Microsoft word - teeth 101.doc

My name is Dr. Timothy Kevin Struwig or the way I prefer it "tim" and I am a dentist
working in Fourways, Johannesburg South Africa. I grew up in a small town named
Graskop in Mpumalanga which is near to the world famous Kruger National park and
went to high school in Carletonville about 70 km outside of Johannesburg I then
graduated from the School of Dentistry at the University of Pretoria.
Enough about me and more about you, of course that is the reason I'm writing this
booklet. My sole purpose for getting involved in this booklet is to help people understand
in plain English what the most important points are when it comes to keeping their
mouths clean. In other words I want to improve your dental IQ so that you can save a lot
of money as well as spend much less time in the dental chair.
I am writing from my own experiences as a general dental practitioner and not all that I
have written is based only on scientific evidence but I promise you if you follow the
guidelines provided in this booklet your mouth will be a much cleaner place.
What exactly is plaque? Well all plaque really is, is mashed up food that remains on or in
between your teeth after eating. Simple hey……. But isn't that a disgusting thought.
Most importantly what you need to understand is that every time you don't brush your
teeth after eating this mashed up left over food then in turn acts as food for bacteria living
in each and every one of our mouths, now this is where plaque becomes dangerous
because it allows the bacteria to bind to it and then eventually these bacteria living on the
food you left behind start to eat away at the tooth structure and this is then known as
tooth decay or caries. These bacteria especially love sucrose or "sugar" in the case of this
being left behind after eating the process is accelerated.
What you eat or drink is not nearly as important as how much and how often you eat or
drink something. Like my mother always said too much of anything is bad for you.
Lets use the worlds number one decay causer for example in other words soft drinks,
when having a soft drink firstly always have it using a straw for two reasons firstly you
don't know where that can has been and secondly so that as little as possible of the
sucrose or sugar comes into contact with your teeth before being swallowed.
Then make sure if at all possible that you finish the whole soft drink within five or less
minutes, the quicker the better, it has been proven that the longer you take to consume
sucrose or sugar rich foods or drinks the higher your risk is to develop tooth decay.
A few more pointers on diet include too many fruit juices are bad for your teeth which
can cause erosion of teeth which will be discussed later. Too many energy drinks can
cause the same problem.
Another very important hint for mothers is to never ever allow your baby to fall asleep
with a bottle in his or her mouth especially not containing milk, soft drinks, coffee or tea
containing sugar or even diluted cold drinks. The only safe thing to allow in a child's
bottle while they're sleeping is water. If this is allowed to happen the child may suffer
from what is known as baby bottle caries which in a nutshell is rotten black teeth which
all have to be removed and often results in extensive and expensive orthodontic treatment
at a later stage.
Vitamins and Minerals
Calcium remains one of the best as far as improving strength of teeth goes as well as
Vitamin C as far as helping to promote healthy gums go. Milk is rich in calcium and
oranges are rich in Vitamin C.
A guy in my class once asked one of our professors if we had to floss all of our teeth and
the professor politely answered "NO only the ones you want to keep"
Yes that is really how important flossing is. I always say that if the media advertised
flossing or floss as much as they did toothpaste and toothbrushes dentists around the
world would be out of business.
Yes flossing is a real pain in the but, I know, but trust me one day when your sixty six
and are still eating biltong with your own teeth while your friend has to cut his up in fine
pieces and go wash his dentures afterwards you will be grateful , very grateful that you
decided to floss.
One thing that people need to understand is that every tooth has five surfaces, three of
which are cleaned through brushing (inside surfaces facing the tongue and palate, outside
surfaces facing the cheeks and of course the top surfaces) and two of which are cleaned
through flossing (these are the parts of a tooth in contact with the two teeth next door to
it). In other words if you don't floss DAILY you are not cleaning two fifths (40%) of the
total surface area of your teeth. If that doesn't motivate you to floss then I don't know
what will.
People without many fillings in between their teeth can use a thinner floss for example
essential floss by oral B, whereas people with many fillings in between their teeth and
who find that the floss keeps breaking when they use it can use a thicker stronger type of
floss such as Satin tape by oral B. And lastly people with crowns or bridges can use
Super floss by oral B, this is very important as there is a thicker fluffy part to this type of
floss which is needed to clean in between and underneath crowns and bridges to ensure
they last as long as possible. Colgate and other brands work just as well and you can
follow the exact same principles as described above.
If you floss and use a mouthwash once a day after supper and brush your teeth after
breakfast, lunch and supper without having too many snacks in between (rinsing with
water after snacks if they are absolutely essential) I can assure you with full confidence
that you will need very little fillings in your life if any. In fact I wish somebody told me
this earlier in my life….
When first starting to floss you can expect your gums to bleed for up to two weeks
(because of all the junk stored up there). If you find the bleeding persists longer than this
try to gain better control of the floss by holding the floss in such a way that the part
actually going through in between your teeth is as short as possible, this should work
Something to remember when flossing is that you must not simply floss up and down but
rather go down between the teeth then press against the tooth in front and keep sliding
against this tooth when going up, then go down again and press against the back and once
again keep sliding against the tooth when going up. The more you floss the quicker you
become until eventually it really shouldn't take you longer than about 3 minutes.
Brushing Technique
There are more than 20 brushing techniques which have been described in dental
literature, some that are good for you and others that are not so good for you.
Lets first talk about the ones that definitely are not good for you. These are the horizontal
or "scrubbing" technique (this is when you scrub the outside surface of your teeth in a
vigorous motion by simply moving the toothbrush forwards and backwards in a
horizontal plane). The most dangerous thing about this brushing technique is that when it
is combined with a hard bristle toothbrush or someone pressing too hard against their
teeth whilst brushing or both then you can actually start to brush away your own tooth
structure, yes you heard right, you can brush away your own teeth if you don't brush
right, this process is known as abrasion and is the number one cause for tooth sensitivity.
The second brushing technique which is definitely not at all good for you is the vertical
brushing technique (this is when you brush the outside surface of your teeth in a directly
up and directly down motion in the vertical plane). This can cause gum recession and
when gums recede then bone often follows and when bone recedes teeth become loose
and when teeth become too loose they need to be extracted (removed). Besides a receded
gum level is not very attractive either. If gums have receded it might be a good idea to go
see a periodontist , the same applies if your teeth are looser than what they should be.
The brushing technique that I have chosen is in fact one of the simplest but most effective
ones, it is actually described for use by primary and pre-school children but I have
believed in it ever since I went on a camp with all my fellow dental students in my final
year of study and when we were all brushing our teeth the one morning I realized that
they were all using the exact same brushing technique as me. Which is the "small circles
brushing technique" this is where you brush the outside surfaces of your teeth by making
small circular motions with your toothbrush (not covering more than 4 to 6 teeth at a
time) and then brush the top surfaces of your teeth with a scrubbing motion in the
horizontal plane and then the upper and lower inside surfaces of your teeth need to be
brushed by holding the toothbrush in a vertical position perpendicular to the floor and
then a up and down movement in the vertical plane needs to be applied for each tooth.
You should take at least 3 to 5 minutes to brush your teeth if you do it properly - go
ahead time yourself for the first while.
Toothbrush Types
Well I don't need to tell you this but there are hundreds if not thousands of toothbrushes
available out there and each one claims to be better than the rest.
There are three main groups of brushes hard, medium or soft bristle brushes. Then you
get brushes with larger heads and brushes with smaller heads as well as brushes with or
without tongue and cheek cleaners. Its difficult to know who needs which brush.
In general the average person should look for a medium bristle brush with a reasonably
small head. The reason for the medium strength bristle is because in my opinion the hard
bristle toothbrushes especially when used by someone with a very hard brushing
technique using the scrubbing technique as described earlier can do tremendous damage
to the enamel of the teeth facing the inside of your cheeks just above or below the gum
level and this is formally known as abrasion of teeth is.
Abrasion is the number one cause of sensitive teeth especially when combined with
erosion which is when tooth structure progressively gets "eaten" away through acids
found in soft drinks which are high in sugar levels.
On the other hand the reason I don't like soft bristle toothbrushes is because first of all
when using this toothbrush it doesn't really feel like the teeth have been cleaned quite as
well as with a toothbrush with slightly firmer bristles and second of all the bristles bend
so quickly that you are going to need to buy yourself a new toothbrush once a month.
I recommend buying a new medium strength toothbrush once every three months
otherwise when you see that more than a quarter of the bristles aren't straight anymore.
I advise people not to use a hard bristle toothbrush if at all possible (if it doesn't say
medium or soft on the wrapping then its hard) and advise everyone to use medium
bristles with a small head (the small head is so that you can reach much further back in
the mouth.) If you already have very sensitive teeth or abrasion or erosion lesions then I
would suggest perhaps trying a soft bristle toothbrush but then remember to get a new
one every month.
The question I am asked most often concerning toothbrushes is whether or not to use an
electric or manual toothbrush and if one is better than the other. My answer to this is that
no one is not better than the other it just depends what you are used to and what you
It is very important though that you remember that if you are using an electric toothbrush
that you need to still concentrate on getting to all the surfaces and that you need to allow
the bristles to rotate on each surface (inside, outside and on top) of each and every tooth
for at least about 4-6 seconds.
An electric toothbrush may be a good idea for somebody using a "scrubbing motion"
brushing technique in the horizontal dimension as described earlier as this will then
prevent the abrasion lesions from progressing any further. Remember to get medium or
soft strength bristles for your electric toothbrush and make sure that your electric
toothbrush has replaceable heads and try to buy one that can be recharged as opposed to
one that is battery operated unless you want to spend a fortune on batteries.
If you can find a toothbrush with something to clean your tongue with too that's a great
bonus because there really are a very lot of bacteria that live in the grooves on the surface
of your tongue and yes even plaque (left over food) remains stuck inside these grooves. If
you have deep grooves or fissures on the surface of your tongue or have more than the
average person and you are suffering from bad breath (halitosis) then chances are your
tongue is playing a very big part in your problem.
Tongue scrapers can also be bought separately and are very useful especially for people
with deep or a high number of grooves on their tongues. My toothbrush of choice is the
Colgate 360 Medium.
Different mouthwashes are used for different reasons. Some mouthwashes have very high
levels of alcohol such as Listerine and this creates a burning sensation in your mouth
which I really don't like. Once again it comes down to preference and the fact that one
mouthwash is not really better than another. Although one might well be better for a
certain problem than another.
As far as bleeding gums go I still prefer good old warm salt water (1 tsp of salt diluted in
a quarter glass of warm water) as the rinse of choice. Rinse with this twice a day for two
weeks together with correct brushing techniques and your bleeding gums (gingivitis) will
be history.
When buying a mouthwash make sure that if it contains high levels of clorhexidine for
example Corsodyl then it should never be used for more than two weeks at a time as this
can lead to staining of teeth.
Remember to rinse for between 30 seconds and 1 minute. My mouthwash of choice is
Colgate Plax for adults and Listerfluor for kids.
The golden rule as far as toothpaste is concerned is that it must contain fluoride. If it
doesn't contain fluoride it cant strengthen your teeth, its as simple as that.
If you suffer from tooth sensitivity then you need to get a desensitizing toothpaste such as
Sensodyne, Mentadent-P or Colgate Sensitive my favorite as far as these three are
concerned is Sensodyne.
The secret about these desensitizing toothpastes though are that they take at least two
weeks to work (brushing at least twice daily of course) and the other thing is that if you
actually apply the desensitizing toothpaste onto the sensitive tooth necks or affected
sensitive areas with your finger and leave it on for five minutes before brushing it will be
much more effective than just brushing with it (usually you don't have 5 minutes extra in
the morning so this might be more practical to do only once a day in the evening after
As far as toothpastes go for the average guy on the street I would recommend Colgate
Total as there is hard evidence to show that it does work both better and longer (as far as
fighting plaque and bacteria in the mouth is concerned) than any other toothpaste.
Once children are over the age of about two to three it is safe for them to start using a
fluoride toothpaste as well, or otherwise as soon as they are able to understand the
importance of not swallowing their toothpaste and actually knowing how to spit it out.
First start them out with a very little bit of fluoride toothpaste and be sure to watch and
help them brush until you are fully confident they know what exactly to do. Before the
child learns to spit out his or her toothpaste on their own they need to use a non fluoride
containing toothpaste.
Remember if your child does happen to swallow fluoride containing tablets, toothpaste
or mouthwash the make sure they drink as much milk as possible and if a substantial
amount was ingested get them to a hospital as soon as possible.

Fluoride Supplements
In most countries drinking water is fluoridated. All this means is that there is a certain
amount of fluoride in the drinking water to help strengthen peoples teeth, the fluoridation
of water is obviously also done for other health reasons but this will not be discussed
here. Extensive research was put in to determine exactly how much fluoride would be the
right amount.
Water in certain areas will have naturally higher fluoride content than others whereas
some areas will have very little fluoride in natural water. It is important to know whether
or not you live in a high or low fluoride area because if you live in a high fluoride area
and the water is not regulated sufficiently your children may suffer from fluorosis.
On the other hand if you live in an area where there is not sufficient fluoride in natural
water and the water is not regulated properly your children may suffer with teeth that are
brittle and therefore weak teeth that break very easily.
Fluorosis is when teeth have very white (mild fluorosis) or even brown to dark brown
discolorations (severe flourosis) and sometimes even malformations can result.
The most common fluoride tablet that I know of is Zymofluor and I have heard this trade
name from many parents of my younger patients and believe it or not these children tend
to have far less (if any) cavities than the children I see that don't take or haven't taken
any fluoride tablets.
The only problem though is that one or two out of probably every twenty patients (about
5% to 10%) that I see that have taken these fluoride tablets (Zymoflour) experience
discoloration of their teeth (fluorosis). These children generally tend to be the ones that
have come from rural areas or areas with higher than normal levels of fluoride in their
drinking water.
Two other important fluoride supplements are of course fluoride toothpaste which is
essential to use at least twice a day as well as fluoride mouth rinses which are also needed
once a day.
What all of this boils down to is that fluoride tablets (Zymofluor) are an amazingly
effective supplement to be taken to strengthen the teeth of children provided that the area
you live in does not have a higher than normal level of fluoride in its drinking water.
Also it seems to me that adults who used fluoride tablets specifically Zymofluor when
they were younger also have much less cavities than adults who did not.
Recipe for a perfectly clean and healthy mouth
Did you know that it is said that the mouth of any given person is dirtier (more bacteria)
than the anus of a dog. So here is what you can do to try and change that.
These are the most commonly known dental specialists and are the guys that deal mainly
with straightening of teeth.
In my opinion the best age for patients to go see the orthodontist is between 10 and 12
years of age as this is when most of the primary teeth (baby teeth) have fallen out and
also the age where a lot of growth is taking place and results can be achieved a lot
The child is also much more capable of keeping their teeth clean at this age. What I
always tell patients that are going for braces is that they will now have to work double as
hard to keep their teeth clean as what they did before they had braces otherwise they will
have perfectly straight teeth but they will be full of ugly cavities and marks, so then what
was the point of straightening them.
Children usually need to wear braces for around 18 months to have the work completed,
where as adults take at least 24 months to get their teeth nice and straight.
More and more adults are starting to wear braces, the oldest patient that I referred to the
orthodontist was a lady that was 56 years old. Most adults prefer to have the upper braces
placed on the inside of the mouth which can be done nowadays to make them less
obvious to the eye but these patients must be aware that this will take a lot more getting
used to than the conventional method of placing the braces on the outside of the teeth.
Braces are painful, don't kid yourself , they take quite a while to get used to. Especially
when placed on the inside or back of the upper teeth.
It must be noted that both general dentists and orthodontists can place braces and in my
opinion it is always better to let the specialist do the job. After all he or she did study at
least another four years to be the best at what they do.
Orthodontic plates can be placed by a general dentist or by an orthodontist but something
to remember is that these plates can only do minor tilting of teeth and can in fact do very
little if there is not enough space in the mouth (i.e if you have your dads teeth and your
moms jaw).
What I am saying is that if you can see that there is obvious lack of space in the mouth
and that teeth are crowding together don't waste your money on an orthodontic plate until
you have at least gone for a consultation with an orthodontist to get his or her opinion on
whether or not the plate will work or not. And chances are that the orthodontist will
suggest that you will need to have some strategic teeth removed (extracted) and that you
will need braces (fixed appliances) which can actually move your teeth and not just tilt
Braces are most often the only answer to skew teeth so don't waste your time and money
with an orthodontic plate unless your orthodontist agrees that it will work or if there are
only one or two teeth that need to be moved (tilted) slightly and you can see that there is
definitely enough space to do so.

These are the guys that deal with the gums and other structures surrounding the teeth.
When gingivitis (bleeding gums) which by the way is the most common disease in the
world becomes chronic this becomes known as the condition of periodontitis.
Gingivitis is caused by inadequate oral hygiene measures and it is pretty much directly as
a result of food getting stuck between your teeth and your gums which is not removed
soon enough.
This process gets repeated over many years and eventually the food and bacteria stuck
between your gums and your teeth actually starts to cause breakdown of the bone
surrounding your teeth and this is why you sometimes see people in their late forties and
early fifties with teeth that become so loose that they have to be removed.
There are two major groups of periodontitis namely adult onset chronic periodontitis
which was just described and the more severe which is called juvenile onset acute
periodontitis and this is when people in their late twenties or early thirties already suffer
from severe forms of bone loss.
The biggest problem is that people only wake up when some of the teeth already start to
loosen and unfortunately it is then often the case of too little too late. Once the dentist
detects signs of gingivitis he or she normally informs the patient and refers him or her to
the oral hygienist or does the professional cleaning of teeth and gums (scale and polish)
on his or her own.
But often us as dentists and hygeinists neglect to inform our patients properly about what
the situation really means (gingivitis) and its potentially serious long term consequences
(periodontitis). A professional cleaning will help for a week or two but if the patient does
not change his or her habits and seriously jack up his or her oral hygiene standards the
problem (gingivitis) will continue until it eventually (usually over twenty to thirty years)
causes teeth to loosen due to bone loss and ultimately loss of numerous if not all teeth.
The periodontist is the dental specialist that deals with periodontal disease amongst other things. Your dentist will usually refer you to a periodontist when he detects loss of bone surrounding your teeth (usually seen on a dental x-ray or full mouth x-ray). Dentists are also allowed to perform certain periodontal surgical procedures but most don't. Most but not all dentists will perform root planing treatments (deep cleaning of the gums surrounding teeth needing local anaesthetic to perform). Root planing treatments can sometimes even be done by an experienced oral hygeniest with the dentist providing local anaesthetic. It must be remembered though that when it comes to periodontal treatment be it root planing or periodontal surgery the periodontist is "king" but like all specialists they charge high fees. I suggest that if you have the money go see them for root planing but if not see your dentist or oral hygienist for this treatment. If you need periodontal surgery depending of the qualifications and experience of your general dentist I would probably suggest you go see the periodontist. The way in which it is generally determined whether or not you need periodontal surgery or simply root planing is by measuring the depths of the pockets between your gums and your teeth. The normal depth of these pockets in people with healthy gums should be 3 mm. When the depths extend between 3 and 6mm root planing might do the trick, normally it is attempted two to three times with 3 month intervals. If no improvement is noted after a few attempts (pocket depths decreasing) then periodontal surgery needs to be considered. If the pocket depths extend deeper than 6mm it is generally accepted that they can not be cleaned by means of root planing alone (the instruments cant get that far down) and open flap periodontal surgery is then required to treat the disease. It is important to remember that all forms of periodontal treatments are very expensive and that the ball is mostly in your court not in the health providers. In other words if you don't jack up your oral hygiene measures to a great extend then your treatment will never be successful and you may just as well have not wasted your money or put yourself through all those invasive and often painful treatment regimes. Also remember to keep up the strict oral hygiene measures every single day of your life once periodontal treatment has been successful and to go for cleanings (scale and polish) at least every three to six months depending on the advice given to you. Otherwise before you wipe out your eyes you will be right back where you started again and all that time, effort and money would have been completely wasted. Maxillo - Facial and Oral Surgeons
These are the really clever guys , most of them nowadays are actually qualified doctors
and dentists (ie the same person is a doctor and a dentist) and they are responsible for
everything from fixing a skull that was obliterated by a shotgun to pulling a tooth that the
dentist might battle with.
The reasons that a dentist might refer you to a maxillo-facial and oral surgeon (MFOS)
include difficult extractions, jaw pains and clicks, unusual pathology, implants as well as
many other conditions.
Extractions become difficult when they are close to certain anatomical structures that
could result in post operative complications. In other words if an upper molar has roots
that extend close to or into the maxillary sinuses (hollow cavities in the middle of the face
to make the head lighter, one on either side amongst others) and such a tooth is extracted
causing the sinus floor to rupture an oro-antral opening may result ie. You might be
drinking coffee and suddenly it might come out of your nose.
If the sinus floor is perforated then your mouth and your nose become connected, most
general dentists don't know how to stitch up or close up this type of perforation whereas
MFOS do.
For this reason when I am in any doubt I always refer such patients to the MFOS and he
can then decide on whether or not to do the extraction under local or general anaesthetic.
Another example is when lower wisdom teeth or third molars are to be extracted they are
sometimes very close to or even in contact with the inferior alveolar nerves (large nerves
which supply either side of the lower jaw) and if the extraction is done can result in
temporary or even permanent parasthesia of part of the lower jaw if this nerve is damaged
during the process.
The general dentist is not as well trained to delicately work around this nerve or even as
aware of its exact position as the MFOS, some MFOS even know how to rejoin this nerve
if it is torn. For this reason if I see any lower molar but especially lower wisdom teeth
anywhere near the inferior alveolar nerve I always refer these patients to a MFOS.
The inferior alveolar nerve exits in between the two permanent lower premolars and I
would also advise that any difficult extraction of one of these four teeth be done by a
MFOS as partial parasthisia of the lower jaw can also result if surgery is done in this
TMJ Problems (Jaw pains and clicks)

TMJ is the acronym for the Tempero-Mandibular Joint which is basically the joint which
allows your lower jaw to connect to your upper jaw or the rest of your skull.
This is a synovial joint or hinge joint which inevitably undergoes a lot of wear and tear
especially in patients that have bone abnormalities or diseases such as rheumatoid
arthritis etc. as well as patients that suffer from bruxism (grinding of teeth) or patients
that have uneven bites due to loss of teeth on one side of the mouth.
This wear and tear of the TMJ eventually results in a clicking sound (crepitus) when
biting or chewing which can be either loud or soft or during opening or during closing or
painful or not painful which all mean different things if left untreated the problem usually
just gets worse and can even eventually result in the jaw becoming dislocated.
In my opinion the best is to go see a MFOS and let him decide whether the click with or
without pain should be treated by means of a occlusal plate (bite plate) or by means of
surgery, pain medication or even physiotherapy.
If you have numerous missing teeth on one side of the mouth you should have this fixed
by means of a partial denture (plate) or implants or bridges before it results in jaw
problems due to an uneven bite ie. You will be placing too many stresses on one side of
your jaw if you are only eating on one side of your mouth and this will inevitably result
in jaw problems.
Also if a crown or filling does not settle within 3 days of placement ie. if it still feels high
after 3 days you should return to your dentist to adjust this for you otherwise your jaw is
placed under certain incorrect stresses and over a long period this can also result in
serious jaw problems.
If you have been informed by somebody that you grind or clench your teeth while
sleeping you should consult your dentist as soon as possible to have a bite plate or
occlusal guard made to protect you from grinding away your teeth and from damaging
your TMJ (jaw joint).
An occlusal guard is a piece of special plastic or acrylic that helps protect your teeth and
jaw while sleeping. Grinding of teeth or bruxism occurs subconsciously while at work, in
traffic or most commonly whilst asleep. Bruxism or grinding of teeth occurs amongst
people who live highly stressed lives and I have seen signs of this condition in children as
young as 14 in my practice.
Aphtous Ulcers
These are those small white ulcers that form in a persons mouth that are extremely
painful and that go away after about 10 days.
They are very common and are especially found in young individuals living highly
stressed lives, as far as treatment goes you can either wait it out for the 10 days after
which it will go away on its own, or put yourself through the burning sensation of good
old table salt and luke warm water to help it clear up faster, or even get a prescription for
kenalog in orobase which can be obtained at your chemist and must be applied by
dipping an ear bud into the solution and then on to the aphtous ulcer - this is known to
work the best.
An interesting fact about aphtous ulcers is that people that smoke don't get them, so yes
there is one good thing about smoking but don't dare forget about the hundreds of bad
things about it. Also if you are trying to quit smoking an get these ulcers in your mouth
every time you try now you know why, so persevere and the ulcers will go away I
Fillings (Restorations)
Amalgam fillings or "lead drippers" as referred to by some of my patients are the silver
fillings that were for a long period of time the filling or restoration of choice. I like to call
them "old school fillings" and I like old school, especially when it comes to the fact that
based on scientific evidence the silver or amalgam fillings are in my opinion still the best
when compared to the more popular composite or white tooth colored fillings when it
comes to back (posterior) teeth as the silver fillings are a lot stronger and have been
shown to last much longer than their white (composite) counterparts.
The thing with silver amalgam fillings is that they are ugly there is no doubt about it. For
this reason there is obviously no dentist in his right mind nowadays that will do one of
these fillings on a front (anterior) tooth anymore. They sometimes even cause the entire
tooth to discolor and become a grayish purplish color, not the best idea for a front tooth I
am sure you will agree.
It is debatable on whether or not a silver amalgam filling would be better than a white
composite filling on a front tooth but there is definitely no debate on whether a beautiful
white tooth colored filling is more socially acceptable on a front tooth than a silver
amalgam one now is there.
In my opinion the silver fillings are especially indicated on the back teeth of children, the
back teeth of elderly people, the back teeth of people with poor oral hygiene, the back
teeth of people with strong biting forces as well as the back teeth of people that grind
their teeth at night
When comparing all the pros and cons of both silver amalgam and white composite fillings it is better in my opinion to get a white filling done when you can see the tooth that needs to be restored whilst making your biggest possible smile which usually extends up to the front surface of the first upper molars and the front surface of the second lower premolars in people with all their teeth still in tact. The other teeth (molars) that can only be seen when you give a big yawn without putting your hand in front of your mouth (as I always tell my patients) should in my opinion be restored with the stronger but less pretty silver amalgam fillings unless the patient has a proven allergy to copper, zinc, silver, tin or mercury. There has been a lot of controversy around the fact that the miniscule amount of mercury in silver amalgam fillings can cause mercury toxicity or poisoning in people with these fillings. According to myself as well as the South African Dental Association and the American Dental Association these statements are not at all validated. In fact there is no scientific evidence whatsoever that the tiny levels of mercury in amalgam fillings can or does cause any harm to humans whatsoever. In fact you have just as much chance of being allergic to silver fillings as what you do to white ones. Having said all of this and knowing all I know, if a patient asks me to replace all his or her silver fillings with white ones because their herbalist told them to do so, and the patient now believes that these silver fillings that they have had for twenty years are now suddenly harmful to their health. I will explain exactly what I believe about the whole story and if they then still choose to rather believe the herbalist as they often do then I will go ahead and replace all the completely healthy silver fillings with white ones because hey a patient is a customer too and everybody knows the customer is always right. Another thing worth mentioning is that white fillings are notorious for causing sensitivity after being placed. This is very common and the slight pain and sensitivity especially to cold things and biting on hard things where the new white filling was placed can last anywhere between 2 days to 6 weeks. Post placement sensitivity is very seldom seen in cases where silver fillings have been placed. I believe that you should never scratch something that isn't itchy or fix something that isn't broken and for this reason I feel that people should not replace healthy silver fillings on back teeth. Its just not worth the risk of post placement sensitivity and a new shiny white one probably wont last as long as the "old faithful" silver one. So which filling is the best in my opinion you might ask. Well firstly there are two main groups of fillings the most common type being a direct filling which is the filling that is done in your dentists chair and which is made by his or her own hands and is completed start to finish at a single visit. The second type is the indirect filling in which case the dentist needs at least two visits. The first visit is to shape and form the tooth in such a
way that all the decay is removed and that allows for an accurate impression to be taken
to send to the dental laboratory so that they can make the so called inlay or onlay
(indirect filling) another task that needs to be done by the dentist at the first visit is then
to place a temporary filling to protect what remains of the tooth until the final product can
be placed within one or two weeks at the second visit.
Obviously the temporary filling will first need to be removed at the second visit before
the final product can then be permanently cemented or glued in. As far as which is better
between direct and indirect fillings it is not an easy question and depends on how good
your dentist or your technician is for that matter. But if I had to choose between the two I
would probably say that indirect fillings tend to last a bit longer, this is a good thing as
you pay about four times as much for an indirect filling compared to a direct one.
To answer the previous question of which filling is the best in my opinion here it is:
1: Gold inlay or onlay (indirect filling) nowadays mostly only for back teeth
2: Porcelain inlay or onlay (indirect filling) only for back teeth
3: Composite inlay or onlay (indirect filling) very rarely done but only for back teeth
4: Amalgam silver filling (direct filling) only for back teeth nowadays
5: Composite white filling (direct filling) for front teeth and sometimes back teeth if patient prefers
Crowns (Caps)
You might ask when do I need a crown (cap) a tooth which is a pretty expensive story
and when can I get away with a filling, well this is not an easy question to answer but in
my experience it is always better to cap a tooth which has been root canal treated as this
tooth is now both lifeless and hollow and trust me these teeth tend to either break or
completely disintegrate after a couple of months or years at best.
Another reason to crown (cap) a tooth is if its visible part (part of the tooth above the
gum) is more than half filling and especially if the filling keeps breaking or falling out. A
much better permanent solution in such a case is always to cap the tooth, you will
probably end up saving money in the long run and also have less trips to the dentist for
that matter because hopefully that tooth will be sorted out for a good 15 to 20 years plus.
There are three main types of crowns namely porcelain only, porcelain fused to metal and
metal only crowns. The porcelain only ones are most commonly used on front teeth
because they give the best aesthetic results and are sometimes also used on back teeth but
are generally known for being the weaker of the three types and therefore not preferred
on back teeth.
The porcelain fused to metal crowns are my favorite choice for teeth that are not as eye
catching as these crowns are almost as strong as the metal crowns but at the same time
almost as beautiful as the porcelain crowns (you get the best of both) these can also be
used for front teeth in patients that cant afford the slightly more expensive porcelain only
The third main type of crown is the metal only crown and is the one that is much less
commonly used today as they are not at all pleasing to the eye. In my opinion they should
only be used on back teeth if the patient has a very strong bite, grinds his or her teeth at
night or has a bite that is collapsing (you have a collapsed bite when you are busy
wearing away your front teeth and have numerous missing other teeth) and needs to be re
opened. If none of these apply to you then you will manage fine with a much prettier
porcelain fused to metal crown.
The basic procedure of preparing a tooth for a porcelain fused to metal crown is to
remove 1mm of tooth structure all the way around the tooth and about 1.5mm to 2mm off
the top surface of the tooth. This may vary slightly for the preparation of the other two
types of crowns.
Root Canal Treatment (Endodontics)
This is the treatment that makes all my patients shudder with fear for some reason. All I
can think of as reasons for why people are so afraid of this specific type of treatment is
simply because firstly they do not really understand what it means to have root canal
treatment and secondly their dentists are not achieving or waiting for proper anaesthesia
before starting this type of treatment.
So what root canal treatment very basically is , is the removal of the nerves and blood
vessels from the inside of a tooth (pulp chamber), in other words causing the tooth to
become both lifeless and hollow on the inside in order to remove pain from a patients
tooth which has undergone severe decay which has now extended all the way into the
pulp chamber (life centre) of the tooth or to remove pain from a tooth which has died off
on its own as a result a severe trauma to the tooth or teeth involved.
You might ask yourself , how then do I avoid having to have root canal done on one of
my teeth. This can be achieved by simply following two rules the first one is to visit your
dentist regularly i.e once every six to twelve months depending on what your dentist
This will allow your dentist do detect decay or caries on or in between teeth by means of
a clinical examination as well as x-rays and by so doing diagnose and treat these holes
(decay) in your teeth while they are still small and no where near the life centre (pulp
chamber) of your tooth or teeth for that matter, depending of course on how many sweets
you eat.
To put it more simply the longer you stay away from the dentist the bigger the small
holes (decay) become on or in between your teeth and the bigger and more difficult the
filling or fillings become until eventually the decay has becomes so large inside the tooth
that it reaches the life centre (pulp chamber filled with nerves and blood vessels) and this
is when you now experience extreme pain.
At this stage it is already too late to save the tooth by means of a filling only and your
dentist will inform you that in order to keep the tooth you will have to have a root canal
done and later you will need a crown to protect the "hollow" root canal treated tooth. The
only other method of pain relief then would be to have the tooth removed (extracted).
Don't get me wrong root canal treatment is very intense for both the dentist and patient
and is a procedure that is very time consuming and expensive. And just to think all root
canals that have ever been done in the world and are ever going to be done could all be
prevented if the decay is simply detected earlier.
Also remember that even if you look inside your mouth and cant see any holes, the place
they most often start is in between your teeth because most people don't floss as often as
they should. The only way any body can see those holes in between your teeth is by
means of a dental x-ray.
The second rule in how to prevent yourself having to go through root canal treatment is to
be careful not to hurt yourself. In other words try to avoid hard knocks to your teeth , this
is of course much easier said than done but a very practical way on how to do this is to
wear a gum guard whenever playing any contact sports. Some other helpful hints are to
always wear a helmut when on a motorcycle and to stay out of fist fights wherever
Pulp Capping (direct and indirect)

Drugs in dentistry
Good pain killers to take for dental pain in my experience include myprodol, nurofen,
stopayne, mybulen (generic for myprodol), panado and brufen all of which contain in
different dosages (depending on which drug you are using) paracetamol, ibuprofen as
well as codeine which is the tablet form of morphine.
My personal favorite "big gun" when it comes to pain killers in dentistry is a drug called
prexige and the dose I recommend is 100mg once a day or break the tablet in half and
take one in the morning and one in the afternoon. This really does work but I only advise
its use when you really cant get to a dentist and none of the normal pain killers are
working. I never prescribe more than five of these at one time as they are very strong and
can cause liver problems if used chronically.
Always do your very best not to take in any pain killers or alcohol for 24 hours before
visiting your dentist as in my experience this might decrease your chances of proper
anaesthesia. Also always remember to stay far away from any pain killers containing
aspirin as far as dental pain is concerned, especially if you are thinking of having a tooth
extracted as this will increase post operative bleeding.
As far as antibiotics go in dentistry it has been proven over and over again that the good
old fashioned cheap combination of amoxil 500mg and flagyll 400mg one of each 3 times
per day after meals is the best by far when it comes to treating dental abscesses or
The problem is though that whilst taking the flagyll 400mg the patient can not at any time
consume any alcohol and if this is not adhered to the patient can suffer numerous very
uncomfortable adverse effects such as nausea and vomiting, stomache cramps, diarrhea
amongst others. And even if no alcohol is consumed with this drug for some reason
patients often still seem to complain of its adverse effects such as making them feel week
For this reason I believe many dentist nowadays rather prescribe augmentin 1000mg
which is one tablet 2 times per day after meals. It is not necessarily as good for dental
infections as the other combination of amoxil and flagyll as mentioned before but it does
not cause as many side effects and still gets the job done. Augmentin is made up of
amoxil and cavulanic acid.
In my opinion a patient that is put on any form of antibiotics should take them along with
a probiotic just to help the stomache and I prescribe Interflora for all my patient which
need to go on antibiotics. An alternative to the interflora I suggest the use of yoghurt
while on the course of antibiotics.
You might ask what the main reason for the use of antibiotics in dentistry is. Well it is
simply to reduce infection in the site of the tooth which needs to be worked on in order to
prevent the spread of infection by way of sticking the dental needle through infected
tissue into healthy tissue and secondly to allow for optimal anaesthesia as this is often not
possible if there is severe infection in an area.
In other words if there is a large abscess on a tooth and the dentist tries to work on it
straight away you might experience some pain because it doesn't go completely numb
and your infection might actually even spread, so if you dentist recommends you go on
antibiotics first then rather just take his or her advice.


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