Dental Chronicles

[Mrsmorton]

I have noticed a number all of the dental related questions on MN get repeated once a month or so; this may be entirely unwelcome but what I intend to do is to make a series of detailed posts answering the most common questions so that I can signpost posters to an answer. Often they disappear in chat and then resurface.

I am a dentist (that's no secret on here) but I have no way of proving my qualifications and neither do I feel the need to. I hope that this will be of some assistance to someone at some point!!

thanks if it gets worse i will probably just get it out! it's frustrating as it is a big molar. i wouldn't sue my dentist, but i think they were drilled and filled too much in the 70s, is that a myth or true? (that dentists were paid per fillings in the 70s)

I did want to mention the GDC, they are our regulators to whom we pay the princely sum of £890 per annum in order to be able to call ourselves dentists.

We have a "union" that is the British Dental Association. They are supposed to represent our interests, I am yet to be convinced.

All dentists are also indemnified with a company that not only pays out if we fuck up but provides us with legal advice if things are going a bit Pete Tong. This costs in the region of a few thousand pounds for a general dentist in practice not doing any implants or botox etc. (in my experience, other dentists probably pay different amounts)

The GDC are an incredible group of people who on the one hand wonder why complaints have increased 110% in four years and on the other hand, actually advertise in the weekend papers for people to complain directly to them. Bonkers.

Anyway, lots of posters on MN had dentists who were "struck off" for bad dentistry. It's actually quite uncommon to get struck off for being bad at fillings or taking teeth out.

What dentists usually get struck off for is either criminal shit (like indecent images or assault etc) or fraud. If a dentist is dishonest, the GDC don't want them. The general thinking being that you can go on a course to get better at fillings, if you are fundamentally dishonest then straight to hell with you.

If you get struck off, you can't work as a dentist for five years and it is very very difficult to get back on the register.

Dental nurses get struck off for things like shoplifting, assault, failing to disclose convictions, very very rarely anything to do with dentistry.

Each time a dentist, dental hygienist, dental technician or dental nurse gets struck off, the GDC have spent £78,000 on investigating them. There are around 100,000 people on the dental register, 40000 dentists and 60000 professionals complimentary to dentistry.

Not sure why I felt the need to explain that but some people think the BDA is there for patients, it's not, it's ours. The GDC is there to "protect patients" apparently.

whatis hmm, it shouldn't be wobbly! Lower centrals are usually the first to go if there is or has been any gum disease. How old are you?

Basically, once the bone goes, the gum is unsupported, down there because of the curve of the jaw and other anatomical variances, the gums tend to follow the bone.

Things can be done but they are only available privately. Have you seen anyone about it?

Its only very slightly wobbly. I did mention it to the dentist but he just said to keep an eye on it. I'm 24.

southeast true and not true. I think some drill and fill did go on, yes. But the technology is also different and research has come a long way.

For example, the pattern on top of your tooth is called a fissure pattern. These days if we see staining or early decay, we treat it with fluoride and diet advice, we may put a fissure sealant over it or even drill away a small amount of enamel and bond in some sealant to protect the tooth.

In the 70's, prevention wasn't a "thing" so fluoride paste wasn't so popular. Also, bonding was in it's very infancy. The only fillings available were really Gold and amalgam (the silver one). Dentists thought they were doing the right thing by putting in silver fillings to prevent decay but now we realise it wasn't ideal.

To put in a silver filling you have to create quite a precise shape of hole, otherwise it will just fall out, that means more tooth had to be removed than to bond in a white fillings because the bonding is really very good these days and it could stick shit to a shovel.

I guess in the same vein, my mum was kept on the maternity ward until she ate some liver before they would let her go home with me. Things change, sadly lots of people had teeth affected by this era.

24 is young to have recession and wobbliness really. When are you due to go back?

There are a few things that can cause it but I would investigate it in someone of your age as I wouldn't expect to see it. By investigate I mean take some x rays, maybe do some additional prodding around the gum.

I'm due to go back in about a month so I'll mention it again then. Thank you so much for this thread and answering my question.

Thinking about it, I'm pretty sure my mum said I had gum disease when I was a toddler. I had most of my teeth removed at 3 years old. But this is a recent problem I've had.

Hi MrsM
I am teeth obsessed, your posts are really helpful!
My 2.6yr old DD is a thumb sucker when she sleeps. Should I worry yet? Her top teeth do look to protrude over her lower teeth. I'm not sure what to do!
Thanks TOOIK

Final post for tonight as I'm waiting for the sewing bee to download.

When we do a check up, we are looking for (amongst other things) tooth decay, gum disease and oral cancer. How high medium or low your risk of these things is, determines how frequently we ask to see you. NICE guidelines say 6-24 months so high risk for any of them = 6 months, low risk for all could = 24 months.

In order to claim that we have done a check up, we need to record something called a BPE score. If we don't do this then essentially we can't ask to be paid for the check up.

BPE stands for Basic Periodontal Examination. We divide your tooth into six, three on the top and three on the bottom, basically upper right molars, upper incisors, upper left molars and same for the lower teeth.

We have to poke your gums, it's practically law. The suggested probing force is 25g, we actually had a "probing force test" at Uni where we had to put 25g on the probe using a set of scales that we couldn't see the numbers on.

The probe has a blunt end and a black band on it, the band is between 3.5 and 5.5mm from the end as is designed to tell us how deep the pockets are. The blunt end is designed to tell us if there is any bleeding on probing and also if there is any calculus or any ledges around the teeth or fillings.

So, the scores on the doors (I hate this topic so much I have shamelessly cut and pasted this)

Code 0: Healthy gingival tissues with no bleeding on gentle probing.

Code 1: The coloured band on the probe remains completely visible in the deepest pocket within the sextant. There are no defective margins or calculus. There is some bleeding (within 30s) after gentle probing.

Code 2: The coloured part of the probe remains visible in the deepest pocket in the sextant supra or sub-gingival calculus detected or defective margin(s) of crowns or restorations.

Code 3: Coloured part of the probe remains visible in the deepest part of the sextant.

Code 4: Coloured part of the probe disappears completely into the deepest pocket in the sextant.

And this score determines what sort of treatment you need, generally if you are a code 3 or 4, you need to see a hygienist regularly. Most people are code 2 which can get away with a scale and polish, code 0 and 1 are the dentists smarty pants and need a sticker.

Ermagerd, download taking ages.

No, don't worry about thumb suckers until the permanent teeth start to arrive (age 6). If she stops around that age there are unlikely to be any problems. If it continues after six then some quite significant issues can arise but at this age, let her and you get some sleep!

thank you!

My 11yo still sucks her thumb . She is starting orthodontic treatment this month with moulds, X-rays etc. Unfortunately, 2 yrs ago she broke both her front teeth in half. Both teeth have been capped, one has died, but has been treated and all is ok at the moment (except for my constant worry that she will break the caps off again ).
Anyway, I have a fear that the mould taking by the orthodontist could pull the caps off her teeth - is this possible?
For the future, are implants a good option? Thank you!

You mentioned silver fillings as not ideal. I have a mouthful of them (back teeth), and have certainly had at least one or two in the last five years. I have asked about having them replaced as I look like Jaws when I open my mouth, but have been told the fillings are either too big, or they're root canals, so white won't work. Is this correct?
Of course, they don't look silver they look black.

And thanks for this .

There's no reason to think that she would need implants unless you've been told there is a poor prognosis?

I broke a front tooth at 13 and it died and I still have it mumble a few years later.

If the restoration breaks while an impression (mould) is being taken then it wouldn't survive contact with food so whilst it occasionally happens, it's because there was something wrong with the filling (cap - hate that word) anyway.

If she breaks them off then just get them redone, it's no biggy although it may be time consuming for you, it's far preferable to extractions and implants.

Avoid crowns or veneers at all costs. Once that tooth has been drilled away, the next thing is always more drilling. The white filling that gets stuck on and shaped is fine for ever, unless the tooth needs crowning for another reason. These days, pretty much all of the front crowns I do are replacement ones, almost all teeth that have been broken and root treated can be made to look just perfect without all of that destruction and time and expense.

Children who are thumb suckers often have what we call class 2 div 1 incisors where the incisors stick out much further than they would normally, this is because the thumb pulls them forward more than the lip can push them back. These teeth are always at a much higher risk of being fractured due to trauma.

I didn't say they aren't ideal , I said that preparing a cavity for a silver filling requires a precisely shaped hole whereas white fillings stick to teeth.

Very big fillings, very deep ones, ones that go under the gum are incredibly difficult to do in white (we call it composite). Composite fillings are extremely technique sensitive and they fail where there is moisture. If the tooth can't be isolated from the saliva well enough or if the filling is under the gum then white is a bit of a recipe for disaster. They can be done but if you were my sister, I'd probably advise against it.

With the root filled teeth, as a way to get a great seal on top of the root filling, the silver filling material is often packed very densely into to the top of the root canal (called a Nayyar core). This can be difficult to remove to start with but also, there's not really a great alternative with composites. You can bond posts in but it's not massively satisfactory. It's also more difficult to create a tight contact between teeth so a food trap can be left.

You are probably far better off leaving sleeping dogs...

If a patient has active decay (that is when they come for a check up, they need new fillings), composite fillings often aren't ideal. Some dentists out there only use composite (private ones) and some are absolutely amazing at placing them but generally, in my experience, more decay happens around white fillings.

They also take a lot longer to place and as a result are expensive.

Excellent information and very well worded Mrs M
Thanks for taking the time

What an amazing thread, Mrsmorton.

Thank you so very much for taking the time to post this & educate so many of us about our teeth - which I am afraid we all take for granted until they go wrong.

Thank you that was helpful .

Mrs M, following on from the gum disease posting, a question of ethics.....

My nhs Dentist (still a nice man) does a scale and polish at my check up if needed, but there's no hygienist in the practice . Would it be unethical to visit a private hygienist in interim months for a Bloomin good clean? Or is that treading on his toes and not the done thing? ( like using a different hairdresser to normal.

Can I ask a question about children and tooth brushing in the morning?

Is it better to brush the teeth before breakfast or after? The interval between eating breakfast and brushing teeth is often only 20 minutes here, so are they brushing acid around their teeth?

I've tried to get them to brush teeth shortly after getting up but then they moan about their breakfast tasting weird.

Also I get them to use disclosing tablets once a week. Is this too much/unnecessary?

Thanks.

If he's anything like me he wouldn't bat an eyelid! I genuinely believe that hygienists are the saviours of our teeth.

For an NHS practice hygiene work is very poorly remunerated; you get no recognition for the time you spend educating a patient. If you were to go and have a really good clean and get some tips on how to maintain things, I would expect him to be delighted.

Better to brush them before, they will get used to the taste. I have brushed before for a very long time and not noticed any affect on the taste of my food tbh!

You can't overdose on disclosing tablets! I think once a week is excellent, it will stop any issues building up. Particularly with children, sometimes parents don't notice the first permanent molars (or even know they are supposed to be) erupting at the very back. This is the tooth in adults that is most likely to have fillings and toothache just because we don't brush it properly when we are children so using disclosing tablets makes you much less likely to miss something like that.

High five for that!!

Thank you. The disclosing tablets work well I think esp for DS as he could see quite clearly that his left side was brushed much more thoroughly than the right. Will continue and try tooth brushing on rising.