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Rheumatoid Arthritis is a difficult condition to live with, as I don’t suffer from this myself my description probably does not do  justice to the impact that this disease has. I have many patients, friends and family who do suffer from it and this post is just a few ideas and suggestions that might make maintaining good home care a little bit easier for anyone with reduced dexterity be it as a result of arthritis or any other condition.

We recognise the need to clean around the teeth and between the teeth. 2  “separate activities,”  for which 2 separate sets of tools are needed.   Lets start with the easy one brushing.

Brushing Choices

Modern electric brushes solve a lot of problems, their handles are thicker than manual tooth brushes and generally they do most of the hard work. There are 2 main types

The oscillatory type – these have a round head that rotates a few degrees back and forwards to create a rotating scrubbing motion. These were made popular by Oral B who still have an extensive range of brushes available to day although other manufacturers so now produce very similar brushes.

The second type of brush is the “sonic” type where tiny micro movements are sent through the toothbrush bristles so there is less visible motion on the head of the brush.  The most commonly brand of this type is Sonicare. The sensation with sonic brushes is definitely different to a manual or indeed an oscillatory brush and can to some people be an acquired taste.

Manufacturers will all claim that their brush technology is best and also highlight that the more you pay the more features the brush will have.  Most of the additional features may make brushing more fun / less boring,  but few of these “add on” tricks will make a quantum difference to the results you achieve. My advice is always – choose the type that you like best and then look for a low cost model with a 2 minute timer ( as this is probably the single most important add on  feature)

Cleaning Between The Teeth

This is a trickier area and for most patients it starts with trial and error.  I cannot recommend one device that will work for everyone but I can suggest a range of things that we have found work well in the hands of our patients.

The first thing to say is that mouthwashes that claim to swirl between the teeth, simply won’t do the job on their own despite the marketing hype!

Long handled interdental brushes

These are great for most sites and the version  with the  longer handle are ( for most people ) easier to use than the shorter ones. The extended handle is relatively narrow  which can make it a little harder to grip but this can be easily overcome with a customised handle.  Dental impression material works very well for this and your hygienist or dentist  should be able to rattle one of these up for you relatively quickly. Brushes are generally regarded as better than floss at cleaning between teeth so if you have spaces that are large enough to allow it these probably should be your first choice.

Flossing Devices

The best devices have a bow type arrangement and  there are many of these on the market. Rather than recommend a specific make there are some key things you should look for.  I think that this type of arrangement works best. When you put this in your mouth and place it towards the back teeth the floss is already orientated the right way and will be much more likely to fit inbetween the teeth. Devices that look a bit like a fiddle bow are not so good for the back teeth  ( Which is where it is really important to get access.)

Many patients with reduced dexterity harv told me that  they can help the floss get through the tight contact with a gentle bit of pressure from the opposing teeth. While we don’t recommend   “biting  to floss ” normally this may make the difference between getting in to the back teeth and not.

The type of floss that the bow is threaded with is also important, where possible look for a monofilament / one that will break cleanly. The last thing you want to end up with is shreds of floss wedged between the back teeth.

Ask us for help

My most important piece of advice is to be sure to ask us to help  if you are struggling to get in with floss or brushes.  Te team are always there to help and have lost of samples on hand  so that you can go rapidly through the trial and error process while you are with us.

Mouthwashes

Finally just a quick word about mouthwashes.  They can be useful, particularly if you are experiencing a higher rate of tooth decay. Many medications interfere with saliva production and can  leave your mouth dry. The lack of saliva means that any sugar in your diet will hang around for longer  and consequently have the potential to cause more damage. It is not uncommon to see someone who starts a  programme of complex medication suddenly developing tooth decay on parts of their teeth were there was none before.  I will cover this in more deail in a future blog post  but for now the key messages in relation to mouthwash are – choose a fluoride containing mouthwash, choose an alcohol free mouthwash, and use it after you have brushed and cleaned in between the teeth.

Well time now to comment on that old adage never let the truth get in the way of a good headline.  Anyone seeing me or the team at Craigentinny will know that we recommended using something to clean in between your teeth at least once a day.
Our hygienists will not miss an opportunity to tell you that brushing alone won’t reach every part of your mouth……

So you can imagine how delighted we were to see articles like this one on the Daily Mail  

To save you clicking the link here is the headline

Flossing is a waste of time! We all hate doing it. Now some experts are saying it has little impact on reducing tooth decay

So what’s the real story, have we been talking rubbish for years?   and have experts finally unearthed the secrets of dental hygiene that we have  all failed to spot?

We genuinely  don’t think so and here is why,

1. we know that if you have enough space to get brushes in then they will clean more effectively than floss

2. if you don’t have enough space for brushes then floss will at least remove food debris ( on which bacteria feed ) and some of the plaque

3. the studies so far may fail to provide the concrete statistical evidence that shows that flossing  works  but this does not automatically mean that it doesn’t.

4. The vast majority of dentists and hygienists up and down the country report that when a patient starts to floss they see less bleeding from that persons gums.

5. given the choice of a part of me that bleeds or does not, i prefer the latter

Remember that science represents “best current knowledge” For example 20  years ago we were told that electric toothbrushes had no evidence to support them as being better than manual toothbrushes….It took many years for the studies to catch up with the day to day experiences of dental hygienists who knew that they were seeing better results from patients  using electric brushes…….  despite ” science” telling them otherwise.

So our conclusion – please please don’t give up cleaning between your teeth  just yet no matter what method you use something is far better than nothing!

We thought we would experiment with a podcast type format this month. Here is a short 3 minute section that shows you how to make sure that the healthy stuff that we all try to eat does not cause accidental damage to the teeth.  I call it Grazing for Humans…. Enjoy

At Craigentinny Dental Care in Edinburgh we have had a genuine interest  in helping patients with dental fear, our web site had information on this since before web sites for dental practices were very common.  I had some fun recently looking at the internet archives of our site dating back to the year 2000. Yes I agree, the web design by today’s standards is woeful  but  even then there was a section dedicated to dental fear and how we can help.  If you are interested I have pasted some images here.

Reflecting back it is amazing how  many changes there have been in dentistry in the last 15 years. technology has advanced, equipment is better and we know more than we used to about the common dental diseases and how to treat them.

More importantly when it comes to dental fear our team has build up a wealth of knowledge and experience helping patients who find visiting the dentist a challenge over more than 20 years.   Thankfully we have been able to help the vast majority of our patients  beat their  dental fear without the need to resort to medications  or sedation but for a few people their fear has been too entrenched to beat with our usual methods. This is why we are delighted to be able to offer dental sedation as an option to our patients in addition to our other dental fear services.

Our team will not ever try to force a solution upon you but will look to find out as much as possible about your fears and your situation before offering you all of the appropriate choices and the support to make an informed decision.

Gum disease covers a wide range of problems ranging all the way from bleeding gums through to loose and wobbly teeth.  As dentists the thing that worries us most is the fact that many people don’t realise how important gum health is in relation to your whole body health and  ignore the early warning signs of trouble.

So what should you look out for to  spot  Gum Disease early  in your own mouth?

The key sign of trouble is bleeding from the gums, usually this can be when you brush or floss, but in  more extreme cases can happen even when you bite into food. Bleeding is a sign that there is inflammation present in the gums and that is not a good thing.

Notice the dark red red swollen shiny gum peaks between each tooth

If you look in the mirror at your gums they should be pale pink with a texture that looks like orange peel, if you see that the gums are darker red, tight, shiny and swollen then this is a sign that  you may have inflammation present.

Can Gum Disease affect the rest of your body too?

research on this is ongoing but there is a growing body of evidence to show that poor gum health can impact on  many other conditions such as high blood pressure and heart disease. it has been associated with premature births, low birth weight babies  and now research is looking at links between gum disease and conditions like  Alzheimer’s and Arthritis.

As gum disease is largely  a pain free condition until the problem is very advanced,  it is possible of gum disease to develop and a lot of the supporting bone for your teeth to be destroyed without you realising. The good news is that for most people the right care and advice can stop Gum disease in its tracks. Caught early enough often little or no lasting damage is done. Best advice is to have a dentist or hygienist check out your gums at least once  a year and more if  you have experienced problems in the past.  For tips on preventing gum disease  see a future blog post.

Here is a  fantastic short TED talk by Ron Gutman, full of snippets that perhaps help to explain why so many of us feel that we want to make the most of our smiles.

I talk to lots of people every week about  all aspects of dental health and smile enhancement.  It is noticeable that many people enquire about improving their smile but are worried that they will be perceived less favourably by others if they take action. I always advise the same thing, that any smile changes should be “for yourself” not others.  At Craigentinny we  provide cosmetic dental treatments in a tooth friendly way, preserving natural tooth or using minimally invasive methods.  For this reason Tooth Whitening and resin bonding are 2 of our most popular treatments. Tooth whitening carried out professionally is effective fast and safe. Resin bonding in most cases can be completed without any drilling or removal of your natural teeth.

I have just spent a pleasurable hour chatting to the dentist behind  a new dental implant  system called Implant Pilot. It is a new way of using computer guided surgery to make the whole procedure less stressful for our patients. By using accurate 3D  jaw scans and combining them with  optical scans of your mouth, the more conventional approach of  cutting and folding back the gum can often be avoided. While the technology involved is both amazing and exciting the important part is that it  means fewer stitches or in some cases none at all after treatment.  Most patients tell us after implant placement that they were  pleasantly surprised at how straight forwards the process was but I do think that this system has the potential to take things to the next level, increasing comfort and reducing tenderness on the days after treatment. Anything that can make implant based treatments even easier to cope with than they already are can only be a good thing.  Our  team are scheduled to learn more about this new technology soon and are hoping to incorporate this technology into our practice at Craigentinny Dental Care over the coming months.

Like many people I have been fortunate to enjoy a few days off over the Easter Bank Holiday Week End. We have traveled  some way to spend some time with family. This  break in the day to day schedule or perhaps a  long journey afford you some time to reflect on things.

The thing that seemed to come to my mind  was the fact that I committed some time ago to doing a  couple of events this year.  The actual events are not that important but they do represent a major physical challenge for a 40 something year old.  Being away from the daily routine gave me just enough  time to allow my brain to start fishing around in its recesses and reminding me of promises I had made to myself.

I recognised that my training to date had not been as extensive as it really needed to be and that I had so far not committed as fully as I needed to to achieve my goals. Time then for the dentist to take a dose of his own medicine!

I shared my thoughts with my long suffering family and explained that I intended to rectify my training schedule and work at it a bit harder. They obviously relished the opportunity to boss me around and encourage me to get on with it!  So what was the outcome….  5 Days away, 3 training sessions and a plan in my diary going forwards to get me back on track.

Like any goal, it is easy to let procrastination creep in or fail to share your commitment with others through fear of failure. It is amazing the change that can be produced  by nothing more than a small conversation with people who want to see you succeed.

No matter what you want to do, be it a long running race, or beating your dental fear, this week end has reminded me of the benefits of setting a goal, sharing it  and committing to it wholeheartedly. If you need someone in your corner to   help you commit to beating your dental fear please just get in touch.  ………and if you make it into see us  before September this year, keep me accountable and ask me how the training is going !

Even top athletes need to remind themselves to commit. Lynsey Sharp at 2014 Commonwealth Games winning a medal in the face of adversity.

Lynsey Sharp

Advances in technology have allowed dental implants to become an increasingly popular and ever more accessible method for replacing missing, or soon-to-be removed teeth.

Whilst implants often prove to be a fantastic long-term solution for many people, it is important to learn as much as possible about the advantages, limitations and available alternatives, so that you can make an informed decision about whether or not they are right for you.

What are dental implants and how do they work?

Dental implants are small, threaded titanium components which are carefully placed into the jaw. Acting like replacement roots, the implants are strategically positioned to occupy gaps left by missing teeth.  Through a process known as ‘osseointegration’, the surrounding bone naturally heals and fuses with the implant, resulting in a firm, secure anchor which dental prosthetics (crowns, bridges or dentures) can be attached to.

What are some of the advantages of dental implants?

• Dental implants are often the most natural looking (and feeling) option available when it comes to replacing missing teeth: In fact, when expertly fitted by a skilled dentist, high quality implants will be virtually indistinguishable from natural teeth, in terms of appearance and how they work.
• As the implants sit below the gum-line, the only parts which are visible to the naked eye are the artificial tooth elements that you are replacing.
• Dental implants directly link to the jawbone so that individual teeth can be replaced, without the need for support from neighbouring teeth as you would find with a bridge: This minimises the need for potentially destructive work on healthy teeth next to the space.
• Implants can also be used to stabilise full or partial dentures. In such a scenario, the implants have special press stud like attachments which connect to the dentures, to lock them in place for added confidence and improved functionality. This option can prove to be more cost-effective than replacing each tooth individually.
• Unlike dentures or bridges, which simply cover up gaps left by missing teeth, implants transfer chewing loads to the jaw, the chewing forces in turn can help to prevent bone-loss and shrinkage that you often see where a bridge or denture is used to replace missing teeth.
• Despite having a higher initial cost than other forms of tooth replacement, dental implants are designed to last significantly longer than dentures or bridges, meaning that you could save money in the long-run.

How can I tell if implants are suitable for me?

Like all technologies, dental implants have some limitations which mean that they are not suitable for everyone.   One limiting factor, for example, is the amount of bone available to allow the implant to be attached to. While this rarely precludes the use of dental implants, a lack of bone may mean that we cannot create a perfect appearance where the replaced tooth emerges from the gum.

As with all surgical procedures, there are a great many factors that need to be taken into consideration on an individual basis   to determine whether or not you are suitable for this type of treatment.

Modern techniques mean that dental implants are available now to more patients than ever before so it is rare to find a situation where there are no implant based treatment options open to you. Equally in order to make sure that you can benefit from dental implants and have the widest range of choices and options it is best to arrange a consultation before a tooth is removed or as soon afterwards as possible.

This is becoming a hot topic in dentistry as we continue to see patients without typical risk factors ( smoking and drinking lots of alcohol) developing oral cancer. The search is on to identify what is really behind the rise in oral cancer rates and mouthwash containing alcohol is coming in for some close scrutiny.

As yet no one has proven beyond all reasonable doubt a significant  link between the use of alcohol containing mouthwash and an increased risk of oral cancer unless you are rinsing 3 or more times per day, which lest be honest  is an awful lot.

What we do know though is that alcohol increases the ability of other toxins to penetrate through the surface of the mouth and throat lining. So it does lead me to wonder if  rinsing your mouth with it every day is a great plan.  We also know that any remnants of alcohol in the mouth can break down into acetaldehyde which its self is though to be a carcinogen. So where does that leave us in terms of practical dental advice?

Here are my views…

1. shot term use ( less than 2 weeks)  of  chlorhexidine and alcohol  containing mouthwash to control plaque after an extraction or when the gums are inflamed for some other reason is fine. Even though it can be bought over the counter it is best used only on the specific advice of a dentist, doctor or pharmacist.

2. if you take medications that cause a dry mouth or have a dry mouth for any other reason  you are more at risk of tooth decay. A fluoride mouthwash is a helpful part of a prevention strategy. As the alcohol free versions are just as effective why not choose one of those? or consider asking your dentist or doctor about prescription strength Fluoride toothpaste.

3.if you have a high rate of decay for some other reason a fluoride mouthwash may be a valuable addition to your home care routine  BUT only after  you have brushed and flossed

4. mouthwash does not an alternative to  tooth brushing, despite the graphics in the adverts unless you mechanically clean the teeth first the mouthwash can’t do its job.