Frequently Asked Questions

Why should I go to the dentist if I don’t have any problems with my teeth?
There are diseases in the teeth and surrounding tissues which may not cause  discomfort in their early stages. Treatment in early stages is always preferable to later treatment, since it will prevent  destruction of tissues, avoid unnecessary pain, and  lower the cost and extent of the treatment.
For example, many people do not feel discomfort from a cavity. If the cavity is not treated before it extends into the tooth nerve, bacteria will infect it. This is typically the point when most people experience pain. At this point, the only possible treatment is to remove the nerve inside the entire tooth (root canal treatment). Furthermore, root canal treated teeth will in many cases need a crown, further complicating the treatment and making it more expensive.
Similarly, periodontal disease often cannot be felt until serious damage has occurred. In periodontal disease, the gums supporting the teeth degrade due to chronic inflammation surrounding the teeth, usually over several years. In many instances, the first sign that something is wrong is that teeth start to become loose. At this point, treatment to save the teeth will have to be be extensive, and may even be impossible.

Is amalgam toxic? Should I have my amalgam fillings changed to another material?
This question has not yet been conclusively answered by scientific investigation. Amalgam fillings contain mercury, a known neurotoxin, which is continually released in small doses. However, it is debated whether the mercury released from tooth fillings is absorbed by the organism or not. Due to this uncertainty, there has been a push, especially in Scandinavia, to out-phase the use of amalgam in dentistry. Some patients attribute a number of symptoms to mercury poisoning from amalgam fillings, but this has been difficult to confirm scientifically. It has however been established that a small number of individuals are allergic to amalgam fillings.
Due to these uncertainties we have chosen not to use amalgam in our clinic.
As to existing amalgam fillings, we do not recommend that they be replaced due to health concerns at present. Amalgam has been used as a filling material for generations, has very good mechanical characteristics, is inexpensive and generally lasts a long time. However, when an old amalgam filling needs to be changed due to wear or other reasons, we recommend replacing it with a filling of a different material, most commonly tooth colored composite. 

It sometimes bleeds from my gums when I brush my teeth. Why is this?
Bleeding from the gums is normally due to inflamed gums or gum disease. The inflammation is caused by inadequate oral hygiene. Once the oral hygiene is improved, bleeding normally ceases within 1-2 weeks. The bleeding in itself is not harmful, so it is important to continue brushing the teeth thoroughly and gently massage the gums with the toothbrush. Visit your dentist to clarify, whether you have inflamed gums or more serious gum disease, which will normally require further treatment. In rare instances, bleeding may also be caused by other diseases.

Is it bad for my teeth to eat sweets and drink soft drinks?
It depends. Cavities are not caused by sugar in itself, but by bacteria ("plaque") which has not been removed from the teeth by brushing or flossing. These bacteria do much more damage to the teeth in the presence of sugar then other foodstuffs, which explains why there is a correlation between sugar consumption and cavities. However, if teeth are kept completely clean of bacteria, cavities do not develop irrespectively of how much sugar is consumed. Since this level of oral hygiene is uncommon, it is best to reduce the consumption of sugar, especially for children and those with a tendency to develop cavities. Furthermore, excessive consumption of soft drinks may also damage teeth due to the acidity, which can cause erosion of the teeth, irrespectively of the drink's sugar content. Excessive sugar consumption may have other ill effects on health, such as predisposing to obesity. 

I think I have bad breath. Can something be done against that?
Bad breath is typically caused by bacteria, which are found at various locations in the mouth. However, the most important site is usually the tongue. You can buy special tongue scrapers, which are simple and inexpensive plastic instruments. A toothbrush may also be used, but is less effective. Scrape the whole tongue surface daily. This removes large amounts of shed surface cells, as well as the odor causing bacteria living among the cells.
Try also brushing and flossing your teeth more thoroughly.
Bad breath may also be caused by gum disease, and is especially pronounced by a rapidly progressing, aggressive type of gum disease. Furthermore, bad breath may be due to some general diseases. Contact your dentist if the advice above does not help.

My teeth are very sensitive to cold. Can something be done about this?
Sensitive teeth may have several causes, but is most frequently due to a cavity or to sensitive tooth necks. Contact your dentist to find the cause.
Sensitive tooth necks are frequently caused by a wrong tooth brushing technique, for example by using a hard toothbrush and a forceful back and forth movement. The tooth necks are susceptible to damage since they are not covered by a layer of enamel as is the rest of the crown. Canals that penetrate from the surface till the nerve are found in the tooth neck. These canals can be opened by abrading the tooth neck, which gives rise to the sensitivity. Improving the toothbrushing technique by using gentle, circular motions and less force, and by using a soft toothbrush, will allow the canals to close by themselves within 1-2 weeks. Try also using toothpaste especially formulated for sensitive teeth. Your dentist can also aid by sealing the canals with a fluor containing varnish.  

I have a terrible toothache-should I use antibiotics?
Generally no. The most frequent cause of intense toothache is, that the tooth nerve or bone surrounding the tooth is infected, because bacteria has penetrated into the nerve. The treatment is to remove the nerve (root canal treatment) and allow the infection to drain. This procedure will  normally relieve the pain considerably immediately, so visit your dentist as soon as possible.

Antibiotic treatment can do nothing to cure the cause of this type of pain. At best, antibiotic treatment may aid to diminish the symptoms after some days, but even this is uncertain, since the bacteria do not always respond to the antibiotic. Normally the pain will cease following root canal treatment, and antibiotic should only be used in case the general health is affected due to the infection (i.e. if there is fever).

Besides being ineffective in this case, antibiotics should only be used sparsely for the following reasons:

-The risk of developing antibiotic-resistant bacterial strains. This is already a significant problem in Portugal, where antibiotics are much overused. The result is, that bacterial infections become increasingly difficult to treat - which may have fatal consequences.

-Direct side effects such as diarrhea, and the increased susceptibility to opportunistic infections caused by depletion of the normal bacterial flora.

-The risk of developing an allergy against the antibiotic. Every time an antibiotic is used, this risk is present.

I have a terrible toothache-which painkillers can I take until my dental appointment?
Ibuprofen 600 mg, 3 times a day (4 times daily for short periods) for adults. Should be taken together with food or milk, or just after a meal. May cause beeding from the stomach or intestine, and must not be taken in the presence of peptic ulcer. Must also not be used in presence of kidney or liver disease, or pregnancy. Consult your family doctor about use if you take any other medication.
Ibuprofen is sold without prescription in Portuguese pharmacies under the names: Brufen 600 mg, Arfen 600 mg, Calbrun 600 mg, Ibuprofeno Generis 600 mg, Ibuprofeno Ratiopharm 600 mg.

If your pain is less intense, try paracetamol 1000 mg, 3 times a day for adults. Do not exceed recommended dose. Paracetamol is sold in Portuguese pharmacies without prescription under the names: Ben-U-Ron 1000 mg, and Panadol 1000 mg.

For children use Paracetamol, 50 mg/kg body weight each 24 hours, divided in 3-4 doses.

I am very afraid of visiting the dentist...
It is perfectly normal to be afraid of visiting the dentist. Most of us feel varying degrees of discomfort at this prospect. Fear of the dentist often dates back to childhood, where many have had traumatic experiences, have had their fear transferred from their parents, or a combination of the two. However, the dental profession is in constant development, both in respect  to the attitude of the dentist towards his/her patients, and in respect to the development of new technologies. For example, it is now possible to treat cavities without the drill or local anesthesia in most cases, by using air abrasion. When local anesthesia is necessary, surface anesthesia is used before the local anesthesia, so that hardly anything is felt at all.

It is also important to realize, that you have the final control with what treatment should be carried out, and how. Demand of your dentist, that he/she listens to, and respects, your wishes and concerns. Visiting the dentist is in principle no different then visiting for example the hairdresser.

When our clients are afraid, we normally start treatment very slowly, or not until a later visit, unless desired. For most people, it is reassuring to know in advance what will happen next, and knowing that nothing surprising will happen behind their back. By proceeding gradually most will realize, that visiting the dentist is not nearly as unpleasant as they feared.