Sedation

You may find treatment easier if you have some form of sedation. This relieves anxiety and
helps you to relax. You will still be awake but you probably won't be able to remember much
about the procedure afterwards. There are three main types of sedation used in dentistry

Oral sedation

Your dentist may prescribe you a medicine, such as temazepam or diazepam, to help reduce
your anxiety. You will take this as a tablet, usually about an hour or two before your
.appointment. You must take these medicines exactly as directed by your dentist
Inhalation sedation

This is also known as 'gas and air'. It's a mixture of nitrous oxide and oxygen. You breathe it
in through a mask placed over your nose. You'll be able to understand what your dentist is
.saying throughout the treatment, but the sedation should reduce your anxiety

When your treatment is finished, the sedation will wear off after a few deep breaths and the
gases will soon leave your body. However, you may be asked to stay in the clinic for up to 30
minutes for the effects of the sedation to wear off fully. Your dentist may ask you to bring a
.friend or family member to accompany you home

Intravenous sedation

If you have intravenous sedation, a medicine will be injected through a fine plastic tube
(cannula) into a vein (usually on the back of your hand). The medicine will make you feel
relaxed, but you will still be able talk and listen to your dentist (although you may not
.)remember any of it afterwards

You must have someone accompany you to and from your dental appointment. Sedation
temporarily affects your co-ordination and reasoning skills, so you must not drive, drink
alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any
doubt about driving, contact your motor insurer so that you’re aware of their
.recommendations, and always follow your dentist’s advice

General anesthesia

Occasionally, people who have severe dental phobia, young children and people with special
needs may need general anaesthesia in a hospital to have dental treatment. However, all
.possible alternatives should be explored first

If you have a general anaesthetic, it means you will be asleep during the treatment. You will
need to arrange for someone to drive you home. Try to have a friend or relative stay with
.you for the first 24 hours after your dental treatment

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
 Tooth decay
Soon after you brush your teeth, a thin, sticky layer of bacteria forms on the surfaces of all
.your teeth. This layer of bacteria is called plaque

When you eat anything sugary, the bacteria on your teeth turn the sugar into energy and
acid. This acid softens and dissolves the hard enamel surface of your teeth in a process
called demineralisation. Over time, demineralisation can cause cavities to form in your
.teeth. This is known as tooth decay or caries

The enamel surface of your teeth doesn't contain any nerves, so you won't initially feel any
pain when you start to get a cavity. Eventually, however, a cavity may reach the dentine –
the yellowish substance underneath the enamel that forms the bulk of your tooth. Dentine
is sensitive to pain, so more advanced cavities may cause pain, especially when you eat or
.drink anything hot, sugary or acidic

Saliva helps to wash away and neutralise the acid on your teeth. It contains minerals to
.replace those lost from the enamel in a process called remineralisation

Demineralisation and remineralisation happen every time you eat or drink something
sugary. If you consume sugary food or drinks too often, the saliva doesn't get long enough to
.fully remineralise your teeth. This will increase your risk of getting tooth decay

+++++++++++++++++++++++++++++++++++++++++++++++++

Gum disease
Gum disease is inflammation of your gums and damage to the bone that anchors your teeth
into your jaw. Gum disease is very common and affects more than half of adults who have
.their own (natural) teeth

If you don't clean plaque off your teeth regularly, your gums will become red, swollen and
shiny, and they may bleed. This is the early stage of gum disease, called gingivitis. Gingivitis
.is completely reversible. If you remove the plaque, your gums will get better

If you don’t get treatment for gingivitis, your gums may begin to pull away from your teeth,
leaving a little pocket around each tooth. These pockets trap plaque that you can't reach
.)with a toothbrush. Over time, the plaque will harden to become tartar (calculus

Plaque and tartar build up and can cause further irritation, which may gradually spread to
the bone structures around your teeth. As time goes by, the pockets can get deeper and
more difficult to clean, and your gum and bone may shrink. This is called periodontitis. If
your gums shrink, they can expose some of the roots of your teeth, making them wobbly
and sensitive. If left untreated over a number of years, your teeth may fall out, or need to be
.taken out by a dentist

You can prevent gum disease by controlling the amount of plaque and tartar that build up on
your teeth. Regular visits to your dentist or hygienist, brushing and flossing your teeth
.properly, and stopping smoking will help
 Dental erosion
Dental erosion is the loss of enamel and dentine, caused by acid attacking the surfaces of
your teeth. But unlike tooth decay, the acids aren't from bacteria. They usually come from
acidic drinks such as fruit juices, fizzy drinks and squashes – even the 'diet' varieties. Over
.half of all children aged 15 to 18 in the UK have some dental erosion

You can help to prevent dental erosion by limiting the number of acidic drinks you consume.
If you have a young child, try to only give him or her water or milk to drink. Or, when your
child does have an acidic drink, give it to him or her in a cup rather than in a feeding bottle
.and only at meal times

Stomach acid in vomit can also cause dental erosion. If you have a health condition that
makes you sick often (for example bulimia nervosa, alcohol or stomach problems), you may
.risk damaging your teeth

Dental erosion is irreversible. It can cause your teeth to become sensitive if the dentine
becomes exposed. If this happens, your teeth may look yellow (since dentine is this colour)
.and you are more likely to get tooth decay

How to look after your teeth

Good oral hygiene is very important to help prevent tooth decay and gum disease. It
involves cleaning your teeth at least twice a day with fluoride toothpaste, visiting the dentist
.and hygienist regularly, and limiting the amount of sugar in your diet

Brush your teeth

Brushing is the most effective way to remove plaque. To get the most benefit from brushing
:your teeth

use a toothbrush with a small head and synthetic bristles

use fluoride toothpaste to protect against decay

start at one side of your mouth and move round to the other side, brushing all the tooth
surfaces thoroughly

pay particular attention to your gumline, angling the bristles into the crevice where your
gums meet your teeth

brush at least twice a day and for around two minutes to allow time to do it properly

replace your toothbrush every two to three months, or sooner if the filaments look worn

Some people prefer to use an electric toothbrush. There is some evidence that certain types
of electric toothbrush are more efficient at removing plaque than brushing by hand.
However, the thoroughness of your cleaning is much more important than what type of
.brush you use

Clean between your teeth

Dental floss or inter-dental brushes can help to remove plaque and small bits of food from
between your teeth and under your gumline – these are areas that a toothbrush can't reach.
.It's important to use the correct technique, so ask for advice from your dentist or hygienist

However, even thorough brushing and flossing may not remove every trace of plaque. This is
because most people have irregularities in their teeth where plaque can build up and harden
into tartar. This can only be removed by a dentist or hygienist using special tools in a process
called scaling. Polishing using a rotating brush and abrasive paste can help to remove stains
.from your teeth

Use mouthwash

Fluoride mouthwashes can help to prevent tooth decay. Some antiseptic mouthwashes
reduce the number of plaque bacteria on your teeth and help to prevent gum disease. If you
use mouthwash to freshen your breath, talk to your dentist for advice as bad breath may be
a sign of poor oral hygiene. Always read the information on the mouthwash box or bottle
.and if you have any questions, ask your dentist or hygienist for advice

Chew gum

Chewing sugar-free gum after a meal stimulates the production of saliva, which helps to
neutralise plaque acid. Some chewing gums contain a sugar-free sweetener called xylitol,
which may help to reduce tooth decay. However, more research is needed to understand
.how this might work

Control sugar in your diet

Eating sugary foods and drinks encourages tooth decay. But it's how often you eat these
sugars, rather than the amount, that's important. Try not to eat or drink them between
meals to give your teeth a chance to be remineralised by saliva. Limiting sugar between
mealtimes is particularly important for children. It's also good for your general health to
.reduce your sugar intake

It's also important not to eat acidic foods or drinks, such as fizzy drinks or citrus fruit juice,
.between meals as these also encourage tooth decay and erosion

Alcohol and tobacco

Drinking alcohol and smoking or chewing tobacco can increase your risk of developing
mouth cancer. Smoking also stains teeth and can increase your risk of gum disease and tooth
loss. Alcoholic drinks, and the mixers used with them, often contain lots of sugar, and so
increase the risk of tooth decay

.
Visiting the dentist and hygienist

.Dentists and hygienists can help you to keep your teeth healthy

At your check-ups, your dentist will try to find any problems early, and give you advice and
treatment. He or she can advise you on how often you should have a check-up. For adults,
this can vary from three months upwards. For people with very good dental health and
.hygiene, this can be up to every two years

Children and adults who are at high risk of developing dental problems may need to see a
dentist more often. You may be at high risk if you smoke, have a diet that’s high in sugar, or
.have had lots of dental treatment in the past

About your child's teeth

Children's teeth start to develop before birth. There are two sets of teeth: milk teeth
.(sometimes called baby teeth) and permanent teeth

Milk teeth

Children usually have 20 milk teeth. They start to push through the gums (erupt) at about six
months. Most children have all 20 teeth by the age of two or three. However, this can vary
.so don’t worry if your child’s teeth come in faster or slower than this

Your child's milk teeth are important for eating, speech, smiling and confidence. They are
also important for the development of permanent teeth, so it's very important to look after
.them

Permanent teeth

Permanent teeth usually start to erupt at the age of six. Adults have up to 32 permanent
.teeth

Most of these will erupt by the age of 13. However, wisdom teeth (those at the very back of
.the mouth) often erupt between the ages of 17 and 25, if at all

If your child's permanent teeth are damaged or need to be removed, there won't be another
.set of natural teeth to replace them

?What can damage my child's teeth

Many children fall over and bump their teeth accidentally. If this happens, take your child
and the tooth if it has been knocked out to your dentist for advice as quickly as possible. If
.you can’t get to your dentist, contact the nearest dentist

.Tooth decay and dental erosion are two preventable causes of damage to children's teeth

Tooth decay

Our mouths are full of bacteria that build up on the teeth in a sticky layer called plaque.
These bacteria digest some of the sugar in our food and drinks, making acids that can
weaken the tooth enamel (the hard outer layer of teeth). If acid remains on the tooth
surface for a long time, it can cause those areas of the tooth to decay. This can happen if
.children often have sugary foods or drinks, or don't clean their teeth properly

If your child has tooth decay that isn't treated by a dentist, it will eventually reach the centre
.of the tooth and can cause an infection or toothache

Dental erosion

Dental erosion is the gradual wearing away of the enamel on the whole surface of the tooth.
It's caused by acid attacking the surfaces of the teeth. These acids usually come from drinks
such as fruit juices, fizzy drinks and squashes – even the sugar-free varieties. These drinks
are so popular that over half of all five-year-olds in the UK have some dental erosion. Acids
.can also be produced if your child vomits or has stomach problems

Dental erosion can cause sensitivity and pain. Although enamel doesn't grow back, dental
erosion doesn't usually need treatment. If your child has a seriously eroded tooth, his or her
.dentist may protect the tooth with a filling

?How can I protect my child's teeth

:To reduce your child's risk of tooth decay and dental erosion

take your child to the dentist regularly

don't give him or her too many sugary or acidic foods and drinks

encourage your child to brush his or her teeth twice a day with at least 1,000ppm fluoride
toothpaste

encourage your child to spit out toothpaste and not rinse with water, as this reduces the
effect of the fluoride

take advice from your dentist about protective treatments such as fluoride supplements and
)fissure sealants (see Fissure sealants

Going to the dentist

It's a good idea to take your child when you go for your routine dental check-ups, even when
he or she is too young to have teeth. This helps your child get familiar with the people and
the surroundings at the dental surgery. Your dentist will look in your child's mouth in an
informal way, and may count how many teeth have erupted and spot any early signs of
decay. Quick check-ups like this help to encourage good co-operation with the dentist when
.your child is older

Your dentist will recommend check-ups at intervals suitable for your child. He or she may
take X-ray images to check for decay. Children usually need dental visits more often than
adults. Milk teeth are smaller and have thinner enamel than permanent teeth, so decay can
spread very quickly. Regular check-ups help your dentist to help you prevent and treat decay
.before it causes toothache
Diet

Reducing sugar in your child's diet is the best way to prevent tooth decay. However, it's how
often your child eats sugar (rather than how much) that is important. Similarly, it's how
often your child has acidic food and drinks (rather than the amount) that affects dental
.erosion

Keep squashes, fizzy drinks, natural fruit juices, sweets and cakes to a minimum. Don't give
your child sugary foods and drinks as snacks between meals or before bedtime. Watch out
.for hidden sugars in sauces, breakfast cereals, etc

Fruit, vegetables, cheese and milk are all healthier snacks because they contain natural
sugars. Remember, however, that as well as natural sugars, fruit contains acids, which can
cause decay if eaten in large amounts. You can help to protect your child's teeth against
erosion by finishing a meal with an alkaline food such as milk or cheese. This will neutralise
.the acid in your child's mouth

Older children can chew sugar-free gum after meals, especially containing xylitol, as this
.helps remove bacteria and so prevent tooth decay

Plain water and plain milk don’t cause tooth decay or erosion. Your child may find it hard to
drink plain water or milk if he or she usually has sweet drinks, but most children get used to
.it over time

Tooth brushing

You should start cleaning your child's teeth as soon as they come through the gums. There
.are special toothbrushes for babies

Make tooth brushing a regular activity, in the morning and before bedtime, so that it
becomes part of your child's daily routine. Don't brush for one hour after eating or drinking
anything acidic (such as orange juice) – this gives time for the teeth to build up their mineral
.content

When your child is about seven, teach him or her how to brush his or her own teeth, using a
gentle, circular motion and fluoride toothpaste. You should supervise your child while he or
she is learning to brush. Give your child plenty of encouragement and praise. It's a good idea
.to check how well he or she is getting on every few days

Disclosing tablets are small pills that, if chewed for 30 seconds, turn plaque a bright colour –
usually pink. This can help you show your child any areas that have been missed when
.brushing

Toothpaste

Most toothpaste contains a mineral called fluoride, which strengthens the tooth enamel
making it more resistant to decay. Fluoride is also added to the water supply in about 10
percent of the UK. In these areas, there has been much less tooth decay. You can find out if
.your water is fluoridated by contacting your water supply company
However, too much fluoride in young children can result in a spotted appearance on their
.)permanent teeth (dental fluorosis

The amount of fluoride in different brands of toothpaste varies. Children under three should
use toothpaste that contains 1,000ppm fluoride. Children over three should use toothpaste
that contains between 1,350 and 1,500ppm fluoride. Ask your dentist which is the best
.toothpaste for your child

Use only a smear of toothpaste for children under three. After that, use an amount about
.the size of a small pea until your child is six

Fluoride supplements

If you live somewhere where there is no fluoride in the water or if your child's teeth are
particularly at risk of decay, your dentist may recommend extra fluoride in the form of
tablets, drops or mouthwashes. Your dentist may recommend fluoride varnish which they
.apply to your child’s teeth for extra protection

Fissure sealants

Some children have very deep fissures (crevices) in their permanent back teeth, which can
be difficult to keep clean. These fissures can be sealed with a resin film to protect the
.surface from decay

Fissure sealants are quick and painless to apply. The dentist cleans the tooth with a special
acid, then washes and dries it. The resin is then painted on to the tooth and hardened with a
.bright, blue light

Fissure sealants can last for several years, but your child should visit the dentist regularly to
check that they haven't worn through. Children with fissure sealants still need to brush their
teeth with fluoride toothpaste

.+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

About dental implants

A dental implant is a metal rod that is placed in the jawbone to hold a false tooth (or teeth)
in place. Implants are usually made of titanium, a metal that is well-tolerated by the body.
Over several months, the jawbone fuses with the titanium rod. Dentures, crowns or bridges
.can be screwed or clipped onto the implant

One implant can support one or more false teeth. Five or six implants are usually enough to
.replace all the teeth in the jaw

One implant can support one or more false teeth. Five or six implants are usually used to
replace all the teeth in the jaw
First aid for dental injuries
For example, if the accident causes you or someone you know to be knocked out (lose
consciousness), or if there is a lot of bleeding, it's important to call for emergency help.
Otherwise, you should contact a dentist straight away. If it's outside usual opening hours, go
.straight to the accident and emergency department at the nearest hospital

.Try to do the following if your tooth has been knocked out

Try not to touch the tooth's root - it's best if you only handle it by the crown (the white bit at
.)the top

If possible, put the tooth back into its socket in your mouth. This is called re-implanting the
tooth. If the tooth is dirty, gently rinse it with milk or saline solution (for example, contact
lens solution) for a few seconds. Don't use water or scrub the tooth. Try to put it in the right
way round, but don't worry too much as your dentist can fix this. The important thing is to
put it back in as quickly as possible. Don't put children’s milk (baby) teeth back in the socket
.as this can damage the developing adult teeth

When your tooth is back in its socket, bite down gently on a clean handkerchief or a piece of
.gauze to keep it in place

If you can't re-implant your tooth straight away, store it in milk or saliva (by spitting into a
container) or place it inside your mouth between your cheek and gum until you can get to a
dentist. However, this isn't recommended for young children as they could swallow or inhale
.the tooth

If you haven't got the whole tooth, don't try to put a broken tooth back in your mouth. Store
.it in a pot of saliva or milk as your dentist may be able to reattach it

Even if you don't think your tooth is broken, it's still important to see your dentist as soon as
.possible. There may be an injury below the gum line that you can't see

Treatment of dental injuries

If your tooth has been loosened or knocked out

When you see a dentist, he or she will look inside your mouth to see if your tooth has been
re-implanted properly. If not, your dentist will try to re-implant it as soon as possible.
.However, this may not always be appropriate - ask your dentist for information

You will need to have your tooth splinted (joined to your neighbouring teeth) to hold it in
place as it heals. There are different types of splint; the most common is made of clear
plastic. Another type is a thin piece of wire, which attaches your loose tooth to those on
either side of it. If you handled your tooth carefully and re-implanted it quickly, you will need
to keep this on for one to two weeks. If your injury was more severe and caused root
.damage, you may need to wear the splint for several weeks
Your dentist may take some X-rays to see how serious your injury is and if there are any
pieces of broken tooth stuck in your lip, gum or tongue. If you think you have inhaled a piece
.of tooth, your dentist may refer you to hospital for a chest X-ray

If your tooth has been chipped

Treatment for a chipped tooth will depend on where your tooth has broken. Teeth have a
core of blood vessels and nerves at their centre called the pulp. If your tooth is injured, the
.pulp can be damaged and the blood vessels may die

If a piece of your tooth has chipped off but the pulp isn't damaged, your dentist will smooth
the uneven edge and replace the corner with a tooth-coloured filling. If the pulp is damaged,
you may need to have root canal treatment to remove the damaged blood vessels and
.nerves from your tooth

Your dentist may also check your mouth to see if the chipped tooth has caused any further
damage to your mouth. You may need to have an X-ray to check that a piece of your tooth
.isn’t embedded in your lip, for example

If your tooth has broken roots

Your teeth have roots that are set in your jawbones. If a root fractures, it's possible that your
tooth won't look any different because the fracture is hidden by bone and gum. However,
.your dentist may be able to see a fractured root on X-ray images

If your tooth is quite firm, your dentist may just ask you to come back for regular X-rays and
tests to make sure that the pulp stays healthy. However, if your tooth is wobbly, it will need
.to be splinted for a few weeks to help the fracture heal

If your dentist finds that the pulp has been damaged and isn't going to recover in the weeks
and months after the root fracture, he or she may recommend that you have root canal
.treatment to save the tooth

Some fractures are unlikely to heal, particularly if they are near the gum or the tooth has
.broken lengthways. Your dentist may recommend that you have your tooth taken out

After your treatment

If at any stage you feel pain or notice any change in colour to your damaged tooth, it's
important to visit your dentist as the pulp can die a long time after a dental injury. If you
have had your tooth re-implanted, continue to get it checked as you may need treatment in
.the future

Dental injuries in children

Young children who injure their milk teeth may need different treatment to that given to
adults or teenagers. For example, if a milk tooth gets knocked out, the dentist is unlikely to
try to re-implant it. This is because it could damage the permanent tooth when it develops.
Occasionally, an injury to a milk tooth can cause damage to the developing adult tooth. This
.will be monitored at check-ups

Prevention of dental injuries

If you regularly play a sport that puts you at any risk (eg rugby, boxing, cricket, hockey) you
may wish to consider getting a mouthguard. This will offer some protection and can reduce
the likelihood of you getting an injury. Mouthguards are usually made of rubber and form a
.cover that goes over your teeth and gums

You can buy mouthguards in some sports shops but it's better to ask your dentist to make
one that is specially fitted for you. If your mouthguard has been made properly, you should
not have any problems talking or breathing normally while you are wearing it. Your dentist
will take a mould of your teeth using a putty-like material. This is then sent to a laboratory
where your mouthguard is made. Children will need to have their mouthguards replaced as
.new teeth develop and their mouths grow

Fillings
Fillings are used to fill holes (cavities) that have formed in your teeth, usually as a result of
decay or general wear and tear. There are two types of fillings – amalgam (silver) and
.)composite (tooth-coloured

Amalgam fillings are made of a combination of metals including silver, tin, copper and
mercury. Amalgam is extremely hard-wearing and can withstand the grinding and chewing
action of your back teeth over long periods of time. Composite fillings can be used instead of
amalgam as a natural-looking alternative. They are often used in teeth that show when you
smile or talk. However, they don't tend to last as long as amalgam fillings, so aren't always
.recommended for the grinding and chewing surfaces of your back teeth

Before you have a filling, your dentist will remove the decayed and weakened parts of your
tooth using a small drill, and clean the cavity. With tooth-coloured fillings, your dentist may
need to build the filling in layers, hardening each layer with a bright light before placing the
.next. This technique may take a bit longer than having an amalgam filling

Crowns

If your tooth has been broken or weakened by a lot of decay or a large filling, your dentist
may recommend fitting a crown. A crown looks just like a natural tooth. It‘s made in a
laboratory and then glued over the top of your damaged tooth to disguise it. Crowns can be
made of porcelain, gold or a combination of metal covered with tooth-coloured porcelain.
You will need to have two appointments to have a crown fitted. At the first, your dentist will
place a temporary crown over your tooth while you wait for the new crown to be made.
Then at the second appointment your dentist will remove the temporary crown and fit the
permanent one

.
Veneers

If one of your front teeth is chipped, damaged or discoloured, a thin layer (veneer), usually
made of porcelain, can be made to fit over it. Sometimes, if you have one or more teeth that
are slightly crooked, veneers of varying thicknesses can be fitted to help them appear
.straighter

You will usually need two visits to the dentist. At the first, your dentist will take a mould of
your tooth, which is then sent to a laboratory for the veneer to be made. He or she will also
remove a small amount of the top layer of your tooth (enamel). On the second visit, your
.dentist will cement the veneer onto the front of your tooth

Veneers can last for several years, but they can be damaged just like normal teeth because
of an accident, break or chip

Tooth whitening

Whitening can be used to lighten the surfaces of your teeth. There are a number of different
bleaching methods available to lighten the natural shade of your teeth. Some you can buy
.and use at home, whereas others require a visit to your dentist

Whitening toothpastes

Whitening toothpastes are slightly abrasive, which may help to remove surface staining, but
don't change the natural shade of your teeth. Experts are currently reviewing how effective
.whitening toothpastes are

Over-the-counter tooth whitening kits

Over-the-counter tooth whitening kits are sold in most major pharmacies throughout the
UK. They usually contain rubber mouth trays (moulds that are approximately the same
shape as your teeth) and tubes of bleaching gel. The bleaching ingredient in the gel is usually
hydrogen peroxide. The kits will only contain weak hydrogen peroxide, so may not be as
.effective as the stronger products used by your dentist

.Always speak to your dentist before using an over-the-counter tooth whitening kit

Professional tooth whitening

Professional bleaching is carried out by your dentist. It’s the most common type of tooth
whitening and can be external or internal. If you have external bleaching, the gel is placed on
the outer surfaces of your teeth. Internal bleaching involves your dentist putting the
bleaching product inside your tooth. External bleaching is more common, as internal
bleaching can only be used if you have had root canal treatment, making access to the inside
.of your tooth easier

Power or laser bleaching can also be done by your dentist. He or she will place a rubber seal
around your teeth to protect your gums. Then the bleaching gel is put onto your teeth and a
special, bright light is used to speed up the whitening process. This treatment usually takes
.about an hour

Possible side-effects of bleaching include tooth sensitivity and gum irritation. The long-term
effects of using these techniques aren't known. All the bleaching techniques only whiten
your teeth temporarily, so you will need to have more treatment if you want to maintain the
.colour

Straightening teeth
Orthodontic treatment is used to straighten or move your teeth to improve their
appearance or function. It can also help to keep your teeth and gums healthy by spreading
the pressure of your bite out evenly. Straight teeth are easier to clean and are less
.vulnerable to tooth decay and gum disease

Orthodontic treatment usually involves wearing a brace on your teeth. This puts gentle
pressure on specific teeth to move them into the right place. You will usually need to wear a
brace for between six months and two years. During this time, your orthodontist will
monitor your teeth closely and make adjustments to the brace. Orthodontic treatment is
.usually carried out during childhood, but adults can have it as well

There are several different types of brace. Some can be removed whereas others are fixed in
.place

Removable braces

Removable braces are made of plastic and usually have wire clips and springs to move
specific teeth. They are most commonly used to move your upper teeth. You will need to
take your brace out to clean it, but otherwise you should wear it at all other times, including
.mealtimes and at night

Fixed braces

Fixed braces (sometimes called 'train tracks') can't be removed from your teeth – except by
your orthodontist when your treatment is finished. They are made of small brackets that are
glued to your teeth with filling material and are joined together with a wire. Fixed braces are
usually made of metal, but can also be made of plastic or ceramic. You may need to have
small elastic bands attached to your brace – these are used to keep the wires in place and
are often available in different colours. Fixed braces can be used on both your upper and
.lower teeth

Once the treatment is finished, your dentist will remove the brackets and clean the filling
.material off your teeth

Orthodontic treatment isn’t always suitable for everyone. Ask your dentist to explain the
options available to you

.
Fillings
Fillings are used to fill holes (cavities) that have formed, usually as a result of decay or tooth
.wear. There are many types of filling, each suitable for different cavities

Most people have a local anaesthetic injection to completely numb the area while the filling
.is being done. The numbness can take several hours to wear off

If you're nervous of having an injection, ask your dentist if you can have an anaesthetic gel
applied to the appropriate area of the gum instead. This gel numbs the gum so you can't feel
.the needle

The decayed and weakened parts of the tooth are removed using small drills and the cavity
is cleaned. If the cavity has spread to the side wall of your tooth, a band will be placed
around the tooth with a small wedge holding it in place. This ensures that the filling hardens
.into the correct shape

To protect the tiny nerves and blood vessels inside the tooth, very thin layers of
underlinings, such as resin, are sometimes painted inside the hole before the filling material
is packed in. The filling will either begin to harden during the first few minutes or, for some
.materials, a blue light is used to make it set within a few seconds

Sometimes temporary fillings are used, at emergency appointments for example, where
there may not be enough time to do the full treatment. Temporary fillings can last for quite
a long time, but they aren't very strong so you will need to arrange to have a durable filling
.placed within a few weeks

Amalgam fillings

Amalgam fillings are made of a combination of metals including silver, tin, copper and
mercury. Amalgam is extremely durable and able to withstand the grinding and chewing of
.your back teeth over long periods of time

Tooth-coloured fillings

You can choose tooth-coloured fillings to match the colour of your teeth, making them a
natural-looking alternative to amalgam fillings. They are often used in teeth that show when
you smile or talk. They aren't as durable as amalgam and so aren't always suitable for the
.grinding and chewing surfaces of the back teeth

There are a few different types of tooth-coloured filling materials. The most common are
called composite and glass ionomer. They are soft and can be moulded to the shape of a
tooth before they harden. Tooth-coloured filling materials stick to teeth so they can be used
.to build up the edges of chipped or worn teeth

Composite shrinks very slightly under the blue light. This can pull on the tooth and may
cause sensitivity. It can also produce a tiny gap between the filling and your tooth that may
attract bacteria and lead to further decay. However, more modern composites have
.significantly reduced this problem in recent years
Tooth-coloured fillings must be kept completely dry until they have set, so the dentist will
take special precautions to keep saliva away from the area. This may include placing a sheet
of rubber over your tooth (called a rubber dam). This only stays in place during the
.treatment

Glass ionomers can release fluoride which prevents decay. They aren't very durable and are
.usually used for children's teeth, small back fillings or fillings on root surfaces

Crowns

If a tooth has been broken or weakened by a lot of decay or a large filling, you can have a
crown (or cap) fitted to strengthen it and improve its appearance. You may have an X-ray
taken to check your tooth. Crowns are shaped like natural teeth and fit over the prepared
tooth. For teeth near the front of the mouth, crowns are usually made of ceramic materials.
Crowns on back teeth may be made of porcelain or gold, or porcelain bonded onto gold.
.Gold crowns can either be gold or silver in appearance

Newer ceramic crowns look like porcelain crowns and are strong enough to be used in all
.areas of the mouth

Your dentist will give you a local anaesthetic injection to numb the tooth and will shape your
tooth so that there is room for the new crown. Once prepared, a mould of your tooth is
taken in a putty-like material so that the dental technician can make a crown that fits the
tooth perfectly

It may take one or two weeks for the crown to be ready, so your dentist will fit a temporary
one. At the second appointment, your dentist will take off the temporary crown and cement
.the new one in place

Inlays and onlays

Inlays and onlays are similar to fillings. An inlay is placed within the biting surface of the
tooth while an onlay covers a larger area of the tooth. However, like crowns, they are made
in a laboratory and then cemented to the tooth with special adhesive. You will probably
.need two visits to the dentist

During the first visit, the dentist removes the old filling or decay and makes a mould of the
tooth in a putty-like material. A temporary filling is placed to protect the tooth while the
dental technician uses the mould to make the inlay or onlay. On the second visit, the
.temporary filling is removed and the inlay or onlay cemented in place

Inlays and onlays are very strong and, in some circumstances, may be more durable than
ordinary fillings. They are suitable for the grinding surfaces of the molar teeth and can be
.made from porcelain or composite material as well as gold

Root fillings

Teeth have a core of blood vessels and nerves at their centre in a space called the root canal.
Very deep decay or injury to a tooth can destroy this living tissue and make it darken in
colour. A 'dead' tooth is prone to infection. This in turn may lead to an abscess which can
cause pain and swelling around the tooth. The root canal needs to be cleaned out
.thoroughly before any restoration work is done

Your dentist will give you a local anaesthetic injection to numb the area before removing any
decay using a drill. It shouldn't feel any different to having a filling. A rubber dam will usually
be placed over your tooth to keep it dry. Disinfectant and thin instruments are used to
remove bacteria and dead cells from the root canals. There can be as many as four root
.canals in each tooth and they all need to be cleaned out in this way

Afterwards your tooth is sealed by placing a temporary filling into the root canal. Once your
.dentist is happy that the infection has gone, a filling or crown can be placed on top

Root fillings are complicated and you may need two or more appointments. You will need to
have a number of X-rays during root canal treatment. When completed, a root filling should
.feel no different to an ordinary filling

Veneers

This is when a thin layer of tooth-coloured material, usually porcelain, is fitted over a
.discoloured tooth

On the first visit you may have a local anaesthetic injection to numb the tooth but this isn't
always necessary. The surface of your tooth may be filed down slightly to allow for the
added thickness of the veneer so bear in mind that it can't be reversed. Your dentist will
then take a mould of your tooth in a putty-like material. This is sent to a laboratory where
the veneer is made by a dental technician over one to two weeks. While you're waiting, you
may have a slightly roughened, sensitive tooth. On the second visit your dentist will bond
.the veneer onto the front of your tooth

Although veneers can last for many years, they can be damaged through an accident, break
.or chip and may need to be replaced

?What are the risks

Amalgam fillings

Some people have concerns about the safety of amalgam fillings because they contain
mercury. In large enough doses mercury is toxic. However, fillings only use very small
.amounts

Very small amounts of mercury collect in our bodies from a number of sources including the
environment, our food and our amalgam fillings. It's estimated that amalgam fillings account
.for a sixth of the average daily amount - about nine millionths of a gram

Extensive research has been done to investigate the effect of amalgam fillings on health. No
harmful effects from amalgam fillings have been shown and the World Health Organization
(WHO) and the UK's Medicines and Healthcare products Regulatory Agency (MHRA) support
the continued use of amalgam fillings. However, dentists take special precautions when
removing amalgam fillings because drilling into the amalgam creates higher levels of
mercury vapour. Your dentist uses extra water and suction to minimise the amount of
.vapour

Although there is no evidence linking amalgam to birth problems, placing and removing
amalgam fillings in pregnant women is generally avoided as a precautionary measure
because mercury can be passed on through the placenta and breast milk. If you are or think
.you may be pregnant, tell your dentist so he or she can plan your treatment accordingly

A very small number of people are allergic to metals in amalgam and may need to have
.another type of treatment

Tooth-coloured fillings

Tooth-coloured filling materials don't contain mercury. However, there have been concerns
that they release a chemical called bisphenol A. This chemical is also used in the
.manufacture of some food packaging and water pipes

Bisphenol A appears to copy the action of human oestrogen hormones and has been linked
to breast cancer, prostate cancer and male infertility. The British Dental Association has
looked into this and found that most filling materials don't release bisphenol A. There is no
evidence of harm from this type of filling. However, this chemical is being used less in newer
.filling products

++++++++++++++++++++++++++++++++++++++++++++++++

About angina
Angina is a symptom of coronary heart disease and affects about two million people in the
UK. You’re more likely to get angina as you get older and men are more likely to get it than
women. Angina usually starts with chest pain or tightness when you’re under stress or doing
.some sort of physical activity

.There are two main types of angina

Stable angina

Stable angina is when you get regular or predictable symptoms that you have had for more
than two months. Symptoms of stable angina usually develop gradually over time and you
can often notice a pattern to your symptoms. For example, it’s common to only get
symptoms when you do physical activity or if you’re under a lot of stress. Symptoms of
.stable angina that get worse with physical activity often pass within a few minutes of rest

Unstable angina

Unstable angina is usually caused by sudden narrowing of a coronary artery and can mean
you’re at risk of having a heart attack or stroke. Symptoms of unstable angina often come on
after only a small amount of effort or even when resting. There is often no pattern to your
symptoms and they may last for 30 minutes or more. Pain and discomfort may develop
quickly and be more severe and frequent than with stable angina. If you get sudden chest
.pain or you think you may have unstable angina, call for emergency help immediately

Angina and heart attack

If a coronary artery becomes completely blocked, part of the heart muscle may be starved of
oxygen and become damaged. This is a heart attack. The pain is usually severe and lasts
longer than that of angina. If you have angina, your usual treatment may not relieve the pain
of a heart attack. If you suspect that you, or someone else, is having a heart attack, call for
.emergency help immediately

Symptoms of angina

Angina is often brought on by physical activity, emotional stress, cold weather or after a
.meal. If you have angina, you may have the following symptoms

.Pain and discomfort in your chest. This pain can feel dull, heavy, tight or severe

.Pain and discomfort that may spread to your jaw, neck, arms, back or stomach

.Palpitations, sweating, feeling sick or shortness of breath

Symptoms of angina may vary depending on the type of angina you have. Some people may
.get very few symptoms, which can make a heart attack difficult to spot

If you have stable angina and your symptom patterns change, see your GP as soon as
.possible. If you get angina symptoms at rest, call for emergency help immediately

Causes of angina

Stable angina is caused by narrowing of the coronary arteries. Gradually over time, fatty
deposits build up on the walls of the coronary arteries and they become narrowed and
hardened. This restricts blood flow to your heart and is known as atherosclerosis, which is
.the cause of coronary heart disease

Unstable angina is caused when a fatty deposit (plaque) bursts (ruptures) and a blood clot
forms around the plaque. This can partially or completely block a coronary artery and
.suddenly reduce blood flow to part of your heart

The main cause of angina is coronary heart disease. You’re more likely to get coronary heart
:disease if you

,have high blood pressure,have diabetes,have high cholesterol,smoke

have an inactive lifestyle,are overweight

have a family history of coronary heart disease

About gum disease
Gum disease is very common – it affects more than half of adults with natural teeth. It can
.be treated by a dentist or hygienist and in the early stages the effects can be reversed

There are three main types of gum disease: gingivitis, periodontitis and acute necrotising
.)ulcerative gingivitis (ANUG

Gingivitis

If you have gingivitis, your gums become irritated by plaque, which is a mixture of food,
bacteria and bacterial waste products that can build up on your teeth. If you don’t clean
plaque off your teeth regularly, your gums will become red, swollen and shiny, and they may
bleed. This is the early stage of gum disease and is completely reversible. If you remove the
plaque, your gums will recover. But if you don’t clean the plaque off your teeth, the gingivitis
.may develop into periodontitis

Periodontitis

If you don’t get treatment for gingivitis, your gums may begin to pull away from your teeth,
leaving small pockets. These pockets trap plaque that you can't reach with a toothbrush.
Over time, the plaque will harden to become tartar (calculus). Plaque and tartar build-up can
cause further irritation, which may gradually spread to the bone structures around your
teeth. As time goes on, the pockets can get deeper and more difficult to clean, and your gum
.and bone may shrink. This is called periodontitis

If your gums shrink, they can expose some of the roots of your teeth, making them sensitive.
And if you have bone loss, your teeth may become loose. If you don’t get treatment for a
.number of years, your teeth may fall out, or need to be taken out by a dentist

It's rarely possible to make the bone structures grow back, so periodontal pockets aren’t
generally reversible. However, if you receive the appropriate treatment and make sure you
floss and brush your teeth well, the progress of the disease can be stopped

Acute necrotising ulcerative gingivitis

ANUG, also known as 'trench mouth', is a severe type of gum disease that develops
suddenly. It can be treated with good dental hygiene, including brushing your teeth twice a
.day, and antibiotics

Symptoms of gum disease

You may not know that you have gum disease. Often it's not painful and you might not get
any symptoms. This is one of the reasons why it's important that you attend regular check-
.ups with your dentist

:Usually the first signs of gingivitis are

bleeding gums when you brush your teeth

red and swollen gums

:If gingivitis has developed into periodontitis, you may have

a bad taste in your mouth

a wobbly tooth or teeth

)gum abscesses (pus that collects under your gum

:The symptoms of ANUG include

painful ulcers that develop suddenly and bleed easily

bad breath

a receding of the V-shaped bits of gum between your teeth

feeling generally unwell

.If you have any of these symptoms, you should see your dentist straight away

Causes of gum disease

Gum disease happens when plaque builds up around teeth that aren’t cleaned properly. This
is more likely to happen if you find it difficult to clean your teeth well, for example if you
wear braces or dentures, or have irregularities in your teeth that you can't reach with a
.toothbrush

There are other factors that can make you more likely to get gum disease, for example if you
smoke or have diabetes. You may also be more likely to get gingivitis during hormonal
.changes, such as during pregnancy or puberty

Diagnosis of gum disease

Your dentist will ask about your symptoms and examine you. He or she may also ask you
.about your medical history

Gingivitis can usually be diagnosed just by your dentist looking at your teeth. But if your
dentist thinks you have periodontitis, he or she may look at your mouth more thoroughly
and check for gum disease using a periodontal probe. This is used to measure how far your
gum has pulled away from your teeth. Your dentist will do this by putting the probe beside
each tooth and underneath your gum line to check how well your gums are attached to your
.teeth

.You may also need to have X-rays to check the condition of your teeth and jaw bone

Treatment of gum disease

The type of treatment you have will depend on how severe your gum disease has become.
Your dentist may refer you for treatment with a dental hygienist – a health professional who
specialises in the prevention and treatment of dental conditions such as periodontal disease.
If you have severe gum disease, your dentist may refer you for treatment with a
.)periodontologist (a health professional who specialises in treating gum disease

Scaling

If you have gingivitis, your dentist or hygienist will clean your teeth thoroughly with a gritty
toothpaste using an electric toothbrush and special instruments called scalers. This type of
thorough cleaning is called scaling. Your hygienist may also recommend an antiseptic
mouthwash that will help to prevent plaque forming, and will help you learn how to brush
.and floss your teeth properly

If gingivitis has developed into periodontitis or you have ANUG, you may need more
extensive scaling to remove plaque and tartar from the periodontal pockets. This can require
several appointments. Your dentist or hygienist may need to inject a local anaesthetic into
your gums before the scaling. This will completely block the feeling from your gums, and you
will remain awake during the treatment. Your dentist or hygienist will monitor the size of the
periodontal pockets during the following months to make sure the treatment has been
.successful and the periodontitis isn’t getting any worse

Gum surgery

You may need to have gum surgery if your gum disease is very severe, but this is rare. Your
dentist may refer you to a periodontologist for this. There are a number of types of surgery
that can help to build your gum tissue back up after it has shrunk from gum disease. If you
need more information, ask your dentist

Prevention of gum disease

You can prevent gum disease by controlling the amount of plaque and tartar that builds up
on your teeth. Regular visits to your dentist or hygienist, brushing and flossing your teeth
.properly and stopping smoking will help to do this

Dental floss or inter-dental brushes can remove plaque and small bits of food from between
your teeth and under your gum line – areas that a manual toothbrush can't reach. You may
prefer to use an electric toothbrush. There is some evidence to suggest that certain types of
electric toothbrush may be more efficient at removing plaque than manual toothbrushes.
.It’s important to use the correct technique, so ask your dentist or hygienist for advice

Some antiseptic mouthwashes reduce the amount of plaque bacteria when combined with
regular brushing. However, there isn't enough evidence to say whether mouthwash can help
to prevent gum disease. If you do use an antiseptic mouthwash, it's important that you don't
use it for too long as it can stain your teeth. Always read the information on the mouthwash
.box or bottle and if you have any questions, ask your dentist or hygienist for advice

Even thorough brushing and flossing can't remove every trace of plaque. Most people have
irregularities in their teeth where plaque can build up out of reach and harden into tartar.
.This can only be removed by your dentist or hygienist during scaling
About jaw joint dysfunction
The jaw joints are where your lower jaw bone (mandible) meets your skull. The medical
name for the jaw joint is the temporomandibular joint (TMJ). You have two jaw joints, one
on each side, just in front of your ears. The joints allow you to open and close your mouth,
.and move it from side to side or backwards and forwards

The joint is made up of part of the surface of each bone - the jaw and the skull - surrounded
by a capsule. One side of the capsule is made of a ligament called the lateral ligament.
.Between the two bones is a disc of fibrous tissue which helps your jaw to move smoothly

The jaw joint is one of the most complicated joints in your body, with a complex
arrangement of muscles and ligaments allowing the different movements. Any problem that
stops the muscles, ligaments, discs and bones from working properly together can cause a
painful condition called temporomandibular dysfunction (TMD) or jaw joint dysfunction. It is
also known as TMJ disorder

Symptoms of jaw joint dysfunction

pain - this is most likely to be an aching around your ear, and possibly in your cheek bone or
neck, and it often relates to the muscles which control the jaw joint

headache

clicking and/or cracking noise (crepitus) in your jaw joint when you move it

jaw locking

)stiffness, or being unable to open your mouth properly (trismus

a change in the way your teeth fit together when your jaw is closed

Your symptoms may be worse when you chew or yawn. They may also be worse if you are
.stressed

Causes of jaw joint dysfunction

:There are three main causes of jaw joint dysfunction. These are

Muscle pain and tension in your face (myofascial pain). Common causes include grinding or
clenching your teeth (bruxism), especially at night, biting your nails, holding things between
.your teeth, stress or injury

Jaw misalignment (internal derangement). This means your jaw is not properly aligned with
your skull, so the joint does not work smoothly. This can happen when the articular disc (thin
disc within the joint) is in the wrong position, you have had a dislocated jaw, or your jaw
.joint has been injured

Degeneration of the joint. This is when the jaw joint is affected by arthritis, which happens
.most commonly in older people. Arthritis can also be caused by injury
Injuries that can trigger jaw joint dysfunction include knocks to your jaw or overstretching
.when yawning, or during dental treatment

Clicking is caused when the cartilage disc within the joint moves forwards out of its usual
position when you open your mouth - the clicking is made when it moves back into place as
you close your mouth. The noise may seem louder to you because the joint is close to your
ear. Your jaw may lock if the cartilage does not return to its usual position after slipping out
.of place

Because the jaw joint is so complicated and there are many possible causes of jaw problems,
it can be difficult to work out what is causing your symptoms. Your dentist will examine your
jaw joint and look at your teeth for signs of wear due to grinding. This will involve checking
the way that you open and close your mouth and feeling the muscles around the jaw to see
if they are tender. Your dentist may also ask if you are stressed, because this can make
grinding or clenching worse

Treatment of jaw joint dysfunction

Self-help

Your dentist will explain the problem to you and give you advice on anything you can do to
reduce pain or clicking, such as stifling yawns and eating soft foods that don't need too much
.chewing

He or she may recommend some exercises for you to do at home. It's important that you
.practise these as you have been shown

Your dentist may also suggest using a heat pad such as a hot water bottle (filled with warm
.but not boiling water) wrapped in a cloth or towel

.If stress is causing your symptoms, you may find that relaxation therapy is helpful

Medicines

You may find that over-the-counter painkillers such as paracetamol or ibuprofen help ease
the pain. Always read the patient information that comes with your medicine and if you
.have any questions, ask your pharmacist for advice

Non-surgical treatment

If your dentist thinks that you are clenching or grinding your teeth at night then he or she
may offer a bite splint. This is a cover made from hard or soft plastic that fits over your
upper or lower teeth and stops them coming into contact. You will probably need to wear
this in the evenings and at night for four to six weeks before your dentist is able to see if it
.has made any improvement. You may notice a reduction in pain sooner than this

These measures will probably relieve your symptoms. But if they don't, your dentist may
refer you to an oral surgeon. The specialist may prescribe stronger painkillers or other
medicines to help relieve the pain. If necessary, he or she may give you a short-term
prescription for medicines which are usually used to treat depression - this is because some
.antidepressants also cause your muscles to relax

Surgery

In a few, rare, cases your oral surgeon may recommend an operation on your jaw joints.
However, it's important to talk through all of the options with him or her before going ahead
.with any surgery

++++++++++++++++++++++++++++++++++++++++++++++++++++++=

About mouth cancer

Mouth cancer is caused by an uncontrolled growth of cells in the mouth. Mouth cancer includes cancer
that starts anywhere in the mouth

Nine out of 10 mouth cancers are squamous cell carcinomas. They develop in the flat, skin-like cells that
cover the inside of the mouth

Symptoms of mouth cancer

Most people with mouth cancer have no early symptoms at all, but others may have:

an ulcer in the mouth or on the lip that won't heal 

constant pain or soreness 
red or white patches in the mouth 
a lump on the lip, tongue or in the neck 
bad breath 
unexplained bleeding in the mouth 
numbness in the mouth 
loose teeth 
These symptoms aren't always caused by mouth cancer but if you have them, visit your GP or dentist.

Causes of mouth cancer

Doctors don't fully understand why mouth cancer develops. However, certain factors make mouth
cancer more likely.

Smoking any form of tobacco - cigarettes, cigars and pipes, as well as bidis or hand-rolled cigarettes 
containing cannabis.
Chewing tobacco, such as betel quid, gutkha and paan. 
Drinking excessive alcohol, especially at the same time as smoking or chewing tobacco. 
Having already had cancer of the head and neck. 
Exposure to the sun or UV light - this increases the risk of lip cancer. 
A weakened immune system - people who have HIV/AIDS, or who are taking medicines that suppress 
the immune system, are more likely to develop mouth cancer.

Diagnosis of mouth cancer

The earlier mouth cancer is diagnosed, the better the chances of recovery. Your dentist may spot mouth
cancer in its early stages during a routine check-up, so it's important to visit your dentist regularly.

Your doctor or dentist will ask you about any symptoms, and examine you using a small mirror for
harder-to-see areas. He or she will feel your neck and face for swellings. You may then be referred to an
ear, nose or throat specialist for further tests.

You may have the following tests to confirm diagnosis.

Mouth and throat examination - your doctor may use a special instrument called a laryngoscope to 
look inside your mouth and throat.
 Biopsy - a sample of cells or tissue is removed and sent to a laboratory for diagnosis. 
Staging the cancer
If the biopsy shows that you have cancer, you will have further tests to find out how far it has spread and
to help decide the type of treatment you will need. This is called staging the cancer. The tests may
include the following.

X-rays of the upper and lower jaw (Panorex X-ray), or the chest, or both. 
Barium swallow - this test involves swallowing a drink containing barium (a substance which shows up 
on X-rays). The X-rays will show up any unusual growths in the throat.
Scans - these may include ultrasound, MRI or CT scans. These are done to check the muscles, 
organs and tissues in your face, throat and chest.
Further biopsies of nearby lymph nodes. Lymph nodes are glands throughout the body that are part of 
the immune system.

Treatment of mouth cancer

Treatment depends on the type of mouth cancer, where it is and how far it has spread. Your doctor will
discuss your treatment options with you. There are three main treatments for mouth cancer.

Surgery
Surgery (including the use of lasers) involves removing just the affected tissue. How much surgery is
needed depends on how much tissue is affected. Surgery is sometimes followed by chemotherapy or
radiotherapy treatment to make sure all the cancer cells are destroyed.

Non-surgical treatments
Radiotherapy - radiation is used to kill cancer cells. 
Chemotherapy - anti-cancer drugs are used to destroy cancer cells. They are usually injected into a 
vein but sometimes may be given as tablets.
Biological therapy - special manufactured monoclonal antibodies (cetuximab) are used to block areas 
on the surface of cancer cells that can trigger growth. Radiotherapy is then used to destroy the cancer
cells. Cetuximab is a new treatment and is approved for use only in advanced squamous cell cancer
of the head and neck.
For answers to frequently asked questions on this topic, see Common questions.
For sources and links to further information, see Resources.

Prevention of mouth cancer

Simple lifestyle changes can reduce your risk of mouth cancer.

Visit your dentist for regular check-ups. 

Look for any changes in your mouth such as, sore patches or ulcers that don't heal and report them to 
your GP.
Don't smoke. 
Don't chew tobacco. 
Drink only in moderation. 
Eat a healthy diet with at least five portions of fruit and vegetables a day. 
Protect your skin from sunlight and other UV exposure such as sunbeds. Wear sunblock on your lips, 
stay out of the sun between 11am and 3pm and wear a wide-brimmed hat to protect your face.

++++++++++++++++++++++++++++++++++++++++++

?What happens during tooth removal

If your tooth is removed under local anaesthesia, your dentist will inject a local anaesthetic
.into your mouth and check it has taken effect before starting the procedure
Your dentist will widen your tooth socket and gently rock the tooth side to side until it’s
loose enough to pull out. You will feel some pressure in your mouth and hear some noise.
.You shouldn’t feel any pain

Most teeth only take a few minutes to remove. Afterwards, your dentist may close your
.tooth socket with stitches

What to expect afterwards

If your tooth is removed under local anaesthesia, you will have some bleeding. Your dentist
will give you a piece of soft padding to bite on to stop the bleeding. You will need to stay at
.the dental surgery until the bleeding is controlled

If your tooth is removed under general anaesthesia or sedation, you will need to rest until
the effects of the anaesthetic or sedative have passed. You will need to arrange for someone
to drive you home. You should try to have a friend or relative stay with you for the first 24
.hours

Both sedation and general anaesthesia temporarily affect your coordination and reasoning
skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24
hours afterwards. If you're in any doubt about driving, please contact your motor insurer so
.that you're aware of their recommendations, and always follow your surgeon's advice

Before you go home, your dentist or surgeon will give you advice about looking after your
teeth and gums. You may be given painkillers, antibiotics and mouthwash solutions to take
.home. You may also be given a date for a follow-up appointment

Recovering from tooth removal

After a local anaesthetic it may take several hours before the feeling comes back into your
.mouth

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or
ibuprofen. Always read the patient information leaflet that comes with your medicine and if
.you have any questions, ask your pharmacist for advice

.After having your tooth removed, there are certain steps you can take to help your recovery

Don’t rinse your mouth out for at least six hours. After that, rinse gently with warm salt
.)water (half a teaspoon of table salt dissolved in a glass of warm water

.When you feel ready to eat, start with sips of warm (not hot or spicy), soft or pureed food

If your gum bleeds, bite down on a clean pad of material such as a handkerchief for at least
.15 minutes

.Don’t drink alcohol for at least 24 hours and don’t smoke until your wound has fully healed

It can take up to seven days to make a full recovery. You can brush your teeth but keep your
.toothbrush away from the healing wound
The length of time your dissolvable stitches will take to disappear depends on what type you
have. However, for this procedure they should usually disappear in about two to three
.weeks. Non-dissolvable stitches are removed about a week after your procedure

?What are the risks

As with every procedure, there are some risks associated with tooth removal. We have not
included the chance of these happening as they are specific to you and differ for every
.person. Ask your surgeon to explain how these risks apply to you

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the
.procedure

You’re likely to have some discomfort and swelling for a few days afterwards, and your jaw
.may feel a little stiff. You may have some bleeding

Complications

Complications are when problems occur during or after the procedure. Complications of
.having your tooth removed are listed below

Infection. If you feel a burning sensation or you have heavy bleeding, increased swelling or
.pain, contact your dentist. You may have an infection and need antibiotics

Dry socket. This happens when the blood doesn’t clot in your tooth socket, so it doesn’t heal
.properly. Symptoms include having severe pain and you will need further treatment

++++++++++++++++++++++++++++++++++++++++++++++++

About replacing missing teeth

When teeth are missing, it can affect the way the rest of your teeth bite together. The
remaining teeth may tilt and drift into the gaps and food can get trapped in the spaces,
increasing your risk of tooth decay and gum disease. When many teeth are missing, your
.facial muscles can become saggy, affecting your speech and appearance

Replacement teeth are made to match the colour of your natural teeth as closely as
.possible

Treatment options

.There are a number of options after you have teeth removed

.Do nothing - accept the space and leave it empty

Have dentures (false teeth) fitted. These are removable plastic or metal frameworks carrying
.false teeth

.Bridges can replace missing teeth. These are false teeth fixed onto adjacent natural teeth
Implants are another option. These are metal 'pegs' placed in your jawbone. Dentures or
.bridges are clipped or screwed on top

The most appropriate treatment will depend on the number of teeth that are missing, where
they are in your mouth and the condition of any remaining teeth. Your dentist will help you
.decide which option is best for you

Dentures

Temporary dentures

After you have had teeth removed, it takes several months for your jawbone and gums to
heal completely. During this time, your dentist may fit a plastic temporary or 'immediate'
.denture. This can even be fitted and worn the same day as your teeth are removed

As your jaw heals, the temporary denture will become loose and may need adjusting. It can
take up to six months for your jawbone and gums to become stable. Your dentist will then
.be able to fit your long-term denture or bridge

Partial dentures

A partial denture can be used to replace one or more missing teeth. A partial denture is a
framework (plate) with a number of false teeth on it

There are different types of partial dentures, but they commonly include a metal and/or
plastic plate with plastic or porcelain false teeth. Partial dentures often have metal clasps.
.Where possible, these clasps are hidden so that they can't be seen when you smile or talk

Full dentures

Full (or 'complete') dentures are needed when you have no teeth left in the upper or lower
.jaw. They are usually made of a plastic plate with plastic teeth

Full upper dentures cover the roof of your mouth (palate). A very thin layer of saliva
between your palate and the denture creates suction, which keeps it firmly in position. Your
.facial muscles and tongue also help to keep it in place

Full lower dentures are often more difficult to keep in place because the floor of your mouth
.moves a lot, and the ridge where your teeth used to be shrinks with age

However, good dentures should fit the mouth exactly so denture adhesive cream (fixative)
.shouldn't be necessary

Getting used to dentures

It's very important to have realistic expectations of dentures. Getting used to them will take
time. They should help you to eat, speak and smile confidently, but even the best dentures
.won't feel the same as natural teeth
Your mouth may feel a bit sore and uncomfortable to start with. Your dentures should start
to feel a bit more secure as you get used to them. Your dentist will schedule a check-up
appointment a week or two after fitting your new dentures. If you're having any problems,
.he or she can make the necessary adjustments to your dentures

.Some words may be difficult to pronounce at first, but this usually improves with time

It takes a while to get used to eating with new dentures, so it's best to start with soft food.
Try to use both sides of your mouth at the same time. This will help to keep the denture in
place

Looking after your denture and mouth

Brush any remaining natural teeth twice a day with fluoride toothpaste. If you have a full set
of dentures, it's still important to clean your gums, tongue and the roof of your mouth with a
.soft brush

Clean your denture after every meal using a soft toothbrush and soap. It's a good idea to
brush over a bowl of water to prevent damaging your denture if you drop it. Ensure that you
.clean all the surfaces of your denture, including the areas that sit against your gums

You should take your denture out at night and leave it in a glass of water or denture cleaning
solution. If you have metal clasps or a soft lining on your denture, you must ask your dentist
.for advice before using any denture cleaning solutions because these are more delicate

Don't soak your denture in any type of bleach or very hot water, as this can weaken them
.and change their appearance

If your denture is worn or ill-fitting it can cause irritation and discomfort. Ideally you should
have your denture remade before these problems arise. Even if you have no natural teeth
left, you should still have regular check-ups with your dentist so that he or she can assess
.the fit of your dentures, and can detect any infections or other conditions at an early stage

Bridges

If only one or two teeth are missing, your dentist may recommend a bridge. A false tooth (or
.teeth) is attached to your natural teeth on either side of the gap

Bridges are made of porcelain and/or metal. There are many bridge designs. The illustration
shows a typical bridge. The natural teeth on either side of the space are specially prepared
for the crowns to fit on top. These crowns are permanently attached to a false tooth in the
.centre

Bridges are cemented in place, so they can't be removed for cleaning. To keep your natural
teeth healthy, you should clean the gap under a bridge with a special dental floss. Ask your
dentist or hygienist to show you how to floss under your bridge. On average, bridges last
between five and ten years

.
Implants

A dental implant is a metal rod that is placed in the jawbone to hold a false tooth (or teeth)
in place. Over several months, the jawbone fuses with the metal rod. Dentures or bridges
.can be screwed or clipped onto the implant

Dentures and bridges that are supported by successful implants tend to be very secure.
.Many people find that their implants last at least 10 years

Despite these advantages, implants aren't everyone's first choice. They can be expensive,
and you will need to have surgery. You need to have healthy gums, and some specialists will
not place implants in people who smoke as it can affect the success of the treatment. Your
.dentist will tell you if this treatment is suitable for you

++++++++++++++++++++++++++++++++++++++++++++++++++++=

About wisdom teeth removal

Wisdom teeth usually emerge from your gums between the ages of 17 and 24. They are the
last of the large grinding teeth at the back of your mouth (molars). Some people never
develop wisdom teeth but you could have up to four - one in each corner of your mouth

For most people, wisdom teeth don't cause any problems so don't need to be removed. However, if
there isn't enough space for them to grow at the back of your mouth, they become what is known as
impacted wisdom teeth, and can cause pain, swelling and/or infection.

It’s important to see your dentist regularly if you have impacted wisdom teeth. Caring for your teeth to
ensure good dental hygiene can prevent wisdom teeth from causing other dental health problems
If your wisdom teeth cause other dental health problems, you may need to have them removed. These
problems may include:

tooth decay 
gum disease 
repeated mouth infections 
an abscess (a collection of pus) on your gums or around your wisdom teeth 
Having your impacted wisdom teeth surgically removed (extracted) can relieve your symptoms. It may
be possible for your dentist to remove your wisdom teeth, or he or she may refer you to an oral surgeon.

What are the alternatives?

Not all wisdom teeth need to be removed. Antibiotics can often help treat an infection if that’s what is
causing your symptoms.

Preparing for wisdom teeth removal

Your dentist or oral surgeon will explain how to prepare for your procedure. For example, if you smoke,
you may be asked to stop as smoking increases your risk of getting a wound infection, which can slow
your recovery.

The operation is usually done under local anaesthesia. This completely blocks pain from your gums and
you will stay awake during the procedure. You may be offered a sedative to help you relax during the
operation. If you go to a hospital and your wisdom teeth are particularly challenging to remove, you may
be given general anaesthesia. This means you will be asleep during the procedure. Your dentist or oral
surgeon will let you know which type of anaesthesia is most suitable for you.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not
eating or drinking, typically for about six hours beforehand. However, it's important to follow your dentist
or oral surgeon's advice.
Your dentist or oral surgeon will discuss with you what will happen before, during and after your
procedure, and any pain you might have. This is your opportunity to understand what will happen, and
you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the
procedure. This will help you to be informed, so you can give your consent for the procedure to go
ahead, which you may be asked to do by signing a consent form.

What happens during wisdom teeth removal

The procedure for removing your wisdom teeth will depend how deeply impacted your teeth are. Many
wisdom teeth can be extracted simply like any other molar. Once the anaesthetic has taken effect, your
dentist or oral surgeon will widen the socket (the area your tooth sits in) using a tool called an elevator
or a pair of special forceps. He or she will then move the tooth from side to side until it is loose enough
to be removed completely.

However, if your tooth is more difficult to remove, your dentist or oral surgeon will cut through your gums
and may remove some of your jawbone to reach your tooth. He or she will remove your wisdom teeth
and then close your wounds with stitches if necessary. Most wisdom teeth only take a few minutes to
remove, but the more difficult cases can take around 20 minutes.

What happens afterwards

You will need to rest until the effects of the general anaesthetic or sedation have passed.

After a local anaesthetic, it may be several hours before the feeling comes back into your jaw. Take
special care not to chew on the area or have any food or drinks that are too hot, as these could burn the
area.

You will be able to go home when you feel ready.

If you had a general anaesthetic or sedation you will need to arrange for someone to drive you home.
You should try to have a friend or relative stay with you for the first 24 hours.

Your dentist or oral surgeon will give you some advice about looking after your teeth and gums before
you go home. You may be given painkillers, antibiotics and mouthwash solutions to take home. You
may also be given a date for a follow-up appointment.

Dissolvable stitches will disappear on their own in seven to 10 days. Non-dissolvable stitches are
removed a week after surgery.

Recovering from wisdom teeth removal

If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow
the instructions in the patient information leaflet that comes with your medicine and ask your pharmacist
for advice. Don't take aspirin because this can make bleeding worse.

Don't vigorously rinse out your mouth during the first 24 hours after having a wisdom tooth removed
because this can disturb blood clots that help the healing process. After meals, you can rinse gently with
warm salt water (half a teaspoon of table salt dissolved in a glass of water).

You should brush your teeth as usual, but keep your toothbrush away from the healing wound for the
first couple of days. At first, you may feel small fragments of bone with your tongue. These are the
edges of the tooth socket and will soon disappear as your gum heals.

Eating and drinking

To begin with, you should eat soft foods, gradually returning to your usual diet once your jaw feels less
stiff.

Bleeding
If your gum bleeds, fold a clean handkerchief or piece of gauze, place it on your bleeding gum and bite
on it for at least 10 to 15 minutes. Don't rinse your mouth out or lie down until the bleeding has stopped.

Most people don't experience any problems after having their wisdom teeth removed. However, contact
your dentist or your GP immediately if you develop any of the following symptoms:
 bleeding that doesn't stop after applying pressure, or that lasts for more than half an hour 
difficulty in breathing or swallowing 
severe pain that isn't helped by painkillers 
a high temperature 
swelling that continues for more than three days after your operation 

What are the risks?

Wisdom teeth removal is commonly performed and generally safe. However, in order to make an
informed decision and give your consent, you need to be aware of the possible side-effects and the risk
of complications of this procedure.

Side-effects
These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling
sick as a result of a general anaesthetic.

You may have some facial swelling, bruising, pain or jaw stiffness for up to two weeks. These symptoms
are usually at their worst for the first two or three days and then gradually improve.

Complications
This is when problems occur during or after the operation. Most people aren't affected. The possible
complications of any operation include an unexpected reaction to the anaesthetic or excessive bleeding.

Specific complications to having your wisdom teeth extracted are uncommon but may include:

infection 
accidental damage to other teeth and your jaw during your operation 
severe pain caused by dry socket - this is when the blood clot breaks away from the wound exposing 
the bone and nerves, causing pain and delaying healing
numbness in your lower lip or tongue, or changes to taste - this can be caused by nerve damage and 
there is a small chance that this could be permanent
jaw stiffness - it's possible that you may not be able to open your mouth fully 
The exact risks are specific to you and will differ for every person, so we have not included statistics
here. Ask your dentist or oral surgeon to explain how these risks apply to you.