ask the dentist
From time to time we get asked a question here at the practice that we think it's worth providing a detailed answer to share with visitors to our website.
If you would like to ask Dr. Hirekodi an oral health care related question then please use our enquiry form.
| At what age should I start bringing my child into the dentist and how best do I look after his teeth? |
| The answer to this varies from dentist to dentist, but we recommend that you bring your child in by the age of one year old. It is important that your child has a healthy mouth to comfortably eat and also speak and to give them confidence in their appearance. Most children should have seen a dentist by the age of five. Research also shows that the most common cause of children missing school is dental problems. By coming in to see the dentist at an early age, the dentist can spot problems early before they are a problem to the child and also issue valuable advice tailored to your childs individual dental status. We recommend that babies teeth and gums are cleaned after feeds using water only with a soft brush or washcloth. Children between one and two years of age use a soft toothbrush or clean washcloth only with water twice a day. After the age of two, a fluoride toothpaste is recommended, but limiting the amount to a small pea, on a soft brush. Children must brush twice a day (morning and just prior to bed time)and adults should ensure that the paste is spat out after each brushing session so that none is swallowed. Chidren should not eat sugary snacks and limit eating sugary food to meal times. Certainly, children should not eat sugary food before bed time. Children must also be careful on their intake of acidic drinks as these are a major source of erosion to teeth. By visiting the dentist, any problems with tooth decay or tooth erosion can be spotted early and therefore treated early. |
| Do I need to come for an examination? I'm not getting any trouble at the moment |
| This is a very common question we receive. As healthcare professionals, we would advocate that you visit us for examinations (check ups) regularly. It's like getting your car serviced regularly but only more important. There are a number of benefits to regular examinations. 1/ Diagnosing dental disease early. When we see that there is a dental problem, it can be solved so much more easily when it is a small problem - and it can be painless. When a problem goes on for too long, often you end up with toothache, a tooth ends up needing root canal treatment, breaks or requires to be removed. We would think that in this day and age people shouldn't be losing teeth due to an easily preventable disease When a dental problem is caught early it is also cheaper to fix. The cost of having a simple filling can be cheaper than an extraction, is cheaper than replacing the tooth if it has to be removed and certainly cheaper than root canal treatment. 2/ Assessing whether it is of benefit to see the dental hygienist. Dental decay is the most common disease in the world - fact. Periodontal disease (disease of the gums and supporting tissues) is almost as common.The amount of oral bacteria and plaque in your mouth doubles every month, so regular visits to the hygienist will help reduced periodontal disease and hence avoid getting loose teeth or teeth falling out. 3/ Detection of Oral Cancer. For us, this should be a compelling reason to have regular examinations. Oral cancer receives little media attention compared to malignant melanoma, cervical and breast cancer. Yet Oral cancer causes more death than these other well known cancers. The death rate is so high because it does not get diagnosed early enough. Survival rates for oral cancer are very good when diagnosed early. Unfortunately, by the time it is diagnosed it is at an advanced stage. Women are continually advised to screen for breast cancer and cervical cancer, yet the easiest screen for oral cancer is to see the dentist on a regular basis who will screen for oral cancer as part of the examination - it only takes 90 seconds |
| Everytime I chew on my back tooth I get a sharp pain but otherwise it seems OK. The same thing happenned to a tooth on the other side last year, but it broke and I don't want this to happen again. |
| It sounds very much like you may have a crack in your tooth. Cracks can often develop under old silver fillings, particularly large fillings. When you bite on the tooth the crack opens up and when you release the bite the crack closes. It is often when you release the bite when the pain occurs. The pain of having a crack in the tooth is quite annoying. If the crack continually keeps opening when you bite, the tooth can fracture. Unfortunately the tooth sometimes cannot be fixed. Also, if the crack has been there a long time the nerve in the tooth can die, causing more severe pain and lead to the tooth needing an extraction or root canal filling. These problem teeth can be treated by several methods. Often the filling can be removed and at the same time, the crack removed and then the tooth filled with a new silver or white filling. If it is not possible to remove the crack then a white filling can be placed into the tooth. Because these white fillings 'bond' to the tooth they splint the tooth together so that the crack cannot open up again. The best long term solution is to have a crown mae for the tooth. This splints the tooth very robustly so that the crack cannot open up again. As with all dental problems, it is best to visit the dentist as soon as you realise there is a problem as this may save the tooth needing a root canal filling also. |
| I brush, floss and see the dentist regularly but still seem to get cavities. Why could this be? |
| Many people ask the same question. Although you can look after your teeth really well and visit the dentist on a regular basis, you could still get tooth cavities if your teeth have deep grooves/fissures. All premolar and molar teeth have fissures/grooves on their biting surfaces and sometimes on their outer aspects. Some front teeth also have these grooves, especially the inside aspects of the upper incisor teeth. These can be quite fine and deep. If this is the case, food can easily get caught in them. This is difficult to clean and then decay can begin in these areas. If the dentist notices deep grooves in the teeth he will recommend that these teeth be 'fissure sealed'. Fissure sealants are opaque or clear resins that flow into the grooves of the teeth and bond there. This prevents food from lodging in them. The procedure is very straight forward and usually no anaesthetic is required. It is a very cost effective way of ensuring that certain teeth do not get decayed. |
| I have been considering having a dental implant done. My work colleagues tell me that I would have to go into Dublin to have the work done, but this is too far for me as I live in Wickow. Do you do implants at your practice? |
| We do do implants here at the practice in Carlow. If you are interested we can send you information on implants. However, the best thing to do is phone our practice and book in for an examination and assessment for implants. Prior to having an implant done, we would need to assess how much bone you have in your jaw as there needs to be enough to support the implant. We also need to assess the appearance of the gum in the area the implant is going into to be sure the dental implant will have a good appearance. Some patients need extra bone placed under the gum if there is not enough for the implant, but we can discuss this at your assessment. We usually need to take a special x-ray (called a panoramic x-ray)and make models of your teeth as part of the assessment. |
| I have been told that I have 'gum disease' but I do not know exactly what this means. How can it be treated? |
| Gum disease generally falls in two different classes - gingivitis (inflamation of the gums alone) and 'periodontal disease'. Gingivitis is redenning and bleeding of the gums only and is easily reversed through good brushing and flossig habits. Most dentists and hygieninsts recommend a 'Bass' technique of brushing which involves angling the bristles of the brush to the gums and using a circular motion to remove the plaque. Incidentally, at Absolute Dental Care, we highly recommend using an electric toothbrush. If scale (hard calcium deposits) have built up around the teeth, it is fairly simple to remove by the dentist or hygienist. Periodontal disease is a progression of gingivitis and involves a breakdown of the tissues that support the tooth. These are the tissues that invest the tooth which include the periodontal membrane, 'cementum' and alveolar bone. Their breakdown is not easy to reverse and ultimately, without treatment lead to loosening of the teeth and their premature loss. The early stages of periodontitis are a pocket forming around the tooth due to the ligament around the tooth breaking away. Once these pockets get deep (we usually say over 4mm) it becomes difficult cleaning the bacteria away and the gum disease is unstable so that the disease is more likely to get worse compared to if the pockets were under 4mm. If treatment is not instigated then there is a risk that bone will be lost around the tooth. Treatment for periodontitis involves seeing the hygienist, who will be able to remove the bacteria from below gum level to try and arrest the disease. There may also be deposits of scale under the gum line which hinders the cleaning process. The hygienist will also remove these. Unfortunately, because the nature of gum disease and periodontitis is uncertain to many people, the reasons to see a hygienist become unclear. It is important to remember that appointments with the hygienist are not simple 'cleaning' appointments. They are therapeutic with the aim of arresting periodontal disease by removing bacteria below the gum line. Simple 'cleanings' only remove plaque and scale above the gum line and do not cure periodontal disease. Scaling and Polishing ('cleanings') are available free under the PRSI scheme for qualified patients twice a year if they do not have periodontal disease. This is where pocketing around the teeth is under 3.5mm. It is not available free under the PRSI scheme where periodontal disease is present (if pocketing is over 3.5mm. Medical card holders with periodontal disease are seen by the hygienist after approval from the health authority is gained for the treatment of this condition. |
| I have been told that my breath smells. What are the causes of this and how can I address this problem? |
| The causes of bad breath are many and varied but it can be a very embarrassing problem to have. People with bad breath are often unaware of this problem and others often find it difficult to tell them about it. The causes of bad breath range from eating food with strong odours (such as garlic)to diseases/disorders of the gastro intestinal tract. These might include indigestion or acid regurgitation. People with dry mouths (often caused by medication) can sometimes also suffer from bad breath. In the case of gastrointestinal disorders it is usually best to get the advice of your doctor for a remedy. The most common reson for bad breath seen at the dental practice, however, is 'periodontal disease'. This is inflamatory disease of the gums and supporting tissues of the teeth caused usually by accumalation of dental plaque. If it goes unchecked it causes premature loss of teeth. Good brushing technique and flossing helps to keep this problem controlled. However, in its advances stages, treatment by a dental hygienist is essential as removal of bacteria and scale below the gum line is required. |
| I need a new partial denture, but I don't know which is best. How can I decide? |
| Partial dentures usually need replacing after 5 years of use. Often this is because they get worn, begin to get loose, stain, 'sink down' or break. Essentially there are two different types of denture - Acrylic and Cobalt chrome. Acrylic are the standard 'plastic' type of denture. They rely on the tissues of the mouth for support (rather than the teeth) so they can start 'sinking' into the gums after a while. They tend to attract plaque more than the cobalt chrome dentures and do not usually fit as tight. They can look good and, if there are any loose teeth in the mouth, they can be added to quite easily. They are economical to make. Cobalt chrome (metal based)dentures , on the other hand, usually have a tighter fit and don't attract as much plaque. Because they rely on the teeth for support, they do not 'sink' into the gums as such. Their appearance is good, but they are not as easy to add to. Because of this, it may be best to get any crowns etc done prior to this type of denture to ensure that no teeth 'break' whist this type of denture is worn. Overall, it is a superior alternative to the acrylic denture and, as such, is more expensive. |
| I read somewhere that unhealthy gums are linked to heart disease and other problems. Is this true? |
| There have been several studies done showing a link between cardiovascular (heart) disease and periodontal (gum and supporting tissues) disease. At the present, however, it is difficult to isolate the exact reason for the connection. Most studies show that patients whose bodies show a reaction to bacteria involved in periodontal disease have an increased risk of heart disease and hence, more prone to heart attacks. It may be that prolonged exposure to the body to periodontal bacteria from the gums may lead to the heart disease. There is also a substance produced by the body called 'high sensitivity c-reactive protein'. This is a strong predictor for cardiovascular disease and acute gum disease causes an elevation of it in the body. So it seems that most people are aware of the role of diet and exercise in reducing cardiovascular disease but it may well be that brushing and flossing of the teeth may be just as beneficial at reducing heart disease. Research is on-going on the role that periodontal disease plays in other general diseases. Apart from cardiovascular disease, periodontal disease may also be linked with chronic kidney disease, diabetes, stroke and rheumatoid arthritis. To help maintain good help of the gum tissues, regular brushig and flossing is recommended as well are regular visits to the dentist. |
| I'm concerned about going to the dentist with this swine flu epidemic going on. Can you reassure me that I will be OK? |
| We can certainly reassure you. I know that the school season has now gone into full swing and that there are predictions that the H1N1 virus flu (swine flu) will increase in number as well as the normal flu. Modern day dentistry has practically elimainated the chances of you catching any diseases such as swine flu from the dental practice. We take every available precaution to avoid transmission of diseases, meaning you are very safe attending the practice. To ensure maximum safety, all surgery surfaces are wiped down with hospital standard disinfectant. Several of the instruments we use are disposable and those that are not are sealed and vacuum sterilised under steam pressure to thoroghly sterilise them. The instruments are not removed from their packaging until absolutely necessary. Antibacterial soap and alcohol area available in all surgeries. As an added precaution we ensure that all commonly touched door handles are wiped with a disinfectant wipe every few hours and there is an antibacterial hand scrub for patient use immediately upon entering the building and upon exit. Most patients avoid going to the dentist if they are ill - prevention is better than cure. So, as you can see, the chances of picking any illness up at the dental practice is very small. I hope this reassures you. |
| I'm getting married later in the year and would like my veneer changed as it has discoloured. Would I need any other work to get my teeth looking great? |
| It is common for patients to want their teeth to look great for their special day. It is advisable to get your dental care in good time prior to your wedding especially if cosmetic dentistry is required. After a thorough examination we can discuss what your needs are regarding cosmetic dental care. Certainly, if your veneer is discoloured, we can change this for you so that it blends in well with your natural teeth. However, ideally, we would make sure your gums are in good health first as these form the framework/backdrop for your teeth. Once your gum health is optimised and any other routine dental work is complete, you may want to discuss having some tooth whitening (dental bleaching) done or any old silver fillings replaced by modern white fillings. If you do opt for tooth bleaching then you should get this done prior to any white fillings being done or your veneer. This enables the new dental work to blend in with the whitened teeth. It is important to plan well for this before the wedding so that you can have a great smile for the wedding |
| I've noticed my gums have been receding for a while now. Why is this and what can I do about it? |
| Receding gums are not uncommon. Sometimes this can lead to an appearance around the neck of the teeth that many people do not like. There are also a few other reasons to be concerned about if you notice the gums receding. When the gums recede, the root of the tooth becomes exposed. Roots are soft compared to the hard, white enamel covering the crown of the tooth. This means that they are more prone to wearing down, particularly from toothbrushing. This is known as tooth brush abrasion. Severe toothbrush abrasion can weaken the tooth and cause it to fracture - altough this is rare. Exposed roots also tend to be sensitive compared to the enamel because 'dentine' (which is what the root is made of) is exposed to the oral environment. And dentine is sensitive. This is known as dentinal hypersensitivity. Gum recession occurs naturally with the passage of time - 'getting long in the tooth' is a commonly heard phrase. However, recession can occur due to overzealous toothbrushing using the wrong technique. It is important not to use a hard brush and to avoid brushing in a horizontal manner. The correct technique is to angle the brush to where the gum meets the tooth and perform circular movement using a medium or soft brush. One of the most common reasons patients get gum recession is as part of an overall 'periodontal disease'. Patients with periodontal disease get receding gums because the bone support of the teeth shrinks back and when this happens the gums often follow this pattern. To avoid this getting worse, it is important to follow an appropriate periodontal programme set by the dental team to help remove the harmful plaque from the mouth - both above the gum line and below. The last thing most patients want is to lose any teeth sooner than they should If you find the appearnce of the gingival recession unsightly then you should discuss this with us so we can inform you of other options. |
| My upper front tooth has been dark since I had a root filling years ago. How can I get it looking better? |
| There are several ways of getting a dark root filled tooth looking lighter in colour. The tooth can be bleached internally. This is quite a simple procedure and usually works very well. Bleaching material is placed into the tooth on top of the root filling and sealed in place for one to two weeks. At a review appointment, if it is decided that the tooth may go lighter still, then more bleaching material can be sealed in. After two sessions of bleaching, the tooth is unlikely to lighten further. Nowadays, another popular way to lighten teeth is the so-called 'inside/outside' bleaching method. Here, a removable tray is made that fits over the tooth to be bleached. A hole is made at the back of the dark tooth and then at home bleach is inserted into the hole and into the tray, which is then placed over the tooth whilst you are sleeping or for a few hours. Usually a very good result is obtained within two weeks. If the tooth is unlikely to lighten up with bleaching methods then a veneer (thin porcelain facing) can be placed over the dark tooth. The other option is a crown. This would be particularly good if the tooth has been heavily filled as it would help protect the tooth from breaking. |
| What has happenned to the GMS (medical card) scheme? |
| The GMS scheme for Medical Card holders has been radically altered since April 26th 2010. The scheme only concentrates on the provision of emergency dental treatment and allows holders to have one examination a year. Medical Card holders are no longer able to have routine fillings, cleanings, 'deep cleanings' or dentures. Although there is uncertainty as to what constitutes an 'emergency', Medical Card holders are now limited to having tooth extractions, root fillings (on front teeth only) or prescrptions if one arises. It is uncertain as to whether the GMS scheme will return back to providing a more comprehensive package for treating the dental needs of Medical Card holders. |
