Love them or loathe them, the dentist is there to fulfil an important role, and the health of your teeth is not something you should ignore.

A few years ago I read some great advice from some actual dentist, that I thought I’d reproduce. First of all, anonymously but still with the authors permission, a little about how NHS and private dentists work.

As a registered NHS patient you are entitled to treatment under the NHS fee scale. This means each item of treatment has an associated fee, of which you pay 80%, and the NHS stumps up the remaining 20%, and yes, this also means that for dentists (like me), it is effectively ‘piece-work’. Therefore, you may be NHS, but you still pay for the majority of it.

It is also worth bearing in mind however, that for it’s 20% stake, the NHS places severe restrictions on what the dentist is able to provide – and I don’t just mean financially. It dictates which materials we can and can’t use in different clinical situations – limiting us only to the cheapest ones (surprise surprise). For example, non-precious metals only for posterior crowns, where perhaps gold or porcelain may be more clinically desirable for its longevity or aesthetic qualities.

Recognising the limitations this places on dentists who wish to provide high quality work, the government said about 10 years ago that patients registered on the NHS could choose to have items of treatment provided privately if they wanted to. This means you can mix and match NHS treatment with private treatment even as an NHS registered patient. So if you want that white filling or gold crown, you can, without losing any of your NHS entitlements (whatever they may be…).

The confusing thing from Dentists’ point of view, is that people are willing to queue overnight to register with an NHS dentist (and offer hundreds of pounds to jump the queue, as recently happened in Wales), so that they can get 20% off the cheapest kind of work.

Please believe me – you are not getting the same thing on the NHS as you would do were you to spend a little bit extra and have it privately. Private dentistry is really not expensive, unless you’ve got a crap diet and don’t clean your teeth, in which case you can expect a hefty bill every five years.

This doesn’t mean you should leave your NHS dentist – the NHS is great for x-rays, extractions and anything else that can’t genuinely be done better/differently. Just ask for the best materials available when you do need something more invasive doing, and take responsibility for looking after the work properly (i.e. floss).

Next, some advise on mouthwash, whitening, toothbrushes and flossing from dentists Andy Medina & Aidan McKeever:

Mouthwash

For all intents and purposes all gum infection and tooth decay is due to bacterial infection (there are some other types of infection and other diseases, but these are rare and irrelevant for the purposes of this discussion).

The bottom line is, bacteria grow on the teeth. The teeth are, if you like, the battle front. From here the teeth and gums are attacked. Can you see bacteria? Most people would say no, but the answer is yes. There are so many on your teeth that, although you don’t see each individual bacterium, you see and feel plaque. That is what plaque is… a solid colony of bacteria, held together by gooey complex sugars called polysaccharides. These polysaccharides are made from the food the bacteria uses, mainly a simple, high energy disaccharide known as sucrose (or sugar to you and me).

Stay with me on this one because it will all become clear…

From the above, we can work out some simple rules:

1. If you remove the bacteria they can’t do so much damage
2. If you remove the bacteria’s food supply it won’t grow so much.

That translates as:

Clean your teeth properly and regularly (brush at least three times a day, floss at least once a week)

There are some other factors here, the main ones being fluoride and the enzymes in saliva. Fluoride inhibits the formation of the decay causing bacteria, although not enough to stop decay on it’s own. Fluoride also reacts with the outer few molecules of your tooth enamel and adds further resistance. Fluoride has no significant effect on gum disease. The enzymes in saliva are part of your immune system, they evolved millions of years ago before sugar became part of our diet, they do a great job of fighting the bacteria, and diluting its effect. However, they do tend to get overwhelmed. A great way of increasing salivary flow it to chew gum (sugar-free of course!)

So where do mouthwashes fit in?

1. Mouthwashes will not and cannot remove plaque-bad!
2. Some mouthwashes contain fluoride-good! But so does 99% of toothpaste-better, because you are using toothpaste anyway.
3. Mouthwashes contain alchohol, which is astringent, ie it causes drying and reduces the amount of saliva present in your mouth-very bad!
4. Mouthwashes taste and smell nice and fresh-good, but only if you’ve had a vindaloo the night before, or haven’t cleaned your teeth properly for several months.
5. Some mouthwashes (mainly those containing Chlorhexidine Gluconate, marketed as Corsodyl) are effective in the short-term-good! But only if you have acute infection. These also cause temporary staining-bad!, and you only usually only need these if you haven’t cleaned your teeth for several months!

Teeth Whitening

Two ways of whitening your teeth professionally – forget toothpastes or over the counter stuff for now (I will return to this)…

1. Home bleaching – the dentist takes impressions of your teeth which enable an upper and lower tray (like a gum-shield) to be constructed. You fill these with the bleaching agent provided (normally carbamide peroxide, high concentration) wear at home (normally in bed) for a couple of weeks and you get a gradual shade change. Advantages are you monitor it yourself and can therefore stop when you get to the shade you’re happy with; relatively inexpensive; can top-up if required. Disadvantage is sensitivity, however this always resolves eventually.
2. In surgery bleaching – same kind of chemicals involved but applied by the dentist and zapped with a special light. Advantage is convenience, but expensive and you cannot control the result with any degree of predictability. Bit of a gimmick in my opinion, option 1 is far better.

NB Any kind of bleaching works best if your teeth really are darker than usual. People with light teeth anyway are often disappointed with results. This is usually very young people.

Whitening toothpastes are more abrasive than standard ones and that’s how they work. They will only remove extrinsic (dietary) staining a bit more effectively – ie coffee/smoke stains. They do not change the intrinsic shade of your teeth and are therefore pretty useless.

Electric Toothbrushes

Yes electric toothbrushes are excellent. Proven in umpteen trials to work effectively at removing plaque, most people would be better off with one of these. If your manual technique is excellent, a manual brush is fine – unfortunately most people don’t know how to use one effectively and therefore the ease of use on an electric brush makes it ideal. In my opinion ones that use sonic technology are far superior (eg. sonicare) although there is little evidence to support this.

Flossing

Lastly, I must make a mention of the huge importance of flossing – it is by far and away the very best thing you can do to improve your oral health. If you are willing to spend time, money and effort on cleaning and whitening but do not floss you are wasting your efforts.