry out additional treatment which patients are used to seeing their dentist provide. Dental therapists can place fillings, extract baby teeth and place preformed crowns on baby teeth. They are not able to place crowns on adult teeth, carry out root canal treatment or extract adult teeth.

A scale and polish is a professional tooth cleaning procedure (professional mechanical plaque removal) to remove tartar. It can be carried out by your dentist, dental hygienist or dental therapist. There are two stages to a scale and polish. During the first stage, hand instruments or ultrasonic scalers are used to remove tartar. Ultrasonic scalers have vibrating tips which produce water. The vibrations loosen tartar from the surface of teeth and water washes away the debris. The teeth are then polished in the second stage of treatment in order to remove stains and to leave a smooth surface. They do this by using a soft rubber cup with polishing paste.

If you have periodontal disease, your dentist or dental hygienist/therapist may recommend you have a deeper clean called root surface instrumentation or subgingival professional mechanical plaque removal. They may also advise you to visit the surgery more frequently in order to manage your gum disease.

Scaling and polishing teeth can sometimes be uncomfortable, especially if you have inflamed gums with gum disease. If you require a deeper clean your dentist may apply a topical anaesthetic gel to help manage pain or they may even numb the gums and teeth using local anaesthetic prior to starting treatment.

After a scale and polish it is normal to experience bleeding gums but this does not last long and if you keep cleaning your teeth regularly, your gums will improve and become healthier.

Your dentist will carry out a full mouth examination and determine whether it is clinically necessary for you to have a scale and polish on the NHS. A simple scale and polish is included in a Band 1 NHS course of treatment. However, If you have more advanced gum disease you may require a deeper clean and this falls under a band 2 NHS course of treatment. Please consult the NHS fee list for further information.

If your dentist informs you that a scale and polish is not clinically necessary, but you would like one anyway, you will have to pay privately.

You may wish to see our dental therapist for professional tooth cleaning and this is available privately. Please consult our private fees list for charges.

There is evidence which supports the use of pit and fissure sealants to reduce the risk of tooth decay. The decision to place pit and fissure sealants will be made by your dentist based on a thorough clinical examination and identification of tooth decay risk factors within your medical and social history. Your dentist may recommend you have sealants in teeth which they feel are at risk of developing tooth decay. Normally teeth such as molars and premolars with deep pits (small hollows) and fissures (grooves) on their biting surfaces are more at risk of developing tooth decay. Pit and fissure sealants can be placed in children, adolescents and adults who are at risk of developing tooth decay.

Placement of pit and fissure sealants is a quick and straightforward process. The tooth surface is first cleaned and a special solution is applied which is then rinsed off the tooth. After drying, a sealant is applied and sets hard when a bright, blue light is shone on the tooth. It only takes several minutes to seal one tooth and is completely painless.

If you have any questions regarding pit and fissure sealants, please speak to your dentist at your next examination. They will be able to advise you as to whether it is a suitable treatment option to help your teeth.

Mouth cancer is the sixth most common cancer in the world and each year around 7,800 new cases of mouth and oropharyngeal cancer are diagnosed in the UK.

Mouth cancer is more commonly found in adults over the age of 55. Only 1 in 8 cases occur in people younger than 50. Men are more likely to develop mouth cancer than women this is because on average, men tend to drink more alcohol than women.

Although the exact cause of mouth and oropharyngeal cancers are unknown, there are several factors which increase the risk of developing mouth/oropharyngeal cancer. If you have one of these risk factors, it does not mean that you will definitely develop mouth/oropharyngeal cancer, but it does mean that you are more susceptible. Risk factors include:

• Smoking

Smokers are more likely to develop mouth and oropharyngeal cancer. Studies suggest that more than 60 out of 100 (more than 60%) of mouth and oropharyngeal cancers in the UK are caused by smoking.

• Alcohol

Studies show that around 30 out of 100 (30%) of mouth and oropharyngeal cancers and caused by drinking alcohol. If you smoke and drink alcohol together this increases the risk further.

• Chewing tobacco or betel quid

• Human papilloma virus (HPV)

HPV is a virus which spreads through close skin to skin contact, usually during sexual activity. It infects the skin and cells lining body cavities. The virus is extremely common and for most people HPV causes no harm and gets better on its own. The virus can cause changes to the tissues in the mouth and throat and increase the risk of mouth and oropharyngeal cancer.

• Poor diet

If you have a diet low in fruit and vegetables, the risk of developing mouth and oropharyngeal cancer increases. It is important to have a balanced diet.

Sunlight or sun beds

Weakened immune system

Family history

Previous cancers

There are many signs and symptoms of mouth cancer and it is extremely important to contact your dentist and/or doctor if you notice any of the following:

• Ulcers which do not heal within three weeks. Ulcers can be painful or painless and are areas of broken skin in the lining of the mouth or lips.

• Unexplained, persistent lump in your mouth or neck which does not go away. A lump can be caused by an enlarged lymph node. Swelling of one or more lymph nodes is a common symptom of mouth cancer. If however, the lump is hot, red or painful the lymph node may be enlarged due to an infection rather than cancer.

• Unexplained loose teeth or sockets which do not heal after an extraction. Teeth can feel loose if you have gum disease or if you have a dental abscess, but if you are unaware of either of these issues and your teeth feel loose, it is important to contact your dentist.

• Unexplained persistent numbness or an odd feeling within the tongue and lips. Lips and cheeks can sometimes feel numb for several hours after having local anaesthetic for a dental procedure but it is not normal for numbness to persist.

• Red or white patches in the mouth or throat. An abnormal patch of skin in the mouth can be a sign of cancer or pre-cancerous changes within the tissues. There are however other causes for red and white patches such as oral thrush. It is therefore important to notify your dentist of any changes.

• Difficult in swallowing can be a sign of mouth cancer along with pain or a burning sensation.

• Speech can be affected and people can sound different, slur their words, have trouble pronouncing specific sounds or talk with a lisp.

In the UK, there currently isn’t a national screening programme in place for mouth and oropharyngeal cancer. This is because studies have been unable to prove that oral cancer screening saves lives. Mouth and oropharyngeal cancers are uncommon and the benefits of possible screening tests do not outweigh the risks.

At Heswall Dental Practice we recommend that you visit the dentist regularly for a dental examination (check-ups), even if you have false teeth or dentures. Dentists routinely check your mouth for mouth and oropharyngeal cancer as part of their examination and can often be the first people to spot signs of early cancer. Your dentist, will examine our mouth to check for signs of mouth cancer. The may also carry out an external examination of your neck to check for any lumps or abnormalities. If they find anything which looks suspicious, they will inform you and refer you to a specialist.