Common dental questions, answered simply

Toothache, root canals and emergencies

How can I stop a toothache at home?

At home you can calm the pain for a few hours, but the cause only goes with treatment on the tooth itself. What helps until you can see a dentist: a painkiller that suits you, chosen by a pharmacist or doctor, and a rinse of lukewarm salty water (not for children). A cold compress on the outside of your cheek helps too, as does soft food that is not hot, cold or sweet. Never put a painkiller tablet on the tooth or gum, because it can burn the gum. Even if the pain eases you still need a check-up soon, and with swelling or a fever don't wait. More on toothache: what to do now and in toothache relief at home.

Does a root canal hurt?

The session itself is done under local anaesthetic, and you usually feel pressure and movement rather than pain, generally no more than with an ordinary filling. A badly inflamed tooth sometimes needs more anaesthetic than usual before it is fully numb; that is expected, and if you feel anything you say so, and more can usually be given. Afterwards, tenderness or discomfort for a few days is normal, and the pain you had before treatment usually eases because its source has been removed. What happens in a root canal session is on the tooth that hurts at night.

Is a dental abscess dangerous?

Yes, an abscess shouldn't be taken lightly: it is pus from an infection, it does not go away on its own, and even if it bursts and the pain eases, the cause is still there. Left alone, the infection can spread to the bone, face and neck, and rarely further, and that can become dangerous. Don't try to pop it at home, because it is treated by a dentist: draining the pus and treating its source in the tooth or gum. It is a hospital emergency right now if it becomes hard to swallow, breathe or speak, or if there is a lot of swelling in your mouth or it reaches your eye or neck. The same goes if your eye becomes painful or your eyesight suddenly changes. More on dental emergencies and abscesses.

Extraction or root canal: how is it decided?

It depends on the tooth, not on the pain: if the tooth can still be saved, a root canal removes the infection and keeps your tooth in place with its root. Extraction becomes the option when the tooth can no longer be saved, such as a crack that reaches the root, decay that has left nothing to build on, or bone and gum that no longer hold it. Dentists usually try to keep a natural tooth when they can, because extraction leaves a gap that needs replacing with an implant, a bridge or a denture, so the decision is made with an examination and an X-ray, not over the phone. More on extraction or root canal: how it is decided.

Why does toothache get worse at night?

One explanation is that the nerve is enclosed inside the tooth between hard walls, so even a small rise in blood and fluid inside it, such as can happen when you lie down, raises the pressure on it. Medical sources confirm that toothache can be worse at night, especially lying down, but the exact link is still an explanation rather than a proven fact. The important sign is not the hour alone: pain that wakes you, throbs, or lingers for more than a few seconds after the cold or heat has gone usually means the nerve has been affected and needs a check-up soon. What to do until morning is on the tooth that hurts at night.

Why do I clench or grind my teeth in my sleep, and can it be treated?

Clenching or grinding in your sleep does not always have a clear cause; the most common one is stress and anxiety, and it is also linked to snoring and sleep apnoea, smoking and a lot of caffeine. Many people do not know they grind until they wake with a sore jaw or a headache, a tooth or filling breaks, or the person sleeping next to them hears it. Not all grinding needs treatment, and when it does, the treatment protects your teeth more than it stops the grinding: a guard your dentist makes to fit you, worn at night, with less stress and regular sleep. If there is loud snoring or pauses in your breathing, talk to your doctor, and if you have crowns or veneers, or are planning them: mention grinding at your first visit.

Tooth decay, fillings and sensitivity

What causes tooth decay?

The main cause is sugar that stays on the teeth: bacteria feed on it and make acid, which dissolves the tooth's surface little by little. Saliva repairs some of that damage between meals, but when sweet food and drinks keep coming through the day, the acid wins and a weak spot becomes a hole. The risk goes up with too little fluoride, too little brushing and flossing, and anything that leaves your mouth dry. More on tooth decay and fillings.

Can tooth decay be treated without a filling?

In its earliest stage, sometimes; once it is a hole, usually not. While it is still a white spot and the surface has not broken, fluoride toothpaste and less sugar between meals, sometimes with a fluoride treatment your dentist recommends, can harden the surface and stop it without any drilling. A hole, though, does not close up on its own, and it is usually treated with a filling; the examination decides where your tooth stands. More on tooth decay and fillings.

How long does a tooth hurt after a filling?

Mild sensitivity to cold, and a little gum soreness, are expected after a filling; they ease day by day and can take up to a week or two to settle. But if it hurts when you bite, or the filling feels high, call us: a small adjustment to the filling usually sorts it out. And if the pain is not easing or is getting worse, or lingers for seconds after the cold or heat has gone, call us rather than wait. Call straight away if your face or jaw swells or you get a fever. And if breathing, swallowing or speaking gets hard, or your eye becomes swollen or painful, go to the emergency department straight away. More on tooth decay and fillings.

Why are my teeth sensitive to cold?

Usually because the layer under the enamel has been exposed: it has tiny channels that carry the cold to the tooth's nerve. That happens when enamel wears away from hard brushing, acidic food and drink or grinding, or when the gum pulls back from the root. Sometimes, though, sensitivity is a sign of something that needs treating, such as decay, a cracked tooth or an old filling that has worn, so the examination finds the cause before anything is treated. More on tooth decay and fillings.

Does decay in baby teeth need treating if they'll fall out anyway?

Usually yes, because a baby tooth does not fall out tomorrow: some baby molars and canines stay until around age 10 to 12. Decay in it can cause pain, infection and swelling, it can harm the permanent tooth forming underneath, and if the tooth is lost early, the space it was keeping for the permanent one can be lost. Treatment depends on how deep the decay goes, from fluoride for an early spot to a filling or a crown, and if it reaches the nerve, nerve treatment or sometimes taking the tooth out; the examination and x-ray decide. More on children's teeth and in a decayed baby tooth.

Gums, cleaning and bad breath

What are the signs of gum disease?

One of the most common and earliest signs is gums that bleed when you brush or floss, with redness and swelling, and sometimes a bad smell or taste in your mouth. As the inflammation goes on, the gum can pull back so a tooth looks longer, or teeth can turn sensitive at the gum line; for those, call this week. But for a tooth that has started to move or a new gap between your teeth, badly swollen and sore gums, or an ulcer, red patch or lump in your mouth, call today. Often there is no pain at all, so bleeding on its own is reason enough to get checked; more on gum inflammation, bleeding and recession.

Why do my gums bleed when I brush?

Usually because they are inflamed by plaque and tartar that have built up at the gum line, and inflamed gums bleed easily, so do not stop brushing because they bleed. In the early stage (gingivitis) they usually settle after a cleaning and proper daily brushing and flossing, but the bleeding can also come from deeper disease that has reached the bone, and the examination tells which. Sometimes the cause is something else, such as pregnancy hormones, diabetes or a blood thinner, which you should never stop on your own. If it has not eased after two weeks of proper care, or your gums bleed on their own without brushing, call: gum inflammation, bleeding and recession.

Does tartar removal weaken your teeth?

No, a proper cleaning does not weaken teeth: it removes the tartar sitting on the tooth, and any effect on the tooth surface stays minor when it is done by trained hands with the right settings. Sensitivity to cold afterwards comes from a part of the tooth that was covered and is now exposed, and bleeding comes from the inflammation that was already there. Both usually settle within days, and the sensitivity can take a month or two after a deep clean below the gum line. What really weakens teeth and gums is tartar left in place, and the tools and mixtures people use to scrape it off at home: teeth cleaning and tartar removal.

What causes bad breath?

Most of the time the cause is in the mouth itself: bacteria living on the back of the tongue, between the teeth, in tartar and under inflamed gums, and in any cavity that traps food. It gets worse when your mouth is dry, as it is during sleep or with some medicines, and with smoking and foods such as garlic and onion. Sometimes the cause lies outside the mouth, in the sinuses, tonsil stones or acid reflux, and that becomes clear once an examination has ruled out the mouth. Morning breath on its own is normal for most people. The part your gums play is on gum inflammation, bleeding and recession, and the difference is explained in morning breath: normal, or a sign of something?

How often should I get my teeth professionally cleaned?

There is no single number for everyone, and the number of months you hear is a familiar figure, not a rule for your mouth. What sets it is the state of your gums, how quickly tartar comes back for you, and things like smoking, diabetes and pregnancy. Large studies found no clear difference between one fixed schedule for everyone and visits timed to each person's needs. In practice, your dentist tells you the interval that suits you after the examination and adjusts it to how quickly the tartar returns: teeth cleaning and tartar removal.

Extractions, wisdom teeth and aftercare

When can I take the gauze out after a tooth extraction?

Keep biting firmly on the gauze you leave the clinic with, usually for half an hour to an hour, or for as long as the doctor tells you. If there is still clear bleeding when you take it out, fold a fresh piece of clean gauze or a clean cotton handkerchief, and bite on it for another half hour. Pink saliva or light streaks of blood on the first day are normal. If it is still bleeding after an hour of pressure, call us now, and if the clinic is closed, go to the nearest hospital emergency department; more on after treatment: what's normal, and what needs a call.

Does wisdom tooth removal hurt?

The extraction itself is done under a local anaesthetic, so you usually feel pressure and movement rather than pain, and that's normal. If you do feel pain partway through, say so, and more anaesthetic is given if it's needed. Once the numbness wears off, some pain and swelling over the first few days are expected, and they tend to be stronger the deeper the tooth sits. They ease with the days; more on wisdom teeth.

How long does pain last after wisdom tooth removal?

Pain is usually at its worst for the first two or three days, then eases day by day, and most people feel settled within one to two weeks. What isn't normal is pain that climbs again after easing, or turns throbbing and spreads towards your head, with a bad taste or smell. That can be a dry socket, which usually shows within the first three days and is treated by a dentist, so call. Call as well if the painkiller the doctor advised no longer helps, you get a fever, or after a week it still isn't easing; more on wisdom teeth.

What can I eat after a tooth extraction?

For the first few days, eat soft food that is lukewarm or cool but not ice-cold, and not spicy, on the other side: soup that isn't hot, rice, pasta, mashed potato, eggs, yoghurt. Until the numbness wears off, don't chew on the numb side or drink anything hot, so you don't bite your cheek or burn yourself. Keep away from hard and crunchy food, nuts and seeds, fizzy drinks and straws, because they can disturb the clot that seals the socket. Go back to your usual food gradually as chewing gets comfortable; more on tooth extraction.

Dental implants, bridges and dentures

Do dental implants hurt?

Not during the procedure itself, as a rule: it is done under local anaesthetic, so you usually feel pressure and movement rather than pain, and if you do feel something you say so, and more anaesthetic can usually be given. Once the numbness wears off, some discomfort and mild swelling for the first few days is normal and eases bit by bit, and the painkiller the doctor recommends on the day of the procedure helps, taken the way the doctor tells you. Pain that grows day by day instead of easing, swelling that grows after the first few days, a fever or pus is a reason to call rather than wait. More on dental implants.

How long does the dental implant process take?

Usually months, not a single visit. First an examination and an x-ray, then the implant visit, then a period of the bone fusing around the implant that cannot be rushed, and finally the abutment and the crown. If the bone needs building up or a tooth has to come out first, a stage is added before, and the doctor gives you the timeline for your case at the examination, as an estimate rather than a promise. More on dental implants.

How long do dental implants last?

There is no fixed number for anyone, because its life depends a great deal on the bone and gum holding it and on how you look after it. With daily cleaning around it, regular check-ups and no smoking it can stay with you for many years, while smoking, neglected cleaning or gum disease can inflame it and lose it early. The crown on top can wear or need repair or replacing over the years, which is separate from the root in the bone. More in how long do dental implants last.

Implant or bridge: which one suits me?

There is no single answer for everyone: an implant stands on its own in the bone and does not touch the teeth next to the gap, but it involves minor surgery and months of healing. A bridge is done in weeks without surgery, but the teeth beside the gap are usually trimmed down to carry it, and that cannot be undone. What decides between them is your bone, the state of the neighbouring teeth, your general health and your time, and the examination and x-ray will show which suits you. More in implant or bridge: what actually differs.

I'm scared of getting an implant. What actually happens?

Being scared is normal, and it eases once you know the steps: the first visit is usually an examination, an x-ray and a talk about your options. On the day, the area is numbed with local anaesthetic and the root is placed in the bone through a small opening in the gum, and the anaesthetic is there so that you do not feel pain. If you feel something, you raise your hand, and at almost every step the work stops; the few steps that can't stop midway, you hear about before it starts. Afterwards there is some discomfort and mild swelling for the first few days, the bone fuses over months while you get on with your life, and the crown goes on at the end. Tell the doctor you're nervous from the very start. More on dental implants and when the visit is hard.

Braces and clear aligners

Do braces hurt?

It can be sore, but it's temporary: pressure and tenderness after fitting and after each adjustment, easing on its own within a few days. Clear aligners bring the same feeling for the first days of each new tray, and fixed brackets can rub the cheek at first, which wax covers. An ordinary pharmacy painkiller is enough for most people, but ask the doctor or pharmacist which kind suits you with braces. Pain that builds instead of easing, or sits in one particular tooth, is a reason to call. More on the braces page.

How long does orthodontic treatment take?

There is no single length that fits everyone: Cleveland Clinic puts the average at roughly two years, with some people finishing in under a year and others taking up to three. The figure for your case comes after the examination as an estimate, not a promise. It depends on how severe the problem is, whether the plan involves extractions or an impacted tooth that has to be brought down, and on how well you keep to appointments, elastics or aligners. In adults it can run a little longer, but age alone is not the main factor once the permanent teeth are in, and after the braces comes a retainer, which has its own timeline. More on the braces page.

Clear aligners or metal braces: what's the difference?

Fixed braces are brackets bonded to the teeth with a wire, staying in your mouth and working around the clock; clear aligners are trays you take out to eat, drink and brush, and they only work when you wear them as instructed. Aligners are easier for eating and cleaning and hard to notice, while fixed braces suit complex cases better, and in cases that need extractions they give a more precise result. A recent systematic review found no clear difference in quality or duration in cases without extractions, so the question is not which one wins but which one fits your case and how consistently you can wear it, and the examination settles that. A point-by-point comparison is on the clear aligners page.

Can braces change the shape of your face?

Not the bones of the jaw or face: braces don't reshape the jawbone or slim the face, but the lips and side profile can change a little in some cases. This is more likely when protruding front teeth are pulled back or teeth are extracted, because the lips move back with them, and how much varies and is hard to predict. So if this matters to you, ask about it before you start. Problems in the jaw itself are different: in a child growth can sometimes be guided, and in an adult a large jaw difference takes braces combined with jaw surgery. Why some people feel their face changed is explained in braces as an adult: age is not the barrier.

Can teeth shift back after braces come off?

They can, it is common, and that is why the retainer is not optional. Teeth keep a tendency to drift back towards their old positions after any orthodontic treatment, that tendency stays for life, and the retainer (a fixed wire behind the teeth or a removable clear tray) is what holds the result. Many people keep wearing it at night for a long time, sometimes indefinitely, and the doctor sets the length for your case; if you stop or it breaks, the longer you wait the further the teeth move back, so call early. More on the braces page.

Can gaps between teeth be closed without braces?

Sometimes, yes, and it depends on what caused the gap and how big it is. A small gap can be closed with tooth-coloured material without much enamel removed, or with a veneer, though a veneer removes some enamel for good. A large gap is closed with braces or aligners, a missing tooth is replaced with a bridge or an implant, and if the cause is the lip tissue or advanced gum disease, that is treated first or alongside. In children, a gap between the front teeth often closes on its own once the permanent teeth come in, so it is usually watched before any treatment. The causes of gaps are on the braces page.

Whitening, veneers and crowns

Is teeth whitening bad for your teeth?

No, not on healthy teeth and gums, at the right strength and under a dentist's supervision. Children usually wait, though, for a teenager the examination decides, and it isn't recommended during pregnancy or breastfeeding. Its most common side effects, sensitivity and mild gum irritation, usually pass on their own. What does harm is whitening over decay or inflamed gums, repeating it often without an examination, or a strong agent with no gum protection. Acidic and abrasive home mixtures wear the enamel with no evidence that they whiten safely, and kits bought from a pharmacy or online work less well and can hurt the teeth and gums. More on the teeth whitening page.

Is teeth whitening permanent?

No, it isn't permanent: the colour darkens a little over time for everyone, but gradually, not overnight. Teeth keep taking on colour from coffee, tea and smoking, and they darken with age on their own as the enamel thins and the yellower layer beneath shows through. How long it holds varies from person to person, and much of it is in your hands: your habits, your cleaning and your check-ups. More in does whitening fade, and what keeps it.

What are the downsides of veneers?

The main one: in most cases a thin layer of enamel is trimmed from the tooth, and that does not grow back. After that the tooth can become sensitive to cold and heat, and the shell can chip, crack, loosen or stain over time, with composite staining faster than porcelain. The tooth under the shell can still decay at its edge, grinding is one of its worst enemies, and years on it is replaced. The downsides one by one in the downsides of veneers, before you decide.

What are dental veneers?

A veneer is a thin shell made for your tooth and bonded to its front face only, to change its colour or shape or to cover a small chip or gap. It comes in two materials: porcelain, made in a lab to fit your tooth, or tooth-coloured composite, built up directly on the tooth. It is not a crown: a veneer covers the front face only, while a crown covers the whole tooth. More, and when something simpler will do, on the veneers page.

What types of dental crowns are there?

A permanent crown is usually made of porcelain, zirconia, porcelain fused to metal or all metal, and resin is mostly used for temporary crowns. Porcelain looks closest to enamel, zirconia stands up well to chewing, porcelain fused to metal is strong but its porcelain can chip and show the metal, and all-metal rarely breaks but shows its colour, so it suits back teeth. So the real question is where the tooth sits, how much it shows and how much load it takes, and that is decided at the examination. More on the dental crowns page.

Children's teeth

Which of a child's teeth fall out and get replaced?

Normally all 20 baby teeth are replaced, starting with the lower front teeth at around age 6 and finishing with the last canines and baby molars at around 12. What is not replaced are the permanent molars that come in at the back without anything falling out first: the six-year molars, the twelve-year molars, and the wisdom teeth if they come through. These erupt once and have no successor, so look after them from day one. And some children are simply missing a permanent tooth under a baby tooth, which only an X-ray shows. More on children's teeth and in baby teeth: when to worry, and when not to.

When do baby teeth fall out?

The changeover usually starts at around age 6 with the lower front teeth and finishes at roughly 11 to 12 with the upper canines and the baby molars. Some children run up to a year behind that, which is usually normal, and the timing often follows when their teeth first came through as babies. But if teeth start falling out before age 4, or none have come out by 8 or 9, that is worth a check-up. More on children's teeth and in baby teeth: when to worry, and when not to.

When do babies start teething?

For most babies the first tooth shows at around 6 months, and it is usually one of the bottom front teeth. Some start before 4 months and some not until after their first birthday, and that is usually just their timing rather than a problem. Most children have all 20 baby teeth by the age of 2 to 3. If you feel it is late, ask about it at the first dental visit, which is due before their first birthday anyway. The first visit is on children's teeth, and the full timeline is in when your child's teeth come through.

When should a child first see the dentist?

Within six months of the first tooth coming through, or before their first birthday, whichever comes first. As soon as there is a tooth it can decay, and an early visit catches anything while it is small and sends you home with advice on brushing and feeding. Your child also gets to know the place while relaxed, before anything hurts. If your child is older and hasn't been yet, it isn't too late: book a calm check-up. More on children's teeth and in at what age is the first dental visit?

Does thumb sucking damage a child's teeth?

In the early years sucking is normal and usually does no harm, and most children give it up on their own between 2 and 4. If it goes on longer, especially as the permanent front teeth get ready to come in, it can push the upper teeth forward, stop the top and bottom front teeth from meeting, or change the shape of the roof of the mouth. The effect depends on how many hours a day, for how many years, and how hard: a thumb resting in the mouth is not the same as vigorous sucking, which can affect even the baby teeth. More on children's teeth and in thumb or dummy: when does it start to affect your child's teeth?

Dental fear, pregnancy and chronic conditions

How can I get over my fear of the dentist?

There is no way to make the fear vanish in a day, but it does shrink step by step. Tell the dentist in your very first sentence, agree on a signal for asking them to pause, and ask them to explain each step before it happens. Start with the smallest visit you can manage, such as a check-up only, because for many people each visit that goes well makes the next one easier. If the fear is strong enough to keep you away, cognitive behavioural therapy with a psychologist has some evidence, still limited, that it helps; more on when the visit is hard.

What should I do before a dental appointment?

The day before, write down your questions and your fear in one sentence, get a list of all your medicines ready, and get to bed on time. On the day, eat something light, unless you have diabetes, in which case don't change your usual meals or medicines on your own. Don't have more coffee or tea than usual, because caffeine can make anxiety feel worse. As soon as you sit down, say you are nervous and agree on a "stop" signal before anything starts; the full list is in what to do before a dental appointment if you're nervous, and more for nervous patients on when the visit is hard.

Is it safe to have dental treatment while pregnant?

Usually, yes, at any stage: check-ups, cleaning and treatment for any pain or infection don't wait, because putting off an infection can make the problem more complicated. Mention the pregnancy when you first call, even if you're not sure yet, and if your pregnancy is classed as high-risk, say so too. An x-ray that can wait, waits, and one that is needed is taken with precautions; the anaesthetic is decided for your case and how far along you are, and laughing gas is put off during pregnancy. Work that can wait is timed by the dentist; dental treatment in pregnancy is covered in full on dental treatment for people with long-term conditions.

Can tooth pain or gum disease raise blood sugar?

Yes, it can: serious gum disease can raise blood sugar and make it harder to control, and an abscess or serious infection, like any illness, can make the body release hormones that push sugar up for a while. The good news is that a Cochrane review found that treating gum disease helps bring your long-term sugar (HbA1c) down by a meaningful amount within roughly three to four months, so treating your gums is part of managing your diabetes. Go to a hospital emergency department right away if the swelling is large or reaches your eye or neck, your eyesight changes, or it becomes hard to open your mouth, speak, swallow or breathe. If you have diabetes and swelling or a fever, call us today, and ask your diabetes doctor whether you should check your sugar more often. More on dental treatment for people with long-term conditions.

Cost, insurance and choosing a dentist

What decides the cost of a dental implant?

There is no single figure for an implant, because the cost is built on your own case: how many teeth are missing, whether there is enough bone to hold the implant or a bone graft is needed first or at the same time. Then there is what goes on top: a crown for one tooth, a bridge, or a denture on implants. The treatment itself usually comes in stages with healing time in between, and your health, such as smoking or diabetes that is not under control, can change the plan. The examination and the X-ray settle it; every factor is on what decides the cost of your treatment.

What decides the cost of braces?

The cost of braces depends on how complex your case is and on the type of brace: mild crowding is not the same as protruding teeth or a reverse bite, and fixed braces are not the same as clear aligners. The length of treatment matters too, because it stretches or shortens with how far the teeth need to move, and the number of visits follows. One part belongs to the plan from day one: the retainer after the braces come off, because it is what stops the teeth moving back; more on what decides the cost of your treatment.

Does health insurance cover dental treatment?

Not through the clinic, because it currently does not work with insurance companies, so you pay the clinic directly. If your policy refunds part of what you paid, you send the paperwork to your insurer yourself, and what is refunded is decided by your contract with them, not by the clinic, so ask them first which documents they need. The details are on health insurance and payment.

Can dental treatment be paid in instalments?

Not at the moment. The doctor is looking into it. What you can do now: after the examination, talk to the doctor about sequencing the plan in stages, the most important first; more under payment and insurance.

How can I tell if a dentist is good?

By things you can see and ask about, not by reputation alone: who will actually treat you, what their qualifications are, and whether they are registered and licensed. Then see whether they explain what you have and how to protect your teeth, and whether they answer all your questions before they start. And at the clinic itself: whether it is clean and orderly, whether your medical history is taken and you hear the cost before treatment starts, and what happens if something goes wrong outside opening hours. These are questions to ask any clinic. The doctor's qualifications are listed in full on Dr. Adnan Alakhras's page.