Hello all!

I am Ammara, one of the dentists at Revive Davyhulme; I am sure many of you know me by now or have been treated by me.  I am relatively new to the blogging world especially relating to the dental world so it here it goes!! I thought it would be nice to share my own tips from the day to day advice I give patients and things I  have picked up on over the years (and no I’m not that old I assure you!)

I see gingival recession on a daily basis (this is when you see the gums move upwards from the neck of the tooth) and you will never believe what is the main cause for this? Hard tooth brushing! Plaque is very soft and easily removed by light stroking of the tooth brush in a round motion on the gums and the teeth (what we call the Bass technique) and I am sure many of our therapists and myself have demonstrated this. Please do not hesitate to ask, it is a very common query, so make sure you are not brushing your gums away! Also I absolutely love the Oral B and Philips Sonicare ranges (electric toothbrushes) they are excellent at maintaining a certain force so it becomes almost impossible to brush too hard. And it gives you that all important fresh dental clean without damaging your teeth!

Till next time, happy brushing.

Filed under: Ammara Mubashar by Ammara
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Nhs dental charges at the dental practice are on the increase, the government in their wisdom have increased NHS dental charges from the 1st of April. The new NHS dental charges will be as follows:

Band 1 payment: £17.50

This covers an examination, diagnosis (eg X-rays) advice on how to prevent future problems, a scale if needed and application of fluoride varnish or fissure sealants. If you require urgent care (an NHS emrgency dental appointment), even if your urgent treatment needs more than one appointment to complete, you will only need to pay one Band 1 charge.

Band 2 : £48.00

Band 2 covers everything listed in Band 1, plus any further treatment such as fillings, root canal work or if your dentist needs to take out one or more of your teeth.

Band 3: £209.00

Band 3 covers everything listed in Band 1 and Band 2, plus crowns, dentures or bridges.

It is important to understand that aesthetical dentistry such as tooth whitening are not included in the NHS service.

Filed under: Ben Atkins by Ben Atkins
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Firstly congratulations to all mothers to be!

It is really important to keep regular visits to our dentist during your pregnancy. The reason for this is that due to hormone changes taking place because of your pregnancy, there can be an effect on the health of your mouth.

For some women more care is required to maintain good oral health at this time. For example, mothers can be more prone to periodontal problems (gum problems) during and in some case for a period after the pregnancy.

There are studies linking gum disease with premature birth and low birth weight, so it is well worth being proactive at preventing these problems.

Why are my gums bleeding?

This is very common during pregnancy and can occur for duration of the pregnancy and sometimes after the birth. As I mentioned before, this is due to hormone changes. This is known as pregnancy gingivitis.

Many of my patients that have experienced this have stopped brushing and flossing as efficiently because it is causing their gums to bleed. If your gums are bleeding, its important during this time to ensure you keep a good standard of oral hygiene to prevent permanent damage to the gums (periodontal disease). Bleeding should stop after the hormones return to normal.

If they are bleeding, you should visit your dentist. You may require a cleaning  and advise to help maintain the health of your gums.

A low percentage of women can develop small lumps on their gum tissue (pyogenic granuloma). Don’t worry they are not cancerous. They usually shrink or go away after the pregnancy. Still if you notice a lump it is still always worth having it checked by your dentist, it’s always better to be safe than sorry.

Is dental treatment safe during pregnancy?

Yes, normal routine treatment should be just fine, but if you do have any concerned do voice them to your dentist.

Usually unless it is completely necessary your dentist will avoid taking x-rays of you teeth while you are pregnant. Again do enure when attending your dentist you inform them of your condition.

It also advised by the department of health that you do not have amalgam fillings placed or removed until after the birth of your child.

Morning sickness

Morning sickness and acid reflux can be troublesome for your teeth, because it is acidic it can cause erosion of the enamel of your teeth. If you suffer from morning sickness and vomit its really important that you DON’T BRUSH YOUR TEETH STRAIGHT AWAY.

The acid softens the enamel of you teeth, if you brush straightaway, you could be brushing away some of the protective enamel of your teeth. Try to wait at least 40 minuets before brushing; you should try to do the same after eating.

Instead try rinsing with water to help neutralise the acid. You could then rinse with a mouth wash if freshness is an issue. Sugar free chewing gums can be handy if you’re out and about. Chewing gum increases you saliva flow helping to neutralise the acid.

Myths

There are a number of myths related to the effect of a pregnancy on the mother teeth For example some mother find that they suddenly have an increase of decay in their teeth during or after the pregnancy

“My baby took the calcium form my teeth when I was pregnant,”

This is unlikely, the more likely cause for the increase of decay during or immediately after the pregnancy is -

• Morning sickness weakening the enamel if you vomit
•  A change in eating behaviour- sugar foods, strangle cravings, increase in the frequency you are eating
• Stopping flossing or brushing, generally maintaining a good standard of oral hygiene. It can become a challenge as some women develop more of a gag reflex during there pregnancy.

The important message for all expectant ladies is that if you can keep a reasonably healthy diet and good oral hygiene, it should reduce the risk of decay and the need for fillings. Also this will decrease the risk of more permanent damage to your gums (periodontal disease).

Filed under: Lorraine Richmond, Prevention, Revive - Davyhulme, Revive - Monton, Uncategorized by Lorraine
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 This is just as essential as tooth brushing . Brushing alone does not clean all the sufaces of your teeth. Brushing  cleans roughly only 65% of the surfaces of your teeth. The  surfaces between the teeth can simply not be reached by brush, leaving millions of  acid producing bacteria  and rotting food behind.

If plaque and debris is left in these interproximal areas inbetween your teeth, it can lead to gum disease( periodontal disease). Interdental  cleaning also  reduces the risk of decay occuring on the interdental surfaces of your teeth. Even if you use mouthwash its not suffient enough to removed or kill the million of acid producing bacteria that eat away at your teeth. If you could imagin only cleanining half your kitchen sink and leaving the rest dirty, this is a simlar example to not cleaning between teeth .

You should be cleaning between your teeth daily

Floss / flossing aids – ensure when flossing you gently pull the floss across the side surfaces of each tooth( up and down movment). It is not recommeded to use a back and forth sawing action once the floss is pushed past the contact point( the point where the to teeth meet).

Floss can come in diffrent forms, eg waxed unwaxed , tape, etc.

Flossing can be a little tricking, if you find it difficult to effectively clean this way you could try using a flossing aid. e.g. as shown in the picture Flossettes

There is also a vibrating flossette avaiable call a hummingbird manufactured by Colgate, although this is a more expensive option.

Super floss can be used to clean around orthodontic appliances/ bridges etc. one end is stiff so you can thread it thought the gap.

 Interdental brushes (i.e. Tepe brushs) – the brushing are pushed back and forth through the gaps of the teeth. Ensure gently brushing the gums with the bristles. The larger the brush you can comfortably push through the gaps between your teeth the more effectively it will help to removed the bacteria,and they can be wash and re-used. You will most likely require a few diffrent sized brushes because the interpoximal gaps tend to differ in sizes.

Some patient’s find these much easier and more effective to use than floss.

These can also be used to clean around orthodontic appliances/ bridges etc.

 Tip- bending the brush 90 degree can make it much easier to reach between the back molars. Some patients like to use toothpaste in the brushes, if you suffer from periodontal disease why not try popping some corsdyl gel on the brushes ( be aware corsdyl causing stain of the teeth).The brushes  can sometimes bend, the smaller the bushes to more they do this, just straighten them out and continue to use them.

Wooden Sticks( toothpicks)

I do not normally recommend these as they are usually much less effective than any of the above interdental cleanining options at removing plaque, although can be helpful to remove food debris after a meal. They are also more likley to cause trauma to the gums if used incorrectly.

Water jets (waterpik)

The water jet is an irrigation device whick relies on removing the plaque with high pressured water,  flushing out the interdental spaces . This can be an effective way to remove plaque, again is a more expensive option.

Cleaning interdentally effectivley  can be a challenging especially around the posterior molars. I have found some patients find diffrent technques easier than others like the interdental brushes, but it’s about what works for you.  Ask your dentist, therapist or hygienist to check you are using which ever method you use effectivley.

Filed under: Lorraine Richmond, Prevention, Revive - Davyhulme, Revive - Monton by Lorraine
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Why is it so important?

As stated by the department of health, regular brushing with fluoride toothpaste reduced the risk of dental decay and periodontal problems

Although primary (baby/milk) teeth are eventually lost they should be looked after

This starts good habits which can be much more difficult to enforces as they get older and reduce the risk of decay and the need for dental treatment which some children can find traumatic at an early age.

They are needed for chewing, but also act as space maintainer for when the adult teeth erupt, if removed to early it can lead to overcrowding of the teeth.

Starting early is important you need to start brushing your child teeth as soon as they erupt.

This is usually around 6 months, by 24 they should have most if not all of their primary teeth, but in some cases this could be earlier or later

You and your child should be brushing their teeth 2 times daily at some point during the day and last thing before bed (this is important).

Avoid brushing your teeth immediately after eating or consuming a sugary or acid drink, you should wait at least 40 minuets

Use a soft bristled brush with a small head

Children under 3 should be using toothpaste with no less than 1,000 ppm F (parts per million fluoride)

Over 3’s and adults should use 1,350 – 1,540 ppm F the maximum should be use for all adults and children to protect from decay apart form if you cant prevent them from eating tooth paste, if your unsure checked with your dentist.

One thing worth considering is that it is just fine to use children tooth paste but to be aware that the flavoured toothpaste may be more difficult to ween them off when its time to switch to adult toothpaste. 

If  you wish to use a mint toothpaste but your child finds the mint flavour to hot, there are mild mint flavours that may be more tolorable option for them. Aquafresh produce a childs mild mint tooth paste with enough fluoirde to provide protection suitable for children over 3. Oral B toothpaste  also do a mild mint flavour.

HOW MUCH TOOTHPASTE?

For under 3’s should be only a smear of toothpaste 

Try to avoid you child licking and eating the toothpaste

children from 3-6 years should use only a small pea size amount

Children should be supervised when bushing up to 7 years old, you could try have a routine of brushing at the same time as your child.

Try discouraging rinsing with water, and just spit out excess toothpaste. If they have to rinse try to keep it to a minimum.

HOW MUCH TOOTHPASTE?

Allow you child to brush there teeth first then brush them again for them, a good tip is to cradle there head in your arms, this way it gives you better visibility to clean all the surfaces

If there are  little older stand behind them and get them to tilt their head back

Tips for reluctant brushers

Enthusiasm is the key. Trying to make it a fun experience, if you child thinks you are having fun then usually they will follow

Let them watch you bush from an early age, make funny noises and faces, sometime being a bit goofy makes the difference

Try letting you child brush your teeth and then you brushing theirs

Encourage them to brushing like mommy and daddy does

Use plenty of praise when they do brush

Colourful tooth brushes can help

by the  age of 4 they can use an electric toothbrush

Filed under: Lorraine Richmond, Prevention, Revive - Davyhulme, Revive - Monton by Lorraine
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•  Spit out excess toothpaste after brushing and try to avoid rinsing.            
• Rinsing with water or mouthwash straight after bushing will wash most of the fluoride (you want to stay on your teeth) down the sink.
•  Using mouthwash at a later time to brushing will maximise the beneficial effects of both products.

 What tooth brush should I be using?

 Manual tooth brushes: look for a small headed tooth brush with soft round-headed filaments. Also, choose one with a compact arrangement of long and short filaments.

Electric brushes: Oscillating (i.e. backward and forward) rotating brushes such as that produced by Oral B are clinically proven to be more effective at removing plaque than a manual toothbrush.

Manual tooth brushes and electric tooth brush heads should be replaced approximately every 3 months.

 How do I use my toothbrush?

•   Most people do not brush for long enough. Brushing should take 2 – 3 minutes. Try timing yourself or play a song on you radio and try to brush for that period of time. 
•  You should brush your teeth last thing before bed and one other time during the day
•    Do not brush straight after eating or drinking sugary or acidic drinks; try to leave it for at least 40 minutes. The reason for this is that, immediately after eating, the enamel of your teeth is softened by the acid and takes at least 40 minutes to re-harden (re-mineralise) again. If you brush within this time you could be brushing away the protective tooth enamel.

Create a brushing routine for yourself.

1. Start by brushing the outer surfaces of one side of your mouth and work gently away around to the other side of your mouth
2. Move back along the inside surfaces of the teeth.
3.  Brush the biting surfaces of your teeth. This sequence should be performed separately on your upper and lower teeth. Brushing systematically will help to ensure that you do not miss any areas.

 What’s the best way to use a manual brush?

There a several technquies for brushing personlly i like the The Bass technique:

 Angle your brush 45 degrees to the gum margins and rotate the brush head in a gentle a circular motion. Brushing this way will help to lift the debris from the spaces between the teeth.

 For the inside surfaces of your front teeth, it may be easier to angle your toothbrush upward (as if you where sucking you thumb); remember also to do the opposite for the inside surfaces of you lower teeth.

Electric oscillating brushes (Oral B)

Angle your brush 45 degrees to the gum line and slowly and gently brush round the tooth surfaces.

Sonic brushes (Sonicare)

Angle your brush 45 degrees towards the gum line and gently work as if you were painting your gums with the brush.

Tip- Put the toothbrush in your mouth before turning it on in order to avoid getting toothpaste everywhere!

 Checking your brushing

 A lovely cheap and effective way to check if you are cleaning effectively is to use Disclosing tablets, which simply dye any bacteria left behind after brushing a different colour,  making it easier for you to spot missed areas.

 This can be especially useful for children and patients with periodontal problems.

I’m a real fan of disclosing tablets and I do use them myself.

• Tip – check to ensure that you are not allergic to food dye.
•  Apply a little Vaseline to your lips first to avoid discolouration.
•  Choose tablets that turn the plaque blue rather than pink; it should make it much easier to see the plaque.
• Getting a hand mirror like the  one shown in the picture will help you check the backs of you teeth

Filed under: Lorraine Richmond, Prevention, Revive - Davyhulme, Revive - Monton by Lorraine
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I want Straight Teeth !

Many patients ask me if they can have straight teeth. Sometimes even after orthodontic treatment as a child their teeth may becomes uneven again in adulthood. The treatment options given to patients are normally restricted to retreatment with long course of fixed braces or sometimes quite a lot of restorative treatment to correct the malalignment. These options may not be suitable for a patient and many patients accept the maligned looks. There is now an effective way of treating uneven teeth within a short period of time with minimum invasion to teeth substance for suitable patients. It can make a dramatic difference to a patient with uneven teeth. By utilizing the modern material this state of the art appliance can possibily change your life, giving you a beautiful and confident smile. If you are concerned about your smile please call for a consultation to get for more information? In addition to the Inman aligner shown below, we can also provide invisible braces for teeth straightening your teeth. Why wait? Your straight smile is waiting for you …

The following video explains how this Inman Aligner orthodontic appliance works.

Senior Dentist Revive Dental Care

Filed under: Cosmetic Dentistry, News, Revive - Monton, Sam Wong by Sam
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 It’s essential to start early in helping your child become acclimatized to the dental environment; you could start even under 1 years old just bring them along to your check up.

•       The most important thing is to create a positive experience and get them used to coming to the dentist; we are trying to get them to trust the dentist.
• Good dental attendees are much more likely to have a healthier mouth, so starting young is important
• You may even wish to bring them to your appointment.
•    One step at a time; if your child is reluctant to sit in the chair it is so important that you do not to force them. See if they will sit on your lap in the chair.

First visit:

•  Use positive reinforcement e.g. use positive language and phases.
• You could try reading them a story about a trip to the dentist a few days before their first appointment (please insure that it is a positive story!).

Examples of talking positively:

•   Avoid negative phrases “like it won’t hurt you”.
•   Make a game of the activity e.g. “Let’s take a ride in the chair” or “Open wide like a lion”.
•  If this fails, you could always try bribing them with a sticker!

 These tips should help them to feel less apprehensive about getting in the chair.

Filed under: Lorraine Richmond, Revive - Davyhulme, Revive - Monton, Uncategorized by Lorraine
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How does fluoride help keep my teeth healthy and when should I have fluoride?

What is fluoride?

Sodium Fluoride is a naturally occurring mineral which can be found in certain foods and water. When used correctly, studies have shown that it can effectively reduce the risk of tooth decay in people of all ages.

What does fluoride do?

• It strengthens the hard outer enamel coating of the teeth making them more resistant to tooth decay.
• It also helps to inhibit the growth of bacteria.

Where can I find fluoride?

Fluoride can be found naturally in certain foods and also water (although the amount varies from area to area). Fluoride can also be found in a great many varieties of tea e.g. green tea in particular.

Non-naturally occurring fluoride may be found in:

• Roughly 10% of the UKs drinking water. Greater Manchester however, is not one of them!
• Most Toothpastes.
• Some Mouthwashes.
• Topical fluoride treatment – carried out by your dentist/ dental therapist/ hygienist or qualified dental nurse.
• Fluoride supplement prescribed by you dentist.

Am I using the right toothpaste?

Most but not all toothpastes contain fluoride MAKE SURE YOURS DOES!

Fluoride toothpaste is an effective way of helping to help reduce the risk if dental decay.

• As soon as the teeth erupt all children under the age of 3 should have fluoride toothpaste, which contains at least 1000ppm (parts per million) fluoride in their toothpaste. Using a smear on the brush.

• Children in the Greater Manchester area must use at least 1000 ppm F because as it is not a fluoridated area.

• Adults and children aged 3 + should be using toothpaste containing 1350 ppm – 1500ppm.

Children under the age of 7 should only have a pea-sized amount of toothpaste on their brush and should be supervised by an adult.  Your dentist may prescribe higher risk patients more concentrated fluoride toothpaste that is not available over the counter.

Recommendations for children aged:

• (8 +) – daily fluoride mouthwash.
• (10 +) – toothpaste containing 2,800 ppm.
• (16 +) – toothpaste containing 5,000 ppm. 

Why should I have extra Fluoride?

It can be beneficial for some adults and all children to have additional fluoride to help prevent decay.  Children from poorer areas or who live in an area containing non-fluoridated water are up to 5 times more likely to develop tooth decay.

Fluoride varnish (applied by your dentist/ dental therapist/hygienist of qualified nurse) to the biting surfaces of your child’s back teeth provides a very effective barrier against the effects of bacteria.

Who needs it?

• 3 – 6 year olds should have varnish applied 2 times per year.
• 3 – 6 year olds with a high risk of decay: 3 – 4 times per year.
• Adults with high risk of decay: 2 times per year.

Fluoride supplements must only be used under the advice of your dentist. 

Are there any side effects?

Dental fluorosis is a condition, which produces the appearance of small white streaks or specks (which may darken over time) in adult teeth.  These spots and stains are permanent and are produced when a child receives too much fluoride (e.g. if a child swallows their toothpaste) during the time when their adult teeth are developing i.e. approximately 1 to 4 years old.

It has also been reported that water fluoridation is harmful. However as to-date there is no scientific evidence to support this claim.

I recommend fluoride treatment to all of my patients as it is one of the easiest and surest ways of helping to reduce the risk of tooth decay; particularly in children who can sometime find the experience of dental treatment very difficult.  From a personal perspective, I had fluoride treatment a child, and, so far I do not had a single filling.

Filed under: Lorraine Richmond, Prevention, Uncategorized by Lorraine
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Who will pay for my dental care?

In this economic climate and in the foreseeable future, the government will be seeking to reduce it’s funding of dental treatment. So in my opinion it is likely that the average person will be having to pay for his/ her dental care. So we, as a nation, will have to take better responsibility for our own health.

How can I make sure that the cost is minimized?

That is a very good question! The answer lies in the prevention of dental disease!

Top Tips for Preventing Dental Disease and Save Money!
1) Reduce sugar in any form to ONLY Meal times. ( Stop feeding the bugs)
2) Good bacteria control by Teeth Brushing with electric toothbrush (Sonicare) at least twice a day.
3) Use fluoride toothpaste, spit and not rinse. Use fluoride mouthwash. (to make teeth stronger)
4) See your dentist for further personalized advice. ( we are all different)
5) Maintain gum health with regular hygiene visits. (get help with cleaning places where you miss or cannot get to)
6) Be aware, be discipline daily and DECIDE to take care of yourself! Make it a priority!

Have the confidence to laugh, smile and have fun with life.

Filed under: Prevention by Sam
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