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Chapter 30- Just for kids.

This chapter is for all children who can read it for themselves or can read it with help. Anyone who is at secondary school and has science lessons will be able to understand some of the other chapters. I suggest you look at chapters;- 1,2,3,4,5,6 and 8.

YOUR TEETH

It is very important to look after your teeth and gums.

We need our teeth to talk and eat properly and to look nice when we smile.

Our gums hold our teeth in place, so they are important too.

The dentist, the nurse and all the other people at the dental practice are there to teach you how to look after your teeth and gums.

A bit further down this page you will find all the things you need to know to make sure you look after your teeth properly. Keep reading it until you know everything on it [get someone to help you if you need to].

The dentist may test you on all the things it says when you visit.

STICKERS

When you visit the dentist if you do all the right things you may be given a sticker afterwards. This is a reward for children who are;

  • good
  • polite and friendly to everyone
  • who come into the surgery nicely
  • climb on the chair
  • open their mouths when the dentist asks
  • keep nice and still when the dentist is counting and polishing their teeth
  • listen carefully to anything the dentist tells them
  • know all the things below in HOW TO LOOK AFTER YOUR TEETH
  • say thank you to the dentist and the nurse when they leave the surgery
  • tidy up the toys and books in the waiting room when they leave.

There are lots of different stickers to collect, someone will show you.

FOOD

It is very important for your teeth and gums that you eat a balanced diet.

This means different ‘types’ of foods.

PROTEIN [meat, cheese, fish]

FATS [butter, margarine, olive oil]

CARBOHYDRATES [bread, rice, pasta, potatoes]

FRESH FRUIT AND VEGETABLES

Different colors of fruit and vegetables have different vitamins and minerals in them, make sure you eat ’5 a day’ and try to eat as many different colors of vegetables as you can.

Raw food is better for you than cooked food.

Brown bread, rice, pasta are better for you than white.

GOOD SNACKS some ideas.

  • Toast.
  • Sandwiches.
  • Pitta bread.
  • Bread sticks.
  • Cream crackers.
  • Rice cakes.
  • Crisp bread.
  • Oat cakes.

To go on top- cold meat, egg, tinned fish, marmite, cheese, just butter or margarine.

Nuts and seeds [not for under 5s].

Raw fruit [apples, oranges, bananas, pears, kiwi fruit, melon, peaches].

Raw vegetables [carrot sticks, celery, cucumber].

Plain natural yogurt with chopped or pureed fruit.

DRINKS.

What you drink is also very important. Fruit juice, fizzy drinks and smoothies are not good for your teeth.

If you have a treat sometimes on a special occasion or a party have your drink with a meal and if possible use a straw to drink it.

HOW TO LOOK AFTER YOUR TEETH.

1- Drink only milk or water.

2- Eat ‘5 fruit and veg’ a day, 3 veg, 2 fruit.

3- Eat 3 meals and 2 snacks only.

4- Do not eat too many sugary things.

[These things are; cakes, sweets, biscuits, jam, chocolate spread, sweet breakfast cereals including naturally sweet things like honey, raisins, muesli bars or refined starchy things like crisps or hula-hoops].

Only eat these things with meals not with snacks.

5- Brush your teeth twice a day– in the morning and before you go to bed.

6- Use a toothpaste that is right for your age, because it will have the right amount of fluoride for you to keep the enamel on your teeth strong.

7- Brush your teeth by moving your toothbrush in little circles or use an electric brush.

8- Put a smear of toothpaste on your toothbrush not a sausage shape.

9- When you have finished cleaning your teeth spit out, but don’t rinse so you leave some fluoride on your teeth for a little while.

10- Wait 40 minutes before brushing your teeth after drinking fruit juice, fizzy drinks, fizzy water or eating oranges, grapefruit or satsumas.

Chapter 29- Accidents, Emergencies and Disasters.

Sports Gum Shields.

It goes without saying that if you are going to play any type of contact, rough, or bat and stick sport  you need to wear a gum shield. Rugby, football, hockey, lacrosse, cricket, boxing, judo, tai-chi the list is endless.

You can buy cheap gum shields in a sports shop that you heat up in hot water and mould to the shape of your upper teeth and jaw. These are better than nothing in an emergency but are very unsatisfactory as they don’t fit very well and require the wearer to run around more or less with their teeth clamped together to hold the appliance in.

The best type of gum shield is one that is custom made by a dentist or a clinical dental technician. They are slightly different thicknesses and designs depending on the sport played. Alternatively the best good quality mouth guards are probably those made by OPRO the official suppliers to lots of professional sports teams in the UK and abroad. Your guard can be in made in lots of different colours and designs. The website also has very good little video with clear instructions for taking your own impressions. www.opro.com

A word of warning- if your child needs a sports gum shield bear in mind that their dentition changes constantly due to teeth being shed/ growing all the time. Do not have a gum shield made at the beginning of the summer holidays as by the time term starts 6 weeks later it won’t fit any more. Better to miss a couple of games at the beginning of term.

Of course you are bound to break your front tooth/ teeth doing something quite innocuous, cycling your bike, going for a walk, side of the swimming pool etc. Here is what to do in those circumstances;-

Broken tooth.

If you are a person with a high lip line so you show a lot/ all of your front teeth you are more likely to have an accident with them because your lip is not there to cushion the blow. If you break a chunk of a front tooth and you can find the broken portion wash it for 10 seconds under cold running water, put it in a little box and take it with you as soon as you can to the dentist as it can often be stuck back on.

Tooth completely knocked out.

Find the tooth and hold it by the crown only [the bit you see in your mouth] .

If it is dirty wash it for 10 seconds only under cold running water.

If you think you can and the person concerned is not too distressed, replace it in the socket, try and get it the right way round! Get the person to bite gently on a clean handkerchief to hold it in place and go straight to the dental surgery.

If you don’t feel you can replant it, milk is the best solution to put it in to transport it. It needs to be placed in milk without delay, an hour at maximum.

Speed is of the essence, you need to get to a dental surgery as soon as you possibly can.

Lost baby teeth.

It is not recommended to replant baby teeth as pushing the tooth into the socket may damage the adult tooth growing underneath. An accidentally lost front tooth in anyone over the age of 6 years or so is going to be an adult tooth. If you are not sure, put it in milk and go straight to the dental surgery.

Broken back teeth/ lost fillings etc.

If a small piece breaks off a back tooth and you are not in pain, don’t leave it forever but there is no need to panic. You will probably be perfectly safe to leave it ‘till you come home from holiday, take your exam etc.

If a big chunk of tooth or filling breaks off you need a temporary dressing.

If you are going abroad;- for a long trip, to take part in sports or other physical activity, to out of the way places I suggest you take a dental repair kit with you. You can buy them at the airport chemist or you can be really organised and buy some online before you go from amongst others www.bootsonline.co.uk just put ‘dental repair’ into the search bar.

Failing everything else a bit of sugarless chewing gum, chewed up ‘till it’s nice and soft and wedged into the hole will hopefully do the trick. With temporary dressing the thing is ‘less is more’. You just want enough to go into the hole and cover the sensitive base of the cavity. Don’t put too much in or you will just knock it off as it will interfere with eating. It doesn’t matter if the hole is not completely ‘full to the brim’.

Broken Braces.

If the wire on your brace breaks or comes out from the bracket that it slots into it will dig into the cheek and cause you a lot of trouble. If it’s just a little bit you may be able to bend it out of the way enough for it not to be a problem or you may be able to cope with orthodontic wax available from a big chemist or boots online as above. If you can’t get to your orthodontist a dentist may be able to cut the offending piece of wire off until you can have it replaced. What ever you do you need to see your orthodontist.

Toothache.

Before I go any further just let me say ANTIBIOTICS WILL NOT CURE TOOTHACHE.

Toothache has many causes and it is important that you visit the dentist for the problem to be diagnosed correctly and the correct treatment administered.

DO NOT TAKE SOMEONE ELSES PAINKILLERS OR ANTIBIOTICS.

The painkiller may not be suitable for toothache and the antibiotic may not be the right one for the type of bacteria that cause toothache.

The best painkillers for toothache are Ibuprofen and/or Paracetamol.

For more advice visit www.nhs.uk and put toothache into the search bar.

The thing about pain is that it is a lot easier to stop pain from happening than to try and get rid of it once it’s there. So if you have had an extraction, a big deep filling, a root filling, some other type of surgery etc don’t wait for the pain to start just dose yourself up before it kicks in. If the procedure has been done under local anaesthetic pain will start to kick in as soon as your anaesthetic starts to wear off by which time you will be home and worried about what to do.

The other thing about pain is your pain threshold goes down if you are cold, tired or not very well. This is why dental surgery waiting rooms are kept warm to keep patients pain thresholds down. The trigger times for pain are about 6pm in the evening when you are tired after a day at work/ looking after the kids and the middle if the night when your painkillers have worn off and you feel you are the only person in the whole wide world awake with toothache.

The best thing to do is take your painkillers through the night rather than through the day time. Otherwise it takes 40 minutes for the pain to wake you up, you take a painkiller and it then takes 40 minutes to work, by which time you have lost 1.5 hours of sleep. If that happens twice in the night you wake up the next morning and you are wrecked because you have had no sleep, even worse if you have a crying baby to look after!

Read the back of the packet, take a painkiller before you go to bed, work out when your next one is due, set your alarm, put the tablet where you can find it easily in the dark, wake up and take it before the pain kicks in. Then you will get a good night’s sleep, you will be refreshed and you will be able to cope in the day because you will be distracted as you are busy.

For further advice, dosages for all age groups, regimes etc put ‘National Pain Relief Poster’ into google or similar and you will find [what was a draft but has now been issued] a very useful poster produced by the NHS and The British Dental Association. It has everything on it you need to know.

If you have had a complicated procedure at the dentist you will have been issued with post-operative instructions and pain relief advice. Make sure you understand the instructions before you leave the surgery, make sure you have it in written form as well, you might not be in a fit state to take it all in, MAKE SURE TO FOLLOW IT TO THE LETTER!

Most of the time if I have a patient who has trouble after treatment it is because they haven’t done what I told them to do!

The environment.

Health care uses a great deal of plastics;- syringes, tubes, aprons, masks, visors, gloves, I could go on for ever, this is just a few of the things I can think of. This all has to be disposed off and incinerated in as safe a way as possible with as little cost to the environment as possible. Not to mention drugs, chemicals, gasses, bits of bodies, fluids etc

In dentistry as I am sure in other branches of the medical profession we are doing as much as we can to minimise environmental impact. More and more environmentally friendly bits and bobs are gradually being invented and produced but all of this takes time as it’s not just the invention and the developing of systems, machinery and manufacturing supply chains but of course if it’s for use in health care it has to be rigidly tested and approved by the relevant safety standards authority.

We now have paper cups, ‘green’ suction tips, air and water syringe tips but of course the best thing would be to have everything able to be sterilised and re used rather than single use. More and more robust plastics that can be sterilized to high temperatures are being produced, so they can be used over and over again.

There are other things to be disposed of in dentistry such as waste amalgam, out of date drugs and chemicals, gypsom etc and all of this ‘clinical waste’ is governed by very strictly controlled waste management systems. It all has to be separated into various types and collected and disposed of in the appropriate manner. Not to mention records kept of its disposal for a legally stipulated length of time.

The public water supply also has to be protected and so there are also regulations ensuring no ‘back flow’ of substances into the public water supply and separating/filtering out harmful materials [such as waste amalgam] before they enter the public drainage system.

A COSH [control of substances hazardous to health] report of all substances [including household chemicals and body fluids] used in a surgery has to be undertaken. This is a carefully thought out regime of storage, use, safety measures, persons who may be affected, disposal etc. This has to be kept updated on a regular basis. All to ensure everyone’s safety but also to minimise environmental impact as well.

DO YOUR BIT FOR THE ENVIRONMENT AND LOOK AFTER YOUR TEETH, THE BEST TYPE OF DENTAL TREATMENT IS NOT TO NEED ANY!

Chapter 28- Teeth cleaning- The Advanced Class. Tips and tricks.

Tooth decay [caries] is caused by this very simple little equation;- plaque + sugar = acid = cavities.

The bacteria in the plaque on your teeth metabolise the sugar in your diet and a by-product of this metabolising is acid. The acid demineralises the enamel of your tooth leading to tooth decay [caries]. Lots of different bacteria are involved.

So to stop decay you need to remove the plaque at regular intervals from your teeth, cut the amount and frequency of sugar in your diet and add fluoride into the mix.

Gum disease is caused by bacteria in plaque.

So it stands to reason that removing the plaque from your teeth effectively, efficiently, thoroughly and frequently is the key to success.

I would thoroughly recommend an electric toothbrush. You can wash your undies in the bathroom sink but it’s so much easier to put them in the washing machine. However if your budget doesn’t stretch that far or you really can’t cope with an electric one for some reason, a manual toothbrush will do the job just as well, just make sure you do it systematically [see the little video in Chapter 6].

Let’s say you haven’t been to the dentist for years for whatever reason, you don’t know where to start, you know your teeth are in a state, you know your gums are in a state because they bleed, you are worried about what the dentist might find etc. I suggest you invest in a basic entry level £30 electric toothbrush. Start with this, unless you’ve actually got raging tooth ache I suggest you start the process of sorting your teeth and gums out yourself! Start today, while you;- wait for an appointment, find a dentist you like, move house, have a baby, take your exams etc

Life gets in the way sometimes but you can make a start yourself.

It’s recommended that you brush your teeth for 2 minutes twice a day. But why 2 minutes? That’s 2 minutes for a tiny little 6 year old with 20 baby teeth and 2 minutes for an enormous gentleman with 32 enormous teeth, it doesn’t make sense. The time has to be prescriptive for the patient.

Some electric tooth brushes have timers to help you. If you’ve been to the dentist, your gums and your teeth are healthy then 2 minutes is fine but if your gums are bleeding because they are infected and inflamed then you are going to need to brush them for longer for a while. Just like wearing in a new pair of high heels around the house for a bit. The other problem with a timer is it lulls you into a false sense of security, your timer goes off you have a mouth full of spearmint flavoured toothpaste- you think your teeth are clean. But they may not necessarily be clean because you may not have brushed every section of your mouth for the same length of time, it’s very easy to just switch it on and idly stare out of the window for 2 minutes without concentrating on what you are doing.

Look at it like this- you are going to mop the kitchen floor, you don’t do a bit here and a bit there, you start in one corner and you mop systematically until you have done it all. You have to do the same with your teeth!

Both the major manufacturers of electric toothbrushes in the UK- Braun/ Oral B and Phillips have models with timers to help you. Not sure which one to buy? Take the plunge with one or the other, if your friend/ partner has one, buy a head of your own and borrow theirs to try it out. It’s no different to buying a match pot of paint to try out a colour on your walls. Personally I would recommend a Braun/ Oral B with a round head and at the time of writing it is the one most recommended by UK dentists. To me it seems logical to have a round head to clean the semi-circular shape of your gum margin but each to their own. The important thing is to use it correctly and thoroughly. The gadget and gismo marketing bits and bobs might be nice but they are unnecessary. Just because you own a fancy four wheel drive doesn’t mean you can drive or park it correctly as I am sure you will have noticed on many occasions!

So back to our kitchen floor, you need to clean every face of your teeth as effectively, efficiently and thoroughly as every other. They are all as important as each other. I’ve had patients who have had terrible gum disease because they didn’t realise you need to clean the back of your teeth as well as the front! So the best thing is to divide your mouth up into sections. Much easier to mop your kitchen floor if it’s got big square tiles or ‘floorboards’ on it as you can use the seams to help you.

Oral B and Phillips have made a brave attempt to do this by having a 30 second timer for each quarter [quadrant] of your mouth. The problem with this is most people spend most of the time allotted on the easy bit, the front of their teeth [the bit you see in the mirror] and the back of their teeth get a bit of a ’lick and a promise’. The other problem is we don’t turn our hands round at the midline, we actually turn our hands about by no 2 and no 3 on our dominant hand side, so the swap round section gets a bit left out, so we accumulate plaque here, we need to double do this bit. It’s a bit like having a cheap curtain track that always gapes at the midline, buy one with a cross over bar and your problem is solved.

To overcome this problem you could;-

  • Be aware of it, stain with disclosing tablets so you can see exactly where it is and where you are missing.
  • Use your 30 second timer to clean the outside/ front surface [the bit you see in the mirror] all the way round and then use the next one to clean the inside/ back surface of your arch. The same top and bottom. Hold your toothbrush vertically on the top arch when you get to your front teeth and you will make a smoother transition from one side to the other. See Adrian Giles in the Guardian 4th Feb ’21.
  • If you use it on each quadrant [as designed] start on the inside surfaces/ back surface of each side and count to 15 seconds [elephants] and then do the outside surfaces/ front side of the arch. Then the 30 seconds will be used equally on both surfaces.

The next common fault is people have their mouths too wide open when they try to clean their teeth. If you think of your skull as a box to hold your brain, your top jaw and all the little bones in between around your eyes and your cheeks are fixed to the bottom of this box. The moveable bit of your skull is your bottom jaw which hinges just in front of your ears. If you open your jaw really wide and then try and put your finger along the outside of your top teeth you will find there is no space but if you half close your mouth and swing your bottom jaw over to that side you will find you have made a space to put your toothbrush in. This is where debris sits- like a hamster’s cheeks! This goes for a manual or an electric toothbrush. Tip- when cleaning your children’s teeth, just pull their cheek out and their jaw will automatically move to one side.

Another common fault if you are using a manual toothbrush is to have a toothbrush that is too long, a couple of centimetres is big enough, any more you can clean your bike chain but you can’t clean your teeth properly! If you have a long narrow arch with a bit of a hair pin bend at the front, hold your toothbrush vertically when cleaning the back of your lower front teeth. If you hold it horizontally you can’t manoeuvre it properly.

With an electric toothbrush personally I think it’s better to divide your mouth into more little sections. Look at it like this- you are buttering a piece of toast, you can butter a small piece of toast in one sweep, but if you have a really large piece of toast, unless your butter is very soft you will need several strokes [this is the best analogy I can think of at the moment I may think of a better one in the future]. So it is when cleaning your teeth, it is very difficult when cleaning a long sweep of teeth, all the way round or even just a quarter to maintain even pressure and momentum especially as you are sweeping round a curve. Better I think to divide your teeth into sextants like this- canine to canine as one section, canine backwards as another section on both sides. 3 sections on the front/outside of your arch and 3 sections on the back/inside. Top and bottom, 12 sections in all, are you with me so far! Brush each section slowly and steadily for 10 seconds [a slow count of ten]. This will be 2 minutes in all. Teach yourself an order so you don’t miss bits out, whatever order is logical to you. Do each section in the same order for ‘ever and ever’. Then you will have brushed each section of your mouth for the same length of time, because every section is as precious as every other. Reverse the order every so often and start at the end.

An important point about tooth brushing is this- your gum is like a little windowsill, the bacteria live on this little windowsill [gum margin] and they make it all swollen, inflamed and miserable. When they have been on this little windowsill for some time they drop down the back of the windowsill and ‘eat away the bone around your teeth’. When cleaning your teeth with whatever type of toothbrush you use, you have to say to yourself all the time ‘can I feel the bristles on my gums’ because what you are trying to do is sweep the bugs off the windowsill.

If you were a little bird and you wanted to build a nest you would not build it on a branch that bounces up and down all the time, you would build it somewhere safe. It is the same with the bacteria on your teeth, you have to have really dirty teeth for bacterial plaque to be on the smooth shiny surface, it’s designed to shed the dirt. The bacteria live where they are not going to get knocked off- on the little windowsill and in between your teeth so these are the most important bits to clean.

A tooth where there isn’t one next door. When you put your little brushes through between your teeth you are not cleaning the gap- its air! You are cleaning the 2 teeth on either side of the gap. So when one of those teeth is missing for some reason you still have to clean across this surface or it will never be cleaned and a big slug of plaque will sit on the bony ridge behind your tooth resulting in a cavity there. Use a little brush [a fairly large size] across that surface just as if you had a tooth next door. By the same logic you need to floss down the back of your last standing tooth, your floss is just a scraper, like scraping frost off a car windscreen with a credit card.

I hope these tips are helpful, if I think of any more I will add them but in conclusion-

THERE IS ABSOLUTLY NO SUBSTITUTE FOR PROFESSIONAL INSTRUCTION.

Chapter 27- Advice for denture wearers.

Approximately 20% of the adult population of the UK wears a denture of one sort or another. A denture is a removable appliance to replace missing teeth.

The device may be temporary or permanent.

A temporary denture is one worn after a tooth/teeth has/have been lost while you wait for the gum to heal up before having a bridge, an implant or a more deluxe type of denture in the future.

A permanent denture is the finished article, one you are going to wear long term. Permanent is a bit of a misleading term really as like anything it will wear out, break and need modifying as your dentition changes over time.

The denture body may be made of various materials; – acrylic, acrylic and metal [chrome cobalt] and soft flexible nylon based plastic. It may also have a soft lining made from silicone rubber or acrylic. The teeth can be made of acrylic, porcelain, composite resin amongst other materials.

The important things to remember about a denture is it has been custom made for you, it is a precision appliance, if you want it to last, like anything else you need to look after it and care for it correctly. If it is a partial denture the health and longevity of your denture depends on the health of your teeth and the health of your teeth depends on the cleanliness of your denture.

Here are the rules-

  • Take it out at night.
  • Take it out when you clean your teeth if it is a partial denture.
  • Clean it correctly.
  • Store it correctly.
  • Have it checked by your dentist on a regular basis.
  • Keep a spare.
  • Have a new one at regular intervals as advised by your dentist.
  • Use denture fix sparingly.

Night time removal.

It’s very important that you take your denture out at night. It’s lovely and warm and moist under a denture. Just the sort of conditions bacteria and fungi like to grow in. On the roof of your mouth you have lots of little ridges, these are called rugae and some people have really bobbly [very technical term] skin on the roof of their mouths [palate]. Bacteria and fungi love to live in these little microclimates and as with anywhere else on your body it’s not a good idea to have bacteria and fungi in places they shouldn’t be.

Cleaning of your denture.

It is really important that your denture like your teeth is cleaned regularly, efficiently and thoroughly without damaging it.

It amazes me that people who would not dream of putting dirty knickers on their bums will happily put dirty dentures in their mouths. You have to think of your denture like a picnic plate, you wouldn’t eat your dinner of a dirty plate so why would you eat your dinner off dirty dentures. If your cutlery in a restaurant wasn’t clean you would complain and ask for a new set. Just because you can’t see under your dentures when you are wearing them, like your knickers it matters that they are clean!

It only takes 30 minutes after cleaning for the structures in your mouth and your denture to be covered in a film of salivary proteins [this is called the salivary pellicle] once this happens other bits of debris, old dead cells, food, bacteria, fungi get stuck onto the surface. Once bacteria and fungi are attached they will of course set up home and start to breed.

Dirty dentures will stain, smell, collect tarter [calculus] and the proliferating bacteria and fungi will cause other oral disease;- caries, gum disease [periodontitis], denture stomatitis, angular cheilitis. Micro-organisms growing on a denture are also associated with other systemic [whole body] diseases, either because they get into your blood system or because you inhale them. Poor denture hygiene has been shown to be linked to a higher risk of pneumonia in elderly patients.

If you have a partial denture it is even more important that it is kept free from debris as if bits of food and plaque are held onto your teeth by your denture you will develop cavities in those places.

It is also important [and this may sound obvious but to some people it isn’t] take your denture out when you clean your own teeth.

Cleaning Regime.

Last thing at night.

Remove your denture and clean your own teeth effectively, efficiently and thoroughly.

Put some water or a flannel in the bottom of the wash basin so if you drop your denture it won’t break.

Hold your denture between your thumb and your fingers front to back not side to side as you are liable to flex and crush it.

Scrub your denture with a denture brush, a manual tooth brush or your electric toothbrush. Scrub the side with the teeth and the side that goes on your gum [the fitting surface].Use a denture cream, soap, liquid soap, washing up liquid but whatever you do DON’T USE TOOTHPASTE. Toothpaste contains mild abrasives to keep the stains off your teeth, it will scratch the acrylic of your denture meaning it will stain, collect debris and look less life like.

You need to scrub a full set of dentures for 3 minutes. 1½ minutes for the top set and the same for the bottom. 45 seconds for the side with teeth and the same for the fitting surface. Using this as a guide you must calculate the time needed for your particular denture depending on the surface area your denture covers. The fitting surface is especially important as bacteria and fungi live on your dentures and you need to eradicate them each time you clean in order to reduce reinfection. If you have a soft lining on your denture use a soft brush gently to avoid damage and be careful cleaning round any clasps so as not to bend them.

When you have mechanically cleaned your denture you may put it in a proprietary cleaner if you wish. All cleaners on the market use different chemicals, make sure the one you purchase is suitable for the type of denture you have [it may not be if your denture is part metal, is a soft denture or has a soft lining]. Make sure you read the instructions very carefully and only soak your denture for the length of time stipulated, otherwise you may damage it. When you have removed it from soak, rinse thoroughly and either leave dry in a safe place or in water overnight.

DO NOT PUT YOUR DENTURES IN HOUSEHOLD BLEACH you will make them brittle and damage them.

In the morning.

Clean your teeth if you do it before breakfast, put your dentures in, have your breakfast and then take your dentures out, re clean your teeth and use your little brushes [see chapter 26] and then  clean your denture with a brush and denture cream or soap/detergent.

After lunch.

Clean your teeth if possible, clean your denture or at least if you can’t do that if you are out and about get your denture out and rinse it under the tap. Ideally rinse your denture after eating anything.

Denture cleaning machines.

You can now purchase ultra-sonic denture cleaning machines/baths. You may find them in a large chemist or your dentist may be able to advise you where you can purchase one online. As with anything make sure you follow the instructions especially as to length of time to be used, solutions to be used and type of denture it is suitable for.

Storage.

It is a good idea to have a special box to keep your denture in either a ‘denture box’ [available from the chemist] or a designated box of your own. It’s very easy, especially if you haven’t got your glasses on to; – knock them of the bedside cabinet, loose them amongst the sheets and end up putting them on a hot wash by mistake, drop them on your tiled bathroom floor etc.

Whatever you do don’t leave them lying around. I have had patients lose their teeth in the most peculiar of circumstances.

One gentleman left his dentures on the kitchen table at night and they were stolen by rats [I am not making this up, apparently rats like jackdaws are attracted to shiny things, they also left something in their place because some rats are borrowing rats- rats are very interesting!].

Another lost their dentures on a picnic, took them out to eat lunch, wrapped them in a paper napkin, put all the picnic rubbish in the council bin, got halfway home on the motorway, realised their mistake, rushed back only to find the efficient council concerned has just emptied all the bins!

Countless patients have lost their dentures swimming in the sea, if you are going for anything more than a paddle take your teeth [and your earrings] out first. One lady surprisingly found both of them several hours later wedged together between two rocks- truth is sometimes stranger than fiction!

If you think you are going to be sick, try and take your teeth out first. I had one lovely lady flushed hers round the U bend before she realised she had lost them. Sadly she was at a very smart function she had been looking forward to for ages and she had no choice but to go home.

Visit your dentist.

Whatever type of denture you have it is important to have it checked on a regular basis by your dentist.

Your dentist will check the fit, the wear and the material for fractures. Your ridge carries on shrinking under your denture, so you end up with a gap underneath where debris collects, it may be possible to correct this with a reline. An ill-fitting denture is more likely to break as it rocks and if it’s a partial denture will put more strain on your own teeth. If your denture does have a little crack this is much easier to repair at this stage than to wait till it has completely broken in two.

If you have a partial denture and you are visiting your dentist to have your own teeth checked DON’T FORGET TO TAKE YOUR PARTIAL DENTURE WITH YOU.

If you have complete dentures still visit your dentist at least annually for all the above reasons but also to check the health of the rest of your mouth. Sometimes nasty little cancers grow under dentures.

You need a spare.

Unless your denture is only temporary you need a spare. If you have an old one even if it doesn’t fit perfectly that will do. If you fall over and break your denture you can’t go to work without it. If it’s a break, a couple of days and it will be fixed but if it’s completely smashed or worse lost altogether you may need several weeks while a new one is made. Make sure you take your spare on holiday with you.

A new one every 5 years.

Your mouth changes shape over time, your own teeth move, your ridge shrinks and you wear your artificial teeth down so they no longer feel ‘sharp’.

As we all get older it takes longer to adapt to new things, if you leave it many years before you replace your denture you will find the new denture more difficult to adapt to. So better to have a new denture on a regular basis. Keep your old one as a spare. Try it in occasionally to make sure you can still wear it even though it’s only going to be needed in an absolute emergency.

If you find your new one difficult to adapt to, wear it round the house first, like a new pair of shoes till you get your confidence up and do go back to your dentist if you feel it needs adjusting. I always tell my patients a new denture will need at least 6 adjustments as standard. You might be lucky and need none or you might need more. Your dentist will be happy to help you, your dentist will want you to be happy with the service you have received. No one wants an unhappy customer!

Denture fixatives.

This is basically glue to help stick your dentures in. In an ideal world no denture would need adhesive but not always so. Or it might be the case that most of the time it’s fine but if you have to give a speech, a presentation, a lecture or you are going to some really important social event and you just want a bit of help to give you confidence, a bit of insurance against disaster. Denture fix can be very useful. Buy a good brand, follow the instructions and make sure you remove it thoroughly from your denture and your mouth last thing at night or bacteria and fungi will grow in it. Use it sparingly and only when absolutely necessary.

I hope this information is useful but if you have any other questions please ask your dentist.

Chapter 26- The Mature and the Very Mature Patient.

So we will all get older, it’s inescapable.

If we have our teeth and want to keep our teeth it will require diligence, attention to detail and effort on our part to do so it won’t just happen by magic or luck!

No amount of going to the dentist and no amount of money is going to keep our teeth in our head unless we are prepared to do the day in, day out maintenance consistently, thoroughly and effectively. This includes perfect oral hygiene and attention to what we eat and drink.

So you do all that already [bravo] and you think that’s the whole story but there are certain things that happen as we age which you need to be aware of in order to keep on top of things;-

Eyesight.

So most of us get to a certain age and need reading glasses or you may always have needed glasses for near vision. Make sure you put your glasses on when you clean your teeth and do it in the mirror, you need to see what you are doing to clean your teeth effectively and efficiently. Good lighting is also essential, by the age of 60 we need 3x more light to be able to see detail than we did when we were younger.

A very useful source of information about light, sight and ageing eyesight can be found on The Serious Light website at www.seriousreaders.com they also give all the links to the relevant NHS information for conditions that affect your eyesight as you get older.

Dry Mouth.

So as we get older lots of us get a dry mouth [see chapter 11].

Our mouths are like a little sluice, saliva is constantly being made by our salivary glands and washing things down our throats. Saliva has a function.

It lubricates our mouths to make it comfortable to chew, swallow and speak properly. Some of our food needs to partially dissolve in saliva in order for us to taste it. It helps with immunity as it contains antibodies and other antimicrobials. It contains enzymes [alpha amylase in particular] which start digesting out food helping to ‘clear up the bits’. It helps in remineralising our enamel and it buffers the acid in our food and drink back to neutral to stop it dissolving away our teeth.

Saliva is a truly magical substance.

Leaving aside certain conditions the two commonest reasons for a dry mouth are our salivary glands being a little less efficient as we get older and polypharmacy.

Salivary Glands.

As we all get a bit older our salivary glands like other bits of us become a little less efficient. You have 3 major pairs of salivary glands; – parotids in front of your ears [swell up when you get mumps], sub mandibular underneath the angle of your jaw and sublingual under your tongue. These produce to different extents a mixture of mainly serous [watery] saliva and mucous [thicker saliva]. All over the inside of your mouth you have lots of little salivary glands within the skin of your mouth [oral mucosa][a bit like the sebaceous glands in your hair], these make mucous.

Poly Pharmacy.

So as we all get older some of us are on drugs for various conditions and as we are living longer more and more people are living with medical conditions [co- morbidities] that 50 or so years ago we would not have been living with because we may not have lived long enough to get them! [Not to mention non-communicable diseases / life- style conditions such as diabetes type 2]. Some of the drugs for these conditions cause dry mouth, the commonest ones are the ‘antis’;- antihistamines, antihypertensives [high blood pressure] and some anti-depressants, plus loads of others.

So if you are producing less saliva for whatever reason, you are not constantly washing, remineralising etc your teeth and so you will become INCREASINGLY SUSCEPTIBLE TO CARIES [TOOTH DECAY] AS YOU GET OLDER!

Something which may help you if you suffer with a dry mouth at night are Xylimelts. These are naturally adhering discs that you stick to your gum above your top back teeth, they deliver time released xylitol, so stimulating saliva production. Available from www.mouthulcers.co.uk . You can buy a trial pack for £1 so you can’t go wrong!

Manual Dexterity.

As we get older we may get a bit of osteo arthritis in our hands, lots of other conditions may make us less manually dexterous, or you may have had something like a stroke on a side of your brain that  means you have lost/ reduced use of your dominant hand. This of course means you have to start learning to clean your teeth all over again at a ripe age with the wrong hand. Not easy at all!

An electric toothbrush can be very helpful in these circumstances. I would choose a round headed one for preference as it is the same shape as the surface you are trying to clean, namely the gum margin around your tooth where bacteria like to lodge [see below]. Whatever brand you choose you do not need to by the fancy expensive model to start with, just buy the basic one that is perfectly good enough. Then if you find you get on with it you could update to a newer model in the future [keep the old one for holidays it’s bound to be your nice new expensive one you leave in a hotel room or campsite somewhere!] You will find with an electric toothbrush that it starts to loose it’s oomph after 5 years or so, so you can buy an updated one then.

There are also lots of gadgets and toothbrush designs to help those with problems gripping a toothbrush. Ask your dentist or hygienist for help that is what they are there for- to help you take care of your teeth.

I myself keep a big box of samples of such things that I have been given by various dental companies to try out on my patients. I am sure other dentists do the same. If it works for you it may help another with similar problems. You have the problem, our job is to try and help you achieve your desired solution- to be able to clean your teeth effectively, thoroughly and efficiently.

Forgetfulness.

Well this happens. If we are not looking for our glasses we are trying to remember what we were looking for! We don’t lose our memory we lose our recall- not the same thing.

Dementia sufferers have even more problems.

Reduceable/ treatable [reversible] causes of dementia include;- drug and alcohol misuse, emotional illnesses such as depression, some metabolic disorders, endocrine disorders [glandular], nutritional deficiencies [especially B vitamins], trauma to the brain, some infections and arteriosclerosis [plaques of debris sticking to the inside of the blood vessels] of the blood vessels in our brains.

Irreversible dementia includes Alzheimer’s disease [about 70% of cases in the UK], vascular dementia [20%] and lots of other rarer types [10%].

More and more people are being diagnosed with dementia due to better diagnosis, we are also living long enough to get it and of course it ranges in severity from one patient to another.

If this is you or a loved one it is very important that you have a good oral hygiene regime, so it’s ingrained in your psyche- put instructions to yourself up on the  bathroom mirror, put the bottle of mouthwash on the loo cistern so when you go for a wee after lunch you see it and it reminds you.

Dental teams are becoming more and more adept/ aware of the problems facing people who have dementia as regards their oral health. They are there to help you. If you have a carer or relative who helps you with personal care it’s not a bad idea to take them with you to your appointments so they can get advice from a professional and understand how they may help you.

THERE IS NO SUBSTITUTE FOR PROFESSIONAL HELP TAILORED TO THE INDIVIDUAL!

Here are some things you need to be particularly aware of;

1- Root caries.

As we get a little older some of us start to show our roots. The crown [the top portion of our tooth] is covered in nice hard impervious enamel but our roots are not. They are covered in cementum which is quite soft and is probably brushed off in the first year it is exposed. So we are left with bare dentine which is more susceptible to decay [caries].

The dentine is not prone to decay, prone is- ‘she forgets to put her glasses on so is prone to walking into lamp posts’, no your dentine is susceptible to caries underneath any plaque you may leave on it.

Prone and susceptible are not the same thing.

If you leave plaque on your roots you will get decay under that plaque. The bacteria in the plaque will metabolise the sugar in your diet producing acid which causes caries. The plaque sits on the little window sill of gum around your tooth and in-between your teeth so these are the areas that need particular attention when you clean.

Your teeth need to be cleaned regularly, effectively, efficiently and thoroughly.

The factor you can’t do anything about is reduced saliva flow but you can ensure that you keep yourself hydrated [1.5 litres of fluid per day for a woman and 2 litres for a man], you can chew sugarless chewing gum after eating to encourage the flow of saliva.

You need to eat a healthy diet with plenty of fresh fruit and vegetables [at least 3 veg and 2 fruit] with as little refined sugar as possible. Any sugar eaten should be eaten with a meal and not constantly snacked upon, the amount and the frequency are equally as important.

If you have a lot of exposed roots, especially if you have reduced salivary flow your dentist may prescribe high dose fluoride toothpaste, to use on your little brushes in-between your teeth and perhaps to clean all of your teeth. This is a prescription only medicine [POM] and like all prescribed medicines only to be used by the person it is intended for. It is not for use by all the family and should be kept out of reach of small children and other vulnerable people.

If you have early decay on your roots you may also be prescribed this medicine as it is better for the health of your tooth to treat this problem medically by stopping [arresting] the caries from progressing by cleaning and ‘medicating’ with fluoride than drilling a hole in your tooth which will weaken its structure.

Time for a couple of little diagrams-

2- Before or after breakfast.

So should you clean your teeth before or after breakfast? This is always a subject of debate within the dental profession.

Here is the theory; – if all the bacteria [that have grown over night] are removed from your teeth before breakfast then, in theory it shouldn’t matter how much sugar you eat for breakfast there will be no bacteria to metabolise it into acid.

This all sounds wonderful and logical BUT theory is all very well, doesn’t always work in practice. For a start no one is a perfect cleaner [though that is no excuse for you not to strive for perfection!]. Secondly if you are a person with great big gaps in-between your teeth you are going to leave toast and marmalade/croissant/ raisons in-between your teeth which is not going to get brushed off/ washed out ‘till lunchtime, when more will be added!

So I would say do your whole cleaning routine before breakfast and then use your little brushes and give them a once over again with your toothbrush after breakfast and the same after lunch.

Research also shows that 3x oral hygiene per day reduces your risk of heart and other non-communicable diseases [NCDs], as it reduces the risk of gum [periodontal] disease, a chronic inflammatory condition. If your gums are inflamed and infected they will bleed, if the blood can leak out, the bacteria can leak in and so can be carried around in your blood system to settle in places it would be better they didn’t!

3- Denture health and cleanliness.

This is covered in the next chapter number 27.