Melbourne Smile Clinic

Frequently Asked Questions (FAQs)

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General Information

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Bad breath (scienfic word: Halitosis) can be caused by factors linked to the mouth and teeth (intra-oral) or due to health issues arising from the lungs, digestive system or hormonal disturbances (extra-oral).

The most common causes of bad breath are intra-oral. The build up of bacteria in the mouth, associated with poor oral hygiene, is one of the main causes. Bacteria grow on plaque (food debris) which builds up around teeth, under the gum margins and tongue surface, hence the need for thorough brushing, flossing and regular professional cleans. More severe cases of bad breath can be attributed to established gum disease as a result of poor oral hygiene and neglect over an extended period of time. The types of bacteria in the oral cavity evolve over time if the plaque level keeps growing and this  can lead to more virulent bacteria that cause gum disease and bad breath. 

Large cavities in a tooth and infected teeth are also breeding grounds to bacteria that contribute to bad breath. The wearing of appliances such as braces and dentures can also make oral hygiene more difficult, increasing the level of plaque bacteria in the mouth that contribute to bad breath.

If you are concerned about possibly having bad breath, the Melbourne Smile Clinic is able to assist you with the right advice. Call us or book an appointment online. 

Reference: Halitosis: Prevalence, risk factors, sources, measurements and treatment- a review of the litterature. Wu J., Cannon R., Ji P. et al. Australian Dental Journal (volume 65, issue 1, pages 4-11), March 2020

 

Mouth ulcers can be caused by

Recurrent aphtous stomatitis: This is the most common cause of mouth ulcers that have a tendency to recur for no apparent reason. These are more common in younger people (10-29 yoa). They can lead to small, large or a cluster of ulcers which are quite painful. The  most common underlying cause for recurrent aphtous ulcers are genetic factors, stress and nutritional deficiencies (mainly of iron, folic acid and vitamin B12). Rinsing with salt water can help heal the smaller and less painful ulcers. Otherwise, topical steroid ointment can be helpful and must be prescribed by a health professional. 

Trauma: cheek biting or chewing, rubbing against a sharp tooth/ ill-fitting dentures and piercings, foods that are too hot or hard-textured are all possible causes of ulceration. Usually these ulcers are once-off and disappear once the cause is removed.  

Chemical: Ulcers can be caused by a chemical irritant, such as keeping a tablet of aspirin against a tooth in the hope that it will alleviate a toothache (please note that aspirin must be swallowed for any pain-relief result). Another example is the improper use or application of teeth bleaching gel. These contain high levels of peroxide that when in contact with the mucosa for too long, will lead to ulcerative burns.

Medication-related: Chemotherapy medications used in cancer cause oral ulceration while radiotherapy cause ulcers only when used in the head and neck region. Medications used to prevent transplant rejection also have this effect. It is usually recommended that patients ensure that their dental health is good prior to starting such medical treatments. This is because dental treatment is made more difficult and uncomfortable due to the presence of ulcers in the mouth and there are higher risks of infection.

Infections: Viral infections can cause of recurrent mouth ulcers. For example, first-time infection by the Herpes virus can cause red, sore gums and blisters that rupture to form ulcers. In Hand, food and mouth disease, a different virus is responsible (coxsackier virus). The patient develops malaise and fever and ulcers can appear anywhere in the mouth.

Mucocutaneous and autoimmunce diseases:

Mucocutaneous diseases are disorders directly affecting  the soft tissues of the mouth. The oral soft tissues are hypersensitive and hyper-reactive. An example is Lichen Planus, a rare condition affecting only 1-2% of the population, where manifestations are sloughing and bleeding gums, ulcerations, altered taste and sensitivity to spicy foods. 

Autoimmune diseases include inflammatory bowel diseases such as celiac disease, Crohn's disease and Ulcerative colitis. These can have oral manifestations including mouth ulcers which usually resolve when the underlying disease is treated. Other autoimmune diseases such a Behcet's disease and SLE (systemic lupus erythematous) affect multiple systems in the body, including the oral cavity, leading to ulcerations. 

Reference: Recurrent oral ulceration. Aetiology, classification, management and diagnostic algorith. Elizabeth A. Bilodeau, Lalla R.V. Periodontology 2000 (Volume 80, issue 1, pg 49-60) June 2019

They are necessary for a variety of reasons:

For decay detection

During an examination, decay in a tooth can be seen if it is in an area that is visible in the mouth. Often, however, the decay between teeth or in areas where it cannot be easily visualised with the naked eye and hence remain undetected.  The following images illustrate how taking a radiograph allows detection of decay otherwise not visible to the naked eye.

For root canal treatment

During root canal treatment, radiographs are an absolute necessity as the dentist is operating inside the tooth within the root system. 

For pre-assessement before major dental treatment such as:      

Orthodontics

Implant placement

Crown and bridge work

Prior to extraction of teeth

Radiographs show the hidden root structure of a tooth and also its position relative to other teeth and other anatomical structures. 

For general diagnosis of pathology and gum disease

Pain in the oro-facial region is often dentally related. Radiographs can be helpful in confirming the diagnosis. Simple visual examination might not provide enough information to allow the dentist to reach a definite diagnosis.

Radiographs also allow assessment of gum disease severity.

The recommendations are:

For decay assessment:

If it is your first visit at the dentist and you have had a lot of fillings in the past or decay is detected in your teeth, radiographs are recommended.  

If it is a recall visit and you have had decay in the past and considered high risk of recurring decay, radiographs are recommended at 6-18 months interval for adults and 6-12 months interval for children of up to 11 years of age.
If it is a recall visit and you have not had fillings and is considered at low risk of decay, radiographs are recommended at 24- 36 months interval for adults and 12-24 months interval for children.

For gum disease monitoring:

When gum disease is present, specific radiographs a required to assess its severity atdifferent intervals depending on the case to determine whether there is progression or stabilisation of the disease. The frequency is decided by the dentist based on clinical judgement.

For post-treatment monitoring:

In cases where a patient has received more complex treatment like implants, root canal treatment or crown and bridge work, radiographs might be necessary to ensure the restoration  or treatment site is being maintained in good health. Again, frequency is determined by clinical judgement.

Reference: Dental radiographic examinations: recommendations for patient selection and limiting radiation exposure. American Dental Association. Council on Scientific Affairs. 2012

Smile Makeover

Invisalign straightens teeth by using a series of clear aligners that are worn 24/7 except at meal times and during toothbrushing.

Each aligner is designed to apply specific forces to the teeth to move them to the right position in a gradual manner. Each aligner is to be worn for a minimum of 1 week. The number of aligners used will vary from case to case. The aligners are custom-made for each patient. A scan or impression of the patien's teeth must be obtained at the start of treatment for the aligners to be generated. 

To help with tooth movement, invisalign treatment usually also requires the use of attachments and IPR (Interproximal reduction)

What are attachments?

In order to move the teeth efficiently and in the right direction, attachments made of resin material are often necessary and are bonded to the teeth at the start of treatment. These are small blobs of tooth-coloured material that are placed at specific sites on the teeth to engage the aligners and allow the desired tooth movement. Attachments are not visually noticeable when placed on the teeth. However, it can take some time for patients to get used to them. They can get stained if a diet high in staining foods is consumed or oral hygiene is poor.

What is IPR (Interproximal reduction)?

IPR is the removal of a very thin layer of enamel on the sides of particular teeth during Invisalign treatment. The thickness of enamel to be removed is usually no more than 0.5mm. This is carried out by the dentist using fine polishing strips. There is no harm caused to the tooth and there is no noticeable change in the appearance of the tooth. 

IPR is necessary to provide additional space into which teeth can be moved to obtain the right alignment when there is crowding.  

 

 

The durability of veneers depends on the material they are made from and on the condition of the teeth they are placed on.

Resin veneers are made from a plastic-like material (composite resin). They last up to five years, are more prone to staining and chipping. They require regular polishing and maintenance to keep their lustre. 

Ceramic veneers made from specialised dental porcelain can last up to 15 years. They do not stain easily but can chip or fracture if excessive forces are applied to them. While less maintenance is needed for ceramic veneers to keep their lustre, chipping or fracturing is harder to repair and might require a full replacement. 

The condition of the teeth on which the veneers are placed will affect the veneers' lifespan. Teeth need to be free of decay and gum disease before veneers are placed. Decay in the teeth can lead discoloration of the venner or to the veneer falling off prematurely. Gum disease can lead to the teeth becoming loose and falling out.

Before veneers are placed, it is essential that a full oral assessment is made to ensure teeth are free of decay and gums are healthy. 

Good oral hygiene and regular professional cleans are also critical to maintain the lifespan of veneers.

Invisalign is effective in the majority of cases where teeth straightening is desired. However, an assessment by a trained dentist is required to determine this. 

First, your dentist will ensure that your mouth is free of decay, gum disease and other pathology prior to starting Invisalign. If this is not the case, other dental treatment will be needed to achieve a healthy oral condition first. 

Once the dentition is restored to health, an Invisalign assessment is carried out. This involves photographic records and taking a scan or impression of the teeth.

These records will then be analysed to determine how the misalignment of the teeth (maloccusion) can be corrected. 

The degree of correction necessary to achieve the desired result must also be taken in consideration. If the starting maloccusion is very severe, Invisalign aligners alone might not be sufficient. Other devices might be needed to correct the bite (such as elastics or a palatal expansion device). If this is the case, an orthodontist (specialist) referral is the preferred course of action.

In cases where there is also severe jaw misalignment, jaw surgery might be needed to correct the problem and an oral surgeon needs to be involved as well.

Patients with extensive decay, untreated gum disease, many missing teeth and severe jaw misalignment must consult a dentist before commencing any aligner treatment.

 

Veneers are a thin shell of material bonded on the front surfaces of teeth to improve their appearance. 

Veneers can be made of ceramic or resin. They are tooth- coloured and their shapes and contours can be customised to improve the appearance of the natural teeth that they cover.  

Veneers can be placed over 1 or 2 appointments and provide a relatively quick solution to improve an unaesthetic smile. However, each case must be assessed thoroughly to ensure that veneers are the most appropriate treatment modality.

Ceramic Veneers

The durability of veneers depends on the material they are made from and on the condition of the teeth they are placed on.

Resin veneers are made from a plastic-like material (composite resin). They last up to five years, are more prone to staining and chipping. They require regular polishing and maintenance to keep their lustre. 

Ceramic veneers made from specialised dental porcelain can last up to 15 years. They do not stain easily but can chip or fracture if excessive forces are applied to them. While less maintenance is needed for ceramic veneers to keep their lustre, chipping or fracturing is harder to repair and might require a full replacement. 

The condition of the teeth on which the veneers are placed will affect the veneers' lifespan. Teeth need to be free of decay and gum disease before veneers are placed. Decay in the teeth can lead discoloration of the venner or to the veneer falling off prematurely. Gum disease can lead to the teeth becoming loose and falling out.

Before veneers are placed, it is essential that a full oral assessment is made to ensure teeth are free of decay and gums are healthy. 

Good oral hygiene and regular professional cleans are also critical to maintain the lifespan of veneers.

Veneers are a thin shell of material bonded on the front surfaces of teeth to improve their appearance. 

Veneers can be made of ceramic or resin. They are tooth- coloured and their shapes and contours can be customised to improve the appearance of the natural teeth that they cover.  

Veneers can be placed over 1 or 2 appointments and provide a relatively quick solution to improve an unaesthetic smile. However, each case must be assessed thoroughly to ensure that veneers are the most appropriate treatment modality.

Veneers are a thin layer of tooth-colored material placed on the front of teeth to improve their color and/or shape. They are used to create a more esthetic smile.

Resin veneers consist of a material similar to plastic. They are placed onto the tooth directly by the dentist and shaped to give the desired result. The tooth has to be treated with an acidic gel so the resin material can chemically bond to the tooth enamel. In some cases, a thin layer of the tooth enamel might need to be shaved off so that a sufficient thickness of the resin material can be added to the tooth to obtain the desired change in color or shape. Resin veneers are considered to be a direct technique and can be placed in a single visit. Resin veneers are however more prone to staining over time. The material can also fracture or chip over time. Resin veneers once placed with require regular maintenance to retain the desired effect.

Ceramic veneers consist of a thin layer (at least 0.8mm) of ceramic that is held onto the tooth by a cement. Ceramic veneers are manufactured in a dental laboratory after the dentist has prepared the teeth and sent a scan or impression of the prepared teeth. This is considered an indirect technique and require 2 visits for completion. Since the ceramic veneer has to be of a minimum thickness, some tooth enamel usually has to be removed from the front of the teeth to achieve the desired result. Ceramic veneers are quite durable and do not stain easily. They usually require less maintenance than resin veneers and provide a long-lasting esthetic result. 

 

Teeth Whitening/ Bleaching

Is Bleaching safe?

Yes. Provided the bleaching gel is used correctly and in the appropriate concentration.

  • Carbamide and hydrogen peroxide do not cause any morphological changes to the tooth enamel when the tooth is healthy and free of decay.
  • The increased sensitivity to thermal stimulus (hot or cold) is a transient effect and does not represent a danger to the tooth.
  • While there are no adverse effects to the teeth, exposure of soft tissues (gums, lips, oral cavity and digestive system) to the peroxide can lead to severe burns and irritation. This is why it is strongly advisable to ensure that dental bleaching procedures and supply of bleaching gels are carried out by a qualified and registered dental practitioner. 

If done correctly and with the correct supervision, dental bleaching is safe. 

When is bleaching not recommended?

  • In the presence of untreated dental decay, gum and mucosal disease, bleaching is not recommended. Bleaching is safest and most effective when teeth and soft tissues are healthy.
  • Bleaching is also contra indicated for pregnant and lactating women.
  • Teeth that have been restored with large fillings, crowns or veneers cannot be bleached adequately. While natural tooth enamel can be bleached, the materials used for fillings and the ceramic in crowns and veneers will not change colour. This can result in a discrepancy between the colour of the natural teeth and those that have been restored. It is advised that bleaching is carried out before the placement of crowns and veneers on teeth. If old fillings are present, they might need to be replaced after the bleaching process if a colour discrepancy arises between the bleached enamel and the colour of the filling material.

Teeth Straightening (Orthodontics)

Invisalign straightens teeth by using a series of clear aligners that are worn 24/7 except at meal times and during toothbrushing.

Each aligner is designed to apply specific forces to the teeth to move them to the right position in a gradual manner. Each aligner is to be worn for a minimum of 1 week. The number of aligners used will vary from case to case. The aligners are custom-made for each patient. A scan or impression of the patien's teeth must be obtained at the start of treatment for the aligners to be generated. 

To help with tooth movement, invisalign treatment usually also requires the use of attachments and IPR (Interproximal reduction)

What are attachments?

In order to move the teeth efficiently and in the right direction, attachments made of resin material are often necessary and are bonded to the teeth at the start of treatment. These are small blobs of tooth-coloured material that are placed at specific sites on the teeth to engage the aligners and allow the desired tooth movement. Attachments are not visually noticeable when placed on the teeth. However, it can take some time for patients to get used to them. They can get stained if a diet high in staining foods is consumed or oral hygiene is poor.

What is IPR (Interproximal reduction)?

IPR is the removal of a very thin layer of enamel on the sides of particular teeth during Invisalign treatment. The thickness of enamel to be removed is usually no more than 0.5mm. This is carried out by the dentist using fine polishing strips. There is no harm caused to the tooth and there is no noticeable change in the appearance of the tooth. 

IPR is necessary to provide additional space into which teeth can be moved to obtain the right alignment when there is crowding.  

 

 

Invisalign is effective in the majority of cases where teeth straightening is desired. However, an assessment by a trained dentist is required to determine this. 

First, your dentist will ensure that your mouth is free of decay, gum disease and other pathology prior to starting Invisalign. If this is not the case, other dental treatment will be needed to achieve a healthy oral condition first. 

Once the dentition is restored to health, an Invisalign assessment is carried out. This involves photographic records and taking a scan or impression of the teeth.

These records will then be analysed to determine how the misalignment of the teeth (maloccusion) can be corrected. 

The degree of correction necessary to achieve the desired result must also be taken in consideration. If the starting maloccusion is very severe, Invisalign aligners alone might not be sufficient. Other devices might be needed to correct the bite (such as elastics or a palatal expansion device). If this is the case, an orthodontist (specialist) referral is the preferred course of action.

In cases where there is also severe jaw misalignment, jaw surgery might be needed to correct the problem and an oral surgeon needs to be involved as well.

Patients with extensive decay, untreated gum disease, many missing teeth and severe jaw misalignment must consult a dentist before commencing any aligner treatment.

 

Implant Dentistry

Implants have been proven to be safe and biocompatible. Implant screws are made of titanium metal, the same material used in artificial joint. Titinium dental implants, when placed into healthy bone tissue, allows close apposition of new bone around the implant locking it solidly into the bone. This process is called osseointegration. For an implant to be successful, osseointegration is essential. For osseointegration to occur, a minimum healing period of  8 weeks is usually necessary after surgical placement of the implant. 

Implants nowadays, have a success rate of 98%, when placed in a healthy site and by a trained operator.

The implant itself can fail if the surrounding bone does not heal properly after it has been placed. This is called integration failure and  can occur as a result of infection of the site, poor bone healing or premature loading of the implant after surgical placement. A history of smoking and gum disease can reduce the success rate of implants. If an implant fails to integrate, it will eventually become loose in the bone and can even fall out. It is therefore critical that all proper procedures are followed to allow the implant to integrate successfully in the jaw bone.

Failure can also happen if the artificial tooth (crown) placed on the implant breaks or falls off.  In some cases, the crown is held onto the implant by a small screw. Loosening of that screw can happen over time and does not necessarily imply failure as the screw can often be tightened or replaced. However, if the chewing forces on the crown are excessive, the crown can fracture and need to be replaced.

It is important to have regular checks at your dentist to ensure the implant remains in good condition. Good gum health is vital and must be maintained by adequate oral hygiene and regular professional cleans.  

Fillings

Several factors affect how long a filling can last.

These are:

  • The Material used- Resin composites are not as durable as amalgam (silver) fillings.  However, the strength of resin composites have improved over time and some studies have shown that the durability of resin composites is similar to amalgam fillings when the right technique is used for placement.
  • Size of the filling- the larger a filling is, the higher the likelihood of failure or other complications as a large filling means that there was a large amount of decay in the tooth to start with. With extensive decay, a tooth is more likely to develop further issues such as nerve inflammation. A larger filling is also more likely to chip or fracture. 
  • The location of the tooth in the mouth affects the likelihood of the filling failing. A filling in a back tooth that does most of the chewing can wear down or chip more easily than a filling in a front tooth.
  • Oral hygiene level will affect the lifetime of a filling. With poor oral hygiene, there is a higher likelihood of decay developing again under or around an existing filling, causing failure.
  • A diet high in sugary and acidic foods can also lead to increased rates of decay under and around existing fillings.

The higher the number of fillings a person has, the more important it is to have good oral hygiene, avoid frequent sugary foods, have regular checks and cleans at the dentist in order to maximise the lifetime of the fillings.

Biocompatibility
All materials used in the dental setting have been approved by the Australian TGA (therapeutic goods administration)

Resin composites
Resin composites are commonly used routinely as a tooth-coloured filling material. There is concern from members of the public that they contain bisphenol A (BPA) which is thought to have oestrogenic effects on cells. The evidence comes from studies showing that BPA binds to oestrogen receptors in vitro. However, the oestrogenic effect of BPA is 1000-fold less potent than the native oestrogen hormone.

All current resin composites consist of methacrylate monomers (such as Bis-GMA) and DO NOT contain BPA. However, BPA is a synthetic chemical starting point from which all methacrylates are derived – in dentistry as well as many other plastics.

No evidence exists that dental composites have estrogenic effects in vitro or invivo.

Dental ceramics
Dental ceramics are very chemically inert materials and remain stable over very long periods of time. They therefore have excellent biocompatibility.

They furthermore exhibit excellent flexure strength, fracture toughness, wear resistance and colour stability. The ceramics can also be formed into precise shape to replace missing parts of a tooth.

They are an excellent material where a substantial part of a tooth is missing or for crowns.

However, in order to be held onto the tooth, the ceramic restoration has to be bonded to the tooth surface with a cement.  The cement in some cases has to be a resin cement in order to provide the best adhesion.  Resin cements have chemical similarities to resin composites which have been described above.

Reference: Phillips’ Science of Dental Materials, Kenneth J. Anusavice 2007.

Gum Health & Oral Hygiene

Receding gums arise when the gums shrink away and more of the tooth root surface becomes exposed. The primary cause of gum recession is inflammation (gingivitis) caused by bacteria in plaque.  Plaque is a film of food debris and bacteria and is not always visible to the naked eye. When plaque is deposited along the gum line, the bacteria in the plaque leads to inflammation of the gums. The plaque can also harder into calculus (also known as tartar). Calculus is a hard, sticky substance that cannot be brushed off and contributes to gum inflammation. Inflamed gums tend to bleed easily.  If however this inflammation is chronic over a long period of time, the gums eventually recede and the condition is known as periodontitis. This might occur over a number of years and not be immediately noticeable. 

However, once it has occurred, gum recession is irreversible and the lost tissue cannot be regrown. If the gum recession continues unabated, the teeth can loosen up and eventuall fall out. 

Other less common causes of gum recession are:

  • Past orthodontic treatment- if too much force is applied to teeth to move them, gum recession can occur
  • Overly aggressive brushing- brushing too vigorously and with a hard brush can lead to gingival trauma and recession

To prevent gum recession, it is important to have good oral hygiene with the correct toothbrushing technique and daily flossing. 

Regular professional cleans are also critical to prevent a high build-up of plaque and calculus. 

 

Why do my gums bleed?

We often have patients reporting that their gums bleed during brushing or eating or even spontaneously, and this is often a cause of anxiety. 

The most common cause of bleeding gums is gum disease. Gum disease means that the gum tissues are inflamed. This inflammation is most often caused by a deposit of plaque and calculus (soft and hard debris) , which act as an irritant, around the gum lines. Inflamed gums usually look red, swollen and bleed easily. The more severe the inflammation, the more severe the bleeding.

In the early stages of gum inflammation, this is known as gingivitis. Gingivitis is reversible. When the irritant is removed, the gums are able to recover and stop bleeding.

However, continuous inflammation over a long period of time can lead to irreversible changes where the gums recede. This more advanced state of disease is known as periodontitis. Periodontitis can lead to teeth becoming loose and eventually falling out. Periodontitis requires immediate professional treatment to stop its progression. 

Inflamed gums that bleed easily can make other dental treatment more challenging. It is important that prior to more complex dental treatment such as cosmetic dentistry, orthodontics, implant placement, and even filllings, that the gums are as healthy as possible. 

The best way to prevent gum disease is with good oral hygiene both by adequate tooth brushing and flossing as well as professional cleans on a regular basis.

While bleeding of the gums from gum disease is not life-threatening, it is indicative of chronic inflammation of the gums and we recommend that you seek advice from your dentist as soon as possible.   

Not finding what you need?
Routine Dental treatment is available for patients who present no Covid-19 risk factors. Patients who have been exposed to Covid-19, have been a close contact of a positive case or have been to any listed exposure sites are advised to delay dental treatment until clear of all risks. Patients are kindly asked to check-in using the QR code at reception and to make sure that they do not present any symptoms indicative of possible Covid-19 infection. Patients will need to hand-sanitise and use a disinfecting mouthrinse prior to treatment being provided.