Sedation

What is sedation and why is it used in dentistry? . . .

Sedation involves the use of a variety of drugs that relax the patient during a medical or dental procedure. It can vary in depth from very light sedation where the patient is tranquillised but fully aware of what is going on, right through to almost a general anaesthetic there the patient is unconscious.

In dentistry, CONSCIOUS SEDATION is used whereby the patient may be relaxed enough to drop off, but can easily be roused. Sedation does not control pain, but can alter the patient's perception of it, and can often raise the pain threshold in those patients who find that local anaesthetics don’t always work.

A variety of drugs may be used singly or in combination, delivered either by mouth, nose or by injection. Pain control is carried out by local anaesthesia.

Some dentists use RELATIVE ANALGESIA, commonly known as gas and air, which has the advantage of being suitable for all ages and does not depend on the patient being in good health and wears off very quickly..

Who carries it out? . . .

Some dentist are qualified to carry out basic sedation, but most would employ an anaesthetist or sedationist if the case is complex. This leaves the dentist free to concentrate on the dentistry.

Who can benefit from it? . . .

Sedation helps calm patients who are nervous or anxious about treatment and is useful for lengthy and unpleasant procedures. patients with a history of cardiac problems may also benefit from sedation to reduce stress during long treatment.

Is there anyone it is not suitable for? . . .

Sedation is not suitable for young children, nor people suffering from very ill-health, whose sedation should be carried out in a hospital setting. Conditions such as high blood pressure(hypertension), diabetes, asthma, allergies, etc in isolation are not aggravated by sedation- in fact reducing the stress may be helpful in these cases.

Is it safe? . . .

Sedation is a very safe technique, provided it is carried out by a qualified and experienced person and all the necessary monitoring and resuscitation equipment is on hand.

Some patients experience amnesia for a few hours or sleepiness for a day or so afterwards. However all patients who have been sedated are advised not to drive for the rest of the day or to take any major life decisions, and should be given a number to contact for the first 24 hours afterwards in case of concerns.

For safety reasons full general anaesthesia may not now be carried out in the dental surgery.

Are there any drawbacks? . . .

Sedation may be costly, especially if an anaesthetist is employed in addition to the dentist. The process may also take slightly longer, as a lead-in time and recovery period are added to the time taken for the dental procedure. Most sedation is carried out in private practice, though some units may offer it on the NHS. Dentists are under no obligation to provide sedation for patients, but it is fairly widely available.

Flossing

Why are my teeth so important? . . .

Your teeth vary in shape and size depending on their position within your mouth. These differences allow the teeth to do many different jobs. Teeth help us to chew and digest food. They help us to talk, and to pronounce different sounds clearly. Finally, teeth help to give our face its shape. A healthy smile can be a great asset and because this is so important, it makes sense to give your teeth the best care possible.

How should I clean between my teeth? . . .

One way to clean between your teeth is with dental floss or tape. Flossing removes plaque and food particles from between your teeth and under the gumline, areas a toothbrush can't reach. Your dentist or hygienist can show you proper flossing techniques.

The following suggestions may help:

*Break off about 18 inches of floss, and wind most of it around one of your middle fingers. Wind the remaining floss around the same finger of the other hand. As you use the floss, you will take up the used section with this finger.

*Hold the floss tightly between your thumb and forefingers, with about an inch of floss between them, leaving no slack. Use a gentle 'rocking' motion to guide the floss between your teeth. Do not jerk the floss or snap the floss into the gums.

*When the floss reaches the gumline, curve it into a C-shape against one tooth until you feel resistance.

*Hold the floss against the tooth. Gently scrape the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth

*Don't forget the back of your last tooth.

*When flossing, keep to a regular pattern. Start at the top and work from left to right, then move to the bottom and again work from the left to right. This way you're less likely to miss any teeth.

*It is also very important to clean around the edges of any crowns, bridges or implants. This can be difficult to do effectively using traditional floss and there are now specialist flosses to do the job thoroughly (such as super floss and specialist floss threaders). Ask your dentist or hygienist on how to use these properly and which method you should use.

Should my gums bleed when I floss? . . .

Your gums may bleed or be sore for the first five or six days that you floss. This should stop once the plaque is broken up and the bacteria has gone. If the bleeding does not stop, tell your dentist. It may be that you are not flossing correctly or your teeth and gums need a more thorough clean by your dentist or hygienist.

What do I do if I have difficulty using floss? . . .

If you have trouble using floss you can use a floss holder or an interdental cleaning aid. Interdental cleaning aids include woodsticks or small interdental brushes used to remove plaque from between the teeth. Your dentist or hygienist can explain how to use these properly.

Bad Breath

What causes bad breath? . . .

Bad breath is a very common problem and there are many different causes. Persistent bad breath is usually caused by the smelly gases released by bacteria that coat your teeth and gums. However, strong foods like garlic and onions can add to the problem. Smoking is also one of the main causes of bad breath, along with certain illnesses such as nasal and stomach conditions. Bits of food that get caught between the teeth and on the tongue will rot and can sometimes cause an unpleasant smell. So correct and regular brushing is very important to keep your breath smelling fresh.

The bacteria on our teeth and gums (plaque) also cause gum disease and dental decay. If you see your dentist regularly this will not only help prevent bad breath but will also let the dentist look for and treat these problems.

How can I tell if I have bad breath? . . .

Lots of small signals can show that you have bad breath. Have you noticed people stepping away when you start to talk? Do people turn their cheek when you kiss them goodbye?

If you think you might have bad breath, there is a simple test that you can do. Simply lick the inside of your wrist and sniff – if the smell is bad, you can be pretty sure that your breath is too.

Or, ask a very good friend to be absolutely honest, but do make sure they are a true friend.

How can my dentist help? . . .

If you do have bad breath, you will need to start a routine for keeping your mouth clean and fresh. Regular check-ups will allow your dentist to watch out for any areas where plaque is caught between your teeth. Your dentist or hygienist will be able to clean all those areas that are difficult to reach. They will also be able to show you the best way to clean your teeth and gums, and show you any areas you may be missing, including your tongue.

Can I prevent bad breath? . . .

To keep your breath fresh, you must get rid of any gum disease, and keep your mouth clean and fresh. If you do have bad breath, try keeping a diary of all the foods you eat and list any medicines you are taking. Take this diary to your dentist who may be able to suggest ways to solve the problem.

Brush your teeth and gums twice a day with a fluoride toothpaste. Don't forget to brush your tongue as well. Use dental floss once a day for cleaning between your teeth. There are other products you can buy to clean between your teeth (they are called ‘interdental cleaners').

If you wear dentures, take them out at night to give your mouth chance to rest. Do not clean them with toothpaste as it will scratch the surface and more stains will build up. They will also lose their shine. Hold them over a bowl of water or a towel in case you drop them. Clean them thoroughly with soap and lukewarm water, a denture cream or a denture cleaning tablet. Use a denture brush kept just for the purpose. Remember to clean the surfaces that fit against your gums and palate. This will make sure your dentures are always fresh and clean, and avoid the plaque build-up on the denture that may cause bad breath.

What products are available? . . .

There are several types of toothpastes you can use, from total care toothpastes to those especially for sensitive teeth. Look for the toothpaste that will suit your needs. If you know that you often get food stuck between your teeth, you may need to brush after every meal. So carry a brush and interdental cleaner with you.

Most mouthwashes only disguise bad breath for a short time. So if you find that you are using a mouthwash all the time, talk to your dentist, because they may be able to recommend an antibacterial or chlorhexidine mouthwash for you to use. Some mouthwashes that are recommended for gum disease can cause tooth staining if you use them for a long time. It is important to read the manufacturer's instructions or ask your dentist about how and when to use them.

Look for products carrying the British Dental Health Foundation 'Approved' symbol. These products have been clinically and scientifically tested, and a panel of dental experts have decided whether the packaging claims are correct before giving their accreditation badge.

Sealants

What are sealants? . . .

Sealants are a safe and painless way or protecting your children's teeth from decay. A sealant is a protective plastic coating, which is applied to the biting surfaces of the back teeth. The sealant forms a hard shield that keeps food and bacteria from getting into the tiny grooves in the teeth and causing decay.

Which teeth should be sealed? . . .

Sealants are only applied to the back teeth - the molars and premolars. These are the teeth that have pits and fissures on their biting surfaces. Your dentist will tell you which teeth should be sealed after they have examined them, and checked whether the fissures are deep enough for sealing to help. Some teeth naturally form with deep grooves, which will need to be sealed, others with shallow ones which will not need sealing.

What is involved? . . .

The process is usually quick and straightforward taking only a few minutes per tooth. The tooth is thoroughly cleaned, prepared with a special solution, and dried. The liquid sealant is then applied and allowed to set hard - usually by shining an ultraviolet light onto it.

Will my child feel it? . . .

No, it is totally pain free, and the teeth do not feel any different afterwards.

How long do they last? . . .

Sealants usually last for many years, but your dentist will want to check them regularly to make sure that the seal is still intact. They can wear over time, and sometimes the dentist needs to add or replace some sealant to be sure that no decay can start underneath them.

How do they work? . . .

The sealant forms a smooth, protective barrier, by covering all the little grooves and dips in the surface of the tooth. Dental decay easily starts in these grooves.

When should this be done? . . .

Sealants are often applied as soon as the permanent teeth start to come through. This is usually between 6 and 7 years of age. The rest are usually sealed as soon as they appear which can be any time between 11 and 14 years of age.

How much does it cost? . . .

Most dentists offer fissure sealing. It may be available on the NHS and is not expensive. But in many cases it is available only privately. The cost varies from dentist to dentist, but it is usually good value.

Do my children still have to clean their teeth? . . .

Yes. It is still vital that they do this. The smooth, sealed surface is now much easier to keep cleanand healthy with normal toothbrushing. Using a fluoride toothpaste will also help to protect your children's teeth. Pit and fissure sealing reduces tooth decay and the number of fillings your child might need.

Whom do I ask about the treatment? . . .

If you would like to know more about the treatment, ask your dentist or hygienist. They will tell you if fissure sealing will help your children's teeth, and if it is the right time to do it.

Interdental Brush

What is an interdental brush? . . .

It is a small brush that can be held between your thumb and your fingers. Interdental brushes are available in various sizes which enables you to choose which size is most suitable for you. You may need to use more than one size to enable you to effectively clean all spaces between your teeth.

Why clean between teeth? . . .

Over the course of a day, food and debris get lodged in between your teeth, and in any gaps you may have. If left, this debris can cause dental decay and gum disease. Removing food debris with an interdental brush will help keep your breath fresh. Cleaning in between your teeth makes sure that you are cleaning your mouth as thoroughly as possible.

Should I use an interdental brush instead of my normal toothbrush? . . .

No. These small brushes should be used as part of your normal oral hygiene routine to be effective.

Why is my normal toothbrush not enough? . . .

You will know that there are certain places in your mouth that are difficult to reach with your normal brush. There are also some gaps between your teeth that your toothbrush will not be able to access.

How can the interdental brush help? . . .

With its small bristles and tiny bottle type head the brush can be moved between the teeth to remove debris and plaque that will not have been removed by your usual toothbrush.

How do I use it? . . .

Select a suitable sized interdental brush. Never force the brush between the teeth. Between front teeth, use a finer brush, a twisting movement eases the brush comfortably between the teeth. Remove the brush by gently pulling thereby removing plaque and debris. Repeat the twisting motion to re-insert and pull out several times until you are satisfied the space is clean. For larger spaces nearer the back of the mouth, a larger headed brush should be selected. To be as effective as possible, shape the head into a "banana" curve. You will then be able to easily locate and clean the space effectively. Rinsing the brush enables you to use the brush again.

When should I use it? . . .

You don't need to be in the bathroom to be able to clean interdentally. You don't even need to do it at the same as you brush your teeth. You could be anywhere.