Sometimes things happen… whether its a ball to the head, a knee to the mouth, or tripping over your own shoelaces. Would you know what to do if a tooth is knocked out??

Firstly it is important to understand the difference between exfoliation and avulsion.
Exfoliation is when the tooth is lost due to natural circumstances – the most common cause of exfoliation is loss of a baby tooth due to the impending eruption of the permanent successor.
Avulsion is when the tooth exfoliates forcibly due to unnatural circumstances, such as a knock to the face.

In cases of exfoliation:

PRIMARY TEETH: Children lose their primary teeth from the ages of about 6-12 years of age; you can usually tell if it is a baby tooth by the size (quite small), colour (very white), and if the tooth was ready to exfoliate there will be no or very little of the remaining roots attached. You may also notice a new permanent tooth already erupting through the gum, or see/feel a bulge where that new tooth is sitting close to the surface of the gum.

PERMANENT TEETH: If a permanent tooth is lost and there has been no trauma involved, you may wish to seek advice from your dental professional as there may be more complicated underlying issues present.

In cases of trauma and/or avulsion:

PRIMARY TEETH: If a primary tooth suffers avulsion, never re-implant the tooth due to risk of damage to the underlying permanent tooth. You may wish to keep the tooth and make an emergency appointment with your dental professional to check that the tooth has come out in one piece and if there is any remaining tooth fragments left in the bone.

PERMANENT TEETH: For permanent teeth that exfoliate before their time due to a knock or trauma, there are a few steps to follow:

  1. Find the tooth and pick it up by the crown (avoid touching the root/s).
  2. If you feel confident replanting (re-inserting) the tooth you may do so, BUT make sure you place the tooth in the correct position / the right way around because once it is back in it isn’t coming out again for hopefully a very long time!
  3. If the tooth has debris on it, clean the tooth under cool running water (max 10 seconds) prior to replantation.
  4. If you do not feel confident replanting the tooth yourself, either place the tooth into a cup or glad bag of milk, or if milk is unavailable, you can place the tooth inside the patients mouth between the lower teeth and the cheek BUT DO NOT SWALLOW IT!
  5. Make an emergency appointment with your dental professional or closest dental clinic for assessment, replantation, and splinting/stabilisation where appropriate.
  6. NOTE: For the best long-term prognosis, the tooth should be replanted immediately, or no later than 1-2 hours after avulsion.

Once a tooth has avulsed and been replanted, there is a significant risk the nerve inside the tooth will not survive the trauma, and it may require further treatment later down the track; this could take days, months, years, or even decades. Regular dental appointments, diagnostic tests, and radiographs (x-rays) will be performed for ongoing assessment of the vitality of the tooth.

If you have any questions or concerns about exfoliation or avulsion, you are more than welcome to call Riverside Dental Spa on 4323-4323 to discuss these with our friendly team!

Teeth Whitening with Activated Charcoal

Charcoal toothpastes and powders are a recent innovation to the dental product market. Marketing campaigns flooding social media such as Instagram, Facebook and YouTube claim that brushing with activated charcoal whitens teeth and improves the health of the teeth and gums.

So how does it work?

In the early 1900’s the World Health Organisation (WHO) listed activated charcoal as an essential medicine for treating poisoning and overdoses. When taken, the activated charcoal allows the drugs and toxins to bind to it, helping to safely rid the body of  unwanted substances. To date there have been no scientific studies to confirm that activated charcoal is effective in whitening teeth or improving the health of the teeth or the gums.

Some wellness gurus advocate the activated charcoal toothpastes essentially help rid the mouth of bacteria and toxins the same way it helps the gut – binding to the toxins and expelling them. However, due to the abrasiveness of charcoal products the disadvantages outweigh the benefits.

Abrasive products can certainly help lift extrinsic (surface) staining from things such as tea, coffee, red wine and tobacco, making the teeth appear whiter.

Excess abrasion to the teeth can cause gingival recession , enamel loss and dentine exposure, all of which lead to heightened sensitivity to hot and cold and increased risk of tooth decay.

How does this happen?

Enamel is essentially the hard protective, white layer of the teeth. It protects the inner, softer layers from hot and cold stimulus and well as being a strong barrier against decay causing bacteria.

With any abrasive products loss of enamel leads to the darkening or yellowing of the teeth – this is the second layer of the tooth, the dentine being exposed. Thus counteracting any “ whitening” from the charcoal toothpaste.

Exposed dentine also increases tooth sensitivity and is at higher risk of dental decay due to its soft composition, decay is likely to spread at a higher rate.

It is important to understand enamel has no regenerative components, once it is gone, its gone. The only way to improve the discolouration or damage is by having a dentist place a restoration. (Filling/ crown/ veneer)

Further , the charcoal products can have a negative aesthetic effect by staining or lodging in the margins of existing  restorations/fillings/ veneers making the margin appear dark and stained. Any charcoal lodging below the gums can cause inflammation and trauma. This can be not only be unsightly, but also difficult to remove or polish away.

Our View on Charcoal Toothpastes and Whitening Products:

While brushing with an activated charcoal tooth paste may feel fresh and clean, it is important to consider the long term effects and damage you may be causing to your teeth and always consult with your dental professional prior to using.

Charcoal products have been shown to lift surface staining providing a superficial , temporary result. However there is no formal evidence to suggest any actual whitening or further dental health benefits. Long term use is not recommended due to the abrasive nature of the product. As dental professionals we will always recommend products that are backed with research due to the fact it has been tried and tested for safety, the health of the mouth and possible side effects.

For whitening the products we recommend will contain either carbide peroxide or hydrogen peroxide. Low percentage peroxide products can be purchased over the counter but higher strength professional whitening products should always be applied for administered by a dental professional.

Hydrogen and carbamide peroxides work by penetrating the enamel and breaking molecular bonds, charcoal products only remove surface stains through abrasion. So while activated charcoal has been approved by the FDA, as with any abrasive products it is best used with caution. Always consult with your dental professional when considering using alternative dental products.

1: The Pharmaceutical Journal , Charcoal Toothpastes : What we know so far


2: Academy of General Dentistry: Activated Charcoal as a Whitening Dentrifice


3: Dentistry IQ: Black Toothpaste and White Toothpaste, When Opposites Collide


4: Clifton M. Carey, BA, MS, PhD, Professor, Tooth Whitening: what we now know https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058574/

5: Journal of Physics: Conference Series, Surface Changes of enamel after brushing with charcoal toothpaste



Jaw Joint Disorder Treatments

The jaw joints, otherwise known as the temporomandibular joints (TMJs) are the most complex joints in the human body. They are acted on by the bodies strongest and most dense muscles and whilst chewing are subject to enormous forces in a multitude of different directions. It is perhaps a little surprizing then that most of the problems associated with these joints have nothing to do with eating.

Most frequently these problems emerge as a result of clenching or grinding the teeth. This can result from stress, head injuries, sleep apnoea, certain prescription medications (most notably a sub type of antidepressant medication, known a SSRIs – like Prozac, Zoloft, cyprimil, Lexapro etc, but also appetite suppressants like duromine, and stimulants like dexaphetamine) and also illicit drugs like ice, speed and ecstasy.

The pain associated with disorders of the TMJ can be intense, unrelenting and like most pain in the head and neck region, can refer to other parts of the head and face, making diagnosis at times quite tricky. Headaches are often associated with either the joints themselves or the muscles that act on them. In addition, in the immediate vicinity of the joints in the human skull, is the machinery for balance (middle ear) and hearing (outer ear), so it is not uncommon to have dizziness or tinnitus (ringing in the ear) associated with jaw dysfunction.

As a general rule, treatments for jaw joint problems can be pretty hit and miss. A long-time staple of dental treatment for jaw joint problems is a device known as an occlusal splint, which is effectively a wedge of plastic that keeps the jaws separated at night (usually). It is ultra-effective at protecting the teeth from damage, but nowhere near as predictable in relieving the jaw pain.

The unpredictability of the occlusal splint in treating the TMJ comes down to a number of factors. The anatomy of the individual is one. Given the enormous variety in shape of the human jaw, it’s not all that surprising that a one design fits all approach won’t necessarily work.

One feature common to almost all of the causes of TMJ disorders, is the excess tension in the chewing muscles. Tension in these muscles pushes the lower jaw into the joint, effectively squashing the disk and cartilage, and causing inflammation and pain.

Strategic use of our products can relieve the tension in these muscles, take pressure off the joints and allow them heal, no matter what the cause.

31st May : No Tobacco Day

Smoking and the effects on your dental health:

No tobacco day is the perfect opportunity to start minimising the amount you smoke and ultimately quit smoking!

The Centres for Disease Control and Prevention (CDC) reports that smoking is the leading preventable cause of death and disease in the United States. (https://www.colgate.com/en-us/oral-health/basics/threats-to-dental-health/what-you-need-to-know-about-smoking-and-oral-health-0814 )
People who smoke generally have a much higher rate of gum disease , complications after having teeth extracted and developing oral cancers.
The risk of tobacco related dental disease depends on how long you have smoked and the amount of cigarettes smoked daily however there are no healthy levels of exposure , even second hand smoke.

There are numerous benefits of stopping smoking not only for your dental health, but your overall health and wellbeing.

Dental Disease/ Complications Caused by Tobacco:

1: Oral Cancer :

Oral cancer is cancer of the mouth , including tongue, cheek , palate , floor of the mouth and lips. – Around 80% of oral cancer patients use tobacco.

Oral cancers are particularly dangerous due to the fact they are often not diagnosed until the later stages when it has metastasized to other parts of the body. Thus making it much more difficult to treat.
Symptoms include:

  • Swellings, thickness, lumps on lips, gums, tongue / other area of the mouth that to not go away.
  • White/ red patches in the mouth.
  • Unexplained bleeding.
  • Persistent sores on the face, neck, or mouth that bleed easily and do not heal.
  • Difficulty chewing, swallowing , speaking or moving the jaw.

2: Periodontal Disease:

Periodontal (gum) disease is disease that effects, the gums, ligaments and bone supporting the teeth. Build up of plaque and bacteria creates an immune response that causes inflammation of the gums and attacks the bone and supporting structures.
As gum diseases progresses more bone is lost from around the teeth ultimately causing them to become loose.

People who smoke less than 10 cigarettes daily are two times more likely to develop gum disease. This increases to four to five times more likely in heavier smokers.

Smokers are also at high risk of developing acute necrotising ulcerative gingivitis, also known as trench mouth- a painful gum condition which looks, smells and tastes terrible.

Smokers are also much less responsive to treatment of gum disease due to the bodies decreased ability to repair itself, encouragingly once people cease smoking the positive response to treatment increases.

Symptoms include:

  • Red , swollen, bleeding gums
  • Pain or tenderness of the gums
  • Discharge/ pus coming from the gums
  • Loose gums that fall away from the teeth
  • Bad breath/ bad taste
  • Loose teeth
  • Spaces opening up between teeth

3: Bad Breath/ Halitosis

With the increased incidence of gum disease also comes increased incidence of bad breath (halitosis).

Often smokers are not aware of the smell caused by excess tobacco. This will usually subside and improve once smoking has ceased.

4: Stained Teeth

The nicotine in tobacco will quickly cause the teeth to darken or go yellow, this will occur whether you smoke or chew tobacco. While staining is not detrimental to the health of the teeth it can often be difficult to remove as the tar settles into the small cracks and grooves of the teeth.

5: Black Hairy Tongue

Black hairy tongue is a harmless oral condition that gives the tongue a dark furry appearance. Although being harmless black hairy tongue can be quite unsightly.

Hairy tongue occurs from a build up of dead skin cells on the surface of the tongue that contains papillae (taste buds). Tobacco is one of the main contributing factors .

usually black hairy tongue can be resolved by eliminating the contributing factors as well as good dental hygiene.

Dental Care for Smokers:

If you are a smoker there are a few important things to remember when looking after your oral health;

  • Try to stop smoking ; this is the number one biggest factor in improving the health of your mouth, teeth and gums. Your doctor or Quitline are available for help and support.
  • If stopping completely is too hard; At the very least try to reduce the amount you are smoking daily.
  • Thoroughly brushing with fluoridated tooth paste twice a day. Do not use an abrasive (Smokers) toothpaste as it will damage the gums and roots of your teeth.
  • Use dental floss or interdental brushes to clean in between your teeth.
  • Visit your Dentist/ Hygienist regularly for preventive dental care.
  • Drink plenty of water.
  • Limit alcohol intake.

Where To Get Help on Your Journey to Quitting:

  • Your Doctor
  • Dentist or Healthcare professional
  • Australian Dental Association Tel. (03) 8825 4600
  • QUITLINE: Tel. 13 7848 (13 QUIT)

Floss the teeth you want to keep!

Every time you go to see your dentist or hygienist you probably dread those four little words, ‘have you been flossing?’ Let me assure you it is always asked with good intentions.

So why do we care so much about flossing?

As health professionals we aim to have your best interest at heart – your general health. Over the years research has come a long way and there is more evidence to support the links between oral health and general health. With that in mind you should be eager to learn ways that will help to prevent tooth decay, gum disease or better yet heart disease!

The bristles of your tooth brush (despite ‘flossing action’ toothbrushes) do not go into those tiny little spaces between your teeth. Brushing alone is not sufficient to prevent tooth decay or gum disease.

It is becoming more and more common for people to present to our surgery with incipient (early) lesions between the teeth. This is easily prevented with flossing and the right home care.

When should I floss?

Flossing once a day is recommended. It only takes 48 hours for plaque to calcify making it impossible for your toothbrush or floss to remove the calcified plaque – tartar.

Research shows that flossing is most effective if carried out of a night time before bed.
We know that bacteria naturally resides in the mouth making it like a feeding ground for the bacteria to grow if not removed within a timely manner.
During the day our saliva plays a vital role in removing plaque. This is significantly reduced overnight.
If not removed plaque is highly acidic. This leads to a break down in tooth enamel and furthermore tooth decay.

We always encourage our patients to brush thoroughly before bed. Not brushing or flossing prior to bed means that the bacteria thrive and basically have a party in your mouth while you sleep!

Is there anything else I can use to clean in between my teeth?

Yes! When you attend our practice for your regular preventative care appointment we will show you alternate devices for cleaning in between your teeth. We know that not everyone finds flossing to come naturally.

These can include: flossettes, interdental brushes, or even water flossers.

My gums bleed everytime I floss

We hear this phrase day in day out. When we see you for your dental check up we will revise the technique with you. More often than not bleeding is not caused by flossing incorrectly.

Inflammation of the gums, otherwise known as gingivitis is what causes bleeding of the gums. As a general rule if you notice bleeding when flossing it is usually a good indication that you need to floss more regularly.

Flossing takes up to much time

The most common excuse we hear on a regular basis when it comes to flossing is: ‘I just don’t have enough time.’ So basically what you are trying to tell us is that for two minutes in a 24 hour period that you don’t have time to floss? If that is the case why not floss whilst watching TV?
With practice flossing takes less than one minute to go around the whole mouth.

Medical conditions that rely on good oral health

When your mouth is healthy, chances are your overall health is good too. On the other hand, if you have poor oral health, you may have other health problems. The most common diseases linked with oral health include, but are not limited to:

  • Diabetes
  • Heart disease
  • Immune disorders

Just remember, a healthy mouth equals a healthy body and if you would like to keep your teeth for the rest of your life then simply ‘floss the teeth that you would like to keep!’