In the past, it seemed like only adolescents and teenagers wore orthodontic braces. However, more recently braces are also being worn by adults. Approximately 30% of orthodontic patients in the U.S. are adults, and others countries are catching up to this percentage. Even though this trend is here in London, it is still a good idea to start orthodontic treatment at an early age for the best results. Your London dentist recommends that children have an orthodontic evaluation at 7 years old. Malocclusion and crooked teeth are both a restorative and cosmetic issue. Independent of your age, orthodontic treatment can help to protect your bite, increase your teeth’s ability to perform their functions, and align your teeth, allowing for a more aesthetic appearance. Additionally, straighter teeth can make good oral hygiene easier to perform and maintain.
If your dentist feels that you are a candidate for orthodontics, they will most likely refer you to an orthodontist (i.e., a specialist in the field). Initially, the orthodontist will use various methods to develop your treatment plan. These methods include: facial and intraoral photographs; a facial, oral and functional exam; panoramic and cephalometric radiographs; and alginate impressions for your plaster dental models to analyse your teeth and bite. Then the orthodontist comes up with a specific treatment plan for just you, and presents this to you during the second visit. The orthodontist will also tell you how long the whole process will take. This is usually dependent upon the complexity of the situation, how well the treatment plan is followed, and the age of the patient. Younger patients usually have shorter treatments than adults, due to the supporting bone structure around the teeth. But, this again is dependent upon a number of other factors.

Teeth are essentially indestructible under the correct conditions. However, in the living person, teeth are continuously being assaulted by microbial challenges. Dental caries ranks as one of the most universal burdens of man, but are not life- threatening. Dental caries is widespread in London. Advances in preventive procedures to deal with this disease have significantly reduced the overall caries rate. In London, being poor is a risk factor for increased tooth decay. More than one-third of poor 2 – 9 year old children have untreated decayed primary teeth, and this number varies with age and race/ethnicity.

Dental caries is a multi-factorial disease requiring a susceptible host (a tooth), cariogenic microorganisms, and a suitable substrate (e.g., sugar) interacting for a sufficient length of time. Streptococcus mutans (Sm) is the primary etiologic agent of this disease. Sm is transmissible, and a positive relationship exists between the number of Sm and dental caries. Dental decay did not become an important health problem until sucrose (sugar) became a major component of the human diet. However, good oral hygiene can reduce the chance of caries by reducing the number of cariogenic bacteria and removing the substrate, sugar. Sm is the primary etiological agent of dental caries in man and other animals. Under normal circumstances of health, Sm procduces bacterial acids that cause a continuous minute demineralization of the hard tooth surfaces. In addition, the consumption of acidic foods and drinks, and even toothbrush abrasion can cause enamel demineralization53, 54. If this demineralization is limited, the body’s own remineralization capability is able to restore the tooth’s lost minerals by using minerals available in saliva12.
Dental decay (caries) is the result of irreversible solubilization (demineralization) of tooth mineral by acid, predominantly lactic acid, formed by plaque bacteria that adhere to teeth surfaces, after the consumption of foods that contain fermentable carbohydrates (sugar). Frequent sucrose ingestion increases the lengths of time that sucrose is available for fermentation and acid formation by plaque. Thus, eating frequency, the amount of sugar retained in the mouth (particularly on tooth surfaces), and the length of time that sugar is retained in critical areas, are more important than the total amount of sugars consumed12.
The chemical conversion of sugar into simpler substances causes a quick decrease in pH (5.0 or <) at the plaque-enamel junction. Frequently consuming sugar or sugar-based foods causes Sm to flourish and become the principal bacterial organism in plaque. A drop of pH to this level puts undue pressure on the buffers in the saliva and lactic acid (the end-product of Sm metabolism) spreads into the outer layer of the tooth (i.e., enamel) causing it to begin breaking down, and to discharge calcium and phosphate ions at areas below the top surface enamel. This low (acid) pH is derived from acid-producing bacterial organisms, and favors demineralization over a period of time, resulting in a cavity. The tooth enamel (which is made up predominantly of hydroxyapatite) is permanently dissolved from these acids, particularly lactic acid. These bacteria begin to adhere more strongly to the tooth surface and form bacterial colonies or communities called “plaque”. Sm and other bacteria, such as lactobacilli, store sugars and continue to secrete acid long after the food has been swallowed. Dental plaque will continue to build up on the tooth surface, unless it is adequately removed. These processes result in dental decay.

In London, your dentist will properly care for your dental needs to prevent calculus from forming on your teeth. Some dental plaques mature into dental calculus. Some people do not form calculus, others form only moderate amounts, and still others form heavy amounts. Before supragingival plaque (above the gums) mineralizes to form dental calculus, you can remove it with proper oral hygiene. As the plaque matures, it becomes more resistant to removal with a toothbrush, and significantly more pressure is required for its removal. Once dental calculus is formed, your London dentist, using professional instrumentation needs to remove it; you can no longer remove it.Calculus itself is not harmful; however calculus needs to be removed because its presence makes routine oral hygiene more difficult or even impossible and it may contribute to greater plaque accumulation and stagnation. Calculus formation is related to the fact that saliva is saturated with calcium and phosphate ions as well as other ions, such as magnesium, zinc, fluoride, and carbonate. Supragingival calculus that forms on the tooth crown frequently developing opposite the duct orifices (openings) of the major salivary glands and is often found where saliva pools on the lingual surfaces of the mandibular incisors. It can also form in the grooves of the tooth (called fissures). Subgingival calculus forms from calcium phosphate and organic materials derived from blood serum which contributes to its mineralization, and may be darker in appearance.

Local factors, behavioral and systemic conditions affect calculus formation. Conversely, medications such as beta-blockers, diuretics, and anticholinergics can result in significant reduced levels of calculus. The medications are either excreted directly into the saliva affecting the rate of crystallization, or they alter the composition of the saliva, and as a result indirectly affected calculus formation.

Teeth problems have been associated with TMJ dysfunction. These problems can be treated in the London Dental Clinic. Loose and mobile teeth are usually due to resorption or damage of the surrounding oral bone by excessive lateral influences on the teeth. Tooth movement may cause the jaw to close down or bite in a misaligned position, thus changing the configuration of the mouth, teeth, temporomandibular joints, and jaw and facial muscles. Dental pulp inflammation can also occur if the forces are too great.
Outside causes put excessive stress on the TMJ. Some of the causes are: (1) Opening the mouth and jaw further than it normally should open, and habitual and recurring lateral and forward movements of the lower jaw; (2) alteration of the biting surfaces of the teeth due to excessive wear, neglecting oral hygiene (i.e., dental cavity formation), or tooth damage; (3) inadvertent speaking patterns; (4) too much gum chewing or chewing of finger nails; (5) too much lower jaw activities when exercising and/or teeth grinding; and (6) over-stretching of the mouth when eating. Also, several investigations have shown an association between TMJ disorder and people with a diagnosis of bipolar disorder.
Proper occlusion must be restored if the teeth are decayed or damaged. Some medications may relieve the primary pain; however these medications may not work in all cases. Several tricyclic antidepressants have been shown to work better than pain medication in some cases. Prior to using drugs or surgery to help alleviate the pain associated with TMJ dysfunction and correct the problem, you and your London dentist should try every other conservative approach to resolve the problem.

London dentists say that “dental caries can be prevented by good oral hygiene and regular professional care, and can be effectively treated by adequate brushing and flossing of the teeth and by the use of fluoride based oral care products.” Mouth rinses, gels, and toothpastes, when used in conjunction with toothbrushing and flossing, are probably adequate to deliver the needed preventive measures. If the carious lesion reaches the underlying dentin layer of the tooth the dentist in London will treat it. The dentist will place a filling (amalgam or composite) to restore proper functioning of the tooth.
The role of fluoride in caries prevention has been extensively documented. The decrease in dental caries that occurs after adding fluoride to the water supply is by and large accredited to the fluoride molecule being substituted for hydroxyl molecules in the tooth enamel, forming fluorapatite in the place of hydroxyapatite. Fluorapatite is less acid soluble than hydroxyapatite, causing enamel to demineralise more slowly when under attack by plaque. Fluoride containing enamel also remineralises more quickly between the times it is being bombarded with sugar. This does not explain all of the mechanisms of action of fluoride.
More recently the spotlight has shifted to deleterious effect on fluoride on tooth development. The prevalence of fluorosis in infants and young children is increasing. The increase in fluorosis among infants and children in both fluoridated and non-fluoridate communities has led to the following recommendations: 1) the use of low-fluoride water in infant formulas; 2) adult supervision of children during brushing; and 3) rigid fluoride application standards when administering fluoride supplements to children. Nonetheless, community water supply fluoridation is the most effective way to prevent dental caries.
When neutral 1.0% sodium fluoride was used on a daily basis by high risk adults (i.e., those with mouth dryness after jaw carcinoma radiation), the finding was minimal to zero dental caries. Children, aged five to six years were treated with 1.2% F- fluoride gel versus a placebo gel twice daily, and the children receiving fluoride showed approximately 40% caries reduction when compared to the placebo group after a 2 year period; S mutans (the bacteria that causes decay) were also lower. Thorough cleaning with the fluoride paste significantly reduced the streptococci (sanguis, mitis, and mutans), preventing colonization of these bacteria. Higher fluoride paste doses (i.e., 5%) instantly stop these bacteria. Also interesting, is that fluoride levels of 1-5 ppm stopped oral streptococci at low pH levels. These doses are commonly found in people using fluoridated oral care products and/or fluoridated water. For more in depth prevention measures, visit your London dentist!

Many dental care products available in London contain various nutritional supplements; coenzyme Q 10 is one of these supplements. Historically, the benefits of coenzyme Q 10 (CoQ10) in oral health have been known for decades. Oxidative damage occurs in periodontal disease, and research has demonstrated possible therapeutic effects of anti-oxidants in treating and/or preventing periodontal disease are useful, with special attention on CoQ10. Clinically, topical application of CoQ10 to periodontal pockets was evaluated with and without professional cleaning below the gum tissue, and significant improvements were seen that included the reduction of gingivitis, bleeding on periodontal probing and gingival enzyme activity, only at the CoQ10 treated sites. Another clinical study demonstrated that topical application of CoQ10 was extraordinarily effective in reducing periodontal pocket depth, and that healing was so excellent after 5-7 days of treatment that diseased gingival sites were difficult to locate.
Additionally, a clinical study demonstrated that patients with periodontitis frequently have significant gingival and white blood cell CoQ10 deficiencies. This white blood cell CoQ10 deficiency indicated a systemic nutritional imbalance, and was not likely caused by neglected oral hygiene. A gingival deficiency of CoQ10 could predispose individuals to gingivitis and periodontitis, and periodontitis could even augment CoQ10 deficiency. Also, the beneficial effect of CoQ10 has also been reported in an individual case study, where three dentists separately and independently scored clinical improvements of five symptoms of gingivitis and periodontitis, with the initial benefits being observed only three weeks after the beginning CoQ10 treatment.
Although, significant clinical reports demonstrated beneficial effects with CoQ10 on periodontal disease, the mechanism of the role of CoQ10 in periodontal disease was not known until, from 1971 to 1974, when CoQ10 gum tissue deficiencies were observed in patients with periodontal disease when compared to patients without periodontal disease. Clinical results suggested that topical application of CoQ10 improves adult periodontitis not only as a sole treatment, but also in combination with traditional non-surgical periodontal therapy.