Whitening, what’s the difference?

Shade match

We love a bright smile and there are so many different ‘whitening’ solutions out there at the moment that it can all get a little confusing.

First let’s cover the two different types of staining:

Extrinsic staining is caused by outside sources for stain being adhered to the tooth and changing the surface colour and texture, common causes for this type of stain may include tea, coffee, red wine or high pigment foods. Extrinsic staining may be removed with a scale and prophylaxis treatment by your dental practitioner.

Intrinsic staining has an internal origin and changes the underlying colour or dentine of the tooth. This can not only be removed with a simple scale and prophylaxis treatment and requires a whitening agent to change the underlying colour of the tooth.

What’s out there?

  • Whitening system prescribed by a dentist
  • In chair whitening not prescribed by a dentist
  • Toothpastes
  • Charcoal
  • Whitening strips
  • Gel trays (such as HiSmile)

There are many tooth whitening systems on the market however not all of them are able to achieve the same results. It is always a good idea to check a product has a whitening agent and is not only going to act upon the extrinsic staining on a tooth surface.

Why do we recommend a dentist prescribed tooth whitening solution?

Tooth whitening can be very variable and it is important for patients to know what results they can expect before committing to a procedure that could permanently alter the appearance and sensitivity of their teeth. In general we recommend having a check-up before whitening (or recently) to discuss:

  • What to expect for each person’s case.
    • Not everyone will get the same result. Due to the many factors that contribute to the effectiveness of tooth whitening it is important to remember that not everyone’s experience would be the same.
  • Are fillings or restorations present?
    • The presence of crowns, veneers, bridges or restorations (fillings) in the front (anterior) teeth is an important consideration in the tooth whitening process as the colour of these restorations will be unchanged by tooth whitening.
  • Is there any recession?
    • When the roots of teeth become exposed due to recession the structure of the tooth is behaves differently to the tooth covered in enamel. The process of tooth whitening is designed for teeth covered by enamel and therefore may have only a minimal effect on areas of recession creating a higher shade contrast between the crown of the tooth and these area where recession is present.
  • How much sensitivity can you expect?
    • Cases where patients already experience a higher degree of sensitivity may be treated in a different way, such as use of desensitising toothpaste before treatment, lower doses or different types of the whitening agent; treatment being more spread out. In some cases, people with high levels of pre-existing sensitivity maybe be advised against whitening.
  • Discolouration due to the formation of the tooth such as fluorosal spots, intrinsic staining or hypomineralisation.
    • Whitening in cases such as these can have highly variable results, with some teeth appearing mottled, due to the difference in the formation of the enamel.
  • Discolouration due to knocks, root treated or non-vital teeth.
    • These teeth are resistant to whitening as it is not the enamel that is discoloured but the layers beneath appearing darker.
  • Is there a need for a clean before commencing whitening?
    • Teeth with moderate to high levels of extrinsic staining or calculus can produce variable results due to the solution acting on the stain and calculus.
  • The effects of whitening treatments on pregnancy has not been observed and is therefore not advised.

What options do we offer?

Due to sensitivity and reliability of results we offer a personal (with an individually fitted tray) whitening system with the highest amount of active ingredient that can be prescribed in a take home kit. For patient preference we offer either hydrogen peroxide (for shorter day wear) or carbamide peroxide (for night wear).

The impressions needed are quick and painless and we can have your kit made for you within a few days. Full instructions are given and how ‘white’ you go is completely controlled by you. To make a booking, call the practice on (02) 4324 1181.

Quitting smoking? What help is available to me?

Quitting smoking? What help is available to me?

Dentist office illustration.

The decision to quit smoking is life changing and not without its’ trials and temptations but a successful attempt is very rewarding mentally, physically and financially.
How do you know if you are ready to quit smoking?
• You have made the decision to quit
• You have sought out support and any information you may need
• You have started or made a plan
• You have decided on a date
You are not alone. Quitting smoking can seem overwhelming and may take several attempts but there is help available.

Quit kits are available by contacting 13 7848 (13 QUIT) or visiting iCanQuit.com.au.
These kits help you to create a quit plan, give you access to professional support 7 days a week and advice. Professional advice can increase you chance of quitting significantly as compared with those that seek no advice. NSW quitline reports that “Multiple calls with the NSW Quitline: 25-50% increase (quitting)” (iCanQuit, 2019).
Nicotine Replacement Therapy (NRT)
NRT releases smaller and slowly absorbed levels of nicotine into the body as compared with smoking. The purpose of NRT is to minimise the severity of withdrawal symptoms and to reduce the intensity of cravings.
NRT products available include:
• Nicotine patches
• Nicotine gum
• Nicotine lozenges
• Nicotine mouth spray
• Nicotine inhaler
• Combination therapy
• Cut down to quit

Consulting your doctor
Attempts at quitting can be made more successful when using prescription medication. Professional medical intervention can make you up to four times more likely to succeed in quitting. Remembering that “Smoking is not just a ‘bad habit’. It’s an addiction – a chronic condition” (Pfizer Australia Pty Limited, 2018). Seeing a doctor can help to manage the physical repercussions of quitting.
A range of applications and support programs are also available to help keep you motivated.
If you are unsuccessful in quitting permanently take the time you managed to quit as a win. Remember that you just have to choose another date and try again.

Choosing the right toothbrush

There are many different options of toothbrushes currently on the market. The most important things to look at before purchasing is: toothbrush head size and bristle softness.
Always look for a toothbrush with a smaller head – this will enable you to get to the back teeth and the hard to reach places a bit easier. Soft or ultra-soft bristles are also advisable, anything harder than this could potentially cause damage to the enamel tooth structure particularly if used with the incorrect technique.
A powered/electric toothbrush is a good alternative to a manual toothbrush. It can do a better job of cleaning the teeth, especially for those who have difficulty brushing or who have limited manual dexterity.

Charcoal, friend or foe?

A recent trend in oral health has been that of using charcoal to accompany or even replace toothpastes however there are some risks associated with it’s use.
Charcoal is very abrasive and as a result can affect the surface of the teeth by beginning to wear away the shiny and protective outer layer (enamel) of the tooth. This damage can lead to abrasion wear facets, a matte/scuffed looking enamel and sensitivity. As well as wearing away the enamel of the tooth abrasion can also wear away the gums and cause recession, making the tooth appear longer and possibly exposing the neck of the tooth which is generally darker in colour than the enamel and more open to sensitivity.
In some cases charcoal may have a negative effect in the mouth including discolouration of non-natural material such as filling material. Some people, especially those that experience minor abrasions and ulcers may find that their soft tissue is also affected by charcoal as it may cause some irritation to these areas.
Studies are being currently being conducted and early results are showing that on a microscopic level the abrasives in charcoal products are doing significantly more damage to the surface enamel of the teeth than a standard toothpaste. There have been no proven studies to show whether clinically the charcoal in these products are effective in tooth whitening, oral hygiene and prevention.

Why are ‘baby’ teeth so important?

It can be difficult to get kids on board with brushing and taking care of their teeth and while they do lose their deciduous (baby) teeth the early habits and oral conditions can have an effect on the permanent adult teeth that follow them.
Teeth aid in a child’s ability to smile, speak, chew and gives structure to the face all of these things can affect a child’s social interactions and self-esteem. They are space maintainers for the permanent teeth so that they may hopefully be guided into the correct position in the mouth and promote correct oral health behaviours that will be used for a lifetime.
To aid the baby teeth it is important to look at several factors including:
Diet – while diet has an effect on oral hygiene it can also change when a child is severely affected by caries as children may be continuing to eat foods that have a negative impact on oral health or may turn to softer easier to chew foods. Be sure to monitor a child’s sugar intake as sugar is metabolised by the bacteria that is able to create decay.
Systemic disease – certain diseases such as diabetes can have an effect on oral health both at a young age and later in life. Building good habits at a young age will aid in allowing children to keep their teeth healthy and hopefully prevent need for major dental work.
Brushing and flossing – it is important to brush twice per day (morning and night), when plaque builds up on the teeth for prolonged periods of time it can begin to affect the enamel surface of the tooth. This change will first it will appear as a new white spot on the tooth (at this stage if it is kept clean it may not result in a cavity) and after this may further progress into a cavity. It is important to brush your child’s teeth from the appearance of the first baby tooth up until an age where they have the dexterity to brush alone. Assisted/shared brushing is advised even to the age of 8-9 often with the adult doing the nightly brush and the child being allowed to handle the morning one. After ceasing to brush it is still important to monitor the child/adolescence’s teeth so that a high standard of oral health can be achieved.
Behaviour – there are several behaviours that can affect the placement of the teeth and the promotion of jaw growth including sucking on a dummy or thumb, a tongue thrust, clenching and grinding and open mouth breathing. Each of these actions may have an effect on baby teeth but may also have long term consequences and effects on adult teeth that may require intervention at a later point.
Taking children for regular dental check-ups (especially when nothing is wrong) is an important step in building trust, pointing out any areas of concern early and creating a good hygiene habit for later life. Early dental visits can make intervention much easier on the child, parent and practitioner as they have previous good experiences to reflect back upon.

Why does my dentist ask for my medical history every visit?

Image: Bigstock.com

When first attending a new dental surgery, patients will be asked a series of questions regarding their health including things such as allergies, previous dental history, previous and current medical history including conditions and medications, smoking status and even dietary information.
All allergies are important to disclose as there may be products that are used in a patient’s mouth that contain surprising ingredients or agents that a patient may react to; this includes food, medication, preservatives, dyes, metals, minerals and compounds.
While some questions may seem trivial they play an important role in the dental experience. There are some conditions and surgeries for which a patient may be required to take antibiotic covers before any treatment these may include some heart conditions, joint replacements and prosthetics or as advised by a GP or specialist.
Oral disease can be affected by the state of one’s oral health and vice versa, poor oral hygiene has been linked as a contributing factor for conditions such as heart disease and Alzheimer’s and therefore may require some thorough attention. Alternatively, conditions and lifestyle choices such as diabetes, systemic disorders, radiation therapy, diet, alcohol intake and smoking status can affect the teeth, gums and tissues of the mouth and may explain some changes that are observed over subsequent appointments.
Medications play a significant role in the treatment of oral disease, there are a high number of medications that cause xerostomia (dry mouth) which can have a significant impact on some patients. Certain medications such as those to treat osteoporosis (such as Prolia) and blood thinners (such as Warfarin) may require treatment such as extractions to be delayed to lower the risk of bone necrosis or excessive bleeding.
All medical information is confidential and kept on record for the purposes of dental treatment.

What are veneers?

Veneers are a thin layer of material that sits on the front surface of the tooth to change it’s appearance. They can be used to improve the appearance of the teeth including colour, shape and position by coating the surface in a thin layer of porcelain or composite.
Porcelain veneers are prepared and fitted over two appointments, they are more robust, have a high lustre and require less maintenance however they may still chip or break with certain habits such as a heavy bite, fingernail biting and grinding.
Composite veneers are more cost effective and can be completed in a single appointment (depending on the number of teeth), they are colour matched to each patient’s needs using several shades of composite material for a great aesthetic result. This material requires some maintenance and polishing and is slightly more prone to chipping than porcelain.
To find out whether veneers are suitable for you feel free to make an appointment with us on (02) 4324 1181.

How do I know if I have gum disease?

The signs and symptoms associated with gum disease will vary from person to person but may include:
– Tender gums
– Red or purple appearance of the gums around the teeth
– Bleeding when brushing or flossing
– Bad breath (halitosis)
– Swollen or spongey looking gums
– Recession
– Suppuration (pus)
The early stage of gum disease is called gingivitis and at this stage considered reversible. The gums may show some of the symptoms including bleeding and inflammation however with a thorough cleaning and a good home oral care regime it may be rectified with no long-term repercussions.
If left unchecked or continued poor oral hygiene gingivitis may progress to periodontitis at this stage not only the visible gums (gingiva) are affected, but also the underlying structures and bone (periodontium) that hold the teeth in place. The destruction of these structures is irreversible and may lead to tooth mobility and even tooth loss.

Gum disease

Gum disease

Gum disease has been linked to medical conditions such as heart attack and diabetes as well as general ill health. Although symptoms such as bleeding or receding gums, bad breath and loose teeth are common, they are often ignored as there is no associated pain. It is important to understand that gum disease leads to loss of bone support which in turn leads to loose teeth and finally tooth loss. It is important to have these issues attended to by our staff so feel free to ask about your gums at your next visit. Plan and act so as to keep your own teeth for life as dentures are not inevitable.

Pregnancy can induce an increase in gum disease and not only affect the mother’s health but also that of her unborn child. A good reason to have your teeth and gums checked whilst pregnant.

Oral piercings

Before you decide to get an oral piercing, always consider the effect it can have on your mouth. Possible risks of oral piercings (particularly tongue piercings) may include:

  • infection
  • chipped or cracked teeth
  • gum damage
  • nerve damage (resulting in loss of sensation in the tongue)
  • interference with speaking and swallowing
  • potential blockage of airways due to excessive swelling
  • excessive drooling
  • excessive bleeding from the accidental piercing of a blood vessel or artery
  • ongoing pain (neuralgia)
  • HIV or hepatitis from the use of non-sterile equipment
  • internal damage which may be caused by accidentally swallowing loose jewellery
What you can do

Before you get your mouth pierced, it is wise to check with your doctor if you are pregnant, have allergies, heart disease, diabetes or a skin disorder.

If you want to get an oral piercing, get it done professionally and seek after care advice from your piercer. In particular, request information and evidence of their sterilising processes. Do not pierce yourself or get a friend to do it.

Immediately after a piercing

  • Minimise swelling by consuming cold, icy drinks and sleeping with your head slightly elevated during the initial healing process.
  • Rinse your mouth with anti-bacterial mouthwash regularly – especially after eating (preferably use non-alcohol based mouth washes).
  • Avoid smoking and do not drink alcohol or eat spicy foods until the piercing site is fully healed.
  • Do not pick, tug or put unclean hands near the piercing.
  • If pain and swelling continues after several days, or if you have severe redness, bleeding, pain or pus around your piercing, visit your doctor or oral health professional immediately.

Once your piercing has healed

  • Try to keep your tongue away from your teeth and gums to minimise damage.
  • Ask your piercer for jewellery alternatives which are less damaging to your teeth and gums (e.g. bioplast rather than stainless steel).
  • Tighten the ball ends of your jewellery with clean hands regularly to minimise the risk of accidental digestion.
  • Maintain good oral health by brushing twice per day (including the tongue area around the piercing).

If you notice any damage to your gums or teeth or experience any pain, visit your oral health professional.

Article originally appeared on https://www.dhsv.org.au/dental-health/teeth-tips-and-facts/piercing