Patient Information
We have a great deal of information available to our patients about their treatments, advice about post treatment procedures and general oral health information. Please scroll below for the pages of information. Some pages are in PDF format and you will need to download PDF software if you don't have it installed yet. The Adobe link will take you to a website where you can get the software.
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Acid Attack & Tooth Erosion
Acid attack and tooth erosion occur every time we eat or drink something containing SUGAR. Acidic foods and drinks are also a factor. It is not how much sugar we consume but the frequency of consumption that does the most damage to your teeth. Teeth can sustain 3 acid attacks a day.
How Acid Attack Happens
Your mouth is in a neutral state, pH 7, until food and drink containing sugar are introduced. The sugar reacts with the bacteria in the plaque and forms a toxin (acid) this will cause the pH to drop. When the pH drops below 5 tooth erosion starts. Drinks with a pH of 5 or below will also cause tooth erosion.
pH Values of Some Popular Drinks
Mineral water still |
|
pH 7.8 |
Milk (non fat) |
|
pH 6.5 |
Mineral water (Highland Spring) |
|
pH5.0 |
Pure Orange juice |
|
pH 4.1 |
Ribena Toothkind |
|
pH 3.6 |
Pure Apple juice |
|
pH 3.5 |
Red Bull |
|
pH 3.3 |
Lucozade Sport |
|
pH 3.3 |
Diet cola |
|
pH 3.2 |
Sunny Delight |
|
pH 3.1 |
Flavoured water (Volvic) |
|
pH 2.8 |
Red wine |
|
pH 2.5 |
Cola |
|
pH 2.2 |
Vinegar |
|
pH 2.0 |
pH Values of Some Mouthwashes
Aquafresh |
|
pH 7.6 |
Sensodyne |
|
pH 7.6 |
Corsodyl |
|
pH 7.1 |
Retardex |
|
pH 6.4 |
Junior Reach |
|
pH 6.4 |
Boots Smile |
|
pH 6.7 |
Colgate Plax |
|
pH 6.0 |
Fluorigard Alcohol Free |
|
pH 5.9 |
Dentyl |
|
pH 5.7 |
Listerine |
|
pH 4.5 |
Peroxyl |
|
pH 3.5 |
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Post Dental Treatment Advice
After Local Anaesthetic
i) Wait until the anaesthetic has worn off completely before eating anything.
ii) Do not have any hot drinks as you could burn yourself.
iii) Do not smoke until the anaesthetic has completely worn off.
After Root Canal Treatment
i) You may experience some tenderness up to 48 hours after treatment. If it has not subsided after this please contact the surgery.
ii) You may need to take painkillers e.g. Nurofen for the first day after treatment
iii) If the temporary filling comes out please contact the surgery straight away.
After Hygienist visit
i) Your teeth will feel nice and smooth and clean
ii) Your gums may bleed a little after treatment but make sure you carry on brushing that area, do not avoid it.
iii) Use a mouth rinse e.g. Corsodyl for the first few days after treatment which will help.
After fillings
Silver Fillings
i) These take longer to set so be careful for 24 hours.
ii) Try not to eat on the side where you had the filling for the whole day.
Tooth Coloured Fillings
i) These fillings set straight away
ii) Please try not to have any tea and coffee for 24 hours after the new filling have been placed as the fillings absorb water and you get staining around these new fillings.
Some teeth may be sensitive after fillings, this can last for up to a month. If after this time the tooth has not settled please contact the practice.
After Crown preparations
You have had a crown preparation today and a temporary crown has been placed while the new crown is made at the technician’s laboratory. The temporary crown is cemented with a soft paste so that it can be easily removed afterwards. Please be careful about chewing toffees, wine gums, chewing gum, granary rolls and tough steak in the area of the crowns. Please do not floss around the temporary crown.
i) Try to avoid eating curry while the temporary crown is in place as it can cause the temporary crown to turn bright yellow or orange.
ii) If the temporary crown should come out please telephone the surgery immediately so they can be re-cemented.
After Root Planing
i) Wait until the anaesthetic has worn off before eating.
ii) Rinse with Corsodyl mouthwash three times a day for 1 week and then stop.
iii) The area, which was treated, may feel tender for a few days.
iv) Continue to brush and clean and use the interdental brushes as demonstrated.
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Post op Advice and Instructions After Implant Surgery
Osseo-integrated implant surgery takes place over two stages, the first when the implants are inserted and the second when they are recovered in readiness for the reconstruction. Second stage recovery surgery in the lower jaw takes place after three months of implant placement and after six months of implant placement in the upper jaw. The following post operative instructions should be taken note of by all patients having sinus grafting and/or osseointegrated implant surgery.
Immediately after surgery a routine ice pack usage must be followed i.e. 15 minutes on and 5 minutes off to assist in reduction of swelling. This must continue as much as possible for at least two days.
Bacterial invasion of the surgical site will be reduced by rinsing with Corsodyl twice daily for 2 – 3 weeks and by swabbing the area with Corsodyl 2 to 3 times per day for the healing period of 3 to 6 months.
- Hot food and drink must be avoided for at least 1 week following surgery.
- The head must be kept raised at night to assist in reduction of swelling.
- Antibiotics prescribed following surgery must be taken as directed and the course completed.
- Smoking will reduce the success rate of the implants and it is therefore recommended to cease smoking for at least the duration of healing.
- Our surgical team invites you to contact us with any queries you might have prior to the procedure or during the healing period.
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Post Periodontal Examination Advice and Information
This is an information sheet explains some of the considerations for periodontitis (gum disease) and its treatment.
The schematic diagrams of the teeth appear in 4 rows. Each row represents either the outer or tongue side of the upper and lower teeth. These are labelled as such. The blue line represents the position of where the gum is now. The red line is where the attachment starts between the gum and the tooth, at the base of the “periodontal pocket”.
The numbers are millimetre measurements of these values. The red dots are sites that bled when measured with the periodontal probe.
There are three rows of squares shown below that have been divided into triangles. The yellow colours represent surfaces with detectable plaque, which were recorded at your initial visit.
We will be using these values to monitor your tooth cleaning abilities. This will be correlated with the level of inflammation in your gums, represented by the number of red dots on this chart. As a rule of thumb, we consider probing depths that are 4-5mm and greater as sufficiently deep to be classified as periodontitis, which usually requires treatment.
Periodontal treatment is usually divided into 3 phases. The initial phase of treatment is focussed on plaque control and root surface debridement to reduce the plaque and tartar from the gum pockets. After a few weeks we reassess the response to this therapy.
The next phase is usually corrective and sometimes involves surgery at the deeper sites. The need for this kind of treatment is usually decided upon and planned at the reassessment appointment. After this the final phase is the maintenance phase, which involves 3 monthly recalls to a hygienist. This interval can be increased if your teeth are particularly well maintained. Sometimes during the maintenance phase, more minor treatment may be required if there is any localised recurrent inflammation.
What Causes Gum Disease?
Dental plaque (soft yellow/white film containing bacteria) is the cause of gum disease. Therapy is focussed on the removal of plaque and tartar (calcified plaque) from all the surfaces of the teeth. Following treatment patients develop the skills required to routinely clean plaque off above gum level for all the teeth.
Tartar needs to be professionally removed, usually by the dentist or hygienist. Where pockets are deep, this task gets increasingly difficult to the point where pockets of 6mm and deeper on multi-rooted teeth may be better accessed by surgical procedures for effective cleaning. However, this level of treatment can only be justified when patient plaque control skills are at an appropriate level, i.e. less than 15-20% of tooth surfaces with detectable plaque. When this is sustained, there is a reduction of bleeding from the gum, and we aim for a score of less than 15%.
If these objectives are achieved, the benefits to you as a patient are that the gum pockets heal and reduce in depth to healthy level. This dramatically reduces the risk of further periodontal break down, and tooth loss.
Additional advantages are a fresher breath, firmer gums and less mobile teeth.
Most patients will need to see either a Periodontist or a Hygienist for the initial phase and this is dependent on the severity of your periodontal disease at initial presentation. Usually these appointments are booked in 60 minutes to 90 minutes slots. It is most common to have a few of these appointments to achieve the required objectives as stated above. A few weeks after your last visit you will need to see the Periodontist again for reassessment. At this stage, if the gums have adequately healed up, you will enter the maintenance programme.
If there are residual sites that have not completely healed, the Periodontist will offer more complex treatment to resolve these areas.
What You Can Expect Immediately After Treatment.
With some periodontal therapy, gum recession and temporary symptom of sensitivity can occur. Recession occurs because your healthy gum tissue is resting onto where your bone is as a result of the loss of bone from periodontal (“gum”) disease. In most instances, we aim to reduce the amount of gum recession in aesthetic areas and the sensitivity can also be controlled with appropriate toothpaste.
Constantine Ong
BDS MFDS MClinDent MRD RCS (Eng)
Specialist Periodontist
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Post Periodontal Surgery Advice
Following periodontal surgery some discomfort may be expected . This may be controlled by taking the pain-relieving tablets you normally use, or by taking ibuprofen, codeine or paracetamol in the dose recommended on the container. Aspirin taken immediately after surgery may encourage bleeding, and should be avoided in the 24 hour period after surgery.
A small amount of bleeding may occur during the first day, but this should stop soon (within 15 minutes). Pressure on both sides of the wound or dressing for 15 minutes should be sufficient to control it.
Some swelling may occur within the 24 hours following surgery. This is normal and should not cause concern. However, this can be reduced by placing an ice-pack on the affected area. If swelling occurs after the first 24 hours, you should contact the surgery.
When a periodontal dressing has been used, it will usually remain in place until your next appointment. Should the dressing come off before this, no special precaution needs to be taken if the area is comfortable.
The use of a toothbrush in the area of surgery is not recommended during the first week after surgery. Plaque control can be achieved by using corsodyl mouthwash, following the instructions on the bottle.
If you have been given an antibiotic, use as prescribed.
Alcoholic drinks and smoking should be restricted for the first 24 hours after surgery, as well as excessive exercise.
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Post Oral Surgery Advice
Pain
- There should be no pain immediately after the operation due the local anaesthetic.
- This should last for 3-4 hours before sensation returns slowly and care should be taken to avoid biting the lip or tongue during this time.
- Pain tends to be worse on the 2nd or 3rd day but gradually improves over a period of 7-10 days. Pain can be quite severe after wisdom tooth surgery.
- Simple pain killers such as Paracetamol, Ibuprofen or Codydramol should control the pain. In cases of wisdom tooth surgery a combination of Paracetamol and Ibuprofen
- or Codiene (depending on severity) will be needed regularly for 5-7 days.
- If there is a sudden increase in pain after a few days, this may indicate infection and the surgery should be contacted.
Swelling
- This is common after surgery has been carried out in the jaw and reaches its maximum 2-3 days after surgery. The swelling should resolve 7-10 days after surgery.
- The best way to bring the swelling down is using ice packs where the surgery has been carried out.
- Bruising of the face occasionally occurs and can take up to 2 weeks to resolve.
Bleeding
- This should be minimal by the time you leave the surgery.
- Blood stained saliva is to be expected for 24-48 hours after the operation.
- Do not rinse the mouth or keep spitting for the first few days as this may disturb the blood clot and cause bleeding.
- If persistent bleeding occurs, roll up a piece of gauze, place over the wound and bite firmly for at least 15 minutes.
Oral Hygiene
- The next day warm salt water gargles are recommended.
- Keep your teeth clean with gentle brushing.
- Chlorhexidine (Corsodyl) mouthwash will help reduce plaque while tooth brushing is difficult.
Diet
- Your mouth opening will be restricted for about a week so you may want to stick to semi-solid diet. You may then begin to eat normally at your own pace.
Stitches
- If you have stitches (sutures) in your mouth, these should dissolve and drop out after a period of 7-10 days. If they persist beyond this time gentle brushing usually gets rid of the stitch.
Medication
- Antibiotics after the operation are not administered on a routine basis owing to the risk of antibiotic resistance (you may not respond to same antibiotics at a later date).
- If needed, antibiotics will be prescribed or advice given.
Time off Work
- This will depend on your profession and the amount of surgery.
Smoking
- Kindly refrain from smoking for at least 24 hours as it can cause a painful condition called dry socket, which requires placement of medicated dressings at a later date
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SEDATION FOR MINOR ORAL SURGERY
Intravenous Sedation Is Used To Help Relax You During Minor Surgical Procedures
- The sedative is given by injection into a vein (intravenous) in your arm or the back of your hand.
- You will remain conscious at all times and able to talk and respond to instructions.
- You will also receive local anaesthetic (injection into your gum) so that the treatment can be carried out.
- Afterwards you will probably have little or no memory of the procedure.
If You Are Having Intravenous Sedation There Are Some Rules You Must Follow For Your Safety
- A responsible adult (friend or relative) must stay in the department during your treatment, drive you home afterwards and stay with you for the rest of the day. If not you cannot have sedation.
- Remember to tell your oral surgeon before treatment of any changes in your medical history, your medication or if you have any allergies or suffer from asthma.
On The Day Of Your Treatment
- You can have a light meal up to 2 hours before your treatment if you wish.
- You can drink fluids and take any medicines as normal unless you have been instructed otherwise.
- Do not drink any alcohol.
- Treatment and recovery time is usually 1-1 ½ hours.
- Wear flat shoes/footwear as you will not be steady on your feet.
After Your Treatment Under Sedation
- A responsible adult must drive you home and stay with you for at least 6 hours following the treatment.
- You must not travel home by public transport such as a bus.
- You should stay at home resting quietly for about 24 hours.
- Do not drive a car, drink alcohol, use machinery (such as a kettle or a bike), do any work or make important decisions for 24 hours. This is to allow the effects of the sedation to wear off.
- You can eat and drink normally as soon as you like.
- If you experience any pain, do not hesitate to take the painkillers as directed.
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REMOVAL OF WISDOM TEETH
This information is for patients who may need to have an operation to remove their impacted wisdom teeth. It explains why they may need to be removed, what is involved and any risks or complications there may be.
The Wisdom Teeth
Adults normally have 32 teeth and wisdom teeth (3rd molars) are the last to come through at the back of the mouth. Normally there are 4 wisdom teeth, one in each side of the upper and lower jaw.
Impacted Wisdom Teeth
If the jaws are too small to accommodate all the teeth, there may not be enough space for the wisdom teeth to come through properly and they become impacted (stuck), often causing problems.
Reasons For The Removal Of Wisdom Teeth
- The most common reason is recurrent infection of the gum overlying a tooth that is part way through the gum (pericoronitis).
- Decay (caries) in the wisdom tooth which your dentist cannot restore.
- Infection of the tooth (abscess) due to advance dental decay.
- When the adjacent molar tooth is affected by gum (periodontal) disease or dental decay due to the impacted wisdom tooth.
- Progressive cystic (fluid filled sack) formation around the tooth.
- As part of other surgical procedures involving the jaw.
- There may be other less common reason that your surgeon will discuss with you.
Removal Of The Wisdom Teeth
- There is great variation in the difficulty of removing wisdom teeth.
- The procedure can be carried out under local anaesthesia (injection in the gum to numb the area), with or without intravenous sedation (injection in the arm or hand to reduce anxiety), or under general anaesthetic (completely asleep in hospital).
- Your surgeon will discuss with you which method is most appropriate.
- The degree of difficulty of surgery, any underlying medical conditions and other personal circumstances are taken into account when choosing the method.
- The procedure can involve an incision (cut) in the gum close to the tooth.
- Sometimes some jaw bone around the tooth is removed with a drill and the procedure can be made easier by sectioning (cutting up) the tooth itself into smaller pieces.
What Can Be Expected After The Operation?
- There is a great variation in the pain and discomfort suffered by individuals and this also depends on how difficult the surgery is. The average recovery time is between 5-7 days.
- Swelling is common and tends to be maximum on the 2nd and 3rd day after surgery, reducing over about a week.
- Mouth opening is likely to be restricted and a semi-solid diet will be required over the first few days.
- Expect some pain from the operation site, which should be helped by painkillers.
- Bruising of the face and upper neck occasionally occurs.
Some Possible Complications
Removal of wisdom teeth is a very safe and common procedure but there is some risk associated:
- Most bleeding will have stopped shortly (within ½ hour) of the operation finishing. Blood stained saliva may be noticed for a day or 2. More persistent bleeding may occur which should be dealt with by your surgeon/hospital.
- Some antibiotics are prescribed after the operation. Even if they have infection of a tooth socket occasionally occurs.
- When an adjacent tooth has a large filling or crown it is possible that this can be dislodged during surgery.
- The nerves which give sensation to the lower lip, chin and tongue are very close to the lower wisdom teeth and can be prone to bruising.
- If this happens numbness or a tingling sensation in the lip and chin or tongue will be experienced.
- This is temporary in most cases, but in a small number recovery may not be complete. Very rarely continued pain may be felt from damaged nerves.
Please speak to your surgeon before your operation if you have any concerns about these risks.
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Fissure Sealing Advice
What Are Fissures?
Some back teeth have very deep grooves/fissures on the biting surface. Which makes it very difficult to get the bristles of your toothbrush down into these deep fissures to keep them clean. Food and plaque can stick in these grooves and cause decay.
What Is
Fissure Sealing ?
Fissure sealing is a preventative treatment where we apply a tooth coloured glass-like material into these grooves/fissures. These are usually applied to the permanent teeth, when they start erupting from the age of 6.
With its new smooth surface the tooth is much easier to clean and less likely to decay. The seals last for many years and the procedure is painless.
What To Expect After Fissure Sealing?
You will not see much change when you look at the teeth as the sealant is almost tooth coloured.
It is advisable not to eat or drink for two hours after the procedure.
It is normal that the sealed teeth feel a little high for a day or so.
Fissure seals have proven to be a very effective method towards preventing tooth decay.
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CT HEad Scan
CT Scanner
Why you might need a CT Scan
A CT Scan takes a 3 dimensional image of your jawbone. This is then formatted into pictures of 1 mm thick slices (similar to slides) so we can build an accurate picture of what is happening in your jawbone. The scan provides us with excellent information which helps us diagnose the situation in your mouth. For example we check if you have enough width, height and volume of bone for placement of implants or whether we need to provide additional procedures.
The Scanner
The scanner pictured to the left is a form of a large ring (like an open plate) through which the upper part of your body is slowly moved in order to take the scan. The picture shows the head cradle in which your head will be positioned.
Positioning
The radiographer will explain what the procedure entails before she positions you on the examination table.
The Cradle
The radiographer will secure your head in the head cradle with a trap. This painless procedure helps keep you still as even the slightest movement blurs the results.
Scanner entry
You will be moved into the scanner. The radiographer will control the procedure from an adjacent room, but he or she will still see and hear you. The actual scanning process takes 30 seconds.
The Scan
As the equipment scans your head, you will hear a slight whirring sound. Relax, don’t move your head. You will be moved slightly after each scan – may not even notice the change. The appointment length may take from 10 to 30 minutes, depending on the exact test performed.
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Biteplate instructions
Wearing
The bite plate should be worn every evening where possible particularly during a stressful period in your life.
The bite plate usually feels very strange when you first put it into your mouth. This is often because of the muscle tension you are experiencing, the jaws are tense. The bite plate will help the muscles of the jaw to relax.
When you start wearing the bite plate, try to start to wear it for 1 hour during the day just to get used to the feel of it. Sometimes it can feel a little tight in the front teeth. Do not worry about this as it can be adjusted to make it feel very comfortable. Normally we like to see you one week after wearing the plate and for two other adjustment sessions to make sure it is feeling comfortable. Always bring your bite plate to each dental appointment.
Looking after your bite plate
1. Always keep it moist with a little water around the plastic.
2. After wearing it rinse it with cold water
3. Clean it with liquid soap and a soft nail brush over a basin of water so that it doesn't slip or break.
4. You can use toothpaste after cleaning with the liquid soap to give it a better taste.
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