Dental Treatment

Overview

Dental treatment is the care a dental team gives you to keep your teeth and gums healthy and to fix problems when they appear. That can be as simple as a check-up and a clean, or it can mean repairing a hole in a tooth (a filling), treating an infected tooth, replacing a missing tooth, or removing a tooth that cannot be saved. The aim is always the same: to stop pain, keep your mouth working well, and help you keep your own teeth for as long as possible.

Very common. Most people need some kind of dental treatment at some point in their lives, and tooth decay and gum disease are among the most widespread health problems worldwide.

Anyone with teeth, at any age. Children are affected by decay in baby teeth, adults by decay and gum disease, and older adults often by worn fillings, gum recession, root decay, missing teeth and problems with dentures. People with a dry mouth, smokers, people with diabetes, and anyone who finds it hard to access or afford dental care are at higher risk.

Symptoms

Common symptoms

• Toothache that may be sharp, throbbing, or worse when you bite or drink something hot or cold
• Sensitivity to hot, cold, sweet or acidic food and drinks
• A visible hole, dark spot, or rough edge on a tooth
• Gums that bleed when you brush or floss
• Red, swollen or tender gums, or gums that have pulled away from the teeth
• Bad breath that does not go away with brushing
• A loose tooth, or teeth that have started to move or space out
• A chipped, cracked or broken tooth
• A bad taste in the mouth, or a small bump on the gum that leaks pus
• Pain or clicking in the jaw joint, or aching when chewing

Symptoms in children

• White or brown spots on the front or back teeth
• Fussiness with eating, or refusing hot or cold foods
• Crying or holding the side of the face, especially at night
• Not wanting to let you brush their teeth
• Waking up in the night with tooth pain
• Teething discomfort in babies (gum rubbing, dribbling, chewing on things)
• Early loss of a baby tooth because of decay

Symptoms in older adults

• Dry mouth, often caused by medicines, which raises the risk of decay
• Gums that have shrunk back, exposing the darker roots of teeth
• Decay at the root of the tooth, which can be harder to spot
• Loose teeth or teeth that have drifted out of line
• Dentures that rub, feel loose, or make eating sore
• Worn or broken old fillings and crowns
• Difficulty chewing, which can lead to eating less and losing weight

Causes

Main causes

• Tooth decay: bacteria in plaque (a sticky film on teeth) turn sugar from food and drinks into acid, and the acid slowly makes a hole in the tooth
• Gum disease: plaque building up along the gum line causes inflammation, and over time it can damage the bone that holds teeth in
• Injury or trauma to the mouth, such as a fall, a sports knock or biting something hard
• Wear and tear, including grinding or clenching your teeth, often during sleep
• Acidic drinks and foods, and stomach acid from reflux, which wear away the hard outer layer of teeth
• Lost or damaged fillings, crowns or dentures that leave a tooth unprotected
• Not being able to get regular dental care, for reasons such as cost, access or dental anxiety

Risk factors

• Eating and drinking sugary things often through the day, especially between meals
• Not brushing twice a day with fluoride toothpaste
• Smoking or using other tobacco products
• Drinking a lot of fizzy drinks, juice or energy drinks
• A dry mouth, from medicines or a health condition
• Diabetes, which makes gum problems more likely and healing slower
• Pregnancy, when hormone changes can make gums more sensitive
• Grinding your teeth or a bite that does not fit well together
• Long gaps between dental visits, or never having had a check-up
• A family history of weak teeth or gum disease

When to see a doctor

See a doctor urgently if:

• You have severe toothache or pain that keeps you awake and is not helped by pain relief from a pharmacist
• Your face, jaw or gum is swollen
• You have knocked out or badly broken a tooth
• You have bleeding from the mouth that will not stop
• You have a fever along with tooth or gum pain
• A tooth has become very loose, or your bite suddenly feels different

Book a routine appointment if:

• It is time for your regular check-up — how often you need one depends on your mouth, so ask your dental team
• Your gums bleed when you brush, or your breath is not fresh
• You notice a hole, a rough edge or a dark spot on a tooth
• A filling, crown or denture feels loose or sharp
• Your teeth feel sensitive to hot, cold or sweet things
• You are planning a pregnancy and would like your mouth checked
• You feel anxious about dental visits — it is worth telling the team, as they can adapt the appointment for you

Diagnosis

A dentist will start by asking what has been bothering you and looking inside your mouth with a small mirror and a thin probe. They check each tooth for holes, cracks and wear, look at your gums, and check your bite and jaw. If they need to see between teeth or under fillings, or check the bone that holds your teeth, they may take X-rays (pictures of your teeth and jaw). For children and adults alike, the visit is usually quick and nothing is done without telling you first.

Tests that may be done

• Visual check of all your teeth, gums, tongue and the soft tissues inside your mouth
• Gentle probing to check the health of your gums and the bone around the teeth
• Dental X-rays to look for decay between teeth, infection at the root, or bone loss
• A cold or tapping test on a single tooth to see how the nerve is responding
• Photographs or digital scans to help plan treatment such as crowns or braces
• A check of your bite, jaw joint and how your teeth meet
• Occasionally, a referral to a specialist for further tests, including a small sample of tissue being checked in a laboratory

What to expect at your appointment

Most appointments are short — often 10 to 30 minutes. You will sit back in a chair under a bright light while the team looks at your mouth. You can ask questions at any point and agree a signal (such as raising your hand) to ask them to stop. Nothing is usually done on the day without you agreeing. If you need more involved treatment, they should explain the options, the benefits and the risks, and give you time to think it over.

Treatment

Dental treatment is planned around what is wrong and what matters to you. Some problems can be watched and reviewed rather than treated straight away. Others are best fixed early to stop them getting worse. Your dental team should talk you through the choices, including the option of not treating, and what that would mean.

Self-care at home

• Brush your teeth last thing at night and on one other occasion each day, for about two minutes, with fluoride toothpaste
• Spit out after brushing rather than rinsing with water — this keeps the fluoride on your teeth
• Clean between your teeth daily with floss or small interdental brushes
• Cut down on how often you have sugary foods and drinks, and keep them to mealtimes
• Choose water or plain milk between meals instead of fizzy drinks and juice
• Wait about an hour after acidic food or drink before brushing, so you do not brush away softened enamel
• If you have had a tooth removed, follow the aftercare advice your dental team gives you about rinsing and eating
• Ask your pharmacist which pain relief is suitable for you — and never put a tablet against the gum, as this can burn it
• Stop smoking if you can; it is one of the best things you can do for your gums

Medical treatments

Treatment falls into a few broad groups. Preventive care includes a scale and polish, a fluoride coating applied by the dental team, and sealants on children's back teeth. Simple repairs include fillings for decay and re-shaping a chipped edge. Root canal treatment removes the infected soft centre of a tooth and seals it, which can save a tooth that would otherwise be lost. Crowns (caps) and bridges cover or replace damaged teeth, and dentures replace missing ones. Gum treatment involves a deeper clean of the roots under the gum, sometimes over several visits. Braces and clear aligners straighten teeth. Your dental team may also prescribe a short course of antibiotics if an infection is spreading — these do not cure the tooth itself, so the dental treatment still needs to happen. Numbing medicine is used so treatment does not hurt, and you can ask for extra if you feel anything.

When is surgery considered?

Some treatment is done as a small procedure, usually with numbing medicine and often in the dental chair. This includes removing a tooth that is too damaged to repair, taking out a wisdom tooth that keeps causing problems, draining an abscess to release pressure and infection, deeper gum surgery, placing a dental implant, or repositioning tissue after an extraction. More complex cases may be done by a specialist or in a hospital setting, and sedation or a general anaesthetic can be arranged for people who are very anxious or need extensive work.

Living with this condition

Most people carry on with normal life around their dental appointments. You may feel a bit tender for a day or two after treatment, and it can help to eat softer foods and avoid very hot or cold drinks for a short time. Follow any aftercare advice you are given, and go back if something does not feel right.

Lifestyle tips

• Keep to a simple daily routine: brush, clean between your teeth, and avoid sugary snacks between meals
• If you grind your teeth, ask your dental team about a protective night guard
• Wear a well-fitted mouthguard for contact sports
• Limit alcohol and avoid tobacco, both of which raise the risk of gum problems and mouth cancer
• Keep a note of any changes in your mouth, such as a sore that has not healed after two to three weeks, and get them checked
• Book your next appointment before you leave the surgery so it is not forgotten

Diet and exercise

There is no special diet for healthy teeth beyond keeping sugar for mealtimes and drinking water instead of sweet drinks. Foods like cheese, plain yogurt, nuts and crunchy vegetables are kind to teeth. Chewing sugar-free gum after meals can help make extra saliva. Regular physical activity and a healthy weight help with conditions like diabetes, which in turn protects your gums.

Mental health and emotional wellbeing

Dental problems and dental visits can affect how you feel. Pain, broken teeth or missing teeth can make people feel self-conscious, embarrassed about smiling, or worried about eating in front of others. Dental anxiety is very common and nothing to be ashamed of. Tell your dental team — they can offer a slower appointment, a signal to pause, or sedation. Looking after your mouth is part of looking after yourself. If worry about your teeth is affecting your sleep or mood, or you feel overwhelmed, speak to your doctor or a local mental health service. If you ever feel in crisis or unsafe, contact your local crisis line or emergency services straight away.

Prevention

Most dental treatment needs can be prevented or delayed. Tooth decay and gum disease are largely driven by plaque and sugar, so the everyday basics make a real difference: brush twice a day with fluoride toothpaste, clean between your teeth, keep sugar to mealtimes, and see your dental team regularly.

Screening programmes

Regular dental check-ups are the main screening tool for your mouth. The dentist checks for early decay, gum problems and other changes, including a check for mouth cancer at every full examination. How often you need a check-up varies from person to person, so your dental team will advise you — some people only need one every year or two, while others need more frequent visits.

Complications

If left untreated

• Toothache that gets worse and may disturb sleep
• A dental abscess — a pocket of pus at the root of a tooth that can cause severe pain and swelling
• The infection spreading into the face or neck, which is rare but serious and needs emergency care
• Losing a tooth, and then neighbouring teeth drifting out of place
• Gum disease getting worse, with bone loss and eventually loose teeth
• Difficulty chewing or speaking, which can affect what you eat and how you feel
• Costlier and more complex treatment later on than if the problem had been caught early
• In some people, ongoing gum inflammation is linked with poorer control of conditions such as diabetes

Long-term outlook

Very good. Most dental problems are straightforward to treat, and modern treatment is usually quick and comfortable with numbing medicine. Even teeth that are badly damaged can often be saved or replaced. The biggest difference comes from small, steady habits at home and keeping up with check-ups. If you have put off a visit for a long time, that is okay — starting now still makes a real difference, and your dental team is there to help, not to judge.

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