Dental Hygiene

What is a Dental Hygienist?

Dental hygienists are an important part of the dental team that work to prevent both dental decay and gum disease, as well as treat gum disease.

What can I expect at my Dental Hygienist appointment?

To maintain a fabulous smile, keeping regular dental hygiene appointments is a must! Here are some answers to common questions that you might find useful.

How long does it take?
We usually schedule 30 minutes for a dental hygiene appointment however, each appointment will vary in length depending on the complexity and extent of treatment required. Some patients may require 1 hour appointments. This will be discussed with you, if you require more time.

How often should I see a dental hygienist?
This depends on factors such as the current and previous health of your teeth and gums, how long it has been since your last hygienist visit and personal preference – some people prefer more regular appointments due to a build up of staining. The most common recall periods are 3, 6 and 12 months.

What is the price?
If you are covered by Denplan, you will be entitled to between 1-4 appointments a year, depending on which grade you are on. If you pay privately, the cost of an appointment is £84 (£168 if you require a longer appointment).

What happens during a dental hygiene appointment?
Every dental appointment starts with an oral cancer screening. We check all your soft tissues inside your mouth for any changes. Your hygienist will start by taking some measurements around your gums to determine whether there is any gum disease present and to allow them to tailor your hygiene appointment to your needs. Some of the treatment you may experience includes:

• Scaling to remove any plaque and tartar that have built up on the teeth
• Polishing to remove any staining on the teeth
• Oral hygiene advice to allow you to care for your teeth at home
• Oral cancer screening of soft tissues
• Application of fluoride varnish to help prevent sensitivity and decay
• Deeper scaling under local anesthetic to help treat more advanced gum disease

What is gum disease?

Broadly speaking, gum disease is inflammation of the gums and supporting structures around a tooth. This is usually caused by plaque that remains on the gum around the tooth, although other factors can exacerbate it.

Gingivitis:  this is an early stage of gum disease.  Due to insufficient plaque removal around the gums, they become inflamed.  This can present as red, sore gums that bleed when you brush, or may not be visible to you and only picked up when we do your screening.  Studies suggest that some level of inflammation affects up to 90% of the population in at least one location in their mouth.  It can be very easily reversed and treatment is two fold:

1. Hygienist appointment to remove plaque and any factors that cause plaque to be retained more easily on teeth such as tartar or staining.
2. Improvement in oral hygiene at home. This includes both twice daily brushing and cleaning between the teeth at least once a day.

Healthy gums should appear to be a pink colour and not bleed when touched.  If you experience any bleeding at home, please mention it to your hygienist or dentist when you see them.

Periodontitis: this is a more advanced form of gum disease.  If gingivitis (see above) is left untreated, then the jaw bone supporting the teeth can start to become damaged.  Over time, this can lead to mobility in the tooth and eventually, left untreated, tooth loss.  Periodontitis can present as red, swollen, bleeding inflamed gums with or without tooth mobility (you may also experience no symptoms).  There is also bone loss present which can be detected by your dentist or hygienist through taking xrays and taking detailed measurements around each tooth.  This often leads to a ‘pocket’ between the gum and the tooth which can trap plaque which can cause the disease to progress.  Bone loss is irreversible, but can be stabilized so with treatment, we are aiming to halt the progression of bone loss, and reverse the inflammation present in the gums.  Once you are diagnosed with periodontitis, you will always have the condition, however with regular at-home and hygienist maintenance, it can stay in remission.

Treatment is usually as follows;

1. Detailed mapping of the bone levels around each tooth. This is done via detailed measurements around each tooth called a six-point-pocket chart.  This is usually repeated at yearly intervals to monitor the progression of your periodontitis.
2. Deep scaling which can be done with or without local anaesthetic, concentrating on pockets picked up by the six-point-pocket chart.
3. Improvement in oral hygiene at home. This includes both twice daily brushing and cleaning between the teeth at least once a day.
4. Regular maintenance appointments with the hygienist, usually starting at three monthly intervals.

As gum health improves, any swelling may reduce to match the levels of the bone, which sometimes leads to recession of the gums.  In some cases this can cause sensitivity which can be treated by brushing with a sensitive toothpaste.  It does however, make it easier to clean due to the smaller pocket between the gum and the tooth.

Periodontitis, although primarily caused by plaque bacteria, can be exacerbated by other factors including:

• Genetics – especially if a first degree relative also suffers from periodontitis
• Stress
• Hormones
• Diabetes
• Smoking
• Bite

What about mouthwash?
Mouthwash, although harmless (if alcohol free), does not contribute to your oral health. It is not powerful enough to remove plaque so it is best avoided, sticking to plaque removal by brushing and flossing. There are of course exceptions which your dental hygienist will discuss with you at your appointment if required.

Links between oral hygiene and other health conditions

The presence of inflammation and bacteria (plaque) in the mouth due to poor oral hygiene has been linked to several health conditions.  These include:

• Cardiovascular disease including heart attacks and infective endocarditis
• Strokes
• Diabetes
• Alzheimer’s Disease
• Pregnancy
• Respiratory conditions such as COPD, bronchitis and pneumonia
• Inflammatory conditions such as ulcerative colitis and rheumatoid arthritis

You may be advised to delay any dental treatment until 3-6 months after the following:

• Joint replacement
• Heart attack/cardiac arrest
• Valve repair/replacement (may also require prophylactic antibiotic cover – speak to your cardiologist)

Other tips from your Dental Hygienist

1. Brush before breakfast (or 1 hr after). When you eat food containing sugars, the mouth enters an acidic state which will naturally neuralise after 1 hour.  It is sensible to not brush for this hour to prevent unnecessary abrasion to the teeth.  This is heightened if you have eaten or drank acidic foods and drinks such as fruit juices and citrus fruits.
2. Keep sugars to meal times. As above, after eating sugars the mouth enters an acidic state which is naturally neutralized by your saliva within an hour.  The teeth can naturally cope with 4-5 of these periods a day.  Any more than that, then decay starts to occur.  Therefore, any snacks or drinks between meals, keep sugar free such as:
   • Sugar free tea and coffee
   • Sugar free drinks
   • Toast/bread with cheese, houmous, butter, tuna
   • Fruit (whole fruit only – processed fruit is sugary)

3. Keep acidic drinks to a minimum. Acid in drinks such as fizzy drinks, wine, beer and concentrated fruit juices (including lemon water) can cause erosion to the teeth over long periods of time.  These are best kept to a minimum (or drank through a straw to minimise damage as much as possible).
4. Avoiding staining food and drink. Unfortunately some foods and drinks are likely to cause staining.  Your dental hygienist can remove this at your hygienist appointment.  Things that cause staining include:
   • Tea, including green tea
   • Coffee
   • Red wine
   • Soy sauce
   • Balsamic vinegar
   • Curries
   • Tomato based sauces
   • Other sources include liquid iron supplements and some mouthwashes
5. Stop smoking and vaping. Smoking has been proven to be a leading cause of advanced gum disease.  Alongside being a cause, it can mask symptoms such as bleeding so that it goes undetected potentially causing the disease to get worse between it is treated.  It can also cause bad breath and staining on the tongue and teeth.
6. Chewing gum.  Sugar free chewing gum is often chewed to freshen your breath however, it stimulates the flow of saliva which neutralises acids from eating sugars and can help relieve a dry mouth.  Often, the sweetner Xylitol is used in chewing gums which has protective factors against decay.

Which toothpaste should I be using?
It doesn’t matter! As long as it contains the recommended amount of fluoride (1450ppm) then choose one that you like. Two exceptions are sensitive and whitening toothpaste. The active ingredients in sensitive toothpaste work to block any sensitive areas. Whitening toothpastes are unlikely to whiten your teeth however, they can help to remove some external stain. They can sometimes be abrasive to the teeth so it is sensible to keep use of these to a couple of times per week. The key with any toothpaste is so spit out the excess and leave the residue in your mouth so that the fluoride can sit on the teeth for as long as possible.