Tooth decay (or caries) is one of the most common reasons patients visit the dentist.

Eating even small amounts of sugar from chocolate, sweets, cake, honey, sugar in tea and coffee causes bacteria naturally residing in the mouth to proliferate and produce acid. The acid eats away the surface of the tooth and causes decay.

What can the Dentist do?

The dentist is able to carry out a full examination and use digital radiographic imaging to spot decay, even in its early stages.

Early Decay

Symptoms: Often nothing noticed by patient.

If caught early enough the dentist can apply a simple application of Duraphat varnish to the damaged areas. Combining this with advice on brushing techniques and diet is usually enough to reverse the decay and avoid the need for a filling in the future.

Decay Requiring Filling

Symptoms: None, pain to hot and cold or sweet things, hole in the tooth.

As decay progresses, patients may still have no symptoms. In most cases however, patients start to notice sensitivity to hot and cold or when eating sweet foods/drink, lasting for short periods. At this stage, known as 'acute pulpitis', the pattern of decay is often irreversible and usually requires a filling to restore the tooth back to health (see filling, inlays, crowns in treatment section). It is also at this stage a hole in the tooth may or may not be present.

Advanced Decay

If the decay progresses further, patients generally start to experience more frequent pain and eventually pain on biting. At this stage, known as 'chronic pulpitis', the inside if the tooth is dead and infection starts to build up towards the root of the tooth. When a patient bites down, they push the infection into the live bone underneath which causes the symptom 'pain or biting'. An associated abscess can sometimes be seen as a small spot on the gum, or in more advanced cases occur as a swelling around the area.

To resolve the problem, a root canal filling with a restoration is required or if the patient prefers, a simple extraction of the tooth will also remove the problem.

Plaque and tartar occur to some degree on nearly everyone's teeth. At very low levels this is not usually a problem, however anything more than this can result in gum or periodontal problems.

The majority of patients are not aware they are suffering any gum disease. In the early stages, the presence of plaque contributes to gingivitis, bleeding gums and staining. As this disease slowly progresses, the gums attachment to the teeth reduces and progresses to 'periodontitis', which can result in loose teeth, bone loss and bad breath.

Poor brushing technique, lack of correct flossing and lack of regular professional cleaning are the most common causes. Risk factors that also contribute to the disease include smoking, poorly contoured fillings or crowns, crowded teeth, a family history of gum disease, pregnancy and diabetes.

What can the dentist do?

Diagnosis by a dentist of this silent disease is very important because if caught early, it can usually be very simple to correct. In most cases deep scaling, oral hygiene instruction, and correction of any defective restorations by a good dentist or hygienist is sufficient to restore health and eradicate gingivitis.

If the disease has progressed further, known as periodontitis, most cases can be treated with a combination of root planning (deep root cleaning) from the hygienist and a course of antibiotic therapy from the dentist.

When wisdom teeth are partially erupted they usually have a flap of gum partly covering the biting surface of the tooth. This flap is known as an operculum and commonly causes plaque to be trapped underneath. As a result, patients often suffer pain around the wisdom tooth, redness of the surrounding gum and occasionally painful inflammation of the surrounding area. In more severe cases, the pain can radiate to the jaw muscles and cause limited mouth opening.

Wisdom tooth problems are very common in the lower jaw and often occur in patients aged between 18 and 35. The process is known as acute pericoronitis, which means 'inflammation around the crown'.

What can the dentist do?

In most cases, the dentist can relieve patients of the pain and inflammation by flushing the plaque out from the trapped areas and provide an appropriate course of antibiotics.

If the problem reoccurs regularly, the flap can be removed or more commonly, the wisdom tooth can be extracted.

In some cases, if the tooth is severely impacted (pointing at a severe angle), it may require a surgical extraction procedure. This also can be carried out in the practice and usually takes 30 minutes under local anaesthetic, allowing the patients to go home immediately afterwards. If the patient prefers, for more complex extractions, the dentist can provide a referral service for such treatment to be carried out in a hospital setting.

Other problems wisdom teeth can cause include cheek biting, decay due to impaction and also periodontal disease. It is therefore important to see a dentist regularly to monitor the wisdom teeth in order to ensure the most appropriate care is taken.

Often, patients who are keen to have clean teeth can cause damage by brushing their teeth and gums too hard or more than twice a day.

Prolonged damage caused by brushing initially results in receding gums combined with tooth loss in the gum area (known as abrasion). In early stages, the patients are not aware of causing any damage and often have no symptoms. As the damage progresses and enamel is brushed away, the teeth can become sensitive, the roots become exposed and the teeth appear longer.

What can the dentist do?

Early signs of abrasion, tooth wear or over brushing can be diagnosed by a dentist. In the initial stages, no treatment is required other than a simple change of brushing techniques to prevent further damage. In more advanced cases, the dentist can restore the tooth back to its original shape, which will reduce sensitivity and protect the underlying soft dentine from further wear.

In cases where the damaged gum has receded severely, this can be repositioned with the use of periodontal surgery.

Tooth grinding (or bruxism), commonly occurs with up to 30% of the population. It is a parafunctional habit that typically occurs when a patient is sleeping. They are often not aware of grinding themselves however in some cases, is noticed by their partners hearing a glass on glass noise during the night.

Depending on the teeth involved, in early stages, the grinding and clenching causes chipping of the front teeth and flattening of the cusps on the back teeth. The canines, which should be pointed, often develop a flat spot at the tip. Fillings, restorations and parts of teeth commonly fracture with heavy grinding.

As tooth wear progresses, enamel is lost from the teeth, leaving the soft dentine underneath to become exposed. This leads to sensitivity. As the damage continues, periodontal disease can result as the supporting structures to the teeth become overloaded. Such relentless pressure can also bring about pulpitis and eventually death of the tooth.

As the teeth become shorter in length, the bite or 'occlusion' of the jaw changes. This has an effect on the jaw joint, which results in jaw pain, clicking and muscle pain. Tightened muscles in the temple region can also lead to headaches.

What can the dentist do?

Further damage can be prevented by having a dentist construct a grinding appliance (see www.bitesoft.net ) and carrying out any minor repairs on damaged teeth if needed.

In severe cases treatments can become very complex, requiring occlusal rehabilitation, crown lengthening, and jaw joint management.

It is important for a dentist to check whether signs of grinding are occurring. If caught early, prevention of future damage with a bruxist appliance is often enough to avoid the need for complex treatments in the future.

Acid erosion is a common cause of tooth damage. Regular contact of acid from fizzy drinks, carbonated water, fruit and fruit juices dissolves the hard tooth structures enamel and dentine. This can result in sensitivity, yellowing of the front teeth and cupping of the back teeth.

When it occurs on the front teeth, the acid dissolves the enamel evenly except where the gum meets the tooth. As the white enamel is lost, the yellow dentine becomes more apparent causing the teeth to have a yellow appearance. Towards the back of the mouth, acid sitting on the biting surfaces of molars dissolves away the enamel, exposing the soft dentine underneath. This can often lead to a cupping appearance of the teeth.

What can the dentist do?

In early stages of acid erosion a simple change of diet and the use of fluoride mouth wash will help. The application of fluoride paste (commonly Duraphat) and fissure sealants can be carried out by the dentist to reduce further damage.

If tooth loss is greater, the dentist can restore teeth back to normal health using the whole range of direct and indirect filling materials. It is very common for patients to be unaware of the cause of sensitivity or tooth loss being caused by acid erosion. Early diagnosis by a dentist to help patients adjust their diet accordingly is very useful to prevent the need for any dental intervention.