To fit a veneer, the tooth will need a very small amount of enamel removed from its surface. This is usually completely pain free. A mould (impression) will be made of the tooth and the dentist will also record the colour that the new veneer will need to be in order to match the neighbouring teeth. This information will be sent to a dental laboratory who will make the veneer.

Until the veneer has been made the tooth may be more sensitive to hot and cold. A temporary veneer is not usually necessary.

At a later appointment the veneer will be bonded to the teeth.

Veneers are used in a variety of situations:

When there is tooth discoloration that cannot be cleaned away.
When there is an abnormal structure or texture, including chipping, fractures, or wear [erosion] of the tooth.
To aid closure of spaces between the front teeth.
To create the illusion of straight teeth with the desired colour and shape when the front teeth are slightly crowded.
To camouflage front teeth that have multiple, shallow and unsightly fillings
There are no strong reasons against veneering a tooth. However, certain factors increase their risk of failure, such as grinding of teeth, excessively worn teeth, very large fillings, unfavourable bite (occlusion), vomiting associated with bulimia and chronic alcoholism and acid regurgitation as in hiatus hernia. They may also be unsuitable if the teeth are very discoloured.

Veneers are best avoided in situations where the basic rules of dental hygiene are not observed.

Compared with a crown (cap), less of the tooth needs to be drilled away. Veneers are relatively quick and simple, although they require as much planning and attention to detail as any other treatment.

Potential problems

Sometimes the edge can become discoloured with time. Veneers can occasionally become unstuck, and if they are stuck back on again the rebonding will not be as durable as the initial bond. It may also be difficult to match the shade of the veneer to the adjacent teeth if only one front tooth is being veneered.

During the first three days after fitting, while the glue is setting, it is advisable to keep to a soft diet and to avoid extremes of temperature. It is also wise to avoid alcohol and medicated mouthwashes during this initial stage.

Habit patterns such as nail biting or pencil chewing should be avoided, as well as biting into hard food, to prevent fracture of the veneer. Use of a soft mouthguard at night and when involved in any form of contact sport is recommended.

Routine oral hygiene procedures such as the use of a soft toothbrush and floss are a must. Electric toothbrushes may be used on veneers. If plaque removal from between the teeth is a problem, an interdental brush may be used. Use of a less abrasive toothpaste is recommended. The use of acidulated fluoride mouthrinses should be avoided as they might damage the surface finish of the veneers. Routine follow-up visits should be maintained with a dentist.

Although fractured veneers can be repaired, they are at best only a patchwork approach. Hence, the cosmetic outcome will be poor. If the fractured piece is preserved it could be stuck back or some composite resin material can be used to build up the defect. Although the best answer to the problem is to remake the veneer, the quality of the bond to the tooth achieved the second time around may not be as good as the first time.

Teeth may become discoloured while they are forming (during childhood), as a result of an illness or, the use of tetracycline antibiotics. Teeth may also become discoloured when the pulp (nerve and blood vessels) inside the root canal dies or is damaged as a result of tooth decay or trauma. Teeth also darken naturally with age as a result of progressive hardening within the tooth or because of erosion and thinning of the enamel.

Surface Stain
Well-known causes of tooth stains are tobacco (tar), strong tea, coffee, red wine and Melanoidins (large discolouring molecules from cooked vegetable oils). Medicines containing iron and heavily coloured foodstuffs can also be a contributing influence. Deposits of tartar (calculus) that form around the necks of the teeth will also pick up unsightly stains that are extremely difficult to remove.

Internal Stain
Teeth which have had their nerve removed (dead or non-vital) will always be darker than their live (vital) counterparts. Upper front teeth (incisors) that have taken a heavy knock (trauma) will frequently become discoloured if the blood vessels have been ruptured at the end of the root (apex). If a haemorrhage (bleed) has taken place within the tooth itself (pulp chamber) the usual bruising and healing processes of the soft tissues cannot occur. The blood products break down in the tooth and cannot be taken away by a fresh blood supply. As a result the tooth can become seriously discoloured.

Regular visits to the dentist or hygienist and proper tooth brushing are all an essential part of maintaining good oral hygiene, a healthy mouth and clean teeth.

Bleaching is the use of chemical agents to produce an oxidation of the discolouring molecules within the tooth. It is not a temporary process. A dentist using chemical agents can also remove superficial stains such as tobacco, tea and coffee.

External bleaching
Dentists can bleach teeth externally by applying a bleaching product containing peroxides (usually hydrogen peroxide or carbamide peroxide). It can either be done at the dental surgery or by the patient at home (under the dentist’s direction). At-home systems contain lower concentrations of peroxide, usually 3.5%. The dentist takes an impression of the teeth to produce a custom-made tray that covers the teeth to be bleached. The tray will hold the bleaching gel against the teeth with minimal contact with the gums and other oral tissues. The tray is worn for several hours, usually at night time or when it is most convenient. A course of treatment usually takes two to three weeks. Possible side effects include minor sensitivity of the teeth to heat and cold. These symptoms are usually mild and will quickly ease when the treatment ends.

In-surgery systems usually involve a higher concentration of peroxide, which is used with a powerful dental light unit. Your gums need to be protected using a rubber shield or special paint-on varnish. The procedure takes from 30 minutes to an hour. This is sometimes repeated at subsequent appointments to achieve the maximum effect.

Internal bleaching
When a tooth is discoloured following the death of the pulp, the dentist can carry out internal bleaching after the completion of root canal treatment for the tooth. The bleaching agent is sealed inside the tooth for about a week. It is cleaned out when satisfactory lightening is achieved and a tooth-coloured filling is placed inside the tooth. A very effective method is to combine internal and external bleaching.

Internal and external bleaching
Internal and external bleaching is used to lighten dead (non vital) root-filled teeth. The procedure involves putting gel inside the tooth by holding the gel inside a mouthguard. It produces very good results.

Teeth with a yellowish hue usually bleach well, brownish ones less so; greyish teeth may not bleach well at all. Discoloured fillings will not improve with bleaching. They will show more if the surrounding tooth structure is bleached and they may have to be replaced. The dentist will be able to tell if bleaching is suitable, or not, and discuss other options such as veneers and crowns for improving the appearance of the teeth.

Whitening toothpastes contain ingredients that increase the effectiveness of superficial stain removal and can prove a very effective measure, if used regularly, to prevent stains gaining a foothold. However they are unable to alter the intrinsic colour of teeth. All toothpastes contain mild abrasives, which help remove surface stains.

The source of acid that causes the erosion is either from an intrinsic source from within the body (e.g. acid from the stomach) or from an extrinsic source from outside the body (e.g. acidic foods, drinks or medicines). Intrinsic causes are vomiting and acid reflux (where acid from the stomach escapes up into the mouth) which can be caused by a hiatus hernia, obesity or certain drugs. Fruit juices and soft drinks, together with foods such as rhubarb and citrus fruits, are examples of extrinsic sources of acid.

Regular check ups at the dentist mean signs of erosion can be detected early. If dental erosion has been diagnosed the first stage is to record accurately how severe and extensive the damage is; this is best done by the dentist taking impressions of your teeth. The impression is cast in plaster and can be used to see if the amount of erosion is getting worse over a period of time.

For those affected by erosion it is important to:

Limit acidic foods and drinks to meal times.
Reduce the number of times during the day that acidic foods and drinks are consumed.
Choose soft drinks which have no added sugar and have been shown to pose a negligible risk of tooth erosion.
Finish meals with a small piece of cheese or a drink of milk.
Delay brushing teeth immediately after having acidic foods or drinks.
It may be possible to improve the appearance of teeth that have been eroded with the use of adhesive filling materials, veneers or crowns. However, it is important that the cause of tooth erosion is identified first before this kind of dental treatment is undertaken.

Children’s drinks

The best drinks for children’s teeth are water or milk. Many people believe that natural fruit juices or squashes are the safest alternatives to water or milk. However, most contain fruit acids (often quite a lot). Even drinks marked – no added sugar – still contain acids that can cause tooth erosion. Fizzy drinks (whether diet or regular), fruit squashes, cocoa and milk shakes may all cause harm to teeth. The sugar in them can cause tooth decay whilst the acid in both normal and diet drinks dissolves the enamel on the teeth leading to erosion. Always dilute squashes correctly – follow the manu-facturer’s directions for use. Natural fruit juices should be diluted with water to reduce the risk of tooth damage, although even when very diluted, the acids are still there and can do harm to the teeth. Remember that if a child is genuinely thirsty they will always drink water! Water can be made more exciting by giving it in a special cup, adding ice or using a straw. If children require an alternative drink to milk or water look for a – no added sugar – squash that has been specially designed to pose a negligible risk of tooth erosion.

If comfort feeders and bottles containing sugary drinks are given to young children they can cause severe dental problems. Milk or water is the only drink that should be given in a baby’s bottle. When using feeding bottles hold the baby until the feed is finished. Never leave a baby propped up with a bottle; they might choke and it’s bad for their teeth. Never leave a bottle or feeder cup with a sweetened drink by a child’s bed overnight.

REMEMBER

Ideally a child should drink only milk, or water between meals – use a straw for all other drinks to help direct the drink right into the mouth and away from the teeth.
Do not give concentrated drinks – always dilute them correctly and follow the manufacturer’s directions for use.
Sugary and acidic drinks, like fruit juices, squashes and fizzy drinks should only be taken at meal times.
Take drinks over a short time, rather than constantly sipping at them over a long time, as this reduces the time that the drink is in contact with the teeth.
After brushing teeth at bedtime, allow a child to drink only water afterwards.
Cheese is very rich in calcium salts and is a – tooth friendly – food that helps to protect the tooth surfaces from acid attack.
Always try and get sugar free liquid medicine formulas from the pharmacist.

Healthy gums are pale pink and firm. If the gums are red and swollen, there is probably gum disease or gingivitis present. One of the commonest signs is blood on the toothbrush after brushing and often there is bad breath (halitosis) as well. Flossing may also cause bleeding.

The accumulation of a surface film of dental plaque (a sticky layer of germs) starts the inflammatory process. Tiny ulcers appear which penetrate the soft gum tissues and cause the immune system to respond. Large numbers of white blood cells appear on the scene to fight the bacterial invasion and the gums begin to swell. However, if it is left untreated, it gradually progresses resulting in the destruction of the tooth attachment and bone around the teeth (periodontitis). This causes the affected teeth to become loose and in some cases move. The depth of the space between the neck of the tooth (where the tooth meets the gum) and the gum indicates if there is a gum problem or not. These spaces are known as ‘pockets’. The measurements, taken by a dentist or hygienist also show how severe any existing gum problem is. Healthy gums have small pocket measurements (2-3mm), but in where there is disease these pockets can be very deep (5-10mm or more) and means that special treatment is needed.

Periodontitis and gingivitis can affect anyone at any age. The milder form, gingivitis, is more common. Gingivitis causes bleeding gums and, if left untreated, may progress to periodontitis.

Gingivitis can be treated by visiting a dentist or hygienist who will clean the teeth professionally and advise on how to improve tooth cleaning at home. The patient may be unaware that there is a problem, as gingivitis can be painless during the early stages of the disease. Basic periodontal treatment involves cleaning out the deposits of plaque and hardened plaque (tartar) from above and below the gums. The treatment is usually done by cleaning the affected areas, sometimes after making them numb with a local anaesthetic. In most cases the gum problems resolve after this type of treatment when accompanied by an effective oral hygiene routine at home Gum problems are also made worse by smoking and any dental professional will encourage users to stop.

Sometimes basic treatment is not successful at getting the gum disease under control. This is because the pockets in severe periodontitis are so deep that it is not possible to fully clean the roots without actually looking at them. The dentist may then suggest gum (periodontal) surgery. This treatment involves pushing the gums away from the teeth so that the roots can be seen. It is only by doing this that the dentist can be sure that the roots are clean.

Two types of gum surgery are available:-

Surgery to clean the roots of the teeth – root planing.
Surgery to replace the lost bone and soft tissues as well as clean the roots of the teeth
Those who need surgery include:

Patients who have deep periodontal pockets and gum disease
Patients who have short teeth which need crowns. The teeth can be made longer so that crowns can be fitted
Patients who have a high lip line, show a lot of gum and need their smile improved.
The dentist will usually refer to a periodontist who is a specialist in gum diseases and its treatment.

Prevention of this condition can be done by visiting a dentist or hygienist for advice on brushing and flossing techniques and the use of special brushes, together with regular cleaning and dental appointments. Maintaining good oral hygiene will help to prevent gum conditions from worsening.

Dentures are naturally retained in the mouth due to a combination of factors. Learning to eat with artificial teeth requires considerable skill and practice. This is because every person’s mouth has a different structure, which can affect the retention and stability of the denture. Also the level of suction which helps hold the denture in place, particularly the upper denture, will vary according to the amount of saliva produced. Many denture wearers find the lower denture particularly difficult to manage at first. Experience will help as will the use of a carefully selected denture fixative which can help to keep the denture in place and stable.

However well fitting the dentist has made the dentures, they can never provide the biting and chewing efficiency of natural teeth. Using a denture fixative will help to give confidence and dispel many fears about wearing dentures. Even well fitting dentures can benefit and become more stable and secure. The ingredients work together to hold the denture in place and provide a strong and lasting hold that can help to reduce the ‘wobble’, so eating apples, crusty bread and other foods can be enjoyed again.

Gum irritation

A fixative also acts as a supporting layer between dentures and gums. It helps reduce the effects of any pressure spots, helps prevent the dentures rubbing and makes them more comfortable. A fixative will make you more confident when meeting people and eating out.

Dirty dentures are unattractive and may smell or taste unpleasant; in addition, deposits on the dentures can be harmful to the health of gums and any remaining teeth. Deposits on dentures are the same as those that occur on natural teeth and include: food particles, stains, calculus (tartar) and bacterial deposits (plaque). Certain foods and drinks such as tea, coffee and red wine can cause staining, as can tobacco. A denture which has plaque and tartar present will stain more quickly than a denture which is kept clean.

It is a good idea to develop a regular routine for cleaning dentures. Cleaning them at the same time as any remaining natural teeth will make sure that it is done regularly. Whatever the type of denture, it is best to rinse it after every meal and remove any debris with a soft brush, a denture cleaner and warm water. Dentures should be cleaned over a basin half filled with warm water to minimise the risk of damage they are dropped.

Brushing is the most essential aspect of cleaning a denture. Soaking a denture in a cleansing solution alone is not enough. Use a brush (a large toothbrush is fine) to reach into all the crevices of the denture, especially the fitting surface (the part that contacts your gums) and, in the case of partial dentures, inside any metal parts such as clasps. Using a specialist denture cleansing paste is probably the most effective way of removing food debris and bacterial deposits (plaque) and preventing the build up of stains or tartar.

Deposits of tartar(a bit like the ‘fur’ in a kettle) are less likely if your dentures are always kept clean. However, they can be a problem for some people. No commercially available denture cleanser is effective in removing such deposits and this needs to be done professionally by your dentist or in a dental laboratory, where your dentures can easily be descaled and repolished.

Dentures made of metal and plastic

Rinse the denture thoroughly after every meal and remove debris by brushing with a soft brush, soap and warm water. In the evening, clean it thoroughly with a brush and denture cleaning paste. Do NOT soak the denture in a hypochlorite type of cleanser, an acid or household cleanser. Remove it overnight and leave it in cold water. This helps to keep your gums healthy.

Temporary soft lining materials

Sometimes the dentist may ‘reline’ the denture with a temporary soft lining material and this requires special care:

Rinse the denture after every meal with cold water.
After about a week or when the soft material shows signs of hardening, a soft brush may be used to assist cleaning. The denture may be soaked in a hypochlorite type of cleanser for 20 minutes and then rinsed thoroughly with cold water.
Remove the denture overnight and leave in cold water.
Do not use an alkaline peroxide type of cleanser (the ones that make ‘fizzy’ solutions) as this will cause the material to harden and become rough.
Permanent soft lining materials

If your denture has a permanent rubber lining:

Rinse the denture after every meal and remove debris by brushing with a soft brush, soap and cold water.
Soak the denture in a hypochlorite type of cleanser for 20 minutes every evening.
Rinse thoroughly and leave in cold water overnight.
Rinse the denture after every meal and remove debris by brushing with a soft brush, soap and cold water. Soak the denture in a hypochlorite type of cleanser for 20 minutes every evening. Rinse thoroughly and leave in cold water overnight.
Commercially available denture cleansers generally fall into one of the following categories:-

Paste cleansers
Paste cleansers are available in tubes, like toothpaste, but are formulated to be non-abrasive to the plastic of a denture. Many ordinary toothpastes are too abrasive to be used on plastic although perfectly suitable for natural teeth.

Alkaline peroxides
These are supplied either as a large tablet or as a powder which is dissolved in warm water to produce an effervescent solution in which dentures are soaked for a prescribed period.

Liquid cleansers
There are relatively few of these. Current products are usually based either on a dilute solution of hypochlorite (smell of chlorine or bleach) or contain a dilute acid. Neither of these types should be used on metal dentures and the manufacturer’s labelling usually includes a note of caution about this.

Some ulcers appear as single ulcers; some ulcers arrive in groups. Some heal quickly leaving no mark behind, and some heal leaving a scar that may be noticeable for some time. Some ulcers appear and then disappear never to return, others may keep coming back again and again.

A single ulcer, which is not healing and which has been present for more than 10 days should be looked at by your dentist. If there is no good reason for the ulcer not healing, it should be investigated further to exclude a possible cancer. Most ulcers however are not malignant and can be explained after the dentist has asked about different features of the ulcer.

Single ulcers that heal are often caused by some minor damage to the lining of the mouth, such as a scratch from sharp food such as potato crisps, or damage from a sharp broken tooth or filling. Alternatively, a burn from hot food could cause a blister that breaks down to leave an ulcer. Occasionally, an ulcer may arise from a chemical burn; for example, if an aspirin is left to dissolve on the gum next to a painful tooth (this will not stop the toothache). Also, the frequent and prolonged use of some toothache or teething gels can result in an ulcer in the area to which they are applied.

Other single ulcers may result from a cold sore, or much less often, a recurrence of chicken pox affecting the mouth (shingles). More rarely, there are some conditions that can affect the mouth and cause ulceration (e.g. lichen planus, gluten sensitivity and other rare conditions)

Recurring ulcers are known by different names; recurrent oral ulceration, recurrent aphthous (pronounced ‘af-thus’) ulceration and sometimes recurrent aphthous stomatitis. These recurrent ulcers can be divided into three groups depending on their appearance and duration.

The most common type of recurrent ulcers is minor recurrent oral ulceration. The name is given because the ulcers are small, about 3-5mm in diameter. These ulcers often come in groups of half-a-dozen or so. They appear in the mouth over two or three days, last about five to seven days, and then heal over the next couple of days. They most commonly affect areas towards the front of the mouth; the lips, tongue and gums, and when they heal there is no sign of where they have been.

Much less common are major recurrent oral ulcers. These ulcers tend to occur towards the back of the mouth, for example, the back and sides of the tongue, roof of the mouth and in the area of the tonsils. These ulcers are usually single and large (about 1cm in diameter), and may last for many weeks. They slowly heal and leave a scar where the ulcer used to be.

Also very uncommon are herpetiform ulcers. These ulcers are tiny (1mm in diameter) and may appear in all areas of the mouth. There are often many dozens of tiny ulcers appearing together. These will heal in a few days, do not leave a scar, and recur infrequently. The name, herpetiform, is because of the appearance of the ulcers. They do not have anything to do with the virus of a similar name that can cause cold sores.

No treatments are available which will cure the ulcers. Medications can be bought over the counter in a pharmacy that can help to lessen the discomfort, these include;

Chlorhexidine mouthwash (e.g. Corsodyl) – an antiseptic mouthwash that helps to keep the mouth clean.
Difflam – a mouthwash or spray that can temporarily numb the lining of the mouth and reduce the soreness.
Adcortyl in Orabase – a paste application of a mild steroid. The paste acts as a protective covering over the ulcer and the steroid part helps to reduce the inflammation and discomfort.
A dentist can look at the ulcers about which there are worries. If the dentist feels it is appropriate, they may refer to a hospital specialist, such as a consultant in Oral Medicine, for further investigation and/or treatment.

In general, orthodontic treatment is undertaken for two different groups: children, typically aged between 12 and 14 years old, or adults. The specific timing of treatment will, however, vary from patient to patient. A dentist is the first person to speak to. Based on the concerns, a decision will be made, if appropriate, to refer to an orthodontist.

The orthodontist will need to know what particular concerns there are about the teeth. He or she will undertake a detailed examination and possibly take x-rays and photographs of the face and teeth. Before deciding on the best course of treatment, the orthodontist will also take moulds of the teeth. The orthodontist will then explain the preferred course of treatment to obtain the best results. Options will be discussed as well as any potential problems and/or limitations with the proposed treatment.

The orthodontist may ask the dentist to remove one or more of either:-

a) Baby teeth – occasionally baby teeth stay in the mouth for longer than they should and delay the adult teeth coming through. In these cases, their removal will significantly help.

b) Adult (permanent) teeth. Many people have too many teeth for the size of their jaws and so the removal of some of the adult teeth may be needed to make space to straighten the crooked ones. The decision to remove teeth is never taken lightly and is based on careful consideration of the position of the teeth and how they bite together. If the teeth are not too crooked, it may be possible to have treatment without having any removed. In this case, it will usually involve the patient having to wear a night brace (head-gear) in order to make room to straighten the teeth.

The following factors could delay the start of treatment:

The number of adult teeth in the mouth.
Orthodontic treatment that involves the use of fixed braces usually starts when all the adult teeth have appeared in the mouth. However, a removable brace can be fitted at an earlier age if it is necessary.

The general condition of the teeth and gums.
If there is dental decay or gum disease, orthodontic treatment will need to be delayed until it is treated. If it is not, there is a real risk of both the decay and the gum disease getting worse when a brace is fitted.

The presence of a waiting list for treatment.

There is a great demand for orthodontic treatment and relatively few specialist orthodontists. As a consequence, there is often a delay in receiving treatment.

Essentially there are two kinds of brace:-

Fixed braces – these are individually fixed to the teeth with a special glue and therefore cannot be removed by the patient. This type of brace is used when the teeth are very crooked and offers the best results. Some patients (especially children) like to choose different colours on the brace to make them more trendy – e.g. the colours of their favourite football team. Adults may wish to choose clear or ‘invisible’ braces.
Removable braces – are very useful at moving either individual or groups of teeth, for example for correcting a deep bite or widening a narrow upper jaw. As such they can be used at an earlier age than the fixed brace. This type of treatment usually precedes fixed brace treatment. The big advantage of removable braces is that they are easily cleaned.
The time needed to effect the necessary corrections very much depends on:

How crooked the teeth are.
The more complicated the problem, the longer the treatment is likely to take; e.g. teeth that have failed to grow into the mouth properly can take up to two years to straighten.

The type of brace.
Fixed brace treatment on average will take up to 18 months and removable brace treatment, from 6-9 months.

Care of the appliance.
Repeated breakages and poor cleaning of the brace will significantly delay treatment time.

The fitting of the brace is not painful. The patient may well experience a degree of discomfort, from both the teeth and inside of the cheeks, for a few days following the initial placement of the brace and subsequent adjustments.

Once the brace (fixed or removable) has been fitted, visits to the orthodontist at 4-6 week intervals will be needed in order to monitor progress and have the brace adjusted. It is very important to continue with regular check ups with a dentist to ensure that the teeth and gums remain in the very best condition possible throughout the treatment.

It is essential to ensure that both the teeth and the brace are kept as clean as possible. Any particles of food and plaque left around the brace means that you are more at risk of developing tooth decay or gum disease. The orthodontist, dentist or hygienist will advise about the use of any special toothpastes, brushes or mouthrinses to help keep your mouth as healthy as possible during your orthodontic treatment.

There is a wide choice in dentistry from being a salaried consultant oral surgeon working in a hospital environment to the independence and freedom of running a business that a principal experiences in running a private practice.

You can select a topic from our index opposite, or select to read a Career Factfile for one or more of the key roles in dentistry.

More than 100,000 personnel are employed in a variety of ways in the dental industry.Dentistry covers a wide area ranging from primary care in general practice to secondary care embracing the hospital services where highly specialised treatment is provided by consultant maxillofacial surgeons and their teams.They are responsible for performing the most complex surgical operations and looking after the everyday needs of patients referred from general practice.

There are 14,000 dental practices in the UK that are responsible for the provision of the General Dental Services.These private practices provide employment for more than 60,000 personnel ranging from highly qualified dental specialists to trainee dental nurses who may have just left school.The NHS General Dental Services are sub-contracted from private practice by local Health Authorities.

There is an exceptionally wide variety of career opportunities that ranges between the responsibilities of owning and running a small high street business (a dental practice) to becoming the Chief Executive of an international dental company with links to the healthcare industry.