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Oh no, a sore tooth, a broken tooth, or a wobbly tooth? There are many reasons for visiting the dentist and dental emergencies are one of the most common appointments made. We often are faced with the hard decision of whether or not we should remove a tooth or save it. This decision can be difficult at times as we factor finances, time, or pain. Our goal at True Smiles Dental is to assess the situation and determine what treatment options are best for you and your tooth. Often, the pain from a toothache can dictate our decision making and we turn to tooth extraction as a quick solution in alleviating the said pain. An understanding of the situation and the possible solutions have allowed our team to save many teeth which would otherwise have been extracted.

We’ve listed some of the common issues that arise where patients aren’t sure whether they should save their tooth or not. These issues may arise and cause us discomfort or pain, and once assessed, we are faced with the decision of saving or removing the tooth.

1. Root Canal or Not?

Often, a tooth ache can cause excruciating pain, a throbbing pain that lasts all day and night, it disrupts your sleep and pain killers are not effective. Such pain most likely indicates a tooth that may require root canal therapy. Root canal therapy is an effective way to save your tooth and rid you of the pain you are experiencing. The nerve that lives inside your tooth tells you whether something is hot or cold and when bacteria from tooth decay digs deep enough and encounters the nerve, pain ensues. The pain often dictates our decision and its not uncommon for patients to request the tooth to be removed.

Removing the tooth is an option, but is it the best option? Root canal therapy has been well documented as a viable treatment option for saving teeth. Unfortunately, not every tooth can be saved and after careful examination, the team at True Smiles Dental can ascertain whether your tooth can be saved.

2. My tooth is mobile?
Increased mobility in a tooth can be a result of periodontal disease or a large infection. Many patients believe that a tooth that is moving needs to be removed. In certain situations, this may be true, but with the correct treatment, it is very possible to improve the mobility of the tooth and save the tooth in question. We may need to start periodontal treatment, root canal therapy, or a combination. Mobile teeth are generally trickier to save, but not impossible, with careful investigation and the right approach, we can make the impossible possible.

It is very important to seek advice from your dentist to aid in making the important decision of saving or removing a tooth. At True Smiles Dental, we employ the latest x-ray technology to assess your teeth and make the most accurate diagnosis for you. This allows us to confidently tell you what the problem is and how we can address your issue.

Some factors we take in to consideration when assessing if a tooth can be saved or not:

– How big is the hole or cavity?

o Some teeth are heavily decayed and unfortunately have lost far too much tooth structure for long term success. Even with root canal therapy, the pain may improve, but the underlying issue of a large cavity in the tooth may deem the tooth hopeless. Unfortunately, such teeth would require extraction despite our best intentions. Thankfully, most teeth with cavities can be restored. And so, treating the tooth with root canal therapy and the placement of a crown on completion should allow us to save your tooth!

– Is the tooth functional?

o Is your tooth utilized in biting and chewing? This determines if a tooth is ‘functional’, and plays a large role when deciding what to do with your tooth. If the tooth of concern does not serve a purpose in normal mastication. Then often, we may consider removing the tooth as opposed to saving it.

– Mobility of the tooth?

o Teeth can often become mobile due to a large infection or because of periodontal disease. These situations are challenging and commonly lead to extraction due to difficulties in saving the tooth. However, if you are willing to try and save the tooth. Treating a mobile tooth with root canal therapy can often save the tooth and stabilise the tooth.

– How large is the infection?

o The bacteria that colonises in the tooth from tooth decay generally spreads to the apex of the tooth root. Some infections can be quite large and weaken the surrounding bone that holds your tooth in place. The extent of the infection can be seen in x-rays and often dictate the success of treatment.
Reasons for saving your tooth

We’ve listed the many reasons for when we need to make that important decision of saving your tooth, but it is just as crucial to address some important points as to why we should save your tooth.

– Preventing migration of teeth

o Teeth tend to tip or migrate forward as we age. Removal of a tooth allows for teeth neighbouring to start to move or tip over. Teeth that sit adjacent to the offending tooth can tip into the space of the to-be extracted tooth which can lead to issues with biting, food trapping, tooth decay, and periodontal disease.
o Overeruption of opposing teeth can occur after the removal of a tooth. The opposing tooth (the tooth that comes into contact when biting) can start to over-erupt – meaning the tooth can start to come down or up further than its neighbouring teeth. Since there is no longer a tooth to bite on, the opposing tooth tends to move upward/downward. This can lead to cheek biting, food trapping, along with tooth decay or periodontal disease. Consequently, with time, the opposing tooth may need to be removed also.

– Loss of facial height

o Did you know that your teeth dictate the height of your face? Losing multiple back teeth can lead to a reduction in your facial height. This tends to make one look older than they are.
– Eating and chewing
o Loss of teeth will ultimately change the way we bite. Believe it or not, but every tooth serves a purpose when we eat and chew. Your incisors are for biting into food, your canines are for tearing apart food, premolars and molars are for tearing, grinding, and crushing food. Loss of one or more teeth will affect how we eat or chew going forwards.

– Increased risk of fracture/damage to remaining teeth

o When teeth are taken out, the remaining teeth will have to undergo further stresses due to the reduced support from the extracted tooth. If your existing teeth have large fillings, then it is very common for issues to arise after the removal of a tooth. The increased pressure, and reliance of the remaining teeth increase their risk of issues that can develop.

– Keeping your own natural teeth

o Your natural teeth are exceptionally strong and outperforms any dental filling. The natural feel of your tooth is also important, and many patients prefer to keep their teeth to maintain this sensation.
– Cost saving
o Removal of a tooth may seem like the easier option at times. But replacement of a missing tooth can be costly and more time consuming than trying to save the tooth.

Reasons for removing your tooth

At True Smiles Dental, we feel your teeth are very important and we do our utmost to save your natural tooth where possible. Unfortunately, not every tooth can be saved, and tooth extraction may be the only option. Below are a few examples of teeth that can’t be saved and require extraction:

– Cracked tooth

o A cracked tooth is one of the most commons reasons for tooth extraction. A split in the tooth can travel toward the gum or into the roots of the tooth. We call this a vertical root fracture, and to prevent the harboring of bacteria and infection, unfortunately, the best solution is extraction.

– Severe periodontal disease

o Periodontal disease if left untreated, can result in tooth pain, tooth mobility and infection. When severe enough, treatment would provide no benefit and to prevent further damage to surrounding structures, tooth extraction is recommended.

The removal of a tooth is a multifactorial decision, and each situation is unique. We’ve listed the common reasons for saving a tooth and when to pull the tooth out. To aid your decision, the team at True Smiles Dental can make a thorough assessment of the tooth and consider all factors to help you make the right choice. It is our goal to ensure everyone understands the rationale behind the treatment and we strive to make it as pain free as possible. Reach out to us at (02) 7228 7272 or book online at https://truesmilesdental.com.au

There can be a lot going on inside your mouth, a lot of which is not always visible to the naked eye. During your routine dental examination appointments, your dental practitioner may recommend to take dental x-rays to have a better idea of what is happening overall.

Dental x-rays, also known as radiographs are pictures of your teeth that can provide valuable information about the inner layers of your teeth and its surrounding structures.

Depending on the type of x-ray, these radiographs can provide an array of information including:

• – Presence of decay (cavities) including small areas of early decay in between teeth not visible during clinical examinations
• – Size and proximity of decay to the nerve of the tooth
• – Integrity of existing fillings, root canal treatment, implants as well as old crown and bridgework
• – Existing bone levels and areas of bone loss
• – Presence of interdental subgingival calculus (build-up of tartar underneath your gums)
• – Presence of tooth infection or dental abscesses
• – Injuries to the teeth or jaws
• – Presence of extra teeth or absence of missing teeth
• – Dental cysts and tumours in the jaw bone
• – Show problems of tooth/root fractures and bone fractures
• – Number of teeth present including the presence of wisdom teeth and whether they are in the right orientation
• – Proximity of roots to the sinuses and presence of sinus infection
• – Temporo-mandibular joint (TMJ) abnormalities
• – Amount of bone needed for dental implants

Why do dental x-rays need to be taken?

Even if you attend regular dental check-ups every 6-12 months, clinical examinations are not enough. This is because your dentist or oral health therapist is unable to see every nook and cranny of your teeth, particularly the spaces in between or underneath any old fillings (we wish we had x-ray vision!). Therefore, without routine dental x-rays it can be hard to say with 100% certainty that there are no areas of concern.

Thanks to advancements in technology, dental x-rays are safe and take almost no time at all to take (literally a few seconds). Routine radiographs are therefore excellent diagnostic tools to help us see things before they become a problem. Early detection of dental problems such as dental decay allows for far better outcomes. This could include:

• – Preventing smaller areas of decay from growing: not all carious lesions need to be drilled and filled. By detecting early signs of decay in between your teeth, we are able to recommend preventative options including switching to a stronger fluoride toothpaste or incorporating fluoride treatments to strengthen those areas.
• – Smaller fillings: Smaller fillings often means that less tooth structure is removed in the process. This can result in a longer-lasting filling and less need for replacement or re-treatment in the future. Larger, more complex fillings have shown to have a higher rate of failure and risk of requiring further treatment in the future.
• Treating the decay before it reaches the nerve of the tooth: By the time you can feel or see a hole with the naked eye, it often means that a simple filing may not be enough. Dental decay that is identified too late often ends up needing root canal treatment or extraction. This can be time consuming and a burden financially.

Are they dental x-rays safe?

Dental x-rays are safe for children as well as adults of all ages. Of course, as with any x-ray, there is a small amount of radiation. The amount of radiation involved is extremely low and is equivalent to the sort of exposure you’d receive spending 30 minutes in the sun or on a 1–2-hour flight (depending on the x-ray). This means that even if you’re pregnant you can have x-rays taken (although they are generally kept to a minimum during this period)

Although dental x-rays are important diagnostic tools, it is important to note that they are not taken at every appointment. The decision to take a dental x-ray, and the type of X-ray taken, will be influenced by factors such as your past and present oral health. A clinical examination of your mouth, age, and disease risk influence whether we should take x-rays or not.

What are the different types of dental x-rays?

Bitewings

Bitewing radiographs are extremely useful in detecting cavities or decay in between the back teeth. This is because your back teeth are normally more at risk of developing cavities. These radiographs do not show the whole tooth structure because they are aimed at providing information about the spaces in between our teeth. Bitewing x-rays can also highlight any problems underneath existing dental fillings and areas of heavy plaque deposits (calculus or tartar) under the gums.

Periapical (PA)

Periapical x-rays are often taken to look at the whole length of specific isolated teeth. They can help identify signs of decay, infection at the root (abscesses), bony defects and crown or root fractures. Due to the nature of periapical x-rays only showing specific teeth, they are often taken at emergency appointments to have a closer look at the problem area.

OPG

Orthopantomograph’s (or OPG for short) are radiographs that look at the whole jaw and are most commonly taken to assess for the presence of wisdom teeth and whether they need to be removed. The proximity of the roots of your wisdom teeth to the nerve structures that run through the lower jaw (inferior-alveolar nerve) is another important assessment that is considered when looking at wisdom teeth removal.

OPG’s also provide a lot of information about the anatomy of both the upper and lower jaw bones and are used to assess the health of the bone surrounding the teeth. OPG’s are therefore very useful for patients who have periodontal disease.

They can also be taken for children to assess overall development and identify whether a child has the correct number of developing teeth. The presence of extra teeth or absence of teeth is common and can dictate whether a child may need to see an orthodontist later in life. At True Smiles Dental, OPG’s also allow us to assess the nasal region and whether a child may be susceptible to sleep and airway issues.

OPG’s are also important diagnostic tools to assess for the presence of any dental cysts and tumours. Although rare, jaw bone abnormalities do occur and routine OPG’s can help to save a life.

Do children need dental x-rays and are they safe?

Yes! Dental x-rays are safe for children. At True Smiles Dental, we will often recommend radiographs for children for specific reasons. The most common reason dental x-rays are taken for children are to assess for the presence of dental decay in between the teeth.

Australian data has shown that 1 in every 3 children under the age of 6 will have at least one decayed tooth. By assessing for the presence of any areas of decay (big or small) at a young age, we can ensure that we take the right steps toward preventing a life time of problems. Studies have shown that children who develop dental decay at a young age are more likely to develop decay on their permanent teeth.

The second most common reason dental x-rays are taken for children are to assess for the presence of impacted, extra or missing teeth and to ensure that their dental development is on track.

At True Smiles Dental, the team are thoroughly trained in taking dental x-rays for children of all ages. We will of course ensure that your child is comfortable enough to take a dental x-ray before proceeding. Taking a good image is just as important as the reason we need to take them.

How often do dental x-rays need to be taken?

It is important to note that dental x-rays do not need to be taken at every appointment. Depending on the type of radiograph required, how often you need to take x-rays is dependent on varying risk factors. For example, someone who is more at risk of developing dental decay (cavities) may need to take x-rays more regularly (every 6-12 months) compared to someone who is at lower risk of decay (every 18-24 months).

Factors that can determine your risk include oral hygiene habits, oral environment and salivary flow, diet, lifestyle factors or medication and medical history.

What happens during a dental x-ray?

At True Smiles Dental in Marrickville, we have the most up to date, state of the art technology to be able to take a majority of the most commonly required radiographs in-house within seconds to minutes. And the best part – images are displayed onto the computer screen shortly after so that we can go through them with you instantly in your appointment.

If you think you might be due for dental x-rays or would like to know more about them, ask the friendly team at True Smiles Dental at your next dental check-up. Call us on (02) 7228 7272 or visit us at 235 Marrickville Road, Marrickville NSW 2204.

Historically the only method of correcting ones crowding, cross bite, deep bite, or underbite would require traditional orthodontic braces. They were the metal bars that you commonly saw on kids’ teeth at school during their teenage years. Fast forward to the present and the advancements of technology and understanding of tooth movements have introduced a new era of orthodontic correction, Invisalign – a popular option for patients that wish to correct their smile without the metal look on their teeth. Invisalign has fast become a popular treatment choice as it provides a great solution for both adults and teens without the cumbersome appearance of conventional braces.

Braces have long been used by general dentists and specialist orthodontists to correct smiles. They have corrected millions of smiles and still have a rightful place in Orthodontics. One of the biggest nuisances of conventional braces is that they are stuck onto your teeth, which can lead to various issues that many patients need to consider. We’ve listed a few issues that may arise from conventional braces:

• Appearance
  • – Not everyone will happily want metal braces on their teeth that will stay with them for the duration of their treatment, on average 18-24 months.
  • – For this reason, adult braces are not a popular option amongst growing teens and adults.
• Difficulties with oral hygiene
  • – With braces, the metal brackets are adhered to the tooth. This means our oral hygiene needs to be at its best. Conventional flossing can become challenging. Therefore, you may need to use alternative cleaning tools such as superfloss or piksters to help remove plaque and food debris from in-between your teeth.
  • – All the metal appliances fixed to your teeth unfortunately increases the risk of food trapping. This results in more effort when it comes to brushing and flossing, and sequentially, an increased in the amount of time you have to spend in the bathroom cleaning your teeth.
• Risk of decay and periodontal disease
  • – Without the right oral hygiene protocols in place, there is a higher risk of dental decay and periodontal disease associated with braces. Fortunately, this does not occur frequently, but it is something to consider before embarking on your orthodontic journey. A careful assessment of your teeth is highly recommended to identify any issues early on so we can address them immediately.
• Mouth ulcerations
  • – Metal braces and wires fixated on your teeth can rub against your cheek and in some instances, may cut them when they are first put on. This can lead to mouth ulcerations and difficulties in eating and talking for a couple of weeks. Fortunately, this resolves quickly, and the use of orthodontic wax during treatment can aid in the prevention oral ulcerations.

It may seem that the above reasons are good enough to avoid conventional braces. Thankfully, the concerns listed above can be easily managed. One of the issues, the metal colour, have been solved by the introduction of ceramic braces. Ceramic braces are like your conventional metal braces, but instead of metal, the brackets are ceramic in colour. Ceramic brackets blend in with your teeth shade better and can improve the overall look when you smile during orthodontic treatment. Likewise with metal braces, they still result in difficulties with oral hygiene and increased risks of decay and periodontal disease.

For patients that wish to have braces but not have anything show when they smile, technology has created ‘lingual braces’. These are also known as ‘inside braces’, which are popular with patients that don’t want anything to appear on the front surface of their teeth. Although they are more subtle in appearance, they are just like braces and so one should maintain the strictest of oral hygiene regime during treatment. Lingual braces may be quite appealing due to their discreet nature, but they can affect your speech more so than conventional braces. As the lingual braces sit on the inside of your teeth, they are in direct contact with your tongue. This can lead to changes in speech, which will eventually improve with time. Tongue trauma is also common with lingual braces.

The introduction of Invisalign has allowed patients the opportunity to correct their smile and improve their bite without the need of metal braces affixed to your teeth. This has become increasing popular as teens and adults seek an improved smile without the look of metal braces. Invisalign’s discreet aligners gradually correct your teeth with reduced risks associated with conventional braces. Some of the benefits of choosing Invisalign include:

• Discreet appeal
  • – Invisalign are ‘clear’ aligners which are ideal for patients that don’t want the metal look on their teeth. This is increasingly popular for both teens and adults.
  • – Invisalign aligners can be quite difficult to recognise when they are in your mouth. In comparison to metal braces, this is one of the main reasons people choose Invisalign.
• Ability to remove them for meals and oral hygiene
  • – An incredible advantage of Invisalign is the ability to remove them for meals and oral hygiene. This allows patients to eat freely without the risk of food trapping, thus, reducing their risk of decay and periodontal disease. Furthermore, patients can brush and floss with no challenges.
• Less impact on speech
  • – Invisalign aren’t as bulky as conventional braces, and so your speech won’t be as affected. Naturally, when something new is placed in your mouth, your speech may change in the short term. Thankfully, your speech adjusts quite quickly with Invisalign due to their slimmer nature.
    
    

Some things to consider with Invisalign include:

• – Although it is seen as an advantage, there is the associated disadvantage of being able to remove your Invisalign aligners. The ability to freely remove them at the patient’s discretion, leaves much of the treatment success up to the patients’ compliance. Orthodontic correction requires constant pressure for movements to successfully be achieved. Removing your aligners removes these pressures and will undoubtedly delay treatment or in some cases, lead to failure due to lack of wear. We recommend patients wear their aligners 20 to 22 hours a day for the best results. Each aligner gradually shifts your teeth into place, and it is imperative that patients follow the strict protocols when it comes to wearing their aligners. It is always best to follow your dentist’s advice. Failure to do so may lead to unsuccessful orthodontic treatment and subsequently a costly lesson if treatment needs to start again due to lack of compliance. Conventional braces do not have this issue as they are affixed to your teeth, so whether we like it or not, they are there to stay until your orthodontic journey is complete. It isn’t uncommon for patients to remove their aligners when starting due to ‘discomfort’ or ‘pain’, such experiences are common at the early stages of treatment, and quickly subside within the first week or two.
• – Increased risk of staining of teeth can occur during treatment. Coloured food and drinks can lead to an increased attraction of staining of your teeth, aligner and attachments. This is often very difficult to remove and can become quite noticeable. It is best to avoid certain food and drinks whilst receiving Invisalign treatment to prevent this from occurring. Tea, coffee, red wine and saucey meals are the biggest culprits when it comes to staining. If you love any of the above list, then we recommend an increased water intake shortly after consumption.

No one treatment is better than the other. Depending on the amount of crowding, spacing, or bite, the treatment recommendations may differ. Technology has allowed us to correct smiles through a variety of means, and in some cases, a combination may be implemented. Once all options have been carefully explained and discussed, we can help you achieve that perfect smile. Whether your teeth are best suited for conventional braces or Invisalign, our goal is to ensure the best result for you and your teeth. Every case is different and treatment goals should consider your needs as the patient, and careful consideration of what treatment modality would be most successful. In some cases, a referral to an Orthodontist may be required due to the complexities involved. The team at True Smiles Dental assess your teeth regularly during your routine checkups. This allows us to identify possible issues, and suggest a timeframe for intervention. This is particularly important for growing children as orthodontic intervention can start in their early mixed dentition.

We’ve listed several reasons where conventional braces and Invisalign may benefit you to help give patients a better understanding of both treatment modalities. At True Smiles Dental, we strive to accurately assess your teeth and aid in guiding you to the best treatment option. Results are important and so both options should always be considered when it comes to achieving that perfect smile. The team at True Smiles Dental can help assist you on your teeth straightening journey. Call us on 02 7228 7272 or book online at https://truesmilesdental.com.au

If you want to know more about your oral health, how to clean your teeth or what’s good for your teeth and gums, there are no better people to ask than your local Marrickville Dentist or Oral health therapist at True Smiles Dental.
Every day we get asked questions about product recommendations or technique advice. So, we’ve round up a few of the most commonly asked questions and compiled them into one place for your convenience.

1. Is an electric toothbrush or manual toothbrush better?

Unfortunately, there is no clear-cut answer to this. Studies show that there is no significant difference between using an electric or manual toothbrush. Therefore, the technique of how you brush and floss is more important that the type of toothbrush you use.

However, there can be many reasons as to why an electric toothbrush may be more beneficial for you.

– Brushing too hard: Many patients believe that the harder they brush, the cleaner their teeth will be. Sadly, this can be incorrect on many levels as brushing too hard can actually have the opposite effect and cause varying degrees of damage to your teeth and gums. This can result in gingival recession, toothbrush abrasion and increased sensitivity. In these circumstances, switching to an electric toothbrush with a pressure sensor, can be helpful with pressure control. The team at True Smiles Dental recommend only switching to an electric toothbrush if it has a pressure on it and once you have learnt to use it correctly – you should aim to allow the electric toothbrush to do all the work for you and not use it like a manual toothbrush

– Motivation: electric toothbrushes for children can be great for on-going motivation. We understand that children may get bored of brushing, so electric toothbrushes can make it fun and exciting. Some children’s electric toothbrushes come with timers, music and flashing lights to help make brushing more fun and interactive.

– Limited dexterity: electric toothbrushes can be great for patients with limited mobility and arthritis as its power rotation does not require manual movements – it will do all the work for them. Ease of use is perfect for those with dexterity issues, thus improving oral hygiene.

2. Should I brush my teeth before or after breakfast?

Always brush before breakfast and rinse after. Brushing before breakfast allows you to protect your teeth before eating with the fluoride in your toothpaste. Brushing straight after breakfast or eating in general can lead to dental erosion. If you have the time in the morning, we recommend to normally wait at least 30 minutes after eating and drinking before brushing your teeth.

If you want to cleanse your mouth after eating, we recommend to rinse your mouth and then chew on some sugar free chewing gum. Chewing gum can help to stimulate saliva which in turn help with clearing food and debris from your teeth. In addition to this, sugar-free chewing gum with Xyitol specifically, is beneficial as it is good for decay prevention. Xylitol is a naturally occurring sweetener that tastes like sugar, but is actually good for your teeth! It can help to kill the bacteria responsible for dental decay by up to 90% and helps to neutralise plaque acids, making it harder for plaque to stick to your teeth in the future.

3. Should I use a mouthwash?

Mouthwashes can be great in certain circumstances but regular mouth rinses don’t provide a whole lot of benefit.

If you want to incorporate a mouth rinse into your regime, we recommend to use it prior to brushing and waiting at least 30 minutes before brushing. This is because using a mouth rinse after brushing can be counter-intuitive in that it will wash away the fluoride protection you’ve just applied when brushing. We also recommend to select a mouth rinse that is non-alcohol base, as alcohol ingredients can dry out your mouth. A dry mouth is known to increase your risk of tooth decay – something we are trying to prevent!

Occasionally, your Marrickville dental professional may recommend a specific mouth rinse to aid in decay prevention (for higher risk patients or patients undergoing orthodontic treatment) or gum disease.

For example: Mouth wash such as Colgate Neutrafluor 200 or 900 have additional fluoride whereas Savacol or Curasept contain a chlorhexidine ingredient which can be anti-inflammatory to aid in controlling gum infections and inflammation.

It is important to note that mouth washes with additional properties such as those listed above should only be used under the guidance of a dental professional. Long term use of certain mouthwashes can lead to issues in the future. Speak to the team at True Smiles Dental today to find out if incorporating a mouth wash is right for you.

4. What’s the best toothpaste to use?

We recommend using a fluoride toothpaste to help strengthen your teeth and prevent cavities. Fluoride is a natural mineral found in the earth’s core which is scientifically proven to prevent tooth decay or cavities.

If you suffer from sensitive teeth, opting for a sensitive formula toothpaste can definitely help minimize the symptoms of sensitivity. Dental sensitivity can however, be caused by a number of reasons, so it’s important to visit your dentist to assess the cause before investing in sensitive toothpaste. Check out our previous blog on dental sensitivity if you want to know more.

The use of toothpaste for children is completely safe provided we use an age-appropriate fluoride toothpaste for children aged 2-6 years old. Once your child has started to develop adult permanent teeth (usually after the age of 6), it is OK to switch to an adult-strength fluoride toothpaste. Children younger than 2 years old are OK to use non-fluoridated toothpaste if they are unable to spit after brushing.

No matter the brand, always ensure your toothpaste is approved by the TGA (Therapeutic goods administration) and ADA (Australian Dental Association). This is because they have been tested and proven medically to be safe and effective.

5. Is there any toothpaste we don’t recommend?

On the opposite spectrum, we do not recommend using a toothpaste without fluoride where possible. This is because it can increase your risk of dental decay and the need for further dental treatment.

In addition to this, we do not favour whitening toothpaste. This is because they do not work well and can be more abrasive to your enamel in the long term which can result in increased dental sensitivity and other problems. Similarly charcoal toothpastes have no scientific evidence on their effectiveness to whiten teeth or remove stains and are considered more abrasive than regular toothpaste.

6. Do I need to floss and what can I use? Are waterflossers better?

Yes! Brushing your teeth alone will only clean approximately 60% of all teeth surfaces. The remaining 40% of teeth surfaces in between your teeth cannot be fully reached with a toothbrush alone. That is why flossing or cleaning interdentally daily is just as important in the prevention of tooth decay and gum disease.

So what products are available to clean in between your teeth? There is an array of options when shopping for dental cleaning tools. Floss and interdental brushes are the gold standard in most cases as they manually ‘disrupt’ the plaque that can wedge themselves in between your teeth.

Water flossers can be a good alternative for those who have prosthetic dental work (including crowns, bridges and dental implants) however for individuals with natural teeth, we recommend regular conventional floss or interdental brushes! Ask us at True Smiles Dental which interdental cleaning tool might be right for you.

7. Is teeth whitening Safe and what is the best way to whiten my teeth?

Yes, teeth whitening is safe when done correctly. We recommend to speak to a dental professional about any teeth whitening concerns to see what may work best for you. As there are different reasons for why your teeth may be discoloured. It is important to identify if whitening will be enough. Unfortunately, over the counter products such as the above-mentioned whitening toothpaste or charcoal toothpaste can be more abrasive to the tooth enamel resulting in the underlying dentine shining through. Funnily enough, this secondary layer of your tooth is actually yellow in colour which results in the opposite effect of brightening your smile.

Professional whitening under the guidance of a dental professional will allow you to achieve better, more realistic results. See our blog on teeth whitening for more information.

8. How often should I visit the dentist?

It is important to have your teeth checked and clean at least twice a year. Regular dental visits allow us to screen for early signs of dental decay, gum disease or even oral cancers. Unfortunately brushing and flossing alone is not enough to completely avoid these problems. There are often areas that can be missed despite our brushing and flossing efforts. Regular check up and cleans allow us to clean these areas up for you.

Is it time for your next dental check-up? Visit the friendly team at True Smiles Dental at 235 Marrickville Road, Marrickville NSW 2204 or call us on (02) 7228 7272.

If you suffer from bleeding gums, then you may not be alone. Bleeding gums is one of the most common concerns from our patients, so much that some think it’s normal as they have been experiencing it all their lives.

It might be easy to ignore and overlook bleeding gums and think it is harmless, when in reality – if we ignore this early warning sign, we could end up losing our teeth. Healthy gums are needed to support healthy teeth and so bleeding gums is often the first sign of an unhealthy oral environment and should be tended to.

But what causes it? Bleeding gums can be due to a variety of reasons. Here are the 6 most common causes for why your gums may be bleeding:

1. Gum disease or gingivitis

The number one cause for bleeding gums is gum disease, which is essentially an inflammation of your gums. This inflammation is commonly caused by the plaque and bacteria that sticks to your teeth. If we don’t brush adequately or floss for a while, plaque can build up on the uncleaned tooth structure and as the bacteria multiplies, it can cause irritation to your gums.

Gingivitis is the first stage of gum disease, and the most common symptoms can include bleeding gums, gum tenderness, or sensitivity, gum swelling or bad breath.

Fortunately, gingivitis is reversible. Improvements in oral hygiene and home care can help to resolve symptoms when they appear, but a professional clean to remove the harder deposits are often needed to fully revert the gums back to a healthier state.

If left untreated, gingivitis can progress into a more advanced form known as periodontal disease. At this stage, the bone surrounding the teeth can start to deteriorate. This bone loss is irreversible and can weaken the support of the teeth and eventual loss of the teeth. People with chronic periodontitis often require regular and ongoing professional dental treatment to prevent the disease from progressing.

Gum disease and periodontal disease both have systemic links to other health conditions including heart disease and diabetes.

At True Smiles Dental, your dentist or oral health therapist will always check the health of your gums by doing a periodontal screening as part of your check-up prior to your dental cleaning. This periodontal assessment is conducted using a periodontal probe which measures the pockets between your gum and your tooth as well any clinical signs of disease. This helps with determining your risk category for gum disease and is used to place you on a regular 3-, 4- or 6-month recall system accordingly. This is the time frame in which you should return for another dental cleaning to ensure your gum health is in tip-top condition.

2. Medications

The most commonly prescribed medications that may result in bleeding gums can include blood thinners, anti-depressants or blood pressure medications. If you have started a new medication and have since noticed bleeding gums, talk to your dentist or doctor about the new medication to see if it could be causing your bleeding gums. This can be important as your dental professional can help to put together an oral health regime which can be gentler on your gums.

3. Pregnancy

Your teeth and gums can also be affected by a pregnancy, just like other areas of your body. During pregnancy, the changing hormones can cause women to be more susceptible to developing gingivitis. As discussed above, gingivitis is the early stage of gum disease and commonly causes bleeding gums. If you’re pregnant and suffering from bleeding gums, it is important to talk to a dental professional about incorporating additional steps to your dental hygiene routine to protect yourself from gum disease.

4. Just started flossing/change in oral hygiene products

Not flossing enough? Surprisingly, brushing your teeth only cleans approximately about 60% of tooth surfaces. This means that about 40% of your daily plaque accumulation remains in between the teeth – which increases by the day the more we forget to floss. This plaque results in gum inflammation, which when disturbed with the floss results in bleeding.

The use of a hard or medium bristle brush can also result in irritation to our gums and can cause more damage than good. Leave those hard/medium bristle brushes for cleaning the floors and stick to a soft bristle brush to protect your gums.

5. Underlying health conditions

Bleeding gums are a common symptom of type 1 or type 2 diabetes. Patients with diabetes often have a harder time fighting off infections. This can include infections in the mouth like gum disease. Because of this, gum disease in diabetic patients can easily get out of control and progress much faster than in individuals without diabetes. If you have diabetes and bleeding gums, it’s important to notify your dental professional so they can evaluate your gum health and create an oral health plan for you.

Other medical conditions which can increase your risk of gum disease include osteoporosis and cardiovascular disease.

6. Unhealthy diet or lifestyle

Individuals with a higher intake of sugar and carbohydrates can have an increased risk of gingivitis as sugar creates the perfect conditions to encourage increased plaque accumulation. Increased plaque scores result to readily irritated and inflamed soft tissues, which can result in bleeding gums.

Studies have also shown that a deficiency in vitamin C and other minerals may lead to bleeding gums.

What can you do to stop your gums from bleeding at home?

As previously mentioned, the number one cause for bleeding gums is inadequate oral hygiene and plaque being left behind on our teeth. So going back to basics to improve your oral hygiene regime can definitely help with improving the symptoms of gingivitis at home.

Tips for brushing and flossing

• – Using a soft bristle brush, start in one quadrant of your mouth with the bristles aimed at a 45-degree angle towards the gum line.
• – Treat brushing the gum line like a massage, working in a circular motion. Avoid scrubbing as much as possible as this can run the risk of damaging the gum, causing them to recede.
• – Aim to brush for at least 2 minutes, twice daily – morning and night.
• – The most common tool to clean in between the teeth is dental floss. If this doesn’t work well for you, try flossette picks or interdental brushes!

A big reminder is to not be afraid if you see bleeding when you brush or floss. This is often a sign that there are bacteria in the area and needs to be cleaned out thoroughly. Studies have shown that the use of an electric toothbrush has been found to be more effective than a manual brush at removing plaque. To find out which electric toothbrush might be right for you, speak to the friendly team at True Smiles Dental.

Will cleaning my teeth at home be enough? 

If your gums continue to bleed after brushing or flossing, it may be time to visit your dentist or oral health therapist for a thorough professional dental cleaning. Soft plaque can be controlled and removed at home, however, once it calcifies onto the tooth surface, it needs to be professionally and safely removed with our special dental instruments.

Is it normal for my gums to bleed during a dental clean appointment?

If your gums are exhibiting signs of inflammation or there is some notable plaque or tartar build up on your teeth, it can be normal to see some bleeding during your dental cleaning. Once your teeth have been professionally cleaned, your dentist or oral health therapist will run through how to clean your teeth properly at home to ensure that your gum health improves. This can include a mixture of brushing technique, interdental cleaning, specific toothpastes to use and perhaps mouthwash (as directed). Improvements in your gum health may take up to 1-2 weeks before the inflammation settles and the occasional bleeding stops.

How often should I have my teeth professionally cleaned?

For healthy, well-maintained teeth and gums, it is recommended that you visit your trusty Marrickville dentist every 6 months. If your gums need more attention, you may be told that you need to attend more frequently for professional dental cleanings. This can be every 3 or 4 months until your periodontal health is stable. During these visits the health of your gums (and teeth) will be assessed and any essential treatment or preventive options are recommended.

At True Smiles Dental, we have invested in the latest technology to ensure the most comfortable, pain-free dental cleaning services. Our EMS airflow uses a mixture of air, warm water (can be heated up to 40 degrees Celsius!) and fine powder which offers a quicker, gentler and effective teeth clean than ever before. Our ultrasonic scaler, which is used to remove hard tartar build up is also designed with a patented ‘no-pain’ technology for your comfort. To find out more, call our friendly team on (02) 7228 7272 or visit our dental clinic at 235 Marrickville Road, Marrickville NSW 2204.

Imagine this, you’ve just finished dinner and decide to head over to the fridge to grab an ice-cream as a post dinner treat. As you bite down, you feel a zap-like jolt or pain coming from one or more teeth. The pain is momentary, but it keeps re-occurring with each bite.

You then go and brush your teeth before hopping into bed, again that same ache occurs from the cold running water and the motions of brushing. Once you’ve finished brushing your teeth the discomfort and pain goes away.

What is happening? Is this normal?

Tooth sensitivity – it is extremely common and can go untreated in many individuals.

What are sensitive teeth?

Tooth sensitivity is a common name for dentine hypersensitivity and can result in a pain like sensation when the tooth is exposed to cold, hot, sweets, acidic or sour food and beverages. This pain can be mild (like a tingle) or a short and sharp pain shooting through the inside of your tooth (‘nerve pain’). The pain then dissipates as soon as the stimulus is removed.

What are some different triggers?

• – Cold air
• – Cold/hot food and beverages
• – Acidic foods and beverages
• – Sour foods and beverages
• – Brushing teeth: especially when using a medium/hard or electric toothbrush
• – Mouth wash

Why are my teeth sensitive?

In order to understand the mechanics of tooth sensitivity, it is important to understand the anatomy of our teeth.

Our teeth are made up of 3 predominant layers. This includes the:

• – Enamel: This is the hard outer layer of the tooth and covers the top portion of the tooth. The enamel is very dense, composed of a crystalline structure that protects the dentine and pulpal layers. It serves primarily as an insulating barrier that protects the tooth from physical, chemical and thermal forces. The white shiny surface that we can see in the mirror is our enamel.

Fun fact: enamel is one of the hardest substances in our body

• – Dentine: This is the second or inner layer of the tooth and makes up the majority of the tooth. The dentine is comprised of a multitude of tubules (dentine tubules) which connect from the outside of the tooth to the inside of the tooth (pulp). Dentine is generally a yellow/orange colour.
• – Pulp/nerve tissue: This is the most inner layer of the tooth and consists of the nerve tissue and blood supply. Having a nerve and blood supply means that our teeth are essentially ‘alive’ and can be subject to different sensations such as pain.The other surrounding support structures for the tooth include the gums and the underlying bone. The roots (or ‘legs’) of our teeth sit in the bone and the gums cover the bone, the top portion of the roots and a portion of the tooth enamel (only marginally).Dentine hypersensitivity

Over time, our gums can become damaged or recede as a result of age, gum disease or brushing too hard. This exposes the root surfaces of the tooth and the underlying dentinal tubules which can react when they come into contact with cold, hot, acidic, sour or physical stimuli (such as brushing or touching the tooth).It is important to note that not everyone experiences sensitivity to the same degree. Some individuals may experience a lot of sensitivity when a small amount of dentine is exposed, whereas others may not experience anything at all for the same amount.

What causes our teeth to be sensitive?

Of course, it’s not fair or expected you’d have to avoid all the good pleasures in life such as ice cream to escape sensitivity – so by understanding why our teeth are sensitive, we can work out ways to minimise the symptoms.

Tooth wear, is reasonable for the majority of tooth sensitive cases.

Here are a few reasons why your teeth might be sensitive:

1. Worn tooth enamel from brushing too hard or using a hard/medium bristle brush

Although our enamel is one of the hardest substances in our body, it can still be worn away. Remember when brushing your teeth, it is important to use a soft bristle brush and apply gentle pressure. Don’t brush your teeth like how you would scrub our pots and pans. If you’re using a scrubbing motion – you’re doing it wrong.

Some of us are actually stronger than we think, so if you find it hard to control the pressure, it may be time to consider an electric toothbrush. Technology in certain electric toothbrushes now come with pressure sensors to indicate if you are applying too much pressure on your teeth.

2. Dental erosion

Dental erosion is caused from exposure of our teeth to a highly acidic environment. This can be due to the acidic foods we consume or underlying health conditions such as reflux.

Drinking water after consuming acidic foods and beverages can help with increasing salivary flow and diluting the acidic levels in your mouth. If your dental professional has mentioned you may have dental erosion, considerations such as not brushing straight after a meal/beverage can be helpful in limiting further erosion.

3. Tooth decay/ broken teeth/ worn down fillings

Tooth decay, broken teeth or worn-down fillings can cause exposure to the inside of the tooth, which can result in sensitivity. The tooth therefore may require fillings to replace the missing tooth structure and protect the exposed dentine.

4. Gum recession

Gum recession can be a result of brushing too hard or a result of gum disease. Plaque and calculus that builds up near the gum line has the potential to push the gums down further. This exposes the underlying root surfaces which are not covered in enamel. Regular professional dental cleanings are important to remove the build-up in a timely manner before they cause damage to the gums.

5. Grinding or clenching your teeth

Grinding your teeth can cause serious wear to your teeth. This can cause your enamel to be slowly worn down over time exposing the underlying dentine. Similarly, clenching forces are also cause areas of the enamel to break off (most predominantly near the gum line). This is known as ‘abfraction’.

Treatment for clenching and grinding include construction of a custom occlusal splint (night guard) to protect your teeth from further wear or muscle relaxants in the jaw muscle.

6. Developmental Enamel defects

In some cases, some people are born with weaker enamel. Hypomineralised or hypoplastic teeth are defects in the quality and quantity of enamel respectively and one of the biggest side effects can be sensitive teeth. There are many ways to manage enamel defects, but it is always best to speak to your dental professional to determine which treatment is best.

7. Post-dental treatment sensitivity

This can be a common reason for tooth sensitivity but is usually temporary. After procedures such as large fillings, crowns or even teeth whitening, our teeth can become a little sensitive. These symptoms normally subside within a few weeks post-treatment.

Managing sensitive teeth

Sensitive teeth can often be managed at home first with symptoms resolving within a week or two. The following suggestions may help, however, it is important to speak to your dental professional to see what may work best for you.

1. Desensitising toothpaste: specific sensitive toothpaste such as Sensodyne or Colgate sensitive pro-relief have ingredients in them which can help to block and cover the exposed dentinal tubules, which can improve or in some cases eliminate teeth sensitivity.
2. Soft bristle toothbrushes: Using a soft bristle brush (and even soaking it in warm water to soften it further before brushing) can help as this is much gentler on the gums and won’t irritate them as you brush.
3. Specialised dental products: your dentist or oral health therapist may recommend specialised products such as Tooth Mousse Plus or a higher fluoride toothpaste depending on your circumstances. It is always best to speak to a dental professional before using specialised dental products to see if it is right for you
4. Fillings: If tooth sensitivity cannot be managed with at-home products, in some cases, dental fillings may be required to cover up any exposed tooth or dentinal surface.
5. Surgery: In more severe cases where the gums have dramatically receded and you are unhappy with the appearance of your smile, gum grafting may be a solution to bring back the gums.

If you are experiencing tooth sensitivity or are unsure if you are suffering from tooth sensitivity, contact the friendly team at True Smiles Dental in Marrickville to see if we can find a treatment or solution that works for you. Call us on (02) 7228 7272 or book online at www.truesmilesdental.com.au

What are dental veneers?

Dental veneers are a type of restoration that can be applied to your teeth to improve their shape, colour, or position. They are thin, tooth-like coloured in nature that are bonded to your teeth. Veneers are commonly separated into 2 categories, composite resin veneers or porcelain veneers. The term ‘dental bonding’ has often been associated with composite resin veneers. All categories follow similar protocols in improving appearance of your teeth.

There are a number of reasons for why individuals may want veneers. Patients may be unhappy with their smile, the shape of their teeth, existing fillings that have discoloured, the odd positioning of their teeth, or the colour of their teeth. This can have effects on people’s confidence, as they choose not to smile or shy away from showing their teeth during conversation or laughing.

We’ve listed a few reasons for why you may be suitable for veneers, have a read and see if any of these are relevant to you:

• Old fillings that have changed colour
  • – We’ve just come back from the dentist with our new filling, and the colour matches the tooth. But, over the years, coffee, tea, wine or smoking have started to stain the teeth and the fillings also. Now the filling no longer matches the tooth and has become quite noticeable when you smile
• The colour of your teeth
  • – You see others around you, or even those in Hollywood with amazingly white teeth and you think to yourself, I wish my teeth were that white. In come whitening products, several products later to no effect. Your teeth just refuse to whiten, all hope must be lost? Not necessarily!
• History of trauma or root canal treatment
  • – It is extremely common for patients to suffer trauma to their front teeth. This can happen at all ages and is unbelievably unfortunate. Often, treatment involves placement of a filling material or in some cases, the need for root canal treatment. In certain situations, the trauma can be so great that the tooth starts to change colour! This darkening effect of the tooth signifies a loss of vitality in the tooth, the nerve dies and causes the tooth to discolour.
• History of tooth wear or chips
  • – Clenching and grinding can go unnoticed for many years until they become apparent that your teeth ‘feel’ flatter and ‘look’ flatter. As much as would like to think that our teeth are indestructible, they can most definitely be worn down.
  • – In some cases, our front teeth can be worn down to the point where they start to feel sensitive to anything cold
• Misaligned teeth
  • – Some teeth are slightly misaligned, and braces just isn’t an option. Dental veneers can assist in correcting the position of your teeth by masking the misalignment. It is worth noting that this should be carefully discussed with your dentist first
• Discoloured teeth from a young age
  • – Teeth can often be discoloured for a variety of reasons, one specific reason may be antibiotic use at a young age, or white lesions on your teeth due to fluorosis. The colour of your teeth have been affected internally, and conventional methods prove ineffective.

If any of the above reasons relate to your teeth, then dental veneers may be an option for you. One should always consult with their dentist before considering dental veneers as there may be alternative solutions that are better suited. Although dental veneers are great, they may not be suitable for everyone.

Dental veneers are intricately crafted to your teeth to change, the shape, mask discolouration, and in some circumstances, improve the position. Most commonly, they are placed on front teeth as these are in the ‘smile zone’. They can be applied to both top and bottom front teeth. The number of veneers you may need is unique to each case.

Types of Veneers

As mentioned previously, veneers can be categorised into two types:

1. Composite veneers
   • – Composite resin veneers are made from the same filling material we use for dental restorations. They are a less expensive option and can provide great results for those looking for a quick fix.
   • – Composite veneers are often placed over the tooth of your teeth, and are advantageous over porcelain veneers as they are less destructive to the natural tooth structure. However, this can often make the teeth feel bulkier, which can sometimes change the way we speak. Overtime, the mouth does adjust and your speech will improve.
   • – Composite veneers have the advantage of being able to be repaired. In the even they chip or fracture, your dentist might be able to restore these issues.
   • – The disadvantages of composite resin veneers are that they aren’t as strong as porcelain veneers, and are more prone to discolouration overtime. The margins of your veneers may become more apparent over time as they attract stains. Sometimes, a quick polish from your dentist and resolve this issue.
   • – Composite resin veneers are a great option for those looking for a safe, non-destructive, and inexpensive way of improving your smile.
2. Porcelain veneers
   • – The most common type of veneer are porcelain veneers. They are considered the best type of material for replicating the natural shade of healthy teeth, and are highly resistant to staining.
   • – In most cases, in order to achieve the most desirable results, your tooth may require some preparation. Approximately 0.5mm of the top layer of the tooth is removed to may space for the porcelain veneer. This ensures strength in the veneer and that your veneers feel as natural as possible. In some cases, it is possible to perform a ‘no preparation’ veneer method, where no tooth structure is removed. Again, similar to composite resin veneers, thickness of your teeth and speech may be affected.
   • – Preparation of the tooth does mean that we have to remove a small layer of your tooth, this may not always be something patients want.
   • – Unlike composite resin veneers, porcelain veneers are stain-resistant and do not change colour with age. It is important to select the correct shade/colour with your dentist prior to starting any veneer work. Whitening your teeth prior to starting is always recommended, as whitening in the future will not change the colour of your porcelain veneers
   • – Although porcelain veneers are far stronger than composite veneers, they are not immune to chipping. Unfortunately, it is almost impossible to repair a chipped veneer. And so, repair would involve the removal of the veneer and replacement with a new veneer.
   • – Furthermore, if patients tend to grind in their sleep, then it is imperative that patients have a splint constructed to protect their veneers from chipping or fracture. This is applicable to both composite resin and porcelain veneers.

How long do veneers last?

The age-old question as to how long anything will last. We strive to have things last for a long as possible, but the reality is, if we take good care of our teeth or veneers, they should last up to 10 years or more. Everyone is different, and we each put our veneers under different stresses, so mileage will vary from individual to individual.

In general, porcelain veneers tend to last longer as they are stronger and are more compatible with the gums leading to less gum disease. Not to say that composite resin veneers aren’t as good, if they are done well, composite resin veneers can last just if porcelain veneers.

How do I take care of my veneers?

So, we’ve just completed our veneers and we wish to establish the best practices for longevity. Like our natural teeth, we should be flossing and brushing regularly. Treat your veneers like they are your own teeth. In some cases, it is recommended to wear a night guard, also known as an occlusal splint. Many people are shocked to hear when they are told that they clench and grind during their sleep. This can be disastrous to our lovely veneers and inadvertently cause chips or fractures. Your dentist will be able to recognise the signs of clenching and grinding prior to starting any veneer treatment. Occlusal splints are constructed shortly after insertion of dental veneers, they aid to protect your veneers from chipping and fractures during your sleep.

Lastly, we recommend patients avoid eating and biting on anything that would be deemed too hard. Often patients find themselves biting through shells, nuts, or even using their teeth as can openers. If there is an intended tool for such practices, it’s best to leave it up to the tools themselves and not through the convenience of your teeth.

At True Smiles Dental Marrickville, we understand everyone is different and their needs may vary depending on the circumstances. Through careful analysis, our experienced team at True Smiles Dental can help you decide what options are best and what would achieve the best results. Feel free to contact one of our lovely staff members to assist you should you have any further questions. We offer FREE cosmetic consultations at True Smiles Dental Marrickville. Call (02) 7228 7272 or book online at www.truesmilesdental.com.au

Historically, tooth cavities causing people pain would normally be extracted. However without anaesthetic agents, the tooth extraction would be done without anaesthetic! Along came dental amalgams – a solution to fixing those nasty painful holes in people’s teeth and a way to reduce the need for extractions. Amalgams have been around for centuries and were one of the first materials used to fill people’s teeth. Dental amalgams are an alloy, meaning they are a mixture of metals consisting of various quantities of zinc, mercury, tin and copper, which when mixed together, form a very hard, stable and safe material that can withstand the test of the time.

Dental amalgams provide excellent strength, durability, self-sealing properties and antibacterial benefits. For these reasons, they were widely used for the restoration of decayed teeth, and can still be the preferred restorative material of choice in the 21st century. However, due to its metallic colour and ubiquitous concerns regarding health effects and environmental effects, its use in dentistry has vastly decreased.

Mercury and amalgams

Some people may be concerned about the mercury content in amalgams. But, did you know, that mercury is found everywhere in our day to day lives? The air we breathe often contains very small traces of mercury which can be due to environmental or human related activities. Volcanic activity and bushfires release mercury into the atmosphere where it can travel vast distances to settle around the general population. Human activities such as the burning of coal, oil, and wood can release mercury into the air. Power plants that use fossil fuels as energy account for some of the largest sources of mercury emissions. Mercury levels differ depending on which part of the world we reside.

The mercury that travels airborne can settle in bodies of water. Fish and shellfish build up mercury levels over their lifetime. The amount of mercury in a given fish or shellfish is dependent on what they eat (do they eat other fish that contain mercury?), or how long they live (if they live longer, then they are able to ingest more mercury over their lifetime). It is worth mentioning that the levels of mercury in fish have proven to be of low risk with no detrimental effects to the human body. Tuna, a commonly consumed fish in the world contains the largest traces of mercury. This is largely due to the fact that they can grow quite large, and feed off other fish. In fact, the exposure of mercury with dental treatment is less than a can of tuna!

Research has shown that dental amalgams are safe and that there has not been any evidence of impacts to health. Studies have suggested that the leaching of metals into the mouth is exceptionally low and within ranges that are considered safe. However, amalgams can be unsafe when it comes to removal as this can create vapours in small quantities. With the addition of high vacuum suction, found in the dental chair, these vapours can be vastly reduced to a level that is safe. The environmental concerns of amalgam during removal are also important, as to not let such metals enter our waterways. Luckily, dental chairs have amalgam traps which prevent the pollution of amalgam into the water.

In rare circumstances, some people may be allergic to mercury. This is an immune response to very low levels of mercury known as “mercury hypersensitivity”. Patients may experience symptoms to their gums or tissues in the oral cavity. Symptoms include skin rashes around the mouth, itching and swollen lips. Most reactions to amalgams require no treatment and will disappear with time, however in some cases, the amalgam restorations need to be removed and replaced with another restorative substitute. The majority of dental clinics no longer use amalgam as a choice of filling material so patients need not be concerned of such an occurrence happening even if the risk of having a reaction is extremely low.

For the majority of patients that already have amalgam fillings in their teeth, there is very little to no risk to their health. So, the need to rush to the dentist and have all of your amalgam fillings replaced is not necessary for the purpose to reducing mercury levels in the body. Amalgam fillings have been used for over 100 years and have been widely studied in relation to its effect on the human body and their great quality is why they have been the mainstay of dental fillings for the past 100 years.

One of amalgams unique properties is that it has ‘self-sealing’ properties. Through expansion of the amalgam after placement, and corrosion, amalgam fillings can improve their contact with your cavity. Fillings may contain small microleakages when placed in your teeth which acts as a breeding ground for microorganisms causing dental decay. The amalgam’s self-sealing property act to seal this microleakage, thus preventing the recurrence of dental decay. This is one of the best reasons for why amalgam fillings last for a very long time.

Amalgam fillings are extremely durable and can withstand years of wear and tear with the appropriate care. Their strength ensures that you can chew on foods without worrying of pieces of ‘filling’ breaking off. Such durability is evident in many patients that still have their amalgam fillings in their teeth that were placed when they were young.

Why should we replace amalgam fillings?

As much as we would like to think that everything will last forever, amalgam fillings are still susceptible to wear. Because they last for such a long time, wear may not be easily detected. Amalgams do not stick to the tooth so once their margins start to open, they allow for food and bacteria to colonise in the cracks. Over time, the recurrence of decay can eventuate and is often quite difficult to detect, even with X-rays. Careful examinations with your dentist on a regular basis help to monitor the status of your amalgam fillings. Regular X-rays are useful for detecting signs of decay underneath your amalgam. As mentioned previously, it can be quite tricky to determine if there is decay underneath your amalgam filling. The amount of decay detectable underneath amalgam fillings may be quite substantial when it finally appears in the dental X-ray, so it is recommended to attend regularly, not only for your bi-annual cleans, but for thorough assessment of all existing fillings. We also recommend X-rays for patients regularly for the best assessment. The duration of when to take X-rays is dependent on your risk of decay. Those will a higher risk may require more regular X-rays. We recommend bitewing X-rays once every 2 years for the majority of our patients to ensure we are kept up to date with your teeth. If we notice any signs of failure or early signs of decay, we can properly prepare for the replacement of your amalgam whilst conserving as much tooth structure as possible.

Amalgams require bulk to stay in your tooth, and so the cavity designed in your tooth for your amalgam filling to fit in your tooth may often be undermining some of your much needed enamel and dentine. Larger amalgams in teeth, in particular the molar teeth are more prone to fracture. This is an area of concern when conducting a dental examination, and your dentist would generally raise these issues with you and discuss options for ensuring your teeth don’t fail you on the next bite.

Another disadvantage of amalgam fillings is that they can stain the surrounding tooth structure overtime. This may not be aesthetically pleasing for some patients and thus the request for replacement of amalgam fillings. However, replacement of any filling generally leads to a larger filling size and loss of very important tooth structure. One must consider the benefits and risks involved when replacing amalgam fillings. We must also remember that the highest levels of mercury exposure are during amalgam removal. With the appropriate protocols in place at your dentist, removal can still be very safe. Thus, we suggest you discuss with your dentist first whether it is worthwhile to replace your amalgam fillings.

As time and technology advanced, dental amalgams were no longer the preferred choice of material for restoring teeth. Composite fillings and ceramic restorations have become increasingly popular as restorative substitutes due to their aesthetic properties and are now the material of choice for dental restorations. They provide strength, biocompatibility, safety and aesthetics.

So the question is, should I replace my dental amalgams? All fillings have a lifespan and you would be very surprised at how long dental amalgams can last. In some cases, they can outlive the tooth itself! Replacement of dental amalgams should always be assessed carefully and your dentist can help you to determine if it is safe to do so. Because the removal of amalgams may sometimes weaken the tooth and subsequently reduce the lifespan of your tooth, it is best to discuss with your dentist the best options when considering the replacement of amalgam fillings. The team at True Smiles Dental can assist you with these concerns. Contact us at (02) 7228 7272 or book online at https://truesmilesdental.com.au