Dental decay occurs when a triad of factors are present which overwhelm the body’s defence mechanisms. Like many other diseases, decay occurs when viable bacteria find a suitable niche and form plaque, into which dietary sugars diffuse (technically ‘Non-Milk Extrinsic Sugars’ or NMES). The bacteria in turn, with time, break down the sugar into an acid, which wears away at tooth enamel just like a normal acid would eat away at a block of marble. The process of decay is reversible, and if suitable conditions are present, the balance is tipped in favour of the tooth remineralising (regaining sufficient mineral content and getting surface hardness again).  If any of the three requirements for tooth decay are not met (bacteria in plaque, dietary sugar and a susceptible tooth surface) over a period of time, teeth will not decay.

If you brush your teeth well on a daily basis, to brush away the plaque that harbours bacteria, there will not be any organisms that convert dietary sugars into acid. A systematic approach to brushing to make sure all surfaces of the tooth are scrubbed is recommended. However well one might brush, most probably one will not always manage to brush all of the tooth surfaces every time, and so, the more often one brushes, the better the chance of taking off all of the plaque. Brushing is recommended twice daily; morning and evening, just before bedtime. Brushes however, do not manage to clean in between teeth well enough, and floss is therefore recommended to prevent tooth decay that might start between the teeth.

This will serve to cut down on the possibility of bacteria converting the sugar into acid that eats away at the tooth surfaces. “Sugar” does not only include sweets and chocolate, but also encompasses all those edible items that contain “hidden” sugars like tomato ketchup, fruit squashes and some fruit juices, some milk flavouring products and snacks such as flans and biscuits. If in doubt, consult the manufacturer’s contents label on food products; items like “glucose”, glucose syrup” and “sucrose” are sugars that cause decay, as opposed to artificial sweeteners, which do not. Fizzy drinks of the “diet” variety do not contain sugars, but are best avoided in excesses because of their highly acidic nature. Not only is the quantity of sugar in the diet that makes a difference; the frequency of sugar intake is of utmost importance. Hence, frequent snacking on sugary foods is even more harmful than a one-off snack. Snacks in between mealtimes or for one hour before bedtime should be avoided, as should milk given to infants at night or at bedtime. Milk as such does not cause decay, but can ferment overnight in the mouth to form sugar, which is then used by bacteria and causes tooth decay

Normally present in toothpastes, fluoride helps the teeth regain any mineral content that is lost by the action of acid produced by bacteria. It gets incorporated into the teeth where any minerals have been lost, and thus strengthens the teeth again. Fluoride supplements like mouthwashes, tablets or high-fluoride prescripition toothpastes might be recommended by a dentist if required.

It might be beneficial in certain cases to cover over the newly-erupted permanent molars with a special resin that fills up the deep fissures in molars (the area where decay usually starts first). Such fissure sealants that may be recommended by your dentist are very easy to place, in a non-invasive procedure where no drilling is required.

Periodontal disease, also known as gum disease, is a common condition that affects the tissues supporting your teeth. It begins with inflammation of the gums and, if left untreated, can progress to affect the bone and connective tissue that hold teeth in place. Often painless in its early stages, it can quietly lead to tooth loss and other health complications if not addressed

In gingivitis, the gums gets inflamed and swells. They will be sore to touch, and may bleed easily. At this stage, healing occurs simply if the patient brushes more thoroughly. The gums presents ‘false’ pockets of >2mm, as the depth of the healthy pocket is increased only because the gum is bigger, not because of bacterial destruction.

These pockets are colonised by bacteria which relase their own toxins thus making the periodontal fibres loose and weak, leading to further shrinkage of the gums and the bone that supports the teeth. Periodontal disease may not be painful except in end-stage disease, where the teeth start getting mobile and painful to bite on

In initial periodontal disease, plaque stagnates in the ‘false’ pockets which become a safe haven for bacteria. Bacterial toxins infiltrate the gum and cause destruction of the gum next to the tooth margin.

At a later stage as the gums shrink back further, bone destruction occurs, thereby reducing the structural support for the tooth. Pockets deepen, and mobility may set in.

It is therefore quite a dangerous disease as it may go un-noticed by the patient for a number of years and may be diagnosed casually on a routine dental check-up when it might be too late to treat in certain cases. It is therefore important to visit the dentist regularly, even if there is no obvious cause for concern or any symptoms, and have a scaling done regularly to remove all calculus from the teeth, which might be a factor that promotes periodontal disease

When diagnosed early enough, periodontal disease can be treated successfully and the disease stopped, although any bone or gum loss that may have occurred might not be reversed.

Following initial gum therapy and coupled with regular pocket cleansing, healing starts with the reduction of inflammation in the gums, followed by a reduction in pocket depth and consequently, cessation of bone destruction.

Healing is complete when gum inflammation and swelling go down completely, and pocket depth returns to the normal 2-3mm, thereby making the gum margins cleansable again. Some bone healing may occur, although bone regeneration does not usually occur unaided. Bone and gum grafts may be required to restore aesthetics in sensitive areas.

Any signs of bleeding from the gums must be followed up by more careful brushing at that particular spot, as that implies that the gums will have been irritated by the presence of plaque which causes gingival inflammation, which in turn if left unchecked might lead to periodontal disease. Smoking plays a big part in periodontal disease, not least as the bacteria that cause the disease thrive in an atmosphere of reduced oxygen. People with poorly-controlled diabetes are also at an increased risk. Your dentist might recommend seeing a specialist if periodontal disease is especially severe or aggressive

Ultimately, periodontal disease develops as a result of bacterial activity and an exaggerated immune response to the toxins those bacteria produce. Over time, this combination can lead to inflammation, tissue damage, and the gradual loss of the bone supporting the teeth. Because plaque is the primary source of these harmful bacteria, maintaining excellent plaque control on a daily basis is essential to keeping the gums healthy. Regular and thorough cleaning—both above and below the gumline—helps disrupt bacterial build-up before it can cause harm. Electric or mechanical toothbrushes and interdental cleaning aids, such as floss or interdental brushes, are particularly effective tools for this purpose, helping ensure that even the hard-to-reach areas are kept clean and healthy

Restoring badly damaged teeth or replacing missing teeth is the job of advanced dental techniques such as crowns, bridges and implants.  Crowns are ‘jackets’ of metal, porcelain or a mixture of both that are designed to sit onto an adequately prepared tooth to restore function and/or aesthetics as appropriate. Teeth are prepared by being cut into smaller sizes, and a crown is manufactured at a laboratory on a model that is prepared from an impression of the prepared tooth. Being stronger than the original tooth and because it sits over the surface of the tooth, the crown gives added support to the tooth structure which would have been weakened through fracture or extensive filling

Bridges consist of two or more crowns joined together to replace one or more missing teeth. In a conventional bridge, a tooth next to the gap is crowned, and an artificial tooth (or teeth) is attached to it, filling the space.

An alternative option is an adhesive bridge, which does not require a full crown on the supporting tooth. Instead, it uses a thin metal or ceramic wing that is bonded to the back of the adjacent tooth with a special adhesive.

Adhesive bridges offer the key advantage of being minimally invasive and reversible, as they do not require the adjacent tooth to be significantly reduced or crowned

Both crowns and conventional (non-adhesive) bridges require the reduction of the tooth structure to create sufficient space for the supporting crown to be cemented. This process carries a risk of damage to the tooth — approximately 40% of crowned or bridged teeth may develop inflammation of the dental pulp (pulpitis), which can cause sensitivity or discomfort for some time after cementation. In most cases, this sensitivity subsides naturally; however, in some instances, the pulpitis may become irreversible, potentially resulting in toothache and the need for Root Canal Treatment or, in rare cases, extraction

Dental implants represent the gold standard for replacing one or more missing teeth. These metal or ceramic fixtures, shaped like small screws, are precisely placed into the jawbone beneath the gums. After a suitable healing period — allowing the implants to integrate securely with the bone — they are restored in the usual way with crowns or bridges.

For patients who are completely edentulous (missing all teeth), several implants (typically three or four in each jaw) can be used to support either a fixed bridge, usually secured with screws, or a removable denture that remains stable thanks to special attachment mechanisms.

Because implants do not rely on or damage adjacent teeth, they have become the preferred option for tooth replacement — particularly for aesthetically conscious patients and in complex cases where traditional solutions may offer limited long-term success.  If you would like to have teeth replaced with implants, we would be happy to refer you to an implantologist for the surgical placement and then provide the restorative work ourselves