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Tooth polishing and Fluoride

Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time, like limescale in a pipe or kettle. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.

If the scale, or calculus (tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the cleaning and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care.

The professional cleaning of teeth is sometimes referred to as prophylaxis (or prophy for short). It's a Greek word which means "to prevent beforehand" - in this case, it helps prevent gum disease.

Q. How are dental cleanings done ?

The dental hygienist or dentist uses specialized instruments to gently remove these deposits without harming the teeth. The instruments which may be used during your cleaning, and what they feel like, are described below.

Ultrasonic instrument : - Commonly used first is an ultrasonic instrument which uses tickling vibrations to knock larger pieces of tartar loose. It also sprays a cooling mist of water while it works to wash away debris and keep the area at a proper temperature. The device typically emits a humming or high pitched whistling sound. This may seem louder than it actually is because the sound may get amplified inside your head, just like when you put an electric toothbrush into your mouth.

The ultrasonic instrument tips are curved and rounded and are always kept in motion around the teeth. They are by no means sharp since their purpose is to knock tartar loose and not to cut into the teeth. It is best to inform the operator if the sensations are too strong or ticklish so that they can adjust the setting appropriately on the device or modify the pressure applied.

Fine hand tools : - Once the larger pieces of tartar are gone, the dental worker will switch to finer hand tools (called scalers and curettes in dental-speak) to remove smaller deposits and smoothen the tooth surfaces. These tools are curved and shaped to match the curves of the teeth. They allow smaller tartar deposits to be removed by carefully scraping them off with a gentle to moderate amount of pressure. Just like taking a scrubbing brush to a soiled pot, the dental worker has to get the areas clean and smooth.

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Polishing : - Once all the surfaces are smooth, the dental worker may polish your teeth. Polishing is done using a slow speed handpiece with a soft rubber cup that spins on the end. Prophylaxis (short for prophy) paste - a special gritty toothpaste-like material - is scooped up like ice cream into the cup and spun around on the teeth to make them shiny smooth.

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Mild fluorosis in a young teenager Severe fluorosis in an adult

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Your dentist may also apply fluoride. Fluoride foam or gel is then placed into small, flexible foam trays and placed over the teeth for 30 seconds. Afterwards the patient is directed to spit as much out as possible into a saliva ejector. The fluoride helps to strengthen the teeth since the acids from bacteria in dental tartar and plaque will have weakened the surfaces.

It is best not to eat, drink or rinse for 30 minutes after the fluoride has been applied Fluoride is known to strengthen teeth and is an element that occurs in nature. By strengthening the teeth, fluoride is effective in lowering the incidence of decay in teeth. Several sources of fluoride are available to the public, and experts recommend using a variety of sources. Water naturally contains fluoride in very small quantities.

Several foods and beverages naturally contain fluoride, for example eggs, fish, meat, and tea. Many communities have added fluoride to their drinking water, and the majority of toothpastes, mouth rinses, and treatments in the dental office contain fluoride. Fluoride tablets are available with a prescription for children who do not live in areas where fluoridated drinking water is available.

Uses of Fluoride

The outer visible layer of the tooth's crown is made out of hydroxyapatite crystals packed very closely together. On a daily basis, these minerals are lost (also known as demineralisation) and gained (also known as remineralisation) by the teeth. When these processes are balanced, the tooth remains healthy.

Demineralisation is caused when bacteria builds up on your teeth and forms dental plaque. Dietary sugar supplies the energy source for these bacteria, and the end-product of the bacterial metabolism is acids. The tooth enamel crystals are dissolved by these acids. Remineralisation is the process of the enamel being built up again. During remineralisation, several minerals which include phosphate, calcium and fluoride are incorporated into the enamel. When an unbalance occurs and demineralisation dramatically outweighs the remineralisation process, enamel is lost and the decay process begins.

Fluoride replaces the hydroxyl groups in the hydroxyapatite crystals strengthening the teeth by making the crystals less dissolvable and speeding up the remineralisation process. Fluoride also plays a role in inhibiting the bacteria's ability to make acids. Fluoride is absorbed by the teeth by two means. One of these is through children consuming fluoridated foods and beverages and/or supplements. This way, fluoride is absorbed and enters the circulation to become incorporated into the teeth during their development. As a result, the teeth are strengthened, making it more difficult to dissolve the enamel by bacterial acids.

Fluoride enters the mouth and directly enters tooth enamel. This occurs in several ways : -
In-office fluoride treatments are regularly used during a child's regular check-up, every six months. However, if children are at higher risk of dental decay, they will require extra fluoride. These fluoride treatments help to support tooth remineralisation. The in-office and/or supplemental fluoride serve as additional defence against dental decay, even with the consumption of water that is fluoridated.

In children over 6 years old, who have a history of cavities, mouth rinses containing fluoride can help. They are available over-the-counter. The dentist may also prescribe fluoride gels and rinses that contain increased levels of fluoride in certain cases.

Fluoride supplements are generally prescribed by a dentist or a paediatrician to the 6-16 year old category of patients who have no access to fluoridated drinking water. Either tablets or liquids are available, depending on the age of the patient.

Both primary and adult teeth can be helped with fluoride. Basically, anybody at risk for developing tooth decay should receive fluoride treatments.

The following reasons should be considered when evaluating whether additional fluoride should be used with a patient : -

Several medications can cause dry mouth (i.e., xerostomia), including medications used of hypertension, allergies, depression and anxiety. Xerostomia worsens the decay process.

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Fluoride Treatment Preparation

Clean your teeth thoroughly before visiting your dentist for fluoride treatment in the office. Stains on your teeth will be polished away by the dentist or dental hygienist. For home fluoride treatments using gels and/or rinses, and brush and floss your teeth thoroughly prior to using the fluoride-containing product. The best time to use these products are right before bedtime, so that they will stay in the mouth longer, and are less likely to be washed away by foods and beverages.

The Procedure

In-office fluoride treatments contain a higher concentration of fluoride than fluoride-containing products found in stores, and are chemically different; thus allowing the fluoride to stay on the teeth longer. Both children and adults can receive in-office fluoride treatments.

The different types of topically applied fluoride are, acidulated phosphate fluoride (APF) which is acidic as the name implies, and neutral sodium fluoride. People with xerostomia or have white tooth coloured fillings, bonding, veneers, or crowns and bridges, receive neutral sodium fluoride. Fluoride that is acidic can cause mouth irritation when there is mouth dryness, and cause small irregularities in the tooth coloured fillings.

In the dental office, fluoride that is used is either in the form of a varnish, foam, or gel. Prior to the application of the fluoride, the teeth are dried so as not to dilute the fluoride. Trays that resemble mouth guards are used for between 1-4 minutes, to apply the fluoride; or, the dentist can paint the fluoride right onto the teeth surfaces. Fluoride comes in several flavours and should be spit out after application and not swallowed.

Children usually take fluoride supplements in small quantities, from between 0.25-1 mg daily. The strength is dependent on the child's age and level of fluoride in the drinking water. The dentist will not prescribe over 264 mg of fluoride tablets at one time, due to the possibility of overdose. Children that are 2 years old and weigh 22 pounds develop fluoride toxicity at a 320 mg dose. Therefore, do not stock up on fluoride tablets, and call your dentist or paediatrician if you should have any concerns or questions.

When brushing, use toothpaste that contains fluoride, but watch your young children to make sure that they do not swallow the toothpaste. Only place an amount the size of a pea on your child's toothbrush, and make sure that they spit out after they brush. By avoiding flavoured toothpaste, your child will be less likely to swallow it. But, still keep an eye on them. Post Fluoride Treatment.

No eating, smoking, or drinking after yours or your child's fluoride treatment for 30 minutes, as this helps the fluoride to stay on the teeth.

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Warning for Children using Fluoride toothpaste : - Children can swallow some of the toothpaste when brushing. If too much fluoride is ingested during the development of the adult teeth, then the enamel may be discolored. Fluorosis usually happens during a child’s first few years when the teeth are forming. Ingestion of excess fluoride during the first seven years of the child can permanently disco lour the incisor teeth. Most cases ar, however, mild. You should teach your child to avoid swallowing toothpaste and spit out it.

The hazards of Fluoride

There is no doubt that the use of fluoride decreases dental caries. But it is also a fact that the ingestion of too much fluoride can result in fluorosis. You should know the associated hazards of fluoride. Fluoride is an acute toxin. You should monitor your child if he is using a fluoride toothpaste, because, you do not know how much of the toothpaste your child is swallowing. Half a tube of fluoride toothpaste can kill a child.

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