A combination of plaque, sugar and time leads to tooth decay. The bacteria in the plaque, which sits on the tooth surface, use the sugars from our diet to produce acid. These bacteria survive well in an acidic environment and continue to produce more acid. The acids produced will dissolve the tooth surface very quickly by removing Calcium and Phosphate. These minerals are what make the tooth strong. If sugar is frequently available to the bacteria and lots of acid is being produced, the tooth surface will continually dissolve. This leads to tooth decay. If plaque from the tooth surface and sugars from the diet can be eliminated or greatly reduced, the risk of decay starting is minimised. Decay can also be stopped or reversed. This can only happen if acid production stops and the lost minerals are replaced. Lost minerals can be replaced with Fluoride and the Calcium and Phosphate in saliva.

Tooth decay can be detected during a thorough dental examination and history. It is important to detect decay early and determine whether you are at a high risk for developing tooth decay. This allows for preventive strategies specifically designed for your needs to be put in place. These strategies will require a certain amount of time and effort on your part, however the benefits of avoiding tooth decay are well worth it.

How can I prevent decay?

DIET:

• Avoid frequent intake of sugary foods, especially sticky foods. Look at food labels to see what they contain.
• Bacteria love sugar and soon after it is eaten your mouth becomes very acidic. Swish your mouth out or have a drink of water to remove the bulk of remaining sugar from your mouth
• Don’t snack all day, leave a long break between meals so your teeth have a longer time free from acids.
• Casein phosphopeptides are available from some dairy foods and help to prevent decay. Finishing a meal with cheese is a quick and easy strategy.
• You may be asked to complete a dietary analysis sheet to see how your eating habits may be contributing to your tooth decay.

PLAQUE:

• Thorough, daily removal of plaque from the tooth surfaces and in between the teeth reduces the risk of tooth decay. The removal of plaque reduces the numbers of acid producing bacteria in your mouth.
• Try to brush twice a day using a Fluoride toothpaste. Ensure you brush well at night, as during sleep your saliva flow is greatly reduced putting the teeth at greater risk of decay. For shift workers this simply means brushing thoroughly before sleep.
• Don’t brush directly after a meal as dissolved tooth may be scrubbed away. Swish the mouth out or have a drink of water and wait about half an hour before you brush.
• A Chlorohexidine rinse may be recommended to help further reduce the numbers of acid producing bacteria in your mouth. Use this solution after brushing and flossing and rinsing thoroughly.

SALIVA:

• Drink plenty of water to ensure you have an adequate flow of saliva. You feel thirsty after you mouth has already become dry. This means that if you feel thirsty you will already be dehydrated. Dehydration causes a dry, acidic mouth which increases the risk of tooth decay. Ideally, you would drink water if you thought you were likely to get thirsty later on. If you are thirsty then drink water and avoid sweet and acidic drinks.
• Alcohol, caffeine and nicotine all reduce salivary flow. Caffeine is contained in coffee, tea, chocolate, cola and soft drinks and can cause dehydration.
• Many herbal, prescription, recreational and over the counter medications and drugs can make your mouth dry, by reducing the flow of saliva. Cold and flu medications are an example, as are many mouthrinses containing alcohol. Alternatives may be available, however this is not always the case. Products are available to help relieve the discomfort of dry mouth.
• Chewing sugar free gum helps to stimulate salivary flow. Some sugar free gums contain Xylitol which helps to slow the growth of plaque.
• The acidity of a dry mouth can be reduced by using a bicarbonate mouthrinse. This helps the saliva to become alkaline. Rinse vigorously with a mixture of one teaspoon of “baking soda” in a glass of water, don’t swallow and discard the remaining portion. Use a fresh mixture each time.

FLUORIDE:

• Always use a Fluoride toothpaste. Differing strength pastes are available for individual requirements.
• Other Fluoride preparations are available such as tablets, rinses and gels. These are recommended on an individual basis and directions for use should be followed.

This pamphlet gives a brief overview of dental decay and how to prevent it. You may now be able to identify the cause of your decay and take the necessary steps to
prevent the problem continuing. If you have any further questions, we would be more than happy to help and guide you towards maintaining your dental health.

Dental erosion is when tooth structure is dissolved away by strong acid from some foods, beverages and medicines, or from refluxed stomach acids. These enter the mouth frequently enough to simply dissolve the surface layers of tooth enamel and, in extreme cases, the underlying dentine. Erosion is totally unrelated to plaque and tooth decay. Which tooth surfaces are affected depend on where the acid comes from and whether there is enough saliva around to neutralise it. Parts of the teeth that are close to the major salivary glands are almost invariably protected. The sites far away from the salivary ducts are vulnerable, especially if saliva production is low or if the acid attack is frequent.

Some of the more common causes of erosion are

• Drinking carbonated soft drinks or wines or champagnes too frequently. These contain orthophosphoric acid (food acid 338). These can thin enamel on different parts of the upper teeth, depending on how the items are consumed. They often affect the tongue side of the upper teeth.
• Swishing acid drinks around in the mouth before swallowing subjects the teeth to increased acid attack.
• Rinsing the mouth with Vitamin C (ascorbic acid, food acid 331) preparations or chewing Vitamin C tablets for prolonged periods too frequently can cause loss of enamel from most surfaces of the teeth. Vitamin C is contained in all sorts of drinks, sports drinks and candies.
• Eating (especially sucking) citrus fruit too frequently, especially lemons and grapefruit or their concentrated juice (citric acid, food acid 330). Excessive consumption of apple or pineapple juice can also result in erosion. This will usually cause thinning of enamel on the upper front teeth, and sometimes the biting surfaces on the back teeth. Chewing the skins of citrus fruit can increase the risk of dental erosion.
• Having too much vinegar in contact with the teeth – either in salads, directly, or brushing teeth with it – will often affect the teeth on the biting surface.
• Any problem which results in stomach acid refluxed into the mouth, such as: 
gastro oesophageal reflux, heartburn, gastric ulcers or dysfunction, duodenal or peptic ulcers, hiatus hernia, any cause of recurrent vomiting, regurgitation or reflux eg. asthma,, bulimia, anorexia nervosa, during pregnancy, alcoholism, or chronic constipation.

Be aware also of some unusual causes or contributing factors

• Occupational risks eg welders working with acid fluxes, concrete workers using hydrochloric acid.
• Vegetarian diets can sometimes cause erosion, eg. excessive consumption of sour berries or fruits, pickles containing acetic acid.
• Frequent use of spas, or swimming in large improperly chlorinated pools can cause erosion (from excessive hydrochloric acid present). Industrial acids can result in airborne acidic contaminates of the working environment.
• Medicaments such as iron tonics, acid replacements for people suffering from achlorhydria, or acid to dissolve small renal calculi, can cause severe erosion.

All the above can cause erosion to occur much more quickly if accompanied by other factors

• If you have a dry mouth from dehydration eg from thirst during work or play, stress, hard physical work, exercise, or from alcohol consumption your saliva is shut down and cannot confer protection. Dehydration is the most common contributing factor for dental erosion in healthy patients.
• If you have a dry mouth resultant from prescribed drugs, eg. antidepressants, asthma medications, most illegal drugs and a number of medical conditions, eg., diabetes. Over 400 prescribed drugs cause mouth dryness.
• Toothbrushing immediately after an acid challenge.
• Abrasion from chewing especially for people on lactovegetarian diets, stone ground flour.
• Attrition from bruxing (tooth grinding)

How can I tell if I have dental erosion?

Early signs of erosion can only be detected in a thorough history and dental examination. If you can see enamel thinning on the front top teeth and can see some yellow patches showing through, or the length of teeth getting shorter, then the erosion is quite advanced. It is important that it be detected before the damage becomes so severe. There are other ways by which enamel can be worn from teeth. We can help you find out what is causing the problem, and help you to control the causes or protect the teeth from damage. Sometimes your teeth become quickly sensitive to sweet and sour tastes, or cold air. Other factors as well as erosion can cause this to occur, such as dental decay. Again, we can help determine the cause and help control this pain. Brushing with toothpastes like Sensodyne only serves to mask the problem. You might be aware of a sour or bitter taste in your mouth quite often. This may be from regurgitated stomach acids. If you have some medical condition or are taking strong drugs which result in frequent vomiting, frequent checks are required. Early detection of damage can save you a lot of discomfort and costly repair later on.

How can I control dental erosion?

If it is caused by acidic foods or beverages, then it is mainly a matter of trying to stop consuming these, and changing to alternative foods or beverages which are not so acidic, or changing the way these are consumed. Since saliva is such a big issue, it is also about keeping well hydrated and keeping the saliva flowing.

• Start the day with a glass of water and fresh fruit to stimulate your taste buds and get the saliva working.
• Think of different ways to ensure you drink at least 1.5 litres of pure water a day. Carry a small plastic bottle of water with you on outings and when doing physical activities.
• Watch for periods of dehydration. Never drink acids when dehydrated.
• If you are thirsty or dehydrated, drink water, iced tea or coffee, or hot chocolate instead.
• Avoid acidic liquids in the diet (wine, beer, softdrinks, fruitjuices, cordials, sports drinks).
• Look at the labels on foods and beverages. Acidic substances are citric acid (330), ascorbic acid (331), orthophosphoric acid (338), and acetic acid.
• Restrict acid drinks to meal times rather than in between.
• Drink acid beverages quickly or with a straw, do not sip or swish around.
• Limit your caffeine intake (chocolate, cola softdrinks, coffee, tea – use caffeine free or herbal instead).
• Eat a variety of fresh fruit and vegetables for their water and food content and also to increase the amount of saliva in your mouth.
• Chew lots of sugarless gum to also increase saliva in your mouth. At least two times per day preferably for up to 30 minutes, rinse your mouth first if its too dry to chew.
• Finish meals with neutral food, eg cheese, rather than acid drinks, eg wine or Coke.
• Don’t go to bed on a full stomach. Wait at least 2-3 hours after a heavy meal to give your saliva time to neutralise acid.
• If drinking a lot of alcohol at night, have a big glass of water or milk and clean your teeth before you go to bed.
• Neutralise stomach acids with saliva which contains bicarbonate.
• Rinse with water after acid consumption. A simple bicarbonate mouthrinse will neutralise and freshen as well (do not swallow bicarbonate mouthrinses).
• Watch your lifestyle for health hazards. Watch for dehydration and acid drinks in recreation. Adopt a lifestyle and diet that copes with any health problems and doesn’t damage your teeth.

If prescribed medicines are causing a dry mouth, ask your medical doctor whether an alternative medical preparation can be found. If you are a wine taster, and thus have to keep wine in contact with the teeth for long periods of time, or if you have an acid reflux or frequent vomiting problem, or if you have a persistent dry mouth then erosion is much more difficult to control. 
The following is a list of other helpful strategies:

• Fluoride helps strengthen enamel against dissolution. We can supply a very strong neutral pH fluoride toothpaste for use at night if saliva flow is low.
• Don’t brush immediately after a meal or other acid challenge as you can brush off dissolved tooth matrix. Its best to brush before breakfast and last thing at night.
• Always use a soft tooth brush and a vertical brushing technique
• If you have an acid reflux or vomiting problem, rinse your mouth out with water or milk immediately after you feel the acid in your mouth. DO NOT BRUSH YOUR TEETH straight after, even though you would like to. This may brush away dissolved mineral held in the plaque covering your teeth. If you wish to freshen up your mouth, use a fluoride mouthrinse, or a liquid antacid preparation.
• If vomiting or acid reflux occurs at regular times each day, place antacid preparations in your mouth prior to the expected episode. If vomiting is induced voluntarily, we can make a protective mouthguard.

Remember, if you suspect that the erosion is continuing, keep visiting regularly. Special protective coatings may be placed on the surface being damaged, if other methods of control are not totally effective. 
Adapted from material compiled by Prof John McIntyre (Univ Adelaide), Dr William Young (University of Qld) and Prof Laurence J Walsh (University of Qld).

Your new tooth is as strong as possible as soon as we finished it. You can chew and eat as soon as the numbness disappears.

The length of time your new resin restoration will last is determined by the size of the restoration placed, and the biting forces you put the restoration through.

Your tooth or teeth have just been treated.

After any treatment, teeth that may never have had any discomfort may begin to bother you. Removing old restorations and removing decay can cause the tooth’s nerve to act up. The lack of pain prior to treatment is not an indication of no decay…it is an indication that the tooth has not abscessed yet.

Whenever your tooth is drilled into there is some bruising that takes place in the live part of the tooth called the Tooth’s Pulp. This pulp contains nerve fibres that are irritated by the bruising. The bruising makes the tooth’s nerve fibres touchier to cold sensations. You may expect that for the first two or three days you will want to be careful with cold fluids and food on the prepared teeth. Please call us if it you are having any problems with handling the cold sensitivity over the next few days.

Will I Need Further Treatment?


If your resin restoration is large, then chances are you will need further treatment. Large resin restorations often require crown work within 3 to 5 years. Usually, the best we hope for is the restoration lasting 10 years but 5 to 7 years is more realistic.

There are a few important things you need to know about the next few days before we bond your final restoration:

Your tooth or teeth have just been treated.

After any treatment, teeth that may never have had any discomfort may begin to bother you. Removing old restorations and removing decay can cause the tooth’s nerve to act up. The lack of pain prior to treatment is not an indication of no decay…it is an indication that the tooth has not abscessed yet.

Whenever your tooth is drilled into there is some bruising that may take place in the live part of the tooth called the Dental Pulp. This Pulp contains nerve fibres that are irritated by the bruising. Bruising can make the tooth’s nerve fibres touchier to cold sensations. You may expect that for the first two or three days you will want to be careful with cold fluids and food on the prepared teeth. Please call us if it you are having any problems with handling the cold sensitivity over the next few days.

There are Temporary Restorations on your prepared teeth.

To keep your tooth comfortable until you receive your ceramic restoration we placed a temporary restoration in or on the prepared teeth. Please refer to the section dealing with temporary restorations.

What will happen at the next appointment?

When you return for your next appointment your ceramic restoration will be waiting for you. We will need to numb your tooth and place a rubber dam to isolate the area. We use a very technique sensitive procedure to bond the restoration into your tooth. When we are done your tooth will be stronger and ready to use for years of chewing.

It feels rough

Please call us if it is making your tongue sensitive.

It came off

This is probably the most common problem. It is supposed to come off easily and some foods will help in this. Stay away from sticky foods or gum. It’s important for it to be there, so call us and we can re-cement it (or you can push it back into place until you can get in).

It feels high

Come in so we can adjust it. You can bruise a tooth if it is high.

It’s not how I want the permanent to look

Don’t worry; the permanent will look much better, but please let us know immediately what it is that you dislike.

It is sensitive

The temporary will not fit as well as the permanent will, so there may be some sensitivity to hot and cold and perhaps when chewing. If it is too uncomfortable, please call.

The temporary is very important. It protects the exposed dentin so it is not sensitive. It prevents food from gathering in the preparation, and prevents the prepared tooth from shifting and moving that could make seating the permanent more difficult. Use your toothbrush to clean the temporary as you normally do your teeth. The Dental Assistant will let you know if you will be able to floss around it.
If you have any questions concerning the temporary, please feel free to call. Remember, it will only be for a short time and it will be all worth it when you get your beautiful permanent restoration.

Here are a few commonly asked questions and answers about new ceramic restorations that you may have.

Post Treatment Care

Your new restorations are now bonded firmly onto your teeth. You can eat and chew with them right away. Until the numbness is all gone be careful that you do not bite your tongue or cheek. You can also brush and floss around all of your teeth without problems.

Post Treatment Sensitivity

After any treatment, teeth that may never have had any discomfort may begin to bother you. Removing old restorations and removing decay can cause the tooth’s nerve to act up. The lack of pain prior to treatment is not an indication of no decay… it is an indication that the tooth has not abscessed yet.

After receiving treatment, the pulp tissue of the tooth needs time to return to it’s normal resting state. Any bruising that has taken place due to removal of the old mercury restoration or decay under it will need a few days to diminish. Try not to baby the tooth too much as this may prolong the healing process.

Any sensitivity is usually to cold and should last for only as long as the cold is in the tooth or 10 to 15 seconds longer.

If you have extreme reaction to heat or cold that lasts for a minute or more, contact our office. You may have had irreversible damage to the tooth’s pulp and require further treatment to calm the tooth down.

Your Bite Feels Off?

Your mouth was numb while we placed in the new restorations. We have adjusted your new ceramic restorations to fit your occlusion (or bite). Yet, until your numbness is all gone or you have had a chance to chew, you might not be aware of any discrepancy with respect to the fit of the new restorations.

If your bite feels off it is important that you contact the office in order to have the restorations adjusted correctly. Your ceramic restoration is just as hard as your tooth enamel and it will not self adjust. You have to visit us in order to correct the bite. It is an easy thing to do and does not require numbing or the use of a rubber dam.

A severe toothache that’s keeping you awake at night is usually a good indication that a Root Canal Treatment is needed.

Unfortunately, the only alternative to having a Root Canal Treatment is to extract the tooth.

There are a few circumstances in which a tooth will need a Root Canal Treatment. Most common reasons are:
If there are gross amounts of decay in the tooth which go right down into the pulp of the tooth.
If the tooth has had a large restoration (filling or crown) on the tooth for many years which can put “strain” on the tooth.
If the tooth has sustained trauma. E.g. The tooth has been bumped in a fall or accident.

Root Canal Treatments cannot usually be completed in one visit. They’re usually divided over at least three appointments spread over time ranging from weeks to months. We will advise the appropriate time length for you after each visit.

1st Visit

This is usually done to get the tooth comfortable. The tooth is numbed and opened. The pulp is removed and a medicament dressing is placed inside the tooth to help it settle. A long term temporary restoration is placed.

2nd Visit

This visit is usually a longer and more thorough appointment. The tooth is reopened and the previous dressing is cleaned out. The canals in the tooth are then thoroughly cleaned and shaped to an appropriate length, ensuring all the necrotic / infected tissue has been removed. Another “dressing” is placed in the canals to allow them to heal and start clearing any infection.

3rd Visit

This is usually the final stage of the Root Canal Treatment, however in some instances i.e. if there is a large infection in the tooth, this appointment is used to change and redress the canals. If the canals are clean and dry, then they are able to be filled. This involves reopening the tooth and removing all of the previous dressing. The canals are then thoroughly dried and a sealant is placed inside. The shaped spaces in the canals where the pulp used to be are then filled with small rubber points so that nothing can grow up into the space again and possibly reinfect the tooth. The tooth is then sealed with another long term temporary filling.

After a Root Canal Treatment is completed in a back tooth, the tooth is reasonably weak. It is strongly suggested that a crown is placed on the tooth to help maintain its strength. It is advised that this be completed as soon as possible after a Root Canal Treatment as there is a high risk the tooth will fracture and may not be reparable.

Don’t Panic!

Root canal treatment is our way of preventing pain and infection in your teeth. It receives the most negative press of any of our dental treatments. It is the whipping boy of all dental jokes. Yet it doesn’t deserve its notoriety.

Root canals refer to the parts of the tooth that dentists call the pulp chamber. Within the centre of your teeth is a space or chamber that contains live dental tissue called the pulp tissue. This pulp tissue is made up of blood vessels that keep the pulp alive, dental specific tissue that can repair some damage the tooth experiences from decay, and nerve fibres that send pain signals to your brain.

When your tooth has had extensive decay or injury (due to drilling or trauma) the pulp tissue becomes bruised. This bruising can lead to a pressure increase inside the pulp chamber. If the pressure increase is great enough, then the blood circulation in the pulp chamber ceases, and the pulp tissue dies. The problem is that the nerve fibres are the last to die and they let you know it.

Root canal treatment or “Endodontics” lets the dentist get rid of all of the pulp tissue gently and thoroughly and fill the remaining empty pulp chamber with a rubber like material that is cemented and condensed into the cleaned pulp chamber. This prevents infection from starting up in the empty pulp space and makes the tooth comfortable for the rest of your life.

There are a few commonly asked questions about Root Canal Treatment:

Did You Remove My Tooth’s Root?

Root canal treatment (RCT) cleans, shapes and fills the canal system inside your tooth. The root structure that held your tooth in place is still there and intact. We have just sealed the spaces within it.

Will My Tooth be Sore After Treatment?

After receiving treatment the area around the root tips of the treated tooth will be bruised and may cause some tenderness to biting pressure. It may be sore even without any chewing. This is all due to pressure building in the bone around the tooth’s roots with bruising. Till this bruising goes away (usually in 3 to 5 days) Ibuprofen (also known as Nurofen or Herron Blue) will help to keep your tooth comfortable. Take as directed.

Do I Need a Crown on My Tooth?

Your tooth is in a weakened state due to the RCT. A hole has been made in the tooth to gain access to the pulp chamber. That decreases the structural strength of the tooth and makes it more susceptible to fracturing a portion of the tooth away when chewing. You can split the tooth in two or fracture it in such a way that gum surgery is needed. It is important that you are careful chewing in this area. Watch out for foods you need to grind on like breads and buns.

A crown should be done in a prudent time frame. I always tell my patients that they should have their tooth crowned the day before they bite down and break it!

If You Do a Root Canal Through my Crown Will I Need a New One?

Not necessarily. Often we can repair the crown when we have to make a hole through it. The hole must be repaired though.

Sometimes a new crown is required. If you are unsure discuss it with our office.

Your extraction site is likely to ooze a little throughout the day so we have given you some gauze to take with you. Roll some gauze into a ball or square and bite hard on it for 5 minutes or so, until the bleeding stops. A clean handkerchief will do the same. Avoid using a tissue or cotton wool.

You may prefer to take an over the counter pain tablet such as Panadol, Panadeine or Nurofen as the anaesthetic is wearing off.

Avoid anything too hot to eat or drink. If you have a cup of tea or coffee, let it cool right down beforehand. Usually at the temperature you would have normally thrown it out is a good indication of how “warm” you can have it.

Tomorrow and for the next few days, keep the socket clean by rinsing / swishing with warm salty mouth rinses (1 teaspoon of salt in a cup of warm water). Do it a few times a day. Do not swish on the day of extraction as you can wash the clot out and it can make for a slow healing socket.

When you go to bed, prop yourself up on a couple of pillows and place an old towel over them in case the socket oozes through the night.

Avoid or severely limit smoking for at least 24 hours after an extraction.