Your guide to perfect teeth

When it comes to healthy, attractive teeth and gums, ‘it all really comes down to three key elements,’ says Dr Nigel Carter, Chief Executive of the Oral Health Foundation. ‘Brush your teeth for two minutes twice a day with a fluoride toothpaste; cut down on the amount of sugary foods and drinks you have and how often you have them; and visit your dentist regularly, as often as they recommend.’

However, dentists and other experts in the field of dentistry can also let you in on a few other little secrets for great teeth and a fabulous smile.

1. Examine your brushing technique

As Dr Carter emphasises, there’s really no substitute for brushing your teeth twice a day if you want good oral health and beautiful pearly whites. But are you doing it the right way? A joint US and Indian study suggests that using your smartphone to video your brushing technique and then showing that to your dentist could help you brush more effectively, keeping cavities at bay and improving the look of your teeth. Research participants brushed for the same length of time as usual but their brush strokes increased and were more accurate after their dentist made suggestions based on their selfies.

2. Eat crunchy food

Eat foods that keep your teeth healthy. Dr Carter recommends cheese or yoghurt. ‘They help to neutralise any plaque acid and can help to prevent tooth decay,’ he says. ‘A top tip would be to eat a cube of cheese at the end of your meal to help protect your teeth.’

Firm, crisp foods can also help to clean your teeth as you munch on them. Apples, raw carrots, celery and unsweetened popcorn are all good detergent foods – once again, eat them at the end of your meal.

3. Stress relief

Stress can make you grind your teeth at night, which can wear them down and even, in extreme cases, expose the nerve. You might then need root canal treatment. Stress can also cause or exacerbate bleeding gums and abscesses.

Hypnotherapy is one option for dealing with stress. Clinical hypnotherapist Ursula James, who is a patron of Anxiety UK, says, ‘It offers physical relaxation to deal with stress, mental processing (similar to that which should take place during sleep), retraining of the muscles, improved sleep patterns and also helping people generally to manage situations better on a day-to-day basis.’

While one-to-one sessions are usually more effective, videos and MP3 downloads can also help. For MP3s that deal specifically with teeth grinding and with stress generally, go to ursulajames.com.

4. Go on a white teeth diet

Dark coloured food and drink can stain your teeth. Dr Richard Marques of Wimpole Street Dental in London (wimpolestreetdental.com) champions chicken, rice and fish for white teeth. ‘Beware naturally pigmented foods such as beetroots and blueberries, which can transfer colour to the teeth,’ he warns, ‘and be sure to brush thoroughly after consuming.’

Beware balsamic vinegar too. ‘It is deeply pigmented and full of acid, so will stain the teeth and cause erosion,’ says Dr Marques. He advises drinking a glass of water after eating anything containing vinegar.

Curry can also discolour your teeth, points out Nigel Carter, as can some of our favourite tipples: red wine, cola, tea and black coffee. And smoking is a no-no if you want a Hollywood smile.

5. Chew gum

Chomping on gum might look unattractive, but the sugar-free variety can help undo the damage caused by sugar and acid in our diet.

‘It helps to maintain a healthy mouth by stimulating saliva flow,’ explains Nigel Carter.

‘Saliva is the mouth’s natural defence against acid and with increased production it helps speed up the process of getting the mouth back to a natural pH level after eating or drinking, and helps softened enamel to remineralise.’

As well as protecting against cavities and gum disease, chewing gum freshens your breath. It’s an instant teeth-cleaner when you’re out and about, but don’t think gum can replace twice-daily brushing with a fluoride toothpaste. And make sure the gum is always sugar-free.

6. Keep brushing when your gums bleed

You might be tempted to stop, thinking that you’ll only make the bleeding worse if you carry on. Far from it, says Richard Marques. Gums bleed because they are inflamed as a result of plaque and bacteria, so continuing to brush will remove the cause of the inflammation.

‘They will eventually heal and change from being inflamed and bleeding to being healthy and pink,’ he explains.

Choose an electric toothbrush over a manual one, as research shows that they are more effective at reducing plaque and gingivitis (swollen and bleeding gums). Meanwhile, for sore gums, he recommends rinsing with a teaspoon of salt in a cup of warm water.

‘This will increase the pH balance of your mouth, making it difficult for bacteria to spread,’ he says.

7. Avoid sugary drinks - or use a straw

Sugary and fizzy drinks can cause tooth erosion and decay. ‘Some of the worst offenders include fruit juices and smoothies,’ says Nigel Carter. ‘Aside from high levels of sugar, these drinks are often very acidic. Smoothies completely coat the teeth, meaning the effect of the acid is long-lasting and very damaging. Sports drinks are also a big offender.’

Dr Marques issues a warning about the ‘Prosecco smile’. It’s the beginning of tooth decay brought on by our penchant for Italian fizzy wine. A white line just below the gum is a tell-tale sign. ‘Bubbles are well known for eroding tooth enamel due to their high concentration of phosphoric, malic, citric and tartaric acids that literally “melt” the enamel,’ he explains.

But if avoiding sugary and fizzy drinks is just too miserable for words, slurp them through a straw. ‘It allows the liquid to bypass the teeth completely, meaning that acids will not dissolve the enamel or stain the teeth,’ Dr Marques says.

8. Use a tooth repairing toothpaste

You think toothpaste is just that. But some have properties that repair vulnerable areas where teeth are sensitive and protect them. Dental researchers from Queen Mary College at the University of London have developed a toothpaste that provides what they call an ‘armour’ for the teeth. It hardens them, treats the sensitivity that occurs when the dentine becomes exposed as you get older and prevents tooth decay while you sleep.

‘BioMin F contains a bioactive glass similar to that in Sensodyne Repair and Protect,’ explains Professor Robert Hill, who led the research team. ‘However, it contains more phosphate and the fluoride comes from the glass. The glass particles stick to the teeth and dissolve over 10 to 12 hours, releasing calcium phosphate and fluoride ions.’

BioMin F is available at amazon.co.uk.

9. Massage your teeth and gums

Researchers from the University of Gothenburg in Sweden found that rubbing a high-fluoride toothpaste on teeth and gums resulted in a big increase in protection against decay. In their study, they found that normal brushing twice a day supplemented by massaging the front of your teeth with fluoride toothpaste actually quadrupled fluoride protection. While a mouth massage with toothpaste wouldn’t replace regular brushing, it could be a useful extra after lunch, for example.

Anna Nordström, dentist and researcher from the University of Gothenburg, recommends brushing twice a day – after breakfast and before bed – and then either brushing a third time or rubbing on some toothpaste instead. But don’t rinse afterwards, as this lessens the effects of the fluoride. If you get lots of cavities, use a toothpaste that has a higher-than-average fluoride content.

10. Drink tea

Although ordinary tea can stain our teeth it does contain flavonoids and other properties that may prevent harmful bacteria from latching onto your teeth. It also seems to block the production of a sugar that can lead to the formation of cavities. ‘Plus simple black tea has relatively high levels of fluoride, which help protect your teeth from decay,’ says Nigel Carter.

But experts get even more excited about green tea. ‘There is a lot of talk of how green tea can be good for our oral health and it is indeed true,’ says Dr Carter. ‘A cup of green tea a day has been shown to decrease the chances of gum disease. It is thought that the antioxidants in green tea are the key to this improvement.’ As noted, tea can stain teeth, so clean your teeth after your cuppa or drink a glass of water.

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What to do about wonky teeth

Braces (orthodontic treatment)

Why? Overcrowded, overlapping or misaligned teeth can mean much more than a crooked smile. They can trap food, making cleaning harder and increasing the risk of gum disease or decay.

What’s involved? Today’s braces are more comfortable, discreet and smaller than the bulky contraptions of old. There are three options:

• Visible braces. Clear ceramic brackets are placed in front of the teeth and fixed with white wires, so they are less noticeable than the old metal ‘train tracks’.

• Invisible (lingual) braces. Custom-made to each individual tooth, they are attached to the teeth, so they cannot be seen.

• Almost-invisible braces (Invisalign). The newest option, you wear these removable, custom-made, clear plastic ‘aligners’ over your teeth for 22 hours a day, removing them only to eat and brush your teeth.

Veneers

Why? Simpler than braces, requiring fewer surgery visits, veneers can enhance wonky or chipped teeth, close small gaps, align slightly out of place teeth and cover stains.

What’s involved? The dentist shaves off some of the tooth’s enamel and takes a mould. A veneer, colour-matched to your teeth, is stuck over the tooth like a false fingernail, and polished. You’ll usually need to make up to three visits. Apart from the cost, the disadvantage over braces is that removing enamel can kill the tooth.

What’s new? Instant veneers, such as Lumineers, are like dental contact lenses, made from a special thin-yet-strong porcelain that requires minimal tooth preparation. The procedure is reversible as, unlike traditional veneers, the natural tooth structure is left intact.

What to do about bad teeth

Crowns

Why? To protect decayed or weak teeth, damaged fillings or large fillings where there isn’t much tooth left. They can also hold together cracked teeth, and restore or cover badly worn, misshapen or discoloured ones.

What’s involved? The dentist takes an impression of the tooth and a crown is created in a lab from porcelain bonded to gold alloy, porcelain alone, ceramic, glass or gold. This process normally takes around four weeks.

What’s new? Same-day crowns are now possible using CEREC, which is an all-ceramic material that conserves more of the natural tooth. The dentist takes a photograph to create a 3D computer model of your tooth. The resulting design is then beamed wirelessly to a milling machine, which creates the crown on the spot.

Composite restoration

(also known as tooth-coloured fillings, onlays and inlays)

Why? A simpler procedure than most crowns, material made from glass particles or a synthetic resin is used to fill the tooth.

For larger cavities, tooth-coloured inlays, which fit in the tooth, and onlays, which cover several surface cusps, may be required.

What’s involved? The dentist drills out the decay and/or filling and repairs the tooth in a single visit. The fix should last from five to ten years.

Implants

Why? To provide a long-term natural-feeling and looking replacement for a lost tooth, which allows you to bite naturally, eat what you want and brush as normal.

What’s involved? The dentist measures the depth of the bone before inserting a titanium screw, around which bone and tissue grow. A crown is then attached to the screw.

What’s new? A complete set of functioning ‘teeth’ in a day. The dentist uses a CT scan to create a 3D image of your jaw and determine the number and placement of implants. Temporary ones are inserted and, after the bone has started to knit to them, replaced by a permanent set.

Bridges

Why? To improve appearance and correct bite issues or speech problems resulting from missing teeth if you don’t want, can’t afford or aren’t suitable for an implant – perhaps because there’s not enough bone in your jaw to support one.

What’s involved? The dentist drills down the adjacent teeth to remove their enamel. A solid false tooth made from porcelain (or porcelain bonded to precious metal) is then suspended between them. A bridge can last from ten to 15 years.

What to do about worn-down teeth

Night guards

Why? To protect teeth from further wear. Can be used with other treatment such as tooth-coloured fillings, veneers and crowns.

What’s involved? There are two options. You can use soft night guards, which are available over-the-counter or online, to keep your upper and lower teeth apart and prevent grinding in your sleep. Or you can try occlusal splints, which are hard acrylic guards available from your dentist that fit precisely over your teeth.

What to do about dingy teeth

Tooth whitening

Why? Veneers and crowns can be used to hide discoloured teeth, but whitening is less intrusive and there is no need for the enamel to be removed.

What’s involved? Dentist-prescribed home whitening is the gold standard. The dentist makes a mouthpiece, which you fill with a bleaching agent and wear for 30 minutes to an hour over two to four weeks. Newer whitening products can be applied for up to eight hours at a time, producing a result in as little as a week.

What’s new? Instant whitening, aka chairside bleaching, laser whitening or power whitening. The dentist puts a rubber dam over your teeth to protect your gums and applies the whitening agent. A bright light or laser is then used to activate it. The procedure takes around one to two hours.

Whitening should only be done under dentist supervision. Not everyone is suitable for the process and some kits bought online can be too strong.

Foods that whiten teeth naturally

What to do about black triangle teeth

Better dental hygiene

Why? One in three of us suffers the dreaded black triangles at the base of lower teeth caused by receding gums.

Proper brushing and cleaning between teeth with interdental brushes – plus a regular scale and polish – can slow the gum disease that causes the problem, but it can’t cure it.

A deep clean (root-surface debridement) may be recommended if you have particularly deep spaces around the teeth.

Dental hygienist: costs and FAQs

Gum grafting

Why? Treats more serious cases of black-triangle teeth.

What’s involved? A periodontist (a dentist specialising in gum disease) grafts tissue taken from elsewhere in the mouth onto the affected area to cover portions of the root exposed by the receding gum. The procedure halts further recession, eases sensitivity and improves appearance.

Find out how to save money at the dentist.

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