Archive for June, 2010

Questions and answers about tooth worries including pain, infection, bad breath, underbites, anesthesia and discoloration

June 29th, 2010

Q&A with our dentist

Dr Keith Cohen answers online readers’ questions about tooth pain, bad breath, a developing underbite, milk tooth discoloration, root infections, and anesthesia and asthma worries.

Developing an underbite

Q: I am 62 and have badly worn teeth. I used to have an even bite, but now have an underbite due to excessive wear. My teeth are also getting smaller by the year. A consultant at the dental hospital advised me that the condition cannot be stopped. My lower jaw is starting to jut out and my upper lip is losing its support. I am desperate to restore my former appearance. My teeth are fairly good; I wear a night shield and have not had a lot of work done on my teeth. What can I do about this situation?

A: Tooth wear is a relatively common problem and the teeth can often be worn down to gum level in severe cases. You can reduce the damage by wearing a hard or soft night guard. Based on how many teeth are missing and how much tooth structure is remaining, you can opt for restoration which includes wearing dentures over the worn teeth. This kind of treatment can be undertaken by dental specialists or the prosthodontics department in a dental hospital.

Bad breath

Q: Although I have an excellent oral hygiene routine, I have very offensive breath. It is really affecting my life. I even removed my tonsils in the hope that it would help. I do not know what more to do. Can you help please?

A: Bad breath, also known as halitosis, can be caused by different factors. It is mostly due to organisms in the mouth and can be related to poorly fitted crowns and filings, gum disease and different kinds of diets. It is well known that drinking alcohol, smoking, and eating garlic and onions, all cause bad breath. This dental problem can also be caused by lung and nose infection, uncontrolled diabetes, intestinal problems, and other medical conditions.

Clearly, you will have to resolve the dental problem first. Many people underestimate the skill required for good oral hygiene and regularly miss out certain teeth or do not clean in between their teeth.

You should check with your dentist for his/ her opinion about the bad breath and see if you have gum disease or anything else that may be causing the condition.

Look into your diet and for a time try to avoid spicy and strongly flavored foods, alcohol and smoking. Also consider improving your oral hygiene as much as possible: brush your tongue or use a tongue cleaner. Sugar free chewing gum and an anti-septic mouthwash can also be helpful.

Tooth pain

Q: I have an ejected crown which could not be reinserted because the stump was fractured and it had to be extracted. Now the next tooth has become painful when touched. Is it possible that this tooth is fractured also?

A: The next tooth might be fractured, but it is unlikely, unless you suffered a knock to the teeth. Other possible causes for the pain are either a root canal problem or gum disease which your dentist should be able to diagnose quite easily by examining the teeth and getting an X-ray of them.

Anesthesia and asthma worries

Q: I need to take out a tooth from the back of my lower jaw but I am worried about the anesthesia freezing my tongue. I have asthma and I am concerned that it will affect my breathing. Is there any base for my worry?

A: Normally, local anesthesia in the jaw can freeze one side of the jaw and tongue. This can be avoided, according to the kind of treatment you require. Regardless of this, it will not induce an asthma attack. If you are still concerned about this, arrange a consultation appointment with your dentist and discuss your medical history and any apprehensions beforehand. This will allow your dentist to alter the treatment in a way that will suit you.

Root infection

Q: On a recent holiday, I received a course of antibiotics (penicillin) and when returning, a course of metronizadole for an infection under the root of a posted tooth supporting a six-tooth bridge that no one wants to try to remove. An apecoectomy has been suggested but it has been five weeks and there is no discomfort. Is it possible that the infection problem could have been cured by the antibiotics permanently?

A: Antibiotics only actually remove acute symptoms of infection. However, the original problem will still be there and is likely to persist. This can be seen on an X-ray image. If the bridge is satisfactory it is best to leave it in place. Treating this problem depends on the exact cause which is likely to be either from the root canal or the gums.

Discoloured teeth

Q: I am 62 years and have most of my natural teeth. My four front teeth are crowned but the two front ones are whiter than the others and they really stand out. Is there a way to tint them so they match the others or can I replace them?

A: The colour of ceramic or resin materials cannot be altered easily so your only option is to either change the crowns or bleach the surrounding teeth. If somebody is going to have restorations and bleaching, it is best to have tooth whitening done first. Only then should they match the colour of the crowns to the bleached teeth.

Image Source: wordpress.com

Questions and Answers about Dentures

June 29th, 2010

Q&A with our dentist

Dr Keith Cohen answers online readers’ denture related questions including what to do with dentures that don’t fit, how to handle dentures that break or feel unstable as well as denture costs

Dentures keep breaking

Q: My husband had a partial flexible denture made at a laboratory. The teeth on it broke off and he had to make another, which he paid for again. Two days later, another tooth broke off followed by two more! We called the laboratory and they said they would get back to us, but never did. My husband has a bite problem and after paying for two dentures, we cannot afford to pay for another. Can you advise us on what to do?

A: As people have different mouths, dentures that suit one person might not necessarily suit another for reasons like the number of missing teeth, different thicknesses of material, bite forces / location. You can either choose another dentist for a second opinion or write to the laboratory providing details of your dissatisfaction and take further action against them.

Cost of NHS dentures

Q: I am 67 years old. How much would I have to pay for a full set of dentures on the NHS?

A: The fee for a set of complete dentures on the NHS is currently £198.

More advice from Dr Keith Cohen

*NHS check ups; ulcers

*Discoloured milk tooth; osteoporosis and dental implant; white patch on gums

Dentures do not fit

Q: After getting a great set of dentures, I find that there is no way they will stay in position. My dentist has tried numerous things, including some kind of filing to adjust the shape. So far, the cost has been £200 but the denture seems big and out of shape. Can you suggest something for this?

A: The mouth can vary in size and shape, so in certain cases it may be technically difficult to get a good result. I suggest that your dentist refers you to the ‘prosthetics’ department of a dental hospital or a private specialist (although it could be significantly more costly).

Lower denture difficulties

Q: I recently lost my remaining lower teeth and I find that the lower denture is not quite stable. I have heard of ‘denture clinics’, which offer mini implants and more satisfactory dentures. Your comments on the advantages offered by these rather expensive options would be received gratefully. Also, how can someone find recommended clinics offering these options?

A: Complete lower dentures are usually a source of discomfort and looseness. Mini implants or dental implants are the most beneficial in your case. Mini implants are smaller and less traumatic to place, however, there is not as much research on this solution. They may be weaker and might not last as long as conventional implants, even though they are less expensive. You can use various types of attachments to clip the denture onto the implant, but these need routine maintenance. Eventually, you will have to make a new denture, although existing dentures can be modified in some cases. Any type of implant work is complicated, so you would require an experienced dentist. There are many postgraduate implant qualifications that you can look for, or you can also contact a General Dental Council registered specialist.

Scott Maslen visits Dentexcel

June 25th, 2010

Scott has been one of our patients for a while now – and he and his wife regularly come to Dentexcel for their dental needs. You are more likely to know Scott Maslen as Jack, from Eastenders, who has recently won both Best Actor and Sexiest Male in the 2010 British Soap Awards.

Scott is best known for his role as Phil Hunter in the long running ITV1, police drama series The Bill. He is a graduate of the Guidhall School of Music and Drama whose other Alumni include Daniel Craig, Orlando Bloom and Joseph Fiennes. Scott is currently working on EastEnders as the character Jack Branning for this award winning BBC flagship show.

We got a picture of both Scott and his gleaming teeth with Keith Cohen – Scott’s cosmetic dentist.

Questions and Answers about Receding Gums

June 24th, 2010

Q&A with our dentist

Dr Keith Cohen answers online readers’ gum related questions including what to do about white patches or white gyms, as well as handling stains revealed by receding gums

Quickly receding gums

Q: My gums are starting to recede very quickly. I have asked my dentist for advice, but he only tells me to use sensitive toothpaste. Can you suggest methods to stop this from getting worse?

A: Gum recession is usually caused by a gum disease or from incorrect brushing techniques. If your dentist is unable to help you with this, ask if you can be referred to a ‘periodonist’ who specialises in gum treatment or to the ‘periodontal department’ of one of the dental schools for further advice.

•Dairy goodness for gums

Receding gums and stained teeth

Q: The gums across my top front teeth are receding and the area is stained and cannot be cleaned. My dentist proposes to cover the stains with the material used for composite fillings which costs £700 for nine front teeth and is an hour’s work. The stains are not visible as they are above the “smile line”. But my dentist says if I don’t have the work done, my teeth will get worse. What would you advise and is the cost reasonable?

A: There are many causes for stains, but treatment will not be required unless it is for decay on the tooth surface. Unless your dentist is a fast worker, he may not be able to complete nine filings in an hour. If you have any doubts, I think you should consult another dentist to confirm the diagnosis and treatment.

White patch on gum

Q: I had an upper molar extracted a month ago and the next day I noticed a white area, about 1-2 cm on my upper gum. My gum is sore in the region over the adjacent two teeth. The white area which I initially thought was gum bruising is not clearing up. The other gums are slightly sore and my saliva seems thicker than usual. Will it eventually clear up or is there anything to worry about in the long run?

A: The ‘white area’ may be an ulcer in the region of the extraction which would heal up within a week. If this persists ask your dentist to check for any other cause. The saliva may also be modified by any medication which you are taking. Following an extraction it usually takes about one week to get back to normal.

White gums

Q: I recently noticed that my lower jaw gums are white and quite hard on one side of my mouth (which was not the case before). I clean my teeth twice a day, but do not really pay attention to my gums. They seem to have receded a good deal. What should I do? I know someone who transplanted the insides of her cheeks on her gums and they look very healthy. I am an NHS patient but have not seen a dentist since I was ill in hospital last year. Can my dentist undertake this procedure?

A: First you need to understand that everyone’s mouth is different, so it is not advisable to assume you can apply the procedure your friend received to yourself. Dentists receive complete training on treating teeth and also the entire mouth and jaws. Those who smoke usually get white patches in the mouth, but there may be other causes. Check with your dentist for a proper diagnosis and treatment. If he/she cannot help, ask to be referred to an appropriate specialist.

Questions and answers about dental implants

June 22nd, 2010

Q&A with our dentist

Dr Keith Cohen answers online readers’ implant related questions about the impact of smoking on dental implants, tooth loss, gaps between teeth, osteoporosis and ulcers.

Dental implants and smokers

Q: I have been told that I cannot get dental implants because I smoke. And even if I gave up smoking, it would be at least a year before I could get them. Is this true?

A: It is true that smoking reduces the success rate of implants and can even cause complications for surgical procedures. However, there are many factors that have to be considered like how much you smoke and over what time period, as well as general medical health and how straightforward the procedure will be. This depends on how much bone is there to place the implant in. If you insist on going ahead with the treatment and there is a dentist to carry it out, you must accept that there are chances of reduced success. This means that one or more implants might not integrate and will need removing or replacement.

Tooth loss and Implants

Q: I have lost most of my teeth because of chemotherapy and my dentures have gone loose as well. Is it possible to get implants and what would be the cost of this treatment?

A: Generally, it is possible to get dental implants after radiotherapy or chemotherapy. Success rates may be reduced as your bone healing might be affected. For further advice and referral, contact the specialists who previously treated you. Usually, with medical history like this, treatment can be carried out within the hospital service and often without charge.

Growing gap

Q: I am 57 years old and have undergone routine dental treatment all through my life. I have a gap between my two front teeth and with age, the gum is receding and increasing the gap. My gums seem a bit delicate, but my dentist says that I do not have any dental problems. Are there any cosmetic treatments that do not involve extractions for this problem?

A: It is natural for the gums to recede with age, but incorrect brushing and gum disease can make this worse. The simplest way of reducing the gap between the teeth would be by bonding composite restorations to the side of the teeth, if they are healthy. If your teeth are more heavily restored, you can reduce the gap with crowns or veneers. If there is a large space, partially closing it can improve the appearance.

Ulcers and Implants

Q: 12 years ago I had implants done in my lower jaw from a dental hospital. Ulcers have now developed around some of them and I am unable to return to the hospital because of ill health and because I moved to another area. Private treatment will cost £12,000, which is more than I can afford as I am a pensioner. NHS dentists will not touch my teeth. I live in a small town without facilities and cannot travel. Can you suggest anything I can do?

A: It is not easy to make a diagnosis without seeing you. Ulcers are not the only cause for concern. I think you need further advice and would suggest that you ask your dentist to refer you to a local dental hospital or private specialist for an opinion as to the cause and possible lines of treatment. (Initially, it may also be possible for your dentist to email pictures and X-ray images of your mouth to the specialist.)

Osteoporosis and dental implants

Q: I take alendronic acid tablets for osteoporosis. Does this mean I am unable to safely have a dental implant? What about Nonviva injections for the same condition?

A: Some medications used to treat osteoporosis have been associated with ‘osteonecrosis’ in a small percentage of patients. This means, with surgical dental treatment or extractions, areas of bone in the jaws become non-vital. There is more association with intravenous usage than when the medication is taken by mouth. If you need to have some form of surgical treatment, consult the doctor who has prescribed the medication and ask their advice on your particular case before undergoing treatment.

*Dentists may pick up on osteoporosis

Implant insurance

Q: Six years ago I had four implants and have not experienced any problems whatsoever. In fact, the bridge they support feels rock solid. Although the policy doesn’t cover wear/tear, I still insure the implants for £200 every year against treatment costs incurred through accidental damage. Do you think this is worthwhile or can I safely assume the implants are “part of me” now?

A: Unfortunately, there is no treatment which is 100% successful and as time passes there are more chances for problems. Implant treatments are usually very successful, but problems may occur with the implants, screws and even the structure on top which can fracture or chip. Your dentist should be able to check your mouth and give you an idea of whether or not any problems will occur later, so you can decide if it is worth continuing with the policy.

Image Source: wordpress.com

Developing an underbite

June 17th, 2010

Question: I am 62 and my teeth are badly worn. I had an even bite but due to excessive wear I now have an underbite and my teeth are getting smaller by the year. I have been advised by a consultant at the dental hospital that it is impossible to halt. I can see my appearance changing as my lower jaw is beginning to jut out and my upper lip loses its support. I am desperate restore my appearance. I haven’t had a lot of work done to my teeth and they are fairly good. Please help me. I wear a night shield.

Answer: Tooth wear is a relatively common problem and in severe cases the teeth can be worn down to gum level. The damage can be reduced by wearing a soft or hard ‘nightguard’. Restoration is often by means of dentures on top of the worn teeth (overdentures), or crowns and bridges, depending upon how many teeth are missing and how much tooth structure remains. Normally this type of treatment can be carried out by the ‘prosthodontics’ department of a dental hospital or by a dental specialist.

Lower denture difficulties

June 17th, 2010

Question: I have recently lost my remaining lower teeth and find the lower denture not very stable. I have heard of ‘denture clinics’ which offer more satisfactory dentures, and also of mini implants. Your comments on the advantages of either of these (quite expensive) options would be gratefully received. Also how one finds recommended clinics offering these options.

Answer: It is true that complete lower dentures are very often a source of discomfort and looseness. Dental implants or mini-implants will provide the most benefit in your situation. Although mini-implants are smaller and less traumatic to place, they have generally been less well-researched. They are weaker and may not last as long as conventional implants although they are much less costly. The denture will clip onto the implant with various types of attachment, although these often require regular maintenance. You will usually need to make a new denture although in some cases the existing denture can be modified. Any type of implant work can be complicated so you need an experienced dentist. There are now a number of postgraduate implant qualifications or you can contact a General Dental Council registered ’specialist’.

Growing Gap – Dr Keith Cohen answers

June 17th, 2010

Question: I am 57, and have had regular dental treatment/care all my life, but have always had a gap between my two front teeth. As I get older and my gums recede, this gap is growing and I hate it. Can I do anything cosmetic about it without extractions? My gums do appear to be fairly delicate, though my dentist does not say that I have any particular disease. I have asked his opinion about this, but he was not very forthcoming.

Answer: As we grow older, gums quite often recede, and this can be worsened by gum disease and brushing out teeth incorrectly. If the teeth are healthy the simplest way of reducing the space would be by bonding some composite restorations to the side of the teeth. Another option would be with veneers or crowns if the teeth are more heavily restored. However, if the space is quite large then the appearance can also be improved by partially closing it.

Smoking and Implants – Dr Keith Cohen answers

June 17th, 2010

Question: I have been told that I cannot have implants as I smoke – and even if I gave up it would be at least a year before I could – is this true?

Answer: Smoking does reduce the success rate for implants and with regards to surgical procedures, it can produce complications, so to an extent this is true. Having said this, a number of other elements need to be considered, for example, how much you smoke, and over what time period, your general medical health and whether or not the procedure is likely to be straightforward – which will depend upon how much bone there is in which to place the implant. Another dentist may be prepared to carry out the treatment, depending upon your situation, so it may be worth asking for an opinion from a ‘dental specialist’. If you are determined to proceed, and a dentist is willing to carry out the treatment, you need to accept that there may be ‘reduced success’ which means that one or more implants might not integrate and need to be removed or replaced.