Patient Information

Brushing helps remove a sticky film of bacteria called plaque. The bacteria in plaque breaks down tooth enamel, which can cause cavities.

Fight tooth decay and gum disease by brushing your teeth at least twice a day. Brush your teeth a least twice a day, morning and night, for two minutes.

Use a soft, small-headed toothbrush and fluoride toothpaste. Your toothbrush should be placed at a 45 degree angle to your gums.

Brush gently and thoroughly by moving the brush back and forth in short, tooth-wide strokes. Brush all the surfaces of all your teeth including the inner tooth surfaces and chewing surfaces.

Use the "toe" of the brush for the inner front tooth surfaces and don't forget to brush the top surface of your tongue. Change your toothbrush every three months to ensure you always get a proper clean and help avoid harmful bacteria building up on the bristles.
 

Brushing your teeth twice a day helps remove a sticky film of bacteria called plaque. However, bacteria can also be found between teeth, where your toothbrush can't reach. Flossing helps remove plaque from between your teeth and around the gum line. Use enough floss so you can hold the ends comfortably in your hands (about 45 cm).

Wind the floss around both middle fingers and support it across your thumbs and index fingers. Floss at least once a day and remember to insert the floss gently with a side-to-side motion- don't snap it into place.

Hols your thumbs and index fingers closely together to guide the floss between your teeth using a gentle rubbing motion. Curve the floss into a C shape around the tooth at the gum line in order to clean the neck of the tooth. Scrape the floss up and down moving the floss away from the gum line.

Use a clean segment of floss to repeat on the rest of your teeth. Remember to floss the back side of the last tooth.

If you find it difficult handling floss, ask your dentist or hygienist to show you again.

Alternatively, you may want to use a commercial floss holder or tie floss in a loop.
 

Pregnancy is a time when women have special health needs. Oral health needs also change during pregnancy when teeth and gums meed extra care.

During pregnancy your teeth and gums may be affected by your pregnancy, just as other issues 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 estrogen and progesterone.

These hormones may affect your immune response to bacteria and favor bacterial growth. Therefore you may experience more gum problems at this time.

Gingivitis

Pregnant women may experience increased gingivitis (gum inflammation). This may be more noticeable between the second and eighth months of pregnancy and tends to subside after delivery. It is called pregnancy gingivitis.

Symptoms may include redness, bleeding and swelling of your gums.

Pre-existing gum disease may worsen during pregnancy. However if you have healthy gum tissue before pregnancy, pregnancy gingivitis may be prevented with good oral hygiene due to morning sickness, which may cause aversion to the smell or taste of toothpaste, or even having a toothbrush in the mouth.

Periodontitis

In pregnant women with poor oral hygiene, pregnancy gingivitis may progress into periodontitis, a more severe form of gum disease. Periodontitis is chronic and usually not a rapidly progressing disease. Hence, the destruction during nine months is mostly not severe.

However, if left untreated, periodontitis can cause destruction of the gums and bone surrounding your teeth, resulting in tissue (bone and gum) loss.

Severe periodontitis (usually pre-existing) may increase the risk of:

• Preterm birth,
• Low birth weight and
• Pre-eclampsia
  

Pregnancy diabetes

The effects can be minimized with professional cleaning (scaling and root planning) and a good home-care regimen (brushing and flossing). It is important during pregnancy to continue your regular dental examinations, so treatment can be provided if required. It may be beneficial to have more regular professional cleaning visits during your pregnancy.

Pregnancy Granuloma

Occasionally, a gum growth may occur during pregnancy called a pregnancy granuloma (or epulis). 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. (i.e.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 became 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.

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

Dental caries (tooth decay)

Eating sugary foods and drinking acidic may increase your risk for dental caries during pregnancy. Choose healthy, nutritious food and avoid eating sugary, sticky snacks. Brush your teeth twice daily with fluoride toothpaste and a soft toothbrush.

Dental Erosion

Morning sickness may lead to vomiting during some stages of your pregnancy. Frequent vomiting during pregnancy can have erosive (dissolving) effect on your tooth surface. Your tooth enamel may dissolve or become softened by gastric acids. Don't brush your teeth immediately after vomiting. Wait for about 30 minutes before brushing your teeth. Instead rinse your mouth immediately with water. 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.
 

Cracked tooth syndrome relates to a variety of symptoms and signs caused by a crack in a tooth. Early diagnosis and treatment of this condition are important to improve the chances of saving the tooth. However it is sometimes difficult to locate the problem tooth.

Cracked tooth syndrome is a common problem that affects the teeth that have large fillings in them, and indeed some unfilled teeth.

Decay and large fillings cause a weakening in the remaining tooth structure over time. A hairline fracture often develops at the bottom corner of the filling. The molar and premolar teeth are most commonly the teeth affected.

Grinding your teeth will cause a large increase in the stress and strain on your premolar and molar teeth increasing the risk of this condition.

The reason it hurts to bite when you have a cracked tooth is that your tooth is flexing which stimulates the nerve in the tooth.

These hairline (microscopic) cracks open and close causing fluid to move inside the tiny tubules that make up the dentine of the tooth.

This causes pressure on the tooth’s pulp (nerve) resulting in pain. The pulp in the cracked tooth may also be exposed to bacteria and their toxins that can enter the pulp through the crack.

This causes the pulp to become inflamed making it sensitive. If the crack goes untreated it can spread and deepen like a crack in a glass and a part of the tooth may break off causing a need for root canal therapy or extraction.

Symptoms and signs of Cracked tooth syndrome

• The tooth may be very sensitive to hot, cold and sweet stimulus.
• It is often difficult or impossible to locate exactly which tooth is the cause of the discomfort.
• The pain may occur upon release of biting pressure because the crack will close quickly causing pain.
• There is often a history of other similar stimulus.
• The crack may be visible to the eye, or seen on a dental x-ray.
• There may be a gum pocket beside the tooth root surface if the crack extends below the gum margin
  

Diagnosis of Cracked Tooth syndrome

The diagnosis can be difficult because often the symptoms are not consistent. The cracks are often not discovered until there are a variety of symptoms present.

Your dentist may use the following processes for the diagnosis of your cracked tooth:

• Questioning about your dental history and present problem
• Testing individual teeth with hot or cold items to identify the tooth producing the symptoms.

Looking for:

• Signs of teeth wear
• The bite between upper and lower teeth.
• Cracks of the surfaces of teeth.
• Large fillings with weakened cusps (the cusp is the pointed or raised part of the tooth)
• Bite tests can be helpful in locating the pain.
• Your dentist will use an object to direct your biting pressure onto an individual cusp. This may help identify the offending tooth and cusp. X-ray examination may be used to rule out other possible causes of the pain such as decay. However the tooth crack will rarely be seen on an x-ray film.
• The removal of a filling in a suspect tooth may help your dentist identify the position of the crack, and sometimes its direction and extent. A coloured dye can sometimes be used in this situation to highlight the crack.
• Probing below the gum line may help identify an extensive crack. Treatment for a Cracked Tooth Early detection and treatment is important as developing cracks can be slowed down or stopped, increasing the chances that the tooth can be saved. The treatment required depends on the extent and position of the crack.
  

The treatment for most cracked teeth involves removing the weakened cusp and placing a large filling or crown on the tooth. If more than one cusp is cracked or weakened, a crown or overlay is the treatment of choice as this will help protect the other weakened cusps. Sometimes before the crown or filling is placed a stainless steel band and a sedative dressing are placed to see if the tooth pain can be stopped. If the discomfort continues your dentist may suggest the need for root canal treatment prior to the filling or crown being placed. If the crack is a complex one that has led to involvement and inflammation of the pulp (nerve) then root canal treatment will be required prior to crowning of the tooth. This may involve two or three additional appointments, and as with any treatment in complex situations, there is always a possibility that the treatment will not succeed.

Sometimes your dentist will suggest that a referral to a specialist is required for treatment of a particular tooth.

If the crack is terminal (unable to be treated) then your dentist will recommend that removal of the tooth is the best treatment option.

Please remember that diagnosis and management of the cracked tooth is not always a simple task, and that sometimes a number of visits and tests are required before treatment options can be offered.