FAQs

Amalgam Fillings

What's all the fuss about amalgam fillings?

The World Health Organisation and the International Dental Federation have released a joint statement confirming the safety of dental amalgam as a filling material.

The Association believes there is no positive gain in having dental amalgam fillings replaced with other materials, other than for aesthetic reasons.

Is it true that amalgam is dangerous for my baby?

If you already have amalgam fillings, there is no evidence to suggest you or your baby will be harmed because of them. However, general principles of public health during pregnancy suggest that it is prudent to avoid any dental treatment that can be deferred. This includes the removal or placement of amalgam fillings during the pregnancy and during the subsequent period of breastfeeding. The NHMRC Working Party report states: “… general public and environmental health principles dictate that where possible exposure to mercury from dental amalgams be reduced where a safe and practical alternative exists. This becomes more prudent in special populations, including children, women in pregnancy and persons with existing kidney disease.

Should I have my amalgam fillings replaced?

Dentists replace amalgam fillings for a variety of reasons including recurring decay, fracture, endodontic treatment and appearance.

If you seek replacement of quite satisfactory amalgam fillings for other reasons, such as a concern about the effects of mercury, you may create problems that otherwise would not have occurred, such as:

• Possible damage to or weakening of teeth.
• Sensitivity or pain after the filling.
• Financial problems.

Bridge Work

What is a bridge?

A bridge is an appliance permanently fixed in the mouth to replace missing teeth. It uses remaining teeth to support the new artificial tooth or teeth.

A conventional fixed bridge consists of crowns that are fixed to the teeth on either side of the missing teeth and false teeth rigidly attached to these crowns.

An enamel bonded bridge uses a metal or porcelain framework, to which the artificial teeth are attached, then resin bonded to supporting teeth.

Cosmetic Dentistry

What is Cosmetic Dentistry?

In today’s age of technology, your dentist has a range of options to help your teeth look great. Stained teeth, dark teeth, chipped teeth, crooked teeth, and even teeth that are missing altogether, can be repaired or replaced. Cosmetic or aesthetic dentistry is the broad heading under which many dental procedures that improve the appearance of teeth may be described.

Who does cosmetic dentistry?

All general practice dentists use bonding as part of their everyday practice and are trained in and quite skilled at the above procedures.

State Dental Boards are responsible for registering dentists and dental specialists and there is no specialist category of "Cosmetic Dentist".

What is the best way to whiten the teeth?

There are many excellent ways to whiten the teeth and all have advantages and disadvantages. Since each case is different there is no one best way.

When staining is present on the surface, an ADA dentist can professionally clean the teeth, often producing a fresher, whiter appearance.

On the other hand, when staining is actually in the tooth, below the surface, there are a number of ways to whiten the teeth. Sometimes simply replacing old, worn out fillings that are failing at the edges can produce better looking front teeth. Alternatively, when the enamel is heavily stained, crowns or facings may be the best option. ADA dentists have access to continuing education in the latest dental techniques and they can give advice as to the best choices for you.

Cracked Teeth

What type of forces cause teeth to crack?

Front teeth usually break due to a knock, an accident or during biting.

Back teeth can also be fractured from a knock. They are much more likely than front teeth, to crack from forces applied by the jaws slamming together rapidly. This is why sportspeople wear mouthguards to cushion the blow.

Other forces occur during sleep because people grind their teeth with a much greater force than they would ever do while awake. The first sign of problems may be what we call "cracked tooth syndrome" – a sore or sensitive tooth somewhere in the mouth that is often hard for even the dentist to find. In some individuals the grinding, called bruxism, causes tooth wear rather than fracture.

Will my tooth become better?

Unlike fractures elsewhere in the body, this crack will never heal. There is a small chance that the crack will get worse even with a crown placed. This may lead to the need for root canal treatment, or even removal of the tooth. However, many cracks can be fixed without root canal or tooth removal.

Crowns

What is a crown?

Dental crowns (also sometimes referred to as ‘dental caps’ or ‘tooth caps’) cover over and encase the tooth on which they are cemented. Dentists use crowns when rebuilding broken or decayed teeth, as a way to strengthen teeth and as method to improve the cosmetic appearance of a tooth. Crowns are made in a dental laboratory by a dental technician who uses moulds of your teeth made by your dentist.

The type of crown your dentist recommends will depend on the tooth involved and sometimes on your preference. They include porcelain crowns, porcelain-bonded-to-metal crowns, which combine the appearance of tooth coloured material with the strength of metal, gold alloy crowns and acrylic crowns.

Dental Caries

What is dental caries?

Dental caries, or dental decay, is a common disease, which causes cavities and discoloration of both permanent and "baby" teeth. As the disease progresses in a tooth it becomes weaker and its nerve may be damaged.

What causes dental caries?

Dental decay occurs when bacteria in the mouth make acid which then dissolves the tooth. Bacteria only produce this acid when they are exposed to sugar.

How can you prevent dental caries?

If you have a sensible diet, a good flow of saliva, a cleaning routine and your teeth get an appropriate fluoride exposure, you are unlikely to get decay. So, you can prevent decay by:

• being careful with how often you eat sugary foods or have sugary drinks.
• brushing and flossing your teeth carefully to reduce the amount of bacteria on their surfaces.
• using fluoride toothpaste. This will make the surfaces of teeth more resistant to acid. The fluoride in our water supply strengthens the developing teeth of infants and children.

How do dentists treat dental caries?

Early dental caries is reversible. Mineral can be deposited back onto the tooth surface if you can modify your diet and oral hygiene. Your dentist can treat early areas of caries with topical fluoride, and if you are careful with your diet and cleaning no other treatment may be required.

A more advanced area of dental caries will require a "filling". Your dentist will remove the damaged and infected soft tooth structure and repair the tooth. It is important to have this done as early as possible to preserve the strength of the tooth and prevent bacteria damaging the tooth pulp.

It is very important to listen to your dentist’s advice on how to eliminate the cause of your caries. Don’t think that just fixing a cavity will stop the disease from occurring in other areas of the mouth.

Dental Emergencies

What should I do in a dental emergency?

Toothache: Very persistent toothache is always a sign that you need to see a dentist as soon as practicable. In the meantime, you should try to obtain relief by rinsing the mouth with water and trying to clean out debris from any obvious cavities. Use dental floss to remove any food that might be trapped within the cavity (especially between the teeth). If swelling is present, place a cold compress to the outside of the cheek (DO NOT HEAT). Take pain relief if necessary, using pain medicines that you know you are safe with. Remember, no pain relief tablets will work directly on the tooth. They must be swallowed as directed. If placed on the tooth, they can cause more trouble (especially aspirin).

Braces or retainers: If a wire is causing irritation, cover the end of the wire with a small cotton ball or a piece of gauze or soft wax. If a wire is embedded in the cheek, tongue or gum tissue, DO NOT attempt to remove it: Let the dentist do it. If there is a loose or broken appliance, GO TO THE ORTHODONTIST OR DENTIST.

Knocked out tooth: If dirty, rinse tooth in milk holding it by the crown (not roots). If not available use water (few seconds only) or have patient suck it clean, then put the tooth back in the socket. If the tooth cannot be replanted, wrap in Glad Wrap or place it in milk or in the patient's mouth inside the cheek. Go to a dentist within 30 minutes if you can. Time is critical for successful replanting.

Broken tooth: Try to clean debris from the injured area with warm water. If caused by a blow, place a cold compress on the face next to the injured tooth to minimize swelling. Try to find all the bits that are missing and bring them to the dentist, keeping them moist. Some broken bits can be bonded back onto the teeth almost invisibly. Go to the dentist as soon as practicable.

Bitten tongue or lip: Apply direct pressure to bleeding area with a clean cloth. If swelling is present, apply cold compress. If bleeding doesn't stop readily or the bite is severe, go to the dentist or hospital.

Objects wedged between teeth: Try to remove the object with dental floss. Guide the floss in carefully so as not to cut the gums. If unsuccessful, go to a dentist.

Dental Fees

Is there a recommended dental fee scale and how does this relate to Health Fund rebates?

There is no such thing as a 'recommended fee' for any dental treatment. A dentist charges what he or she thinks is appropriate for the service they provide, taking into account all their costs and the particular circumstances of each treatment. The suggestion that some dentists depart from an 'approved' or ‘recommended’ level of fees, thereby creating 'gaps' between the fee and the Health Fund rebates is both false and misleading. In fact, it is against Trade Practices law for dentists to collude in the maintenance of any set fee scale.

Health Funds set their rebates at a level that suits their commercial needs. Those rebates are not related to any recognised fee scale. The responsibility of adequately adjusting rebates lies with the Health Funds.

You can telephone the Association for further information on fee setting mechanisms, but remember there are no 'recommended' fees.

Do I have to pay my dental account on the same day as my treatment?

Dentists, as anyone who provides a service, are entitled to determine their own terms.

Many dentists expect payment on the day of treatment. This practice reflects the problems dentists have traditionally experienced of lack of payment of accounts, and the widespread availability of payment methods such as credit cards. If you are a new patient to a practice, it is usually expected that you be prepared to pay for the first visit at least, before you are approved for any account facilities. This is no different to any other business.

If you are applying for an account, you may be expected to supply enough information to establish your identity and offer some commitment to pay for the treatment.

Often the large laboratory costs incurred by dentists for such things as crowns and dentures will be asked to be paid at the commencement of treatment. Your dentist will inform you of your obligations in this regard.

Dental Phobias

What can I do if I'm scared about dental treatment?

The best way to overcome your fear is to discuss your concerns with your dentist.

Experiences as a child may become distorted by time and reinforced by outdated media presentation of stereotypes. Much has changed, thanks to technology and education, and dentists are skilled professionals in dealing with patients who are apprehensive about seeking treatment.

This will obviously be a team approach between you and your dentist and his/her staff. Communication is the key. You must feel comfortable expressing your fears and concerns and have a sense that you are being listened to.

There are various forms of anaesthesia and relaxation that can be used effectively to change your negative thoughts into a positive experience.

Do all dentists use "happy gas"?

"Happy gas", "laughing gas", "relative analgesia", "nitrous oxide" are all describe the same form of sedation which can be used for patients who are apprehensive of treatment done with local anaesthesia.

Not all dentists utilise these options, but referrals can be made. Likewise, you may elect to have extensive procedures done under full general anaesthesia in a hospital or day centre.

Dental Records

Can I have my dental records?

A patient's dental records and x-rays are the property of the dentist.

They are a professional's working notes used in the planning and performing of treatment.

You may seek access to the information held about you and the dentist will provide this access without undue delay. This access might be by inspection of your dental records at the time of appointment or by special access or copying of information at other times.

There will be no charge made for requesting this information but there may be fees levied just to cover the costs associated with the processing of this request or the copying of information.

Under the some state regulations, the owner of the x-ray equipment is required to provide a copy of an x-ray on receipt of a written request from the patient, but at the expense of the patient.

If you are changing dentists, you could give written permission for your new dentist to seek a copy of a record of your treatment from your previous dentist, or request your current dentist to forward them on to your new dentist.

It is far better for all records to be forwarded directly from dentist to dentist to prevent the loss of these important records during your move. Some dentists provide a summary of relevant treatment which is usually all that is needed by the new dentist.

Dentures

What is the difference between a denture and a crown or bridge?

Removable dentures are those dentures (plates) the wearer can remove and replace at will. These types of dentures can replace one tooth, all your natural teeth, or any number of missing teeth in between. A crown or a bridge is fixed or cemented in place and cannot be removed.

How often should I have my denture checked?

If you currently wear removable dentures of any kind, it is advisable that you have these checked regularly. It is recommended if you have any remaining natural teeth you should have these and your dentures reviewed every six months or as directed by your dentist. If you have no natural teeth and wear removable full dentures, your dentures should be reviewed at least every two years.

Why does my denture need to be relined?

The rapid shrinkage of bone following extractions means the denture will soon need to have the fitting surface relined once that shrinkage has slowed down enough. After a reline, patients report a much better fit. This relining maybe done between three and six months after an immediate denture has been fitted. Your dentist will advise you when an immediate denture is ready to be relined.

Relining involves an additional fee, but this is going to be cheaper than a new set of dentures and it is often very much appreciated.

All dentures lose their fit through natural changes in your mouth. Chewing gum, biting your nails or grinding your teeth can accelerate this. You should see your dentist yearly for a denture check, when refitting or relining may be necessary. For example, many patients report that their full dentures are loose after a period of rapid weight loss.

How long after fitting can I keep going back to have my new dentures adjusted free of charge?

A dentist will be happy to see you and make any necessary adjustments free of charge in the initial stages of fitting your denture. The number of visits you will require is related to the nature of the job and your dentist will be the best person to advise you about this before you proceed.

Filings

Can all teeth with holes or fractures be filled?

Most teeth with small to moderate decay or fractures are easily restored to function with fillings. Where decay is extensive or fractures are large, more complex treatment may be required. Some teeth can be so badly broken down or fractured that they are unable to be saved.

How long do fillings last?

The position, shape, material, and functioning pressure, all influence how long dental fillings will last. Larger fillings that bear a heavy functional load tend to break down more quickly than smaller fillings that bear little force. This is why it is impossible and meaningless to try to state categorically how long fillings should last.

However, when placing a filling, the dentist may have an idea of the expectation of the life of the filling. For example, a very small filling in the groove of a tooth away from biting pressure could be there for decades whereas a very large one in the mouth of a person who grinds their teeth may be lucky to last a few years and really should have a crown.

In a checkup, your dentist is constantly monitoring the state of your fillings, looking for signs of weakness, cracking, decay or discolouration.

Is it possible to avoid fillings?

With proper attention to diet, oral self-care, regular dental check-ups, and the correct use of mouthguards to prevent injury, the need for fillings can be eliminated, and the frequency of filling re-placement can be extended.

Should baby teeth have fillings too?

Yes, baby teeth should be filled to prevent toothaches, to maintain the baby teeth for eating, and to hold the right amount of space for the adult teeth. If the baby teeth are going to be exfoliated (fall out) soon, then it is not always necessary to fill the teeth. This should be discussed with your dentist.

Fluoridation

How do we know that water fluoridation strengthens teeth?

Scientific studies in Australian and overseas consistently report reduced tooth decay in children and adults who drink fluoridated water. The 2002 Australian Child Dental Health Survey examined more than 136,000 children across Australia, and specifically recorded whether they drank fluoridated water or not. The survey found that no matter which state or territory children came from, what age group they were from, whether they were rich or poor, or whether they lived in the capital city or regionally or remotely, children who drank fluoridated water had significantly less tooth decay than children who didn't.

A major 2012 Australian study analysed all studies published worldwide from 1990-2010, in any language, which reported the effects of water fluoridation. The authors found 59 studies from 10 countries, yielding 83 separate evaluations into the effectiveness of water fluoridation (30 for primary teeth and 53 for permanent teeth). Thirteen of the studies were conducted in Australia. Every one of these 59 studies without exception showed a significant reduction in tooth decay from water fluoridation, with most showing reductions of around 20-60%. It is important to note that fillings have a limited life span, and are regularly replaced or repaired. Preventing one permanent tooth cavity in a child may prevent not just one cavity, but a whole lifetime of treatment on that tooth, with each successive treatment becoming larger, more complex and more expensive.

More recent Australian research based on the National Survey of Adult Oral Health 2004-06 confirmed that adults living in fluoridated areas also experience much less tooth decay, even when they grew up without fluoridated water or fluoride toothpaste. Water fluoridation benefits all Australians.

Could I be allergic or sensitive to fluoride in drinking water?

No. The American Academy of Allergy, Asthma, and Immunology and the Council of the British Society for Allergy and Clinical Immunology have both stated that "there is no evidence of allergy or intolerance to fluoride as used in the fluoridation of water supplies".

But most people already use fluoride toothpaste. Is water fluoridation still needed?

Yes. Dentists strongly recommend fluoride toothpastes to reduce tooth decay, and water fluoridation provides an additional benefit.

Guarantees

Does a dentist provide a guarantee for workmanship?

No treatment can be "guaranteed", either in terms of its 'cure' or by a length of time.

A dentist is a skilled professional who practices with the utmost care and responsibility. A dentist cannot foresee what may or may not happen due to natural causes ("Mother Nature") or unpredictable complications.

A dentist should discuss with a patient the prognosis, or likely outcomes of various treatment options, on which a patient can base a final decision.

If you feel dissatisfied with work that has been provided, you should first discuss the matter with your treating dentist. After this discussion if you still feel you wish to take the matter further, you could seek a second opinion and/or contact the ADA Community Relations Officer, or the Health Services Commissioner. Both Officers have conciliatory roles in trying to resolve the situation to the satisfaction of the parties concerned.

Gum disease (Periodontitis)

What is gum disease?

"Gum disease" describes a range of conditions that affect the supporting tissues for the teeth. The supporting tissues comprise both the surface tissues that can be seen in the mouth and also the deeper tissues of the bone, root surface and the ligament that connects the teeth to the bone.

What causes periodontal disease?

Periodontal disease is caused by bacteria. Bacteria form a ‘plaque’ which is a sticky, colourless film that forms on your teeth, particularly around the gum line. Other bacteria thrive deep in the gap between the gum and the tooth (the ‘pocket’). Some people are much more at risk of developing periodontal disease — smoking is one of the major risk factors. Other conditions such as diabetes, stress, pregnancy and various medications can all be contributing factors.

Can gum disease be treated successfully?

Yes.

In the vast majority of cases the progression of gum disease can be arrested with appropriate care. Management of gum disease becomes more difficult and less predictable the more advanced the disease. Therefore, the sooner periodontitis is diagnosed and treated the better. Regular dental examinations are important to check for the presence of gum disease.

The cause of gum disease is bacteria. To manage it, the bacteria must be reduced to a level the body's defense mechanisms can handle. Treatment classically involves:

• achieving the best possible home care
• professional cleaning of the teeth above and below the gum line (into the pockets) to remove the plaque and hard deposits (calculus / tartar), and
• regular reviews
• trying to remove risk factors such as smoking.

Gum disease causes permanent damage to the supporting tissues; therefore the aim of treatment is to stop the progression of the disease through controlling the bacteria. This is an ongoing, lifelong activity.

Your general dentist is trained in managing periodontal problems. They may also use a hygienist to assist in your care. You may be referred to a Periodontist if your dentist considers your condition needs more advanced care. A specialist periodontist has gained additional qualifications and experience to satisfy the requirements of the State Dental Board and may therefore use the title "Periodontist".

Prevention is best. To a large extent periodontitis can be prevented by good oral hygiene and early intervention when problems are identified. See your dentist regularly.

My gums bleed. Is that OK?

No. Bleeding gums are common but not OK. In a healthy state gums do not bleed. Bleeding is often an indication that the gums are inflamed. The inflammation is generally a response to the bacteria on the surface of the teeth. The surface inflammation is Gingivitis. The bleeding may also arise from Periodontitis or traumatic cleaning. Bleeding gums are sometimes associated with serious medical conditions.

A dental practitioner should check bleeding gums.

What are some of the warning signs of periodontal disease?

• Bleeding gums when you brush your teeth.
• Bad breath or a bad taste in your mouth.
• Receding gums.
• Sensitive teeth or gums.
• Loose teeth or teeth that have moved.

Health funds

Why do dental rebates differ from health funds?

Health funds have assessors who determine the level of rebate for particular dental items. There is a balance between the rebate and the level of premium you pay, the type of cover and other factors such as waiting periods, annual limits and any promotional offers.

As a consumer, you choose the private health scheme that best suits your needs.

Most have fixed rebates for treatments irrespective of the actual fees charged. The rebates are generally not designed to provide full cover for dental fees or even a consistent percentage.

In addition, most schemes do not include all treatment items. Some common treatments have no rebate at all.

Remember,

• Your contract with the health fund is between you and the fund. It remains separate from the contract you have with your dentist.
• There is no such thing as a ‘recognised fee’ or ‘schedule fee’ in dentistry and the ADA states categorically that any organisation that implies that their rebates are set to a percentage of a ‘schedule fee’ is misleading the public, regardless of whether it is an ‘internal’ schedule.

Infection Control

Are dental instruments sterilised after each use?

Dentists use an autoclave that is a steriliser which uses steam under pressure to achieve a rapid high heat sterilisation of instruments.

Dentists use autoclavable equipment and instruments. Otherwise they can use disposable items wherever possible. The general standard of infection control in all surgeries in Australia is excellent.

An independent survey conducted by Coopers and Lybrand in 1994 showed that each dentist is spending an additional $24,000 (approximate) per year on implementing responsible infection control measures.

Mouthguards

For which sports is a mouthguard recommended?

Mouthguards should be worn during any sport where there is the chance of a knock to the face.

There are three types of sport when we consider the chance of injury:

• Contact sports where contact is part of the game. These include football, rugby, martial arts and boxing. The mouthguard should be compulsory.
• Collision sports where contact often happens but it is not expected or allowed. These include basketball, hockey, water polo, lacrosse, netball, baseball, softball, squash, soccer, BMX bike riding, horseriding, skateboarding, in-line skating, trampolining, cricket (wicket keeping or batting without a helmet), water skiing and snow ski racing. A mouthguard is highly recommended.
• Non-contact sports where contact is a rare occurrence. These include such sports as tennis where a mouthguard is not needed.

Mouthguards should be worn during all competitions as well as during training sessions, as this is when many injuries occur. This should be stressed to children in junior teams.

Are there different types of mouthguards?

There are two basic types of mouthguards available:

• The custom fitted mouthguard is available from your dentist. This mouthguard is constructed directly from a mould taken of your teeth in the dental surgery and fits tightly and comfortably over your teeth. This type of mouthguard is the type recommended by the dental profession and is the most effective in preventing injuries to the teeth and jaws.
• The "do it yourself" mouthguard, available at many pharmacies are usually poorly fitting and uncomfortable to wear. Dentists do not recommend these as they offer little protection to the teeth and patients are encouraged to obtain the custom-fitted guard as a bare minimum.

How long will my mouthguard last?

For adults, a mouthguard can last several years depending on the frequency of use. If major changes occur to the teeth, such as large restorations or loss of teeth, the mouthguard may not fit as well as originally and may need to be replaced. If the mouthguard material has been bitten through during use it should also be replaced.

For children, if changes occur to their mouth due to growth, the loss of deciduous teeth, or the eruption of the adult teeth, then their mouthguard may need to be changed annually or even more frequently. Remember, a poorly fitting mouthguard may be providing little protection and is less likely to be worn by children because they are uncomfortable.

Will a mouthguard affect my speech or breathing?

A properly fitted custom made mouthguard will not affect breathing and should only minimally affect your ability to talk.

What if my child has bands on the teeth?

If the child is in the middle of orthodontic treatment, they may be encouraged to avoid contact or collision sports for the duration because of the potential of lip lacerations. However, there are ways of making mouthguards that still fit reasonably well if sport must continue.

Oral Pathology

What are the most common types of oral pathology?

Dental decay and periodontal disease are the most common diseases in the oral cavity, but there are other diseases that can affect the mouth and surrounding structures. Some of these conditions may be painful or result in gingival (gum) bleeding or halitosis (bad breath), which may prompt the patient to seek treatment. Other conditions, however, may give no symptoms until late in their course, or may be a manifestation of an underlying systemic disease. It is very important to have regular dental examinations to check on the health of both the teeth and soft tissues of the mouth, as early diagnosis of problems often results in better treatment.

What about oral cancer?

Cancer can occur anywhere in the mouth and is often painless in the early stages. The major risk major risk factor in western countries being tobacco smoking. Cancers of the lower lip occur more commonly in people who have a high exposure to UV sunlight, such as outdoor workers. By not smoking and always using sun protection on exposed skin and lips, patients can decrease their risk of developing these cancers. Your dentist will examine and assess any non-healing ulcer or change in the appearance or texture of the skin. In most cases, the earlier the treatment, the better the outcome. Cancer of the mouth is both a preventable and potentially curable disease if it is detected early enough.

Orthodontics

What is orthodontics?

Orthodontics is the branch of dentistry that specialises in the diagnosis, prevention and treatment of dental and facial irregularities (malocclusion). It generally involves the use of such things as braces, removable appliances, functional appliances or headgear to move the teeth or jaws into an ideal relationship.

When should orthodontic treatment begin?

It is usually wise to have an orthodontic consultation around nine years of age. Some orthodontic problems are easier to correct if detected early, rather than waiting until jaw growth has slowed. Early examination allows the orthodontist to detect and evaluate problems and plan appropriate treatment. Early treatment may prevent more serious problems from developing or make treatment at a later age shorter and less complicated. However, in other cases, treatment will not commence until all the baby teeth have been lost.

How long will I need to wear braces?

On average, orthodontic treatment is approximately eighteen to twenty-four months in duration. However, the length of treatment will depend on the severity of the original malocclusion as well as the type of treatment carried out, and the co-operation of the patient.

At the completion of the active part of orthodontic treatment, the braces are removed and retaining appliances (retainers) are fitted to hold the teeth steady in their new position. These appliances may be removable plates or wires fitted behind the teeth. Retainers play an important role in orthodontic treatment for, if they are not worn according to instructions, the teeth may move back towards their original position.

Who does Orthodontics?

Any dentist may carry out orthodontic treatment, but the vast majority of cases are handled by specialist orthodontists who have restricted their practice to orthodontics exclusively.

A specialist orthodontist has gained additional qualifications and experience to satisfy the requirements of the State Dental Board and therefore use the title "Orthodontist".

Orthodontia requires a teamwork approach that involves, at the very least, a general practitioner dentist and an orthodontist. Some severe orthodontics cases also require oral and maxillofacial surgery, which may involve considerable extra cost. The coordination of the course of care must be through a referring dentist.

Can anyone have orthodontic treatment?

Generally orthodontic treatment is best carried out in children, but many adults have orthodontic treatment too.

Orthodontic treatment involves a full examination of your teeth, which includes taking x-rays and making plaster models of your teeth from impressions, and possibly taking photographs.

Orthodontic treatment is carried out using a range of appliances, which may be removable or fixed temporarily to your teeth, depending on your treatment needs. It is usually necessary to adjust any orthodontic appliance at 4-6 weekly intervals.

Paediatric dentistry

Can babies get tooth decay?

Parents and would-be-parents beware; tooth decay can still be a common problem in infancy and childhood. Over the past few decades, despite the general reduction in dental tooth decay, early childhood tooth decay is still common.

What are the most common dental decay problems seen in preschool children?

The most common dental decay problem seen in infants and younger children is nursing decay. Dental decay can affect baby teeth extensively. Teeth normally affected are the top front teeth. The back teeth in top and bottom may also be affected. Bottle and breast-fed babies are both susceptible. Babies left with a bottle as a pacifier and those who are frequently nursed, especially at night, run the danger of bottle or nursing decay due to the prolonged exposure to milk (human milk is no exception) or juice.

Another common decay problem seen in preschool children is due to frequent exposure to sugary, starchy and acidic foods, including all forms of juices, cordials and soft drinks. Snacking generally promotes dental decay, because the mere presence of food in the mouth feed the plaque that produces acid, causing decay.

At what age should I schedule my child’s first visit to the dentist?

Early visits can prevent minor problems from becoming major ones. Your dentist will be able to detect early decay. Teach good habits early, as good habits start young for a lifetime of healthy teeth and gums. Brush frequently to keep plaque levels low, reduce snacking and begin dental visits early.

Root canal therapy (Endodontics)

What does root canal treatment really mean?

Root canal or endodontic treatment is a process whereby inflamed or dead pulp is removed from the inside of the tooth, enabling a tooth that was causing pain to be retained.

Dental pulp is the soft tissue in the canal that runs through the centre of a tooth. Once a tooth is fully formed it can function normally without its pulp and be kept indefinitely.

After removing the pulp, the root canals are cleaned, sterilised and shaped to a form that can be completely sealed with a filling material to prevent further infection. The treatment can take several appointments, depending on how complex the tooth is, and how long the infection takes to clear.

Subsequently a crown or complex restoration to restore or protect the tooth may be a necessary recommendation, as a tooth after undergoing treatment may be more likely to fracture.

How long will the restored teeth last?

If you look after your teeth and gums, your root canal treated tooth may last a lifetime. However, you must have regular checkups to ensure that the tissues around it are nourishing the root of your treated tooth.

Smoking

Does smoking affect the teeth, gums or mouth?

Yes. Most people are becoming aware that smoking poses a problem to general health. It contributes to heart disease, stroke, and to a third of all cancer deaths, to name just a few conditions. In 1992 it was estimated that almost five thousand deaths in Victoria resulted from smoking.

What is less well known is the effect it has in the mouth.

The main damage is to the gums and mucosa, or lining of the mouth. Smokers develop more oral cancers than non-smokers (about five times more) and invariably suffer some degree of gum or, periodontal disease.

Other than staining, smoking does not affect the teeth. However, it also has a profound effect on the saliva, promoting the formation of the thicker ‘mucous’ form of saliva at the expense of the thinner watery ‘serous’ saliva.. There is a reduction in the acid-buffering capacity of their saliva.

This effect of nicotine explains why some heavy smokers get decay even if they are brushing well.

Does smoking lead to oral cancer?

Yes, smoking is a major cause of cancers in the mouth. It is the single biggest risk factor.

Even when cancer is not present, dentists can often detect changes in the lining of the mouths of young smokers. When these changes become pronounced they predispose to cancer. The mucosa becomes hard and white and develops corrugations. Such areas should be observed routinely and are one more reason why people should have regular dental check-ups.

Does smoking make the teeth loose?

Yes. Smokers are six times more likely to have serious gum (periodontal) disease. Periodontal disease is a deep-seated form of gum disease. It involves not just the pink gum, but also the supporting bone and the membrane that holds the teeth in place. When gum disease damages these supports, the teeth become less stable and move too easily. Eventually they can become painful and loose, and need to be extracted.

Smoking affects the immune system and lowers its ability to reduce harmful bacteria that can cause gum disease.

Detecting and treating precancerous lesions and early cancers is vital in improving survival rates.

Does smoking stain the teeth?

Yes. Tobacco staining on the teeth is often superficial in the first few years of smoking and your dentist can usually readily remove it. Unfortunately, as the years pass, the staining tends to spread into microscopic cracks in the enamel (the outer layer of teeth) and this is far more difficult to remove. Teeth can become permanently stained.

Teeth Cleaning

How long should I brush?

Proper brushing should take two to three minutes.

How often should I brush?

You should brush your teeth at least twice a day. Remember it is important to have the right brushing technique as poor brushing techniques can cause harm to the teeth and gums.

How often should I floss?

You should floss every day.

What should I do if brushing or flossing makes my gums bleed?

If your gums bleed or become sore after flossing, do not panic. If you have not been flossing regularly then the gums will be inflamed and will bleed more easily. If the bleeding persists — see your dentist.

Choosing a toothbrush

The best toothbrush is one with a small head and soft bristles. Electric toothbrushes can also be very good, particularly for people who find proper brushing techniques difficult to master.

Choosing a toothpaste

Always use a toothpaste containing fluoride. Fluoride combines with minerals in your saliva to toughen your tooth enamel and help stop decay.

Teeth Whitening

What do I need to know about Teeth Whitening?

For facts about teeth whitening, visit the ADA's website containing quick facts, natural methods of whitening your teeth, and the potential dangers of undergoing the procedure at the hands of an untrained individual.

www.teethwhiteningfacts.com.au

Wisdom Teeth

What are wisdom teeth?

Wisdom teeth, or third molars, are a set of four teeth that erupt into the back four corners of the mouth, behind the 12 year old molars. This usually occurs between the ages of 17 to 21.

Does everyone have wisdom teeth?

No, some people are naturally missing one or more of their wisdom teeth.

What is impaction?

Your dentist may advise you your wisdom teeth (or third molars) are impacted and that they need to be removed. What this means is that your wisdom teeth will not grow or erupt into a position that allows them to be functional teeth.

Impaction may be due to soft tissues (i.e. gums), or hard tissues such as other teeth or bone. Teeth that become impacted are generally more likely to cause problems.

Who can remove my wisdom teeth?

All dentists are trained in removal of teeth, however sometimes you may need to be referred to a specialist Oral and Maxillofacial Surgeon who can remove your wisdom teeth for you.

Can there be problems with extraction of wisdom teeth?

Yes, as with any surgery, post operative pain, swelling, bruising and infection can occur. Other consequences of wisdom tooth removal may include, difficulty in opening the mouth, sore lips, and bleeding.

There is a small risk with the extraction of lower wisdom teeth, of nerve damage that may cause numbness of the lip or tongue.

Discuss the above risks and consequences of wisdom teeth surgery with your dentist and/or Oral and Maxilofacial Surgeon before having your wisdom teeth out.