Why don’t my dentures fit well anymore?
False teeth, whether they are complete full dentures or partial dentures, are made to fit your mouth at a specific point in time. As you age, everything about you changes, even your mouth. But the false teeth you had made years ago cannot change with you. This is why the quality of the fit slowly deteriorates.

As the years pass, the bone supporting the false teeth continues to change, usually shrinking. This rate of change is different for everyone. Many people notice a change after only two years. Others don’t notice for many years after.

Most people can tell when their dentures are getting loose or uncomfortable, but because this process is gradual it is often ignored until there is so much irritation that it can’t be ignored any more.  This irritation can be red swollen areas that bleed easily, or actual cuts into the gums, which may or may not be tender.

What if my dentures are new?
If your dentures are fairly new andwere made immediately after teeth were extracted, a reline will be required after two to six months. This will take care of the early shrinkage and healing, thus restoring proper fit again. 

I advise that you have a dentist look at your mouth every one or two years, especially at the gums under your dentures. It is best to keep your dentures fitting well so that no irritation develops, because irritation can change the shape and structure of your gums and the bone underneath. These abnormal changes will make it difficult to maintain good fitting dentures.

What does a reline do?
To keep your dentures fitting properly they may need to be relined, as the need arises. Relining is a cost effective procedure as long as you like the way your dentures look. Of course if you don’t like the way your teeth look, because of wear, shape or color, then a reline (which only affects the fit) won’t make you happy.  If you don’t like the way your dentures look or they have been relined several times already you will need new dentures.

What about denture adhesives?
When used as directed with properly fitted dentures, adhesives are a safe, effective aid for comfort and security as well as confidence for the denture wearer.  Using dentures is a skill that the muscles of the mouth, tongue cheeks and lips, must learn and develop. When you first learned to ride a bicycle, your body muscles learned to balance automatically. In a similar way, the muscles in and around your mouth must adapt to controlling the dentures. Denture adhesives are a good help in the beginning.

Like any good tool, dentures need to be kept clean and regularly maintained. Adjustments and maintenance are a fact of life for the denture user.

Should I go to the dentist even if nothing hurts?

Yes, defnitely. Routine dental visits do for your teeth what routine maintenance does for your car. Would you leave the oil level in your car unchecked and oil not changed until your motor stopped? Of course not. Tune-ups for your car keep it running more efficiently and reliably.

The same is true for your mouth and teeth. With routine dental visits, you will be less likely to experience pain or broken teeth. Scheduled dental checkups and cleaning not only alert you to problems and wear of your teeth, but also help prevent gum disease. Gum disease or gingivitis breaks down the connection between your teeth and jaws, and also releases toxins into your blood stream, which leads to heart problems.

Broken and rotten black teeth not only cause pain but are very ugly. Most people with broken or black front teeth don’t smile or even talk to friends comfortably. Regular dental visits and small fillings will save you this embarrassment, and pain.

Everyone is reluctant to visit a dentist. Either fear of pain or fear of paying the bill could keep you away. But most people don’t let these fears stand in the way of good oral health. If you can’t overcome these fears, tell your dentist so that you can get a small anti-anxiety pill before your visit. In most cases, the type and dosage that the dentist will give you won’t make you feel drugged, but it will be enough to relieve your anxiety. This drug is the same that your doctor would give you if you told him you were afraid of flying. It will relieve your anxiety but still not interfere with your ability to deal with the airport and check in

Seeing your dentist twice a year will become a normal habit with very little stress after you have done it several times. After you’ve had your teeth scaled and cleaned once, the next six-month cleaning is much easier on you and the hygienist. And once all of your teeth are restored, very little will need to be done for many years. So after a regular cleaning and checkup you will have the satisfaction of knowing that your mouth and teeth are healthy and clean.

Dental insurance goes a long way to relieve the stress of paying the bill. Some dentists will even deal directly with the insurance company. That way you are not out of pocket, unless the insurance doesn’t cover the whole fee, in which case you have to pay the difference.

A dental visit can be as routine an experience as a visit to the hair dresser.

What are metal dental fillings and what do they do to me?

Most metal dental fillings are an amalgam of about 50% mercury and the rest a mixture of mostly silver, with some copper, zinc and tin. Amalgam has been in common use since about 1860. In 1895 the formula was standardised, and about 1970 the formula was changed to give us what I call modern amalgam. The other metal filling material is gold which is alloyed with other metals to improve its handling and durability in the mouth.

It’s obvious that millions of people have had mercury or silver fillings over many generations. No medical problems have been directly linked to their presence in the mouth. So why change if there is no problem? Well nothing is perfect. Amalgam is ugly in the teeth because of the color contrast. It doesn’t support the tooth structure – in fact, it slowly expands over the years and actually leads to cracks in the tooth. These cracks can cause sensitivity, decay and breakage.

What about the mercury? That’s been a concern from the very beginning of its use in the mouth. Nearly all of the mercury stays bound up with the other metals used to form the amalgam. What happens to the small amount that comes out of the filling, and into your mouth? Some is excreted in the urine, some ends up in your hair and fingernails, the rest stays in your body forever. However, the amount that stays in your body is so minute that medical science tells us it would take about 7000 years to harm you. Yes, 7000 years. Some people do claim to be more sensitive to the effects of mercury on their health than others, and this is an open question.

I haven’t used amalgam to fill teeth in over 15 years. Not because I think that it may be a health hazard, but because there are without question better materials available now.

Pain anywhere in your body can be a warning of an abnormal situation. It is not always serious. For example, the pain of overeating or abdominal gas is real pain but is not dangerous and demanding urgent treatment. Teeth can also be painful due to temperature, usually cold, or pressure. Pressure can be applied either with or without food. In fact the pressure of clenching or grinding the teeth without anything in the mouth, especially while sleeping, is the most severe.

There are a large variety of dental pains and causes. A sharp pain occurring while biting something hard, which stops when the biting pressure is released, is often the sign of a cracked tooth which goes far below the surface. The crack needs to be cut out and the area filled, or the tooth crowned so no pressure can be put on the crack.

Pain from sweet, sour or cold may mean that some nerve endings are right on the surface, just like your eyeball. This area of the tooth needs to be covered and dentists have various methods to do this, depending on the circumstances. For example if the pain is coming from the area of an old filling, it often means that the seal between the filling and tooth has broken down, and fluids are leaking down the side of the filling. In this case you need to have a new filling. When the area of the tooth right at the gum line is tender to pressure, from a fingernail etc, or tooth brushing, toothpaste for sensitive teeth will often solve the problem.

When a tooth has a hole or is broken, even if it doesn’t hurt you need to see a dentist soon. If a broken tooth hurts it means that the nerve is either inflamed because of bacterial infection or irritation from being close to the surface, and exposed to various irritants that act through the thin bit of tooth structure still over the nerve. Your dentist will know the best treatment for the broken tooth.

When the pain is strong and starts with no obvious reason, you probably have an abcess. This is a pocket of puss at the end of as the root. It is the pressure of the pus building up that causes the pain. The pain goes away when the pus is no longer contained in the bone, but can flow out. The puss goes either into your mouth through a little opening which looks like a pimple. This is a draining fistula, a fistula can drain either into your mouth or nasal sinus, or just into the flesh of your face. Needless to say this needs urgent treatment.

If pain seems to appear in teeth in different parts of your mouth, it is often caused by clenching and grinding, due to stress. When you can’t control your stress, then a bruxism guard may help, or an occlusal adjustment may relieve the pain. When your dentist does an occlusal adjustment , the biting pressure is evened out on all the contacting teeth.

Pain with swelling, inside or outside your mouth, means you need to see a dentist or doctor very soon.

Gum disease occurs in varying degrees of severity. In its mildest form it is called gingivitis. The infection is on the surface of the gum tissue, and does not affect the bone, or the ligament which connects the tooth to the bone. Even though the infection is only on the surface, the gums are still red inflamed and bleed easily.

Gingivitis is caused by ineffective or insufficient tooth brushing and flossing, it is also aggravated by even a small amount of tarter at the gum line. This tarter needs to be removed and is best done in the dental office by a dental hygienist. If your gums bleed when you brush or floss, or your breath has an odour, or you have bad tasting saliva, you probably have gum disease.

When the early stages of gingivitis are left untreated, it will progress into periodontitis. At this point your gums are definitely red, swollen, tender and the bleeding and smell are worse. This is caused by tarter build up below the gum line. More important is what is going on below the gums at this point. The structures which hold your teeth attached to your jaw bones is being attacked and destroyed, by the active infection. The bone and periodontal ligament is being eaten away. You will notice some of your teeth are getting loose and tender when you eat. Again this condition needs to be treated by a dentist and hygienist. When the condition is severe with a lot of bone loss, a dental specialist is needed – the specialist is a periodontist.

Medical research has shown that the toxins that enter your blood stream as a result of gum disease may eventually lead to an early and higher incidence of heart problems. People with healthy gums generally feel better, as a whole. Good breath and a bright smile are certainly worth the effort it takes to brush and floss properly. You dentist and staff are the best place to get coaching to help you learn how.

Metal dental fillings, also known as dental amalgams, are made of approximately 50 percent silver and 50 percent mercury. You can tell if you have them in your teeth, because they are grey or almost black from corrosion. The corrosion is a natural and harmless result of the silver content.

The major reason to take into consideration when deciding whether or not to change amalgam fillings is the age of the fillings. After about 10 years in the mouth, there are signs of wear and tear. The margins or joints between the metal and tooth starts to crumble at the top where they meet. A ditch or open space develops, which collects food and bacteria and leads to decay creeping down between the tooth and filling. Eventually you have decay under the filling. About three out of four amalgams over 12 years old have this condition to some extent. Another natural tendency of amalgam is to expand over time. The microscopic expansion leads to cracks in the tooth structure appearing.

If your tooth hurts when you bite down on food, it often means that either the tooth or filling has a crack in it.

The most common material used for fillings today is composite resin. This material is tooth colored. Another major advantage of composite is that it can be bonded to the tooth – that is, “glued” to the tooth. This not only results in a very good seal between the tooth and filling, which keeps out leakage, but it also adds support to the walls of the cavity. The support strengthens the tooth which in turn reduces breaking. The opposite of amalgam, which puts expansion pressure on the tooth, leading to cracking and breakage.

If you are concerned, ask your dentist if it is time to replace your amalgam fillings because of age.

I hear this question from people who don’t like the way their front teeth look when they smile. There are many reasons for this reaction.

When front teeth have large stained fillings.
Depending on the size and shape of the fillings, and position of the front teeth, this situation can be improved by replacing the old fillings with new ones. This is of course the quickest cheapest way to improve a smile. When replacing fillings is not enough, veneers often won’t work either.

Teeth with big fillings don’t make a good foundation for supporting veneers. In this case full crowns are the best answer. They can be all porcelain or porcelain-fused to metal. There are advantages to both. Certain degrees of crookedness can be corrected with crowns.

When the problem is small yellow teeth
Dark teeth look smaller than they are, so I often suggest bleaching the top and bottom teeth. Once the teeth are bright white they appear larger and minor crookedness is not as noticeable . This again can be a fast easy solution for some people. Large and normal size yellow or grey teeth also look better once they are bleached white.

Do veneers last a lifetime?
No they don’t. Veneers are porcelain covers glued to the front teeth, after a small amount of enamel is removed to make space. Well-made veneers will last 8 to 12 years. Over the years the glue joint deteriorates and stain takes hold. Even when the joints are hidden between the teeth, the staining shows through. If you are 25 years old, how many replacements will you need by the time you are 75?

How long do crowns last?
Crowns can last 10 to 30 years depending on many factors. A lot of things happen to people and their mouths over the decades.

Over the course of my dental practice I have had many people ask me similar questions. I think by posting some of these common questions along with answers based on my experience, I can help reduce some of the stress people have about asking dental questions, never mind going to or even speaking to a dentist.

This discussion will be in everyday language, not overly technical, or judgmental.