How To Stop Tooth Decay

I often get asked how to stop tooth decay. You'd think that keeping your teeth healthy by eating healthily & keeping them clean was about as easy as getting off a chairlift - wrong. This movie clip shows -
1) that getting off a chairlift isn't that simple

2) How bacteria form plaque on your teeth and

3) how that plaque ultimately leads to dental decay 

Decay & the subsequent hole that develops is actually a symptom of a disease process called caries. You can only have caries when certain acid-loving bacteria are established in large concentrations in the mouth (to date 60+ bacteria have been recognised to contribute to caries, tooth decay & subsequent cavity formation requiring fillings). This acid-loving bacterial colony is called an “unhealthy biofilm”. It is now possible, using medicaments in the form of mouth rinses & tooth gels & mouth sprays, to change the concentrations of these “bad” bacteria thus altering the bacteria living in your mouth to those that thrive in a more healthy neutral or alkaline environment (healthy biofilm). If this happens then the cycle of getting cavities & needing fillings should stop altogether or slow down.

 

 If you have - 

1) all your cavities restored
2) adequate saliva flow3) a healthy biofilm (good bacteria) &
4) you don’t encourage bad bacteria to “move back into your mouth” by feeding them food/drinks with refined & unrefined sugars

you should not suffer from caries & therefore should not get cavities.

I have compiled some general information & a prescription along with a treatment regime which will assist you. But first

How Tooth Decay Happens

Tooth Decay is caused by certain types of acid loving bacteria (e.g. mutans streptococci and lactobacilli etc) that live in the mouth. When they attach themselves to the teeth and multiply in dental plaque, they can do damage. The bacteria feed on what you eat, especially sugars (including fruit sugars) and cooked starch (bread, potatoes, rice, pasta, etc). Within about five minutes after you eat or drink, the bacteria begin producing acids as a by-product of their digesting your food. Those acids can penetrate into the hard substance of the tooth and dissolve some of its minerals (calcium and phosphate). If the acid attacks are infrequent and of short duration, your saliva can help to repair the damage by neutralizing the acids and supplying minerals and fluoride that can replace those lost from the tooth. However if you have many of these bacteria, or your saliva is defective; then the tooth mineral lost by the attacks of acid is too great and cannot be repaired. This is the start of tooth decay and leads to cavities. Smaller cavities are fixed with either dental fillings. Larger cavieties can be fixed with either dental fillings or stronger more long lasting dental crowns & overlays

Read how diagnosis of tiny dental cavities are found with the help of laser Diagnodent diagnosis & then treated in a minimally invasive manner using Dental Air Abrasion

 Methods of Controlling Tooth Decay

• 1.Diet: Reducing the number of sugary and starchy foods, snacks, drinks, or lollies can help reduce the development of tooth decay. That doesn’t mean you can never eat these types of foods, but you should limit their consumption particularly when eating between main meals. A good rule is 3 meals per day and no more than 3 snacks per day. Your last snack/meal of the day should be at least one hour prior to you going to bed.
• 2. Fluorides: Fluorides help make teeth more resistant to being dissolved by bacterial acids. Fluorides are available from a variety of sources such as drinking water, toothpaste, mouth rinses, and products prescribed by your dentist such as brush on gels used at home or gels and foams applied in the dental surgery. Daily use is very important to help protect against the acid attacks.
• 3. Plaque Removal: The most important thing that you can do at home is to clean your teeth at least twice daily for 2 minutes. The purpose of cleaning the teeth is to reduce the overall level of bacteria in your mouth as well as clean the biting surfaces and the sides of the teeth facing the tongue and cheeks. Brushing is also effective in reversing and preventing gingivitis, but in order to control and prevent tooth decay, you must use a toothpaste containing fluoride. However in order to clean between the teeth other oral hygiene aids must be used daily. E.g. Floss, interproximal brushes. Having a professional dental clean with one of our dentists or dental hygienist is a great way of removing dental plaque, dental calculus & scale that you may have missed
• 4. Saliva: Saliva is critical for controlling tooth decay. It neutralizes tooth decay acids and provides minerals and proteins that protect the teeth. If you cannot brush after a meal or snack, you can chew some sugar free gum. This will stimulate the flow of saliva to help neutralize the acids and bring lost minerals back to the teeth. (Sugar free candy and mints could also be used, but some of these contain acids themselves. These acids will not cause tooth decay, but they can slowly dissolve the enamel surface over time (a process called erosion)). Some sugar free gums are designed to help fight tooth decay and are particularly useful if you have a dry mouth (many medications can cause dry mouth). Some gums contain baking soda, which neutralizes the acids produced by the bacteria in plaque.
• Gum that contains xylitol as its first ingredient is the gum of choice. e.g.: Recaldent; Xtra professional or Xtra for kids
• If you have a dry mouth, you could also fill a drinking bottle with water and add 2 teaspoons of baking soda for each 8 ounces of water and swish with it frequently throughout the day. We also have Carifree boost oral spray (small spray bottles premixed to lubricate dry mouth & keep the oral PH around neutral) Toothpastes containing baking soda are also available from several companies.
• 5. Antibacterial mouth rinses: Carifree treatment & maintenance rinse to reduce the number of bad bacteria that cause tooth decay & encourage a healthy more neutral/alkaline biofilm.
• 6. Preventative resin restorations are plastic coatings bonded to the biting surfaces of back teeth to protect the deep grooves from decay. In some people, the grooves on the surfaces of the teeth are too narrow and deep to clean with a toothbrush, so they may decay in spite of your best efforts thus creating “reservoirs” of bad bacteria that subsequently seed the rest of your mouth causing cavities elsewhere. Sealants are an excellent preventative measure for children and young adults at risk.

Medicaments available in the form of mouth rinses, tooth gels, fluoride applications & mouth sprays are all available at Milford Dentists, North Shore Auckland.

General Prescription

• 1) Floss daily
• 2) Brush twice daily with fluoride toothpaste
• 3) Limit sugary snacks and drinks between meals
• 4) Chew xylitol chewing gum (Recaldent; xtra professional or xtra for kids) after meals or snacking when you cannot brush.
• 5) Drink more water
• 6) Have regular dental cleaning with your dental Hygienist or Dentist
• 7) Use a dental water pick

Please ask us which dental products are suitable to help improve the health of your mouth. 

posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you iradicate dental tooth decay - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest & the Whangaporoa Peninsula give us a call - 09 4896575.

Dental Accident & Emergency

A dental accident & emergency can happen at any time......... So I'm watching TV when I get this text from my fantastic dental technician David De Wet of Oral Art. Just one look at at the attached photo & I knew that this young chap from Takapuna (and his parents & his twin sister) would be very uspset. Fortunately he had already seen a dentist who had checked for any nerve exposures. Thank goodness there weren't. He arrived at my practice with the piece of fractured tooth in a little bag of water to keep the tooth fragment hydrated. Mum filled out an ACC form & we were off.

Amazingly this 10 year old had no pain. After taking a digital x-ray & checking that his tooth was still alive (which it was) I checked to see if the two halves of his tooth would fit together - They did perfectly. Things were looking good. I now put my dental bonding hat on & thoroughly cleaned both the tooth in Takapuna Chaps mouth & the tooth fragment using a gentle spray of powder & sand (this is called dental air abrasion). This creates a superb surface for gluing or dental bonding. I used a clear dental veneer cement to carefully rebond chip A to tooth B.

I think the end result is most pleasing & this lovely family from Takapuna, North Shore, let out a colective sigh of relief.

So if this happens to you or a family member, it is possible to reattach your tooth fragment using dental bonding. If possible try & find the piece of broken tooth & bring it a long. 

If the whole tooth is knocked out you need to get to a dentist as quickly as possible.

Things to do if a whole tooth is knocked out -
1) If someone feels confident, the best thing to do is pick the tooth up by the crown (never hold the tooth by the root) & push it back into the socket if it is clean
2) Then get to a dentist or failing that a hospital A&E ASAP
3) If the root of the tooth is not clean, whilst holding the tooth by the crown, run the root under a jet of water ie tap water or squirt water from a drink bottle, until all the debris has been removed, then push it back into the socket
4) Get to a dentist or failing that a hospital A&E ASAP
5) If you can't get to a dentist quickly you can make a splint by wrapping tin foil over the damaged tooth and its neighbours to help hold it in place & then get to a dentist
6) If you can get to a dentist & don't feel confident about putting the tooth back into the socket, the tooth needs to be carried correctly to the dentist or A&E. If the patient is able to/old enough to understand what's going on, the best place to keep the tooth is in the patients mouth under the tongue
2) If this is not possible then put the tooth in milk
3) If this is not possible then put the tooth in water

If you chip your tooth & don't have the fragment the tooth is often repaired using dental composite resins / white fillings & dental bonding.  

If you break your tooth in a more structural way an option may be to place a dental tooth veneer or dental crown to strengthen your tooth, & improve it's appearance

One of the main functions of any dental practice is the treatment of dental emergencies & we are here to help the good people of the North Shore with all their dental requirements - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest & the Whangaporoa Peninsula and beyond.

What is Gum Disease?

I get asked “what is gum infection” and “how does gum infection happen all the time…….. Also “why do my gums bleed when I brush them” and why do I need a scale & polish” are other favourite questions. Well, gum disease is a bacterial infection of the tooth supporting structures of your mouth ie your gums, the fibres that attach the tooth to your jaw bone (periodontal ligament) & the bone surrounding your teeth. Gum disease begins with plaque. Plaque is continually forming on your teeth, without you even knowing it. Plaque is a bacterial colony. This plaque formation creates a layer on your teeth called a”Biofilm”. The following film clip gives you an idea of the way gum infection happens.  Wait for the biofilm bit where, using time lapse photography, starting with a clean tooth over an 8 hour period you can see just how quickly plaque forms on a tooth – scary stuff for people who don’t brush their teeth

The longer this plaque biofilm is left, the more “glued” onto your tooth it becomes & the harder it is for you to remove it yourself. Without this Bacterial Biofilm everybody would have healthy gums. This is why keeping your teeth clean with correct tooth brushing - at least twice a day for 2 minutes, flossing daily & the use of interdental brushes & a water pick is critical to maintaining a healthy mouth. Gingivitis and periodontitis are the two main stages of gum disease. The end result of untreated periodontitis is the early or premature loss of teeth. After about the age of 18 years more, people loose teeth because of gum infection than because of tooth decay. People usually don’t show signs of gum disease until they are in their 30s or 40s. Gum disease can usually be prevented by good and careful teeth cleaning and regular cleanings or scale and polishes with your dentist or hygienist. Gum disease is a threat to your oral health, & there is now evidence that this bacterial infection is a cause of heart / cardiovascular disease & other systemic problems distant to the mouth. This is caused by these infectious bacteria getting into your blood stream & ”finishing up” causing bacterial infections elsewhere eg in your blood vessels around the heart.

Signs of gum disease
1) Gums that bleed easily when you brush your teeth
2) Gums that are red inflamed or tender
3) Persistent case of bad breath
4) Constant bad taste in your mouth
4) Pus appears between gums and teeth
5) Receding gums that make your teeth look longer
6) Deep pockets surrounding gums and teeth
7) A tooth or teeth becoming loose
8) A change in your bite or teeth does not fit together well

The good news is that, if the gum disease is detected on its early stage, it can be treated and reversed. We at Milford Dentists treat gum infection. See Karen our Dental Hygienist to get an idea of how healthy your gums are

Posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you iradicate gum infection / periodontitis - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575

Kids dentist near me

Are You looking for a close by specialist? Milford Dentists is a Kids dentist near you......... Parents often ask “when should I bring my child to the dentist”. My answer to this is “as early as possible”.

I believe it is very important for children to see health professionals in happy non-threatening situations.

Let’s talk about an imaginary child called Alice. If you bring Alice along when you come to the dentist for a procedure that you are OK with ie that doesn't stress you out, several things might happen. Alice may or may not be interested in what is happening. She may be scared because things are unfamiliar. She may be shy. Whatever happens during this appointment she will be under no pressure to open her mouth & show me her teeth.

After a few visits like this, she will feel fine about her surroundings & often feels left out of the proceedings. At this point, Alice may decide that she wants me to look at her teeth & not the other way round. The end result is someone who hasn’t been “forced” because of necessity to open her mouth.

Compare this ideal scenario with a child who having never been to the dentist, falls over in the playground & chips her front tooth. This scenario is traumatic for everyone. Mum or Dad gets a phone call from kindy or school. The child arrives at the dentist with a worried parent who is oozing feelings of stress & concern (kids being perceptive little things always pick up on this).

Both child & parent are upset & arrive to meet someone the child does not know, which often makes a difficult situation impossible. The child is now scared because a stranger wants to look at her injury. The end result of this is more upset, which is the absolute last thing any of us want.

Other first visits to the dentist can be made incredibly traumatic for a child because parents inadvertently say thoughtless things. Some examples of these would be:

• Reminiscing about your past e.g.: traumatic visits to “The Murder House”.
• Saying things like ~
• “It won’t hurt a bit”
• “She’ll give you an injection”
• “You’ll only feel a little prick”
• “You don’t still use that old slow grinding drill?
• “Don’t worry it’ll be over soon”

Please note that if a child is happy to have me look at their teeth, in most circumstances, if I’m left to do my job without any of the above or similar said, I can carry out many procedures quickly & painlessly. Situations can deteriorate rapidly when a parent tries to help by explaining a procedure on my behalf.

For want of repeating myself, using words like, hurt, pain, needle, injection, or the drill can & do have very upsetting consequences.

Think about this. If your first experience of having a filling was a painless process, why would you be scared for your child?

In summary

• Try to see a dentist before anything needs doing (hopefully things will never need doing).
• If talking about the dentist try not to scare your child.
• Try not to explain things to your child during a procedure unless invited to do so. This invariably always makes things worse. Leave the explanation to me.

Thank you for taking this advice in advance

Posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help children - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.

Dental Hygienist - Masked Hygienist

Many of you visit a Dental Hygienist or Dentist for anything from routine teeth cleaning to advanced Gum Disease Treatment. As well as making your mouth feel great after a scale & polish or more complex root planing therapy, there are proven benifits that impact on your overall health regarding cardiovascular disease susceptibility. People with gum infection have large quantities of pathogenic bacteria sitting right next to inflamed gum tissue. When you chomp together these bacteria are knocked into your blood stream. These bacteria dramatically increase your risk of suffering cardiovascular disease, Subacute bacterial endocarditis & infection of newly placed prosthetic joints like hip replacements. Before you watch the second youtube clip you might want to cheer yourself up by watching our cartoon strip animation - "The Masked Hygienist - Return of the Killer Cereal"

OK back to the serious stuff. This next film clips should give you an idea of the mechanism of gum infection & how it impacts on your ateries & veins & heart. Also read about "What is gum infection" here

We are here to help & here are some options 
Our Dental Hygienist Karen is able to assist with routine procedures like a scale & polish or root planing as do our Dentists Tristan, Geoff & Andrea. Sometimes broken teeth, a broken filling or a broken dental crown can cause food impaction leading to periodontitis / gum infection. Simple fixes like placing a white composite resin bonded filling or a porcelain or gold dental crown or porcelain overlay to close the contacts between the tooth are all that is required.

Regarding our newest team member - we are very excited to welcome Tristan. As well as routine dentistry Tristan brings a very specific skill set regarding the treatment of Periodontal / Gum Disease. After acquiring a great deal of surgical experience whilst working in a UK hospital Maxillofacial department and gaining his membership to the Faculty of Dental Surgery from the Royal College of Surgeons, England, Tristan has furthered his post graduate training with a Diploma in Restorative Dentistry (RCS Eng) & is 2 years into a three year MSc in Clinical Restorative Dentistry with a specific interst in Periodontology. This means he is able to provide treatment above & beyond that of a most general dentists like me (Andrea).

Tristan Barker BDS MFDS RCS(Eng) Dip. Rest. Dent. RCS(Eng) writes - "With regards to periodontal disease & its treatment, I am happy to perform non-surgical and surgical periodontal therapy. Also I am happy to perform periodontal regeneration in infra bony defects with Emdogain, and also root surface coverage with coronally advanced flaps and emdogain +/- alloderm regenerative tissue matrix" ................. Translated into English this means he is a very safe pair of hands.

Tristan enjoys all aspects of general dentistry. He aims to provide his patients with the optimal experience in what is often an extensive and lengthy process. His ethos is of a relaxed but comprehensive attitude in providing the best possible care in a comfortable environment. 

Back to the reason for this blog as I've started waffling .......... Well the good news is that, if the gum disease is detected at its early stages, it can be treated and reversed, so an option is to get an idea of how healthy your gums are & take things from there. We can help with this.

Posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you iradicate gum infection / periodontitis - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575

What Types Of Dental Crowns Are Available?

Dental crowns, dental overlays or dental veneers can be made to create beautiful natural looking teeth whilst also strengthening the underlying tooth.

So what types of dental crowns are available at Milford Dentists, North Shore, in Auckland?

The types of dental crowns that are available

Emax crowns on front teeth

1) All ceramic dental crowns & dental overlays & dental veneers made from different porcelains – There are many different types of porcelain to make dental restorations from. In my opinion, Emax porcelain is the most incredible & exciting material for making dental restorations & it has been my crown material of choice since 2008.

Because this porcelain mimics actually tooth structure, it makes beautiful natural looking crowns. It is incredibly strong (3-4 times more fracture resistant than a porcelain fused to metal crown). As well as being super fracture resistant it can be bonded to a tooth. This laminate effect makes the restoration even stronger

• This bonding means the crown is highly unlikely to be dislodged
• The bonding technology significantly reduces post placement symptoms
• This bonding also helps hold fractured teeth together preventing cracks from getting bigger

Because the crown overlay is bonded to the tooth it requires less tooth to grip onto which means overlay preparations are very conservative ie more of your tooth is saved.

Porcelain Fused to Metal Bridge

2) Porcelain crowns fused to an inner metal thimble (PFM's). This type of crown was the most frequently placed for decades. There is still a place for this type of crown but it has mostly been superseded by Emax crowns and overlays. PFM’s can be placed

- In cosmetic situations where the teeth surrounding the tooth to be crowned also have PFM’s

- Over a dental implant

As part of a dental bridge where the metal connectors in the centre of the bridge are required for strength. The porcelain is fused on the outside of the metal framework

Gold Crown

3) Metal crowns made of gold or semi-precious alloys. In areas where a tooth is subjected to a lot of chewing forces – for instance on the second permanent molars, these restorations are often a good option

4) Composite resin crowns can be placed as temporary crowns, overlays or dental bridges. They tend to wear out quite quickly which is why they are not used in a permanent situation

Zirconia Crowns

5) Zirconium crowns are even stronger than Emax crowns, however, they do not look as beautiful. An option is to place them on teeth which traditionally would have had a gold or semi-precious crown

Posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you strengthen & beautify your teeth - From Devonport and Belmont up through Takapuna, Castor Bay, Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.

The Cost Of Wisdom Tooth Removal

See the table below for "What is the cost of wisdom tooth removal" in New Zealand.

The Cost of Wisdom Teeth Removal
At Milford Dental, the 2017 cost of wisdom tooth removal begins at $253 (per tooth) for easy extraction and advances to more complex teeth from $523 upwards – based on difficulty. If there is added complexity or bone grafting is required, the cost to the fee can increase from XXXX per location grafted and quantity of bone used.

Wisdom teeth are the last set of molar teeth to grow into your mouth. This generally happens when you are between 19 & 21 years old but they can come through sooner or later. If your teeth and jaws are the right size for each other, wisdom teeth tend to erupt & function like ordinary teeth; they are a useful asset in this case. More often than not, however, because the jaw is too small or the actual teeth are too big for the available space, wisdom teeth are misaligned and become stuck or impacted. 

Cost Of Wisdom Tooth Removal At Milford Dentists

Assesment consultation	$59	Per 15 minute block of time
Digital X-ray taken in the mouth	$15	Per x-ray
Digital Panorex X-ray	100
Removal of Straightforward Wisdom Tooth	$253
Removal of Medium Difficulty Wisdom Tooth	$523
Removal of more Complicated Wisdom tooth	$750 +

When the wisdom tooth is impacted it can cause several dental problems - some that cause pain and discomfort & other problems that have no symptoms until it is too late. 

Impacted wisdom teeth can -

• Crowd adjacent teeth. There is evidence suggesting that a wisdom tooth that is tilted towards the front of the mouth actually pushes the teeth in front of it leading to crowding of teeth.
• Result in the molar tooth root in front decaying because the food is trapped & rots between both teeth, well below the gum line. This leads to the loss of the molar tooth in front - this then leads to other problems like loss of chewing ability and over-eruption of the tooth above and so on and so on. This is often a painless process until the decay reaches the nerve & then a painful abscess forms necessitating the wisdom tooth & molar in front to be extracted.
• Affect the flap of gum resting over the tooth leading to an infection called pericoronitis. The gum flap partially covering a wisdom tooth that is not fully erupted & that is stuck hard up against the adjacent tooth or the jaw bone, can trap food around it. This food cannot be cleaned out. Bacteria feast on this rotting food, multiplying and then causing gum infection & disease - pericoronitis. Because the wisdom tooth cannot move this area enters a cycle of infection. 
  
  My patients will often tell me “my wisdom tooth has tried to come through, but it then settled back down.” What is actually happening here is the gum flap is becoming infected & swollen creating a feeling of pressure which you might think is the tooth erupting but actually, it’s gum disease. The infection settles down & the pressure goes which makes you think the tooth has decided to settle back down into its socket – not so.
• This clip below gives you an idea of the problems arising from impacted wisdom teeth 
• 
  

If you are worried about wisdom teeth or are having symptoms or just want to check that they are ok please book in with Andrea, Tristan or Geoff. We can quickly and painlessly assess your wisdom teeth & take an x-ray called a Panorex.

If you have a look at the Panorex below, both lower wisdom teeth are tilting forwards on a 45-degree angle. The wisdom tooth on the left has caused the tooth in front to decay. There is a massive area of dental decay – This patient needed all his wisdom teeth out plus the decaying second molar on the left which was unfixable. This gives you an idea of how useful a Ppanorex x-ray is.

If you need to have your wisdom teeth taken out you have several options.

1. 1) See an oral surgeon for your extractions – If you have health insurance wisdom tooth extractions are often covered – Check with your insurance provider
2. 2) Have your wisdom teeth removed by a dentist. At Milford Dentist, Tristan has a special interest in teeth extractions. Tristan worked in Manchester’s biggest hospital for several years. Here, as well as becoming well versed in & very comfortable with impacted wisdom tooth removal he also plated up fractured jaws & even treated gunshot wounds to the head and neck!

We can assess your wisdom teeth & as of writing this blog our cost estimate of wisdom tooth removal are as follows 

• Assessment consultation - $59 per 15 minute block of time
• Digital x-ray taken in the mouth - $15 per x-ray
• Digital panorex x-ray - $100
• Removal of straight forward wisdom tooth $253
• Removal of medium difficulty wisdom tooth $523
• Removal of more complicated wisdom tooth $750+

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you with wisdom tooth problems - From Devonport and Belmont up through Takapuna, Castor Bay, Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.