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Plaque is a build-up of bacteria in a film on your teeth. If you look in the mirror at your teeth and notice a furry layer that can be scraped off with your fingernails, that’s plaque. Being a film, its soft and is easily removed by toothbrush and floss. A plaque will start forming as soon as after you clean your teeth. It takes 8-12 hours before the film layers build up enough to be noticed. So if you notice a plaque on your teeth, it’s not because you haven’t brushed after your last meal; it’s probably plaque left over from the last time you brushed and indicates the teeth weren’t cleaned thoroughly.

Calculus and tartar are the same things. The two terms are interchangeable. Calculus is the yellow or brown staining you see on your teeth, typically between the bottom front teeth and along the gums. Plaque if left alone and not cleaned off will calcify (harden) in 24-48 hours. The hardened plaque becomes calculus. Think of it as the bacteria on your teeth have now built a house for themselves to live in on your teeth. Once calculus is formed, it’s no longer possible to clean it off by yourself, and you will need to visit your dentist to have them professionally cleaned.

So how bad is it to leave bacteria on your teeth? Yes, the bacteria can cause cavities, but we won’t discuss that in this article. We will focus on how harmful the bacteria in plaque and calculus are to your gums.

Gum disease can be divided into three stages:

The first stage is gum inflammation (also known as gingivitis). This is where your gums will bleed when you brush or floss them. When it gets really bad, your gums can bleed when you eat or even spontaneously! Another symptom of gingivitis is bad breath. The bacteria on your teeth release toxins that will aggravate the gums and produce a smell. Fortunately, gingivitis is reversible. Once the plaque and calculus is removed by yourself or by the dentist, your gums will return to a healthy state.

Unfortunately, the most common mistake people make when they see their gums bleed during brushing and flossing is to avoid brushing their gums and flossing! This means they are avoiding the bacteria around the gums and between their teeth. When your gums bleed, it is actually your body telling you that you need to brush and floss more. If you focus on brushing and flossing for a few days and clean your teeth thoroughly, the bleeding will often stop. However, if the bleeding persists, you likely have calculus formed on your teeth already and you will need to visit the dentist to have them cleaned professionally.

If you ignore getting your teeth cleaned, gum disease will progress to the second stage. The second stage is the gum recession. This is where your gums peel away from your teeth. The gums and supporting bone shrink and expose the roots of your teeth. This is often not noticeable until it has already happened. The main characteristic of gum recession is your teeth will start to become more sensitive.

Unfortunately, by the time you have gum recession, it’s already too late to reverse the effect. Teeth sensitivity can be treated by the dentist. The most important thing is to prevent gum recession from worsening. This is again by thorough cleaning of your teeth with brushing, flossing and visiting your dentist.

The third stage of gum disease is severe periodontitis. Your teeth will start to become loose. If you allow your gums to keep receding, eventually there will be no gums left surrounding your teeth. Your teeth can become so loose that you can no longer chew with them and the only option is to have them extracted. By this stage, the dentist will need to perform deep cleaning or even refer you to a gum specialist for expensive gum surgery should you want to save your loose teeth.

In summary, to prevent gum disease, we need to clean our teeth thoroughly. The toothbrush cannot clean between your teeth. So if you’re not flossing, it’s as if you’re only cleaning half of your teeth. If you can scrape sticky plaque film off your teeth with your fingers, you’re not brushing properly. If the gums persist to bleed when you brush and floss, or you continue to have bad breath, you most likely have calculus on your teeth that requires your dentist to clean off. Very very few people can clean their teeth 100% clean (I’d say 1 in 100). That’s why it’s still important to visit your dentist every six to twelve months for a clean so the dentist can clean the spots where you are missing yourself. Don’t wait for your gums to recede or for them to be painful before you visit your dentist. Prevention is better than treatment!

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Teeth can be yellow, brown or black due to staining on the outer surface of the teeth. The staining can come from tea, coffee, smoking, or any coloured substance. These “external” staining can be removed by professional scale and clean from the dentist.

With age, the stains will slowly penetrate into the microcracks in enamel (the outer layer of teeth) and into the inner dentine layer, making your teeth look more yellow. By doing teeth whitening/bleaching, the process can be reversed and your teeth will appear white again.

How does whitening/bleaching work?

All effective whitening products boil down to active ingredient: hydrogen peroxide. Hydrogen peroxide molecules are able to penetrate into our teeth and breakdown the stains to make teeth whiter again.

Any other product is either not effective or harmful to our teeth. For example, abrasive pastes can remove external staining, but they also strip layers of our teeth away, and acids like lemon can make teeth look whiter but weaken the enamel at the same time.

What’s the difference between all the different whitening products?

As the active ingredient essentially boils down to hydrogen peroxide, the difference is the concentration and the duration of time it is applied to the teeth surface. The higher the concentration and the longer you apply the bleach to your teeth, the whiter they become. When comparing concentrations, the active ingredient is hydrogen peroxide, but commonly, you will see carbamide peroxide, which more stable and breaks down to ⅓ active hydrogen peroxide (e.g. if you see 18% carbamide peroxide, it is equivalent to 6% hydrogen peroxide).

What are the dangers of hydrogen peroxide?

When used correctly, hydrogen peroxide has been shown to safely bleach/whiten teeth. One side effect is that it can cause your teeth to be temporarily sensitive. The sensitivity usually lasts 24-48 hours.

High concentrations of hydrogen peroxide can burn the surrounding gums and soft tissues. High concentrations of hydrogen peroxide applied to teeth for longer than the intended period of time can also damage the nerves inside the teeth, resulting in severe pain.

What types of whitening products are available?

Minimal effect

Toothpastes/mouthwashes – These products typically contain <1% hydrogen peroxide; some may have up to 3%, but how long do you brush your teeth or rinse your mouth for each day? As toothpastes and mouthwashes get everywhere in your mouth, they inherently cannot contain too much hydrogen peroxide.

Some effect

Whitening strips/pens – These typically contain 3-6% hydrogen peroxide. These are effective to some extent, but due to lower concentrations, the whitening effect is limited.

Anything less than 6% hydrogen peroxide can be bought over the counter. Anything above 6% is required by law to be only sold, supplied and used by dental practitioners due to the dangers of bleach mentioned above.

Effective whitening treatment

Take home bleaching kits – With precise custom made bleaching trays, these are designed to apply an even thickness of bleaching gel on the teeth, while minimising any excess from going onto the gums. Bleaching gel concentration is typically around 6-10% hydrogen peroxide, and is applied to the teeth for 30-60mins a day for 1-2 weeks. Treatment ends when you find your teeth are already as white as they can get, or the sensitivity becomes too painful to continue use.

In-office bleaching – Dentists use 30-35% hydrogen peroxide gel and light/heat activation to accelerate the bleaching process. Treatment time is usually 45 – 60mins. Great care is needed to protect the gums and soft tissue from coming in contact with the bleaching gel.

Is whitening/bleaching effective for everyone?

Although hydrogen peroxide will work on most people’s teeth, it will not work on the following:

• Any type of fillings, veneers, or crowns
• Discoloured teeth from root canal treatment (these need bleach placed inside the teeth, called “internal bleaching”)
• Antibiotic stained teeth
• Discoloured teeth from birth

Conclusion
There is no magic to whitening teeth. You need a high enough concentration and a long enough duration for hydrogen peroxide to be effective. At the same time, hydrogen peroxide is a potent chemical that can be dangerous, so it is very important to adhere strictly to the instructions given.

There will always be sensitivity accompanying an effective bleaching process. The amount of sensitivity will vary between individuals and concentrations of hydrogen peroxide used. If you already have sensitive teeth, then in-office bleaching may not be for you. It is probably better to use a lower concentration take-home bleaching kit. It will take longer to achieve the desired result but with less sensitivity.

At Pinewood Dental Group we provide take home bleaching kits with different concentrations to cater for people with different levels of teeth sensitivity. We have avoided in-office bleaching altogether because we have found the risk of severe sensitivity/pain from in-office bleaching, with no better results than take-home bleaching, outweighs the convenience of in-office bleaching. The cost of in-office bleaching can also be twice as much as take-home bleaching kits.

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Many people would think or be told that their wisdom teeth needs to be pulled out, but is that the case for everyone?

If your wisdom teeth is not causing any pain or problems, and is unlikely to cause pain or problems in the future, there is actually no reason to have them pulled out.

Why do wisdom teeth hurt or cause problems?

It all comes down to whether you can clean them properly or not. Like any of your other teeth, if you don’t keep your teeth clean, chances are you will get a cavity in your tooth, which eventually leads to its nerve dying and becoming infected, or your gums around the tooth will become infected.

Wisdom teeth are very far back in the mouth making brushing and flossing them a challenge. Often there is not enough room for the wisdom tooth to grow out fully, or the wisdom tooth may be growing at an angle, preventing it from growing out fully. Under these circumstances, it is impossible to keep them clean and it is only a matter of time before they will cause problems.

When should I leave my wisdom teeth alone?

If your wisdom teeth are fully buried under the gums, then it is very rare for them to cause problems as bacteria would not be able to get to them.

If your wisdom tooth is erupted and fulfil the following criteria, then you can also leave them alone:

• Your wisdom tooth is fully erupted or erupted enough to keep them well cleaned
• The wisdom tooth is in ‘function’ i.e. it has an opposing tooth so that when you chew, your wisdom teeth is in use

When is the best time to remove my wisdom teeth?

The best time to remove wisdom teeth is between the ages of 20 and 30. The older you get, the less flexible your bone becomes, and the harder it is to remove wisdom teeth (and any other teeth in general). There are higher chances of complications such as the roots breaking or nerve damage, etc.

Our jaw usually would be fully grown by the age of twenty. Before the age of twenty, unless the wisdom teeth are already causing pain, the dentist can usually watch and monitor our wisdom teeth. If the wisdom tooth is upright, and our jaw is still growing, there may be a chance for there to be enough room still. If the wisdom tooth is growing at an angle, then we allow it to grow out more making it easier to remove once it is closer to the surface.

Other reasons to remove wisdom teeth

• If you are having orthodontic treatment to straighten your teeth, the treating doctor might want your wisdom teeth removed to allow more room for your teeth to be straightened (usually applies to adults).
• After orthodontic treatment, the treating doctor might advise to remove wisdom teeth to reduce chances of relapse (teeth becoming crooked again) (usually applies to teenagers).
• Any sign of your wisdom tooth damaging the tooth in front. This is usually picked up and monitored by routine OPG x-ray.

If you would like to discuss your wisdom teeth with a dentist, please make an appointment with us on 9802 6645.

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