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1. Sensitive Teeth

   

   Teeth may become sensitive as the gums recede, or as a result of breakage and wear. Heavily filled teeth are prone to fracture, and fillings may break and even fall out, causing sensitivity to cold, hot, or sweet things.

   Treatment for tooth sensitivity in older people may involve managing receding gums, sealing over the fractured tooth surface, or treating the decay or broken tooth or fillings. Regular dental check-ups are important to spot and treat causes of sensitive teeth such as decay, broken teeth or fillings.

2. Oral Ulcers

   

   Oral ulcers are painful areas that appear inside the motuh. They are usually red or yellowish in colour. Ulcers can be caused by trauma due to biting the cheek or tongue, poorly fitting dentures, sharp broken teeth or dental fillings. These areas heal spontaneously or when the cause of the ulcer is removed. 

   If an ulcer does not heal within two weeks it is important to consult with a dentist. 

   Common causes

   • Sharp broken teeth
   • Sharp broken fillings
   • Broken or poorly fitting dentures

   Other but less common causes of oral ulcers include viral infections, cancer, side effects of some drugs and other general diseases. 

   Use of topical analgesics like gels can help manage oral ulcers. Treating the cause such as replacement of old broken fillings or adjustment of poorly fititng dentures will help heal the affected areas.  

3. Oral Cancer

   

   Oral cancer includes cancer of lip, tongue, cheeks and other sites in the mouth. Ulcers lasting for longer than two weeks must be screened for oral cancer. Usually oral cancer is identified by sores or lumps in the mouth that do not heal.

   Common causes

   • Tobacco use
   • High levels of alcohol consumption
   • Infectio with viruses such a HPV

   Warning signs 

   • An ulcer or sore spot in the mouth that does not heal within two weeks
   • A white or red patch in the mouth
   • Difficulty eating or swallowing
   • Swelling of the jaws
   • A lump in the throat
   • Difficulty wearing dentures

   How to prevent/manage

   • Quit smoking
   • Reduce the intake of alcohol
   • Eat a helthy balanced nutritious diet
   • Regular oral examination by a dentist

4. Fungal and Bacterial Infections

   

   Oral Thrush / Candidiasis

   This is a fungal infection of the mouth. This is seen as pacthes of white film that cannot be wiped away or small red dots that can be painful. It can also be a sign of Vitamin B12, folate or iron deficiency. 

   Common causes

   • A weak immune system which can be associated with the frail older people
   • Leaving dentures in the mouth for a long time without adequate cleaning
   • Dry mouth
   • Taking antibiotics for a long time

   Eating a well balanced nutritious diet, especially important in the frail older people. Use of antifungal medications can help manage this. For denture wearers, it is important to allow the gum tissue to rest from wearing dentures. 

   Angular Cheilitis

   This is a bacterial or fungal infection that usually appears as red inflamed sores and cracks at the corners of the mouth.

   Common causes

   • Poorly fitting dentures
   • Dentures not being cleaned properly
   • Underlying immune or nutritional deficiency

   Use of anti-fungal or anti-bacterial medications can help. A check-up by a dentist to treat ill fititng dentures and allowing gum tissue to rest from wearing dentures will help prevent this. It is good to clean and soak dentures overight in a glass of water with a cleaner such as Steradent or Polident.   

   Denture Stomatitis

   This is also a fungal or bacterial infection caused by leaving dentures in the mouth for too long. This is seen as generalised redness usually in the area covered by a denture. 

   Common causes

   • Leaving dentures in the mouth for a along time without adequate cleaning

   Use of anti-fungal or anti-bacterial medications can help. Allowing the gum tissue to rest from wearing dentures is important to prevent this. It is good to clean and soak dentures overnight in a glass of water with a cleaner such as Steradent or Polodent.

5. Pregnancy

   

   Pregnancy is a time when women have special health needs. Your teeth and gums may be affected by your pregnancy, just as other tissues in your body are. If your gums are in good health before you get pregnant and you clean your teeth well, you are less likely to have problems.

   Gum Disease

   Oral tissues may show an exaggerated response to bacterial plaque during pregnancy due to increased levels of oestrogen and progesterone. These hormones may affect your immune response to bacteria and favour bacterial growth. Therefore you may experience more gum problems at this time. Inflammation of the gum or gingivitis may be more noticeable between the second and eighth month of pregnancy and tends to subside after delivery. This is called pregnancy gingivitis. Symptoms may include redness, bleeding and swelling of your gums.

   If you have healthy gum tissue before pregnancy, pregnancy gingivitis may be prevented with good oral hygiene. In pregnant women with poor oral hygiene, pregnancy gingivitis may progress into periodontitis, a more severe form of gum disease. 

   It is important to minimise the effects of pregnancy gingivitis with professional cleaning and a good home care routine. Regular dental check-ups and professional cleaning visits during pregnancy will help prevent gum problems.

   Pregnancy Granuloma

   Occasionally, a gum growth may occur during pregnancy called a pregnancy granuloma. Pregnancy granulomas are more common after the third month of pregnancy and are non-cancerous.  A pregnancy granuloma is caused by the inflammatory response of your gums to local irritants such as bacterial plaque or calculus/tartar.

   The growth usually presents as a red nodule on the gums between the teeth, which may bleed easily and occasionally become ulcerated. The lump is usually painless, however, it may become painful if it interferes with your bite or it accumulates debris. If a pregnancy granuloma forms, professional removal of plaque and calculus is required, supported by good oral hygiene. Pregnancy granulomas normally regress after delivery, however if they require removal, this can be performed by a dentist or a specialist periodontist. This procedure is usually carried out after delivery as it may recur, if removed during pregnancy. 

   if you experience gum problems during your pregnancy, it is important to visit your dentist. Any treatment you might need can be provided before or after delivery as required. 

   Dental Erosion

   Morning sickness may lead to vomiting during some stages of pregnancy. Frequent vomiting during pregnancy can have an erosive effect on your teeth surface. The tooth enamel may dissolve or become softened by gastric acids. It is important to not brush teeth immediately after vomiting. It is good to wait for about 30 minutes before brushing teeth. Instead rinse immediately with water.

   Pregnant women should avoid drinking soft drinks or juices to help ease nausea as acidic drinks are highly erosive. The so-called 'diet' drinks are also acidic, and if taken frequently can lead to erosion.

   Dental Visits

   A dental examination before you plan to become pregnant will allow identification and treatment of teeth and gum problems beforehand. Otherwise a check-up during pregnancy is advisable to help you maintain good oral health, particularly if you have any symptoms of gum disease. 

   If treatment is required during pregnancy, this may be best performed during the second trimester. Emergency treatment can be undertaken at any time with proper safety measures.  

6. Dental Trauma

   

   Knocked out Teeth

   When accidents happen, teeth can sometimes be completely knocked out. Many teeth can be replaced after being knocked out and some will survive very well after this.

   The longer the tooth is out of the socket the poorer the chance it has surviving long term.

   • Replace the tooth into its socket as soon as possible. This can be done by another person or the injured person themselves.
   • Hold the tooth by the crown, ensure that there is no dirt or debris on the root and wash briefly under water.
   • Gently push the tooth back into its socket.
   • Hold the tooth in place by biting gently on a piece of cloth and see your dentist immediately.

   It is important to keep the outside of the root healthy.

   • If the tooth cannot be replaced into its socket, store it in milk to keep the cells on the outside of the tooth as healthy as possible until the tooth can be replanted.
   • If milk is not readily available store the tooth either in saliva in a cup, or under the lip of the injured person (be careful not to swallow it).
   • Scrubbing the root or wrapping it in a dry tissue will damage the root surface.

   See your dentist as soon as you can. 

   • Knocked-out teeth nearly always need to be splinted to hold them into the correct position until the tooth connects to the socket.  
   • Some complications may occur after the tooth has been knocked out and replanted. Your dentist will check for these.

   Please remember this advice is for managing knocked-out permanent teeth. If a baby tooth is knocked out, do not try to put it back in its socket, as this may damage the adult tooth that is developing under it. Always seek advice and treatment from a dentist.

   Broken Teeth 

   Broken or chipped teeth are the most common dental injury. Sometimes these teeth can be very sensitive due to the inner layers of the teeth (dental pulp or dentine) becoming exposed. Other times the teeth don't cause any discomfort, they don't look great.

   • It is important to protect these teeth to prevent infection developing inside the tooth, which can lead to an abscess.
   • See your dentist for a protective covering over the tooth or a filling to replace the broken piece.
   • Sometimes the broken fragment can be replaced, so if this is available then bring it with you and your dentist will decide if it can be used. Your dentist will do their best to get your broken tooth to look normal again.

   Displaced Teeth 

   Sometimes, a tooth can get displaced from its position within your mouth due to dental trauma. This may be very obvious if the tooth is pushed backwards or hanging out. Other times it may be less obvious.

   • After an accident if you are having trouble closing your teeth together in a normal position, it is possible that a tooth may have moved.
   • It is important that these teeth are put back in their normal position as soon as possible.
   • This gives the tooth the best chance of surviving and reduces complications and further treatment later.
   • See your dentist immediately if teeth have been displaced.

   Sometimes injuries to the mouth can result in damage to the lips (cuts and bruises) or gums and structures surrounding the teeth.

   It is important to get these checked properly for any underlying damage, such as broken bones around the teeth or the jaws, and any debris or tooth fragment that may be in a cut lip.

   You can contact your dentist, doctor or the local hospital for this. 

7. Care After Oral Surgery

   

   You can speed up your mouth's recovery after oral surgery by following these steps:

   On the day of surgery

   • Avoid: hot drinks, hot or hard food, alcohol, vigorous physical effort, playing with the wound, and rinsing your mouth.
   • Drink plenty of cold or warm fluid, and eat soft food.
   • Avoid smoking as this delays healing.
   • Use the prescribed tablets for pain relief. It is recommended that you start this before the local anaesthesia wears off.
   • Slight oozing of blood is normal. If significant bleeding occurs, place a gauze or cotton pad over the bleeding site and apply pressure by biting down firmly for 15-30 minutes. This may need to be repeated.
   • If bleeding is excessive and uncontrolled by pressure, contact your dentist.
   • To minimise swelling, an ice pack (small bag of frozen peas wrapped in a cloth) may be held on the side of the face. Apply 10-15 minutes every hour on the day of surgery.

   On the day after surgery

   • It is essential to keep all wounds clean
   • Brush ypour teeth, including those around the wound. Food remnants and plaque delay healing.
   • Rinse your mouth gently 6-8 times a day with very warm, salty water (one quarter teaspoon of salt in a glass of water). Very vigorous rinsing in the first 24 hours should be avoided as this will disturb the blood clot.
   • Chlorhexidine mouthwash will help reduce the risk of infection.

   It is normal to have some bleeding, swelling, discomfort and tightness of jaw muscles. However, if symptoms become severe, contact your dentist immediately.

8. Gum Disease

   

   Gum disease, or periodontal disease, is an inflammatory disease caused by accumulation of bacteria (dental plaque) on the teeth. Dental plaque is a soft, sticky and initially invisible film of bacteria that forms on teeth. If not removed by brushing and flossing, the bacteria in dental plaque can cause tooth decay and gum disease. Gum disease is a major cause of tooth loss in adults.

   Gingivitis

   Gingivitis is a mild form of gum disease, and is most common in adults. Most often it is unnoticed as it is not painful. Your gums may become red, swollen and bleed while cleaning.  Gingivitis can be treated and reversed by professional cleaning and effective home care. If left untreated gingivitis can develop into periodontitis. 

   Periodontitis

   Periodontitis is the destructive form of gum disease and it is not reversible. However it can be treated and stabilised. As the bone and soft tissues supporting the teeth are lost due to this disease, a gum pocket forms around the tooth. This pocket becomes infected, which destroys more supporting bone and soft tissue. Eventually, the tooth becomes loose and falls out or it may need to be removed.

   You can prevent gum disease by brushing twice daily, flossing once a day and visiting your dentist regularly.

   Warning Signs

   • Red, swollen or tender gums
   • Bleeding while brushing or flossing
   • Gums that pull away from the teeth
   • Loose or separating teeth
   • Pus between the gum and the tooth
   • Persistent bad breath
   • A change in the way your teeth fit together when you bite
   • A change in the fit of partial dentures

   Sometimes gum disease can progress without any symptoms or pain. During a regular dental examination, the dentist checks for signs of gum disease, so undetected disease can be treated before it can advance.

   Gum Disease Diagnosis and Prevention

   Proper brushing twice a day and flossing daily will help prevent gum disease.During a regular dental examination, the dentist or hygienist will inspect the gums and probe between the tooth and gum to check for periodontal disease.

   A professional cleaning every three to six months by a dentist or dental hygienist will remove plaque and calculus from hard-to-reach areas that might otherwise be susceptible to periodontal disease. If signs of disease have progressed to a certain point, the dentist may suggest the patient see a periodontist - a dentist who specialises in the treatment of periodontal disease.

9. Tooth Decay

   

   The bacteria sticking to your teeth in plaque break down sugars and other carbohydrates that we eat, and produce acids. These acids dissolve the enamel and dentine that make up the tooth structure, and create a hole in the tooth. This process is called dental caries or tooth decay. 

   Once a hole has developed in the tooth surface you will need to have the decay removed from the tooth and a filling placed to seal the surface and build up the shape of the tooth again. Tooth decay may occur in the enamel cap, around and under fillings and in the softer root dentine exposed as gums recede. 

   Common causes

   • Frequent intake of sugary drinks, including fruit juices and fizzy drinks
   • Snacking on foods high in sugar
   • Poor or lack of tooth brushing with fluoride toothpaste
   • Lack of cleaning between teeth
   • Dry mouth

   Warning sings

   • Tooth covered in food and debris
   • Holes in teeth
   • Broken teeth
   • Brown or discoloured teeth
   • Tooth sensitivity to hot or cold foods
   • Difficulty eating or chewing
   • Toothache
   • Bad breath
   • Swelling the the face and jaw area

   How to prevent

   • Brushing twice daily with fluoride toothpaste
   • Once daily flossing or interdental cleaning
   • Reduction of sugary foods and drinks, especially in between meals - and replacing with healthy alternatives such as water than a fizzy drink
   • Regular professional check-ups to spot and treat tooth decay, to stop further damage to your teeth

10. Tooth Whitening

    

    Tooth whitening is a process that lightens stains in the tooth enamel (outer layer) and dentine (inner layer) of your teeth, to give your tooth a whiter colour. With improvements in dental health, people are increasingly seeking tooth-whitening treatments to improve their appearance.

    The benefits of tooth whitening is the confidence of a bright white smile!

    Are all teeth suitable for whitening?

    There are many causes of tooth discoloration, and any given tooth can exhibit one or more sorts of discoloration, from differing causes. It is therefore important that the cause of tooth discolorations should be identified by a dentist before tooth-whitening treatment is undertaken, as the success of the treatment is very dependent on a correct diagnosis, which will normally require taking a thorough history including radiographs (x-rays), a dietary and a social history.

    In some cases tooth whitening maybe difficult or ineffective, for example tooth with staining caused during tooth formation by certain antibiotics. 

    Tooth whitening mechanism:

    The active ingredient in tooth whitening products is typically hydrogen peroxide.  Hydrogen peroxide is a strong oxidising agent which is thought to react with the dark-coloured molecules located within tooth enamel and dentine making them smaller and less-coloured and rendering the tooth ‘whiter’.  It should be noted that not all coloured molecules are susceptible to the action of hydrogen peroxide and so the correct diagnosis is important.  The hydrogen peroxide is present in different forms and concentrations depending on the tooth whitening product so it is essential that the instructions given by your dentist are followed.

    Tooth whitening methods:

    Tooth whitening can be done at home or in the dental office. Depending on the type of discolouration your dentist may advice which method or technique is best for you.

    At Home

    Your dentist will make an impression for a model of your teeth. Then a thin, custom fitted, clear, plastic tray that fits over your teeth is made for you. At home you are then required to place the whitening gel into the tray, and place the tray over your teeth for up to two hours daily or at night. Though you can see the results after the first day, maximum whitening may take 10-14 days. Your dentist will check on your progress.

    In-surgery

    Here, the whitening gel is applied to the tooth by your dentist and a special light is used for up to 20-30 minutes to activate the gel. This process may be repeated few times to get maximum whitening. 

    Safety

    Sometimes people will experience increased tooth and gum sensitivity during treatment period. This usually goes away shortly after stopping the treatment.

    Before having your teeth whitened, it is important to get your teeth checked by your dentist as the whitening agent can penetrate through cracks or cavities in your teeth  and can cause damage to the tooth pulp, as well as irritating the gums and lining of the mouth and weakening filling materials. Tooth whitening may also make your old fillings or crown look darker after treatment, so it is very important to be checked and advised of this before you proceed.