‘Healthy’ habits that you should be avoiding
It’s not just about having an attractive smile – though thanks to the effect of TV’s Love Island and TikTok, private cosmetic dentistry is booming. But looking after your teeth is vitally important for your physical wellbeing, too.
That’s because poor dental health is increasingly being linked to serious conditions such as heart disease, stroke, diabetes and even dementia.
The good news is that improved dental techniques, including scans to detect problems and the use of fluoride in tap water, mean that our teeth are generally getting better: fewer people now need dentures in old age, for instance.
Yet an acute shortage of NHS dentists has led to ‘dental deserts’ in some areas: the British Dental Association estimates one in four adults – 13 million people – in England alone, have no access to a dentist.
‘It’s a mixed picture when it comes to the nation’s dental health,’ admits Nigel Carter, a dentist and chief executive of the charity Oral Health Foundation.
But there is plenty you can do yourself to help prevent dental problems. From brushing correctly (are you really?) and avoiding the ‘healthy’ habits that sabotage your teeth, to finding the right treatment if you DO need help.
Everything you need to know is here, in this unique guide produced in conjunction with leading dental experts…
Are you making these everyday mistakes?
It is easy to unwittingly undermine your dental health with your ‘healthy’ habits. Here experts look at these and other unexpected pitfalls:
Starting your day with hot lemon and water, or apple cider vinegar
‘Lemon water and apple cider vinegar are both big health crazes, with claims they boost liver and digestive health – but, essentially, they mean you are bathing your teeth in acid,’ says Anni Seaborne, a dentist in London and Surrey and head of general dentistry at Bupa.
Lemon and water is acidic and it takes the saliva in your mouth 30 minutes to neutralise it, adds dentist James Goolnik, of the Optimal Dental Health Clinic in London.
‘If you drink them, use a straw ‘so that the acid bypasses your teeth, or have them at the same time as food so your teeth are not under attack twice but just once’, Anni Seaborne advises.
Brushing teeth straight after food
You may have been told to do this as a kid, but you should wait 30 minutes. This allows saliva to neutralise the acid in the mouth, and tooth enamel to harden – otherwise you’re just brushing it away.
‘If you’re too busy to wait, brush before breakfast,’ says Anni Seaborne. Some dentists advise this anyway, to remove bacteria that’s accumulated overnight and that will feed off what you next eat.
Scrubbing your teeth
Anni Seaborne says: ‘While it’s important to be thorough and spend two minutes brushing twice a day, brushing too hard will weaken your tooth enamel and may also cause gum recession, which can lead to tooth loss.’
Drinking sparkling mineral water or diet fizzy drinks
‘Some carbonated waters are acidic, with pH as low as 2 or 3 [very acidic] which will dissolve your teeth,’ warns James Goolnik (you can check the pH – acidity – of some drinks on the brand’s website).
‘Anything below a pH of 5.5 will dissolve your teeth.
‘If you must drink fizzy water, I’d limit it to once or twice a week, or as a way of transitioning from sugary fizzy drinks.’
And while these are obviously bad for your teeth, diet or zero sugar drinks can also do harm, says James Goolnik, ‘because they are carbonated’.
Looking after your teeth can have far-reaching effects on your health, says Stephen Porter, a professor of oral medicine at University College London. Research has linked advanced gum disease to heart attack, stroke and, recently, to dementia, rheumatoid arthritis and even cancer. One theory is that ‘bad’ bacteria from the mouth can move into the bloodstream and travel around the body.
Plus, the immune system produces inflammatory cells to fight the bacteria, leading to higher levels of inflammation linked to chronic diseases.
The good news is that if you already have conditions such as heart disease, treating your gum disease may help, by improving your blood vessels, ‘which means you will be less likely to have angina, stroke or heart attack’, says Professor Porter.
Similarly, if you have type 2 diabetes, treating your gum disease ‘may reduce inflammation, which reduces blood sugar levels slightly’.
He adds: ‘There’s a theory that if you improve oral health, the risk of dementia may be lessened. Research is at an early stage.’
Eating sushi
We all know sweets, chocolate, fruit juice, cakes and dried fruit are full of sugar that’s bad for teeth, but other staples such as rice also contain it.
This includes sushi which, despite its health halo, is soaked in a sweet Japanese rice wine called mirin – as well as refined carbohydrates such as white bread.
‘They’re sticky foods and will adhere to your teeth like glue if you don’t brush them off or floss to remove them,’ says James Goolnik.
Drinking kombucha
‘Kombucha is a fermented tea which contains ‘good’ bacteria, touted as a health drink for improving the gut microbiome [the community of microbes linked to wellbeing], but it can be very acidic and a lot of products have added sugar,’ says James Goolnik. ‘Check the pH and sugar content on the company website and drink it with a meal to dilute its effects.’
Your prescription medicine
Around 20 per cent of the population, particularly the elderly, suffer from dry mouth.
‘This not only affects their swallowing, taste and speech but can put them at higher risk of tooth decay,’ says Stephen Porter, a professor of oral medicine at University College London. ‘Saliva prevents dental plaque from sticking to the gums and teeth – and has a variety of components that destroy plaque bacteria or inhibit their action upon the tissues,’ he adds.
Dry mouth is also a side-effect of some commonly prescribed drugs, such as diazepam, used for anxiety, as well as some antidepressants.
Saliva supplements (which contain lubricating agents such mucins or glycerin) can counter some dry mouth and are available from pharmacies.
‘For more severe cases, such as after radiotherapy or as a result of conditions that affect saliva production such as the autoimmune disease, Sjogren’s syndrome, there are drugs that increase the amount of saliva (e.g. pilocarpine) which can be prescribed by a doctor or dentist,’ says Professor Porter. ‘It’s important that the cause is established by a clinical team.’
What to do when things go painfully wrong
If, despite your best efforts, you suffer problems, here is our guide to the latest thinking about treatment…
Tooth decay
This is the result of the bacteria in your mouth producing acid, which attacks the protective enamel, leading to cavities, tooth sensitivity and pain, infections and tooth loss.
As well as good dental hygiene, research – such as a 2020 review published in the journal Nutrients – suggests that a lack of vitamin D contributes to tooth decay. ‘So taking a supplement may be beneficial if you have low levels,’ says dentist James Goolnik.
Treatment
Fillings
Silver amalgam is most often used in the NHS. It’s being banned in the EU from January over concerns about environmental mercury pollution, which may then affect supply in the UK.
As a spokesman for the British Dental Association explained, the ban means it won’t be as economic to export it, and could also push up costs.
White fillings are made from composite resin, a blend of plastics and fillers such as silica, and are usually only available on the NHS for front teeth.
Amalgam fillings last between five and 25 years, white fillings between five and 15 years.
Sometimes a filling leaks: the side doesn’t fit snugly against the tooth, allowing debris and saliva to seep into the gap, causing sensitivity. This is usually short-term with amalgam, as it corrodes and seals the edge of the filling.
Composite fillings can become contaminated with saliva, weakening the bond with the tooth, causing sensitivity. This usually settles, but if not, the filling might need to be replaced.
Cost: £73.50 on the NHS for white or amalgam (whether you need one or multiple fillings). An amalgam filling will be £90 to £140, privately, and a white filling, £100 to £180.
Extraction
Some teeth can’t be saved (being too rotten or wobbly due to gum disease) and have to be removed, usually under local anaesthetic.
Cost: £73.50 on the NHS, or free if you are on certain benefits, pregnant or aged under 18; from £50 to £350, privately.
Crowns
These are caps that fit over decayed, broken, weak or worn down teeth; they’re also used on dental implants and root canal-treated teeth, and to anchor dental bridges. They should last at least ten years and can be made from metal, resin and porcelain.
Cost: £319.10 on NHS (whether you need one or more); privately, £600 to £1,000 per crown.
Root canal
This involves removing inflamed or infected tissue inside the tooth and can sometimes prevent the need to remove it. The infection itself can be the result of tooth decay, damage from an accident or leaky fillings. Each tooth contains blood vessels and nerves, called ‘pulp’, which extends down into its roots. The pulp inside the root is called the root canal.
‘If the blood vessels or nerves become exposed and bacteria gets in, it can cause infection, swelling and pain,’ says dentist James Goolnik. ‘A root canal procedure can clear the infection and disinfect the tooth, which is then sealed with gutta percha [a rubber-based material] and topped with a crown.’
Although root canal treatment has a reputation for being painful, a local anaesthetic means you shouldn’t feel anything.
Cost: £73.50 on the NHS; £250 to £320 privately.
Implants
Dental implants can replace teeth that have been lost to decay, gum disease or trauma. They consist of titanium posts implanted into the jawbone.
If you’re out and can’t clean your teeth, eat a piece of cheese – it will neutralise your mouth’s pH and protect your teeth from acid
‘Once the bone has healed, usually after three months, replacement false teeth – crowns, bridges or dentures – can be fitted over the posts,’ says Nilesh Parmar, a dentist at Parmar Dental clinic in Essex. ‘Some dentists provide a same-day service with the teeth attached to the implants as an alternative to dentures if people have very few or no teeth.’
With care, implants can last for more than ten years. While the success rate is 95 per cent, possible complications include infections, gum recession and nerve or tissue damage. Check what training your dentist has had in implant surgery, how many they’ve placed and what happens if it fails.
Implants aren’t usually available on the NHS, except if a patient can’t wear dentures, or their face and mouth have been damaged by cancer or an accident.
Cost: From £2,500 per tooth, privately.
Bridges
Like implants, these are also used to replace missing teeth – essentially false teeth (also known as pontics) are made to measure using porcelain, to fill the gap.
A crown is then cemented on to the tooth on either side of the pontic, to anchor it.
Other styles include cantilever bridges (cemented to one tooth at the side of the pontic rather than two); and resin-bonded fixed partial dentures, placed on to adjacent teeth with a metal structure (invisible at the front of the mouth).
Dentist James Goolnik says the latest bridges are metal-free made from zirconia, a type of ceramic, which are more durable.
‘However, more people now opt for an implant as it doesn’t involve touching adjacent teeth, stabilises the bone, is easier to clean and maintain, plus the implant can last for life and the crown for ten years.’
Cost: £319.10 on the NHS; £350 to £1,000 privately.
Dentures
Around 6 per cent of adults in the UK have no natural teeth left and use dentures to replace a set of teeth. These typically last five to ten years.
Cleaning dentures is essential, as a build-up of plaque and tartar can make them uncomfortable to wear. This means removing and cleaning them nightly, then keeping them in a polythene bag overnight, with a dampened cotton wool ball, or soaked in a dental-cleansing solution.
‘You also need to clean your mouth and tongue with a toothbrush and remove food trapped between your gums and cheeks twice a day,’ says hygienist Caitlin Miller.’
Cost: £319.20 on the NHS: £500 to £2,500 privately.
Gum disease
Poor dental hygiene can lead to a build-up of sticky plaque and tartar (hardened plaque) on the gum line: bacteria collects there, causing inflammation, and swollen, bleeding gums and bad breath.
If untreated, teeth may become loose. You might notice red gums that bleed when you brush.
Treatment
A hygienist or your dentist can remove plaque build-up.
‘Your dentist may also use ozone liquid or gas to clean pockets of gum disease under the gum line,’ adds James Goolnik.
‘It has antimicrobial and immune-stimulating properties.’ (It is only available privately.)
Cost: Part of appointment fee.
Bone grafts
Serious gum disease (‘periodontal’ disease) can lead to bone loss and may require a graft before implants are fitted. Bone is either taken from another part of your jaw, or bone-grafting material is used.
Cost: Not available on NHS; £500 to £2,000 privately.
Laser light
THIS is used to destroy harmful bacteria in the diseased gum and promote faster healing.
Cost: Not available on the NHS; £1,150 to £1,700 privately.
Loose teeth
Typically, this occurs as a result of gum disease.
Treatment
Scaling/ planing
A deep-cleaning procedure to remove tartar from the gums and below the gum line and smooth or ‘plane’ the exposed surfaces of the roots to remove tartar and bacteria. The gum reattaches to the teeth and the bone regrows to anchor the tooth.
Bone grafts may also be necessary to stabilise the tooth; implants or bridges may be needed to replace a lost tooth.Cost: £73.50 on the NHS; from £115 per quadrant privately (dentists divide the mouth into four sections, or quadrants, for diagnosis and treatment).
Sensitive teeth
Common causes include decay, a cracked tooth, a loose filling and gum shrinkage, which expose the nerves inside the tooth.
Overbrushing, using abrasive toothpaste and diet with a lot of acidic foods such as vinegar can also make teeth sensitive (they damage the enamel, exposing the pores – the tiny fluid-filled channels that run from the centre of the tooth to the enamel).
‘Sensitivity can be sign a nerve is dying, so seek advice if it’s lasted over a week,’ says James Goolnik.
Treatment
Toothpastes
‘Treatments include repairing damage to the tooth [such as loose fillings] and using toothpaste for sensitive teeth,’ says James Goolnik.
These work by temporarily filling in pores.
You can also buy toothpaste containing hydroxyapatite, a natural component of teeth which hardens them and blocks the pores for longer.
Ozone
WHILE toothpaste is short-acting and needs to be applied regularly, ozone – a form of gas – effectively treats sensitivity by strengthening the tooth enamel.
‘It’s a very good non-invasive treatment for sensitivity,’ says James Goolnik.
Cost: Not available on the NHS; usually incorporated as part of a private treatment plan.
‘Bad breath – or halitosis – usually has an underlying cause such as gum disease or decaying food caught in gaps, bridges or braces,’ says Caitlin Miller, head of dental hygiene at Bupa. Sometimes, the cause can be a medical condition, such as acid reflux, or it is the result of dry mouth, which is a side-effect of some medications (see below).
Also, your tongue has hundreds of small hairs on its surface plus tastebuds, says dentist James Goolnik.
‘Food, bacteria and dead cells get caught in those nooks and crannies. It’s the by-products of the bacteria that cause the odour. Using a tongue scraper removes the bacteria.
‘I recommend my patients do this every day, ideally before brushing their teeth before bed – it helps with bad breath and gum disease,’ he says.
(A toothbrush isn’t as effective – you need something with a larger surface area.)
As for a breath freshener, ‘this just masks the problem and some alcohol-containing ones actually make it worse because they dry the mouth’, says James Goolnik.
Instead, he recommends chewing parsley or mint leaves, or drinking hot water with cinnamon. If your bad breath persists for more than a few weeks, see your dentist.
Are you sure you’re cleaning teeth properly?
You might think you how to brush but here are some common mistakes:
Skimping on toothbrushes: You should change your toothbrush every three months, yet sales figures show that people only buy 1.3 toothbrushes a year on average.
‘Worn out bristles won’t remove plaque as effectively and will be covered in bacteria,’ says dentist James Goolnik. If you’ve been ill, change your toothbrush or soak it in antibacterial mouthwash overnight – ‘otherwise you’re reinfecting yourself every time you put it in your mouth’.
Rinsing your mouth after brushing: This washes out the fluoride from your toothpaste – fluoride remineralises (i.e. strengthens) teeth, making them more resistant to acid.
‘If you rinse, you will get more holes in your teeth,’ says dentist Ben Atkins, a dentist at the Revive Dental Clinic in Salford.
‘It’s OK to spit out toothpaste, but don’t rinse. Instead, let the fluoride stay on your teeth for as long as possible.’
Using charcoal toothpaste: A popular option ‘because it’s seen as a natural alternative for whitening teeth, but there is little evidence of its effectiveness and it is very abrasive and can make teeth more sensitive’, says dental hygienist Anni Seaborne. Most also don’t contain fluoride.
‘Charcoal toothpaste can even make teeth darker,’ she adds. That’s because they can wear down the enamel, exposing the dentine underneath, which is naturally more yellow.
James Goolnik adds: ‘Check the Relative Dentin Abrasivity value – a measure of how abrasive a toothpaste is. The score needs to be below 70 at least.’
Not brushing correctly: Almost half of us don’t know the correct way, a 2015 survey by Bupa showed. Check your technique against hygienist Caitlin Miller’s rules:
1. Clean gaps between teeth before you brush. Research shows interdental brushes are more effective than flossing. You may need different brush sizes for different gaps.
Use interdental brushes before brushing your teeth at night, to remove the food and plaque and so that toothpaste can penetrate between the teeth. Cleaning between the teeth is even more important at night as saliva production drops, so acid isn’t neutralised as quickly. You can also use a water-flosser, which is like a power wash for teeth.
2. Use a fluoride toothpaste, these are proven to strengthen enamel and remineralise teeth.
3. Use a lentil-sized amount of toothpaste and apply to all surfaces of teeth using a circular motion – that means spending 30 seconds on the bottom gum at the front and 30 seconds at the back, then the same on the top gums. Hold the brush at a 45-degree angle and brush one tooth at a time.
P.S. Unless your dentist says to, there’s no need to use mouthwash, says Caitlin Miller. If you have gum disease, choose a product with chlorhexidine (a type of disinfectant) – but use only as directed by your dentist or hygienist as chlorhexidine can stain your teeth over time, so shouldn’t be used every day.
DIY tips for toothache
You must see a dentist urgently if you have facial swelling, a fever or difficulty swallowing, as these are a sign of an infection, says Julia Coelho, a dentist at The Door W4 clinic, London. Or go to A&E if your dentist isn’t available.
As well as taking painkillers, rinse your mouth with salt water to reduce the bacteria causing any problems. Applying clove oil to a cotton ball is a popular remedy. It contains eugenol which can numb the tooth.
A small study in the British Journal of Maxillofacial Surgery in 2015 found a paste made with eugenol worked better for pain after extraction than gel containing chlorhexidine and those who used it had a lower rate of infection.
But Julia Coelho says clove oil can damage gums and inside the tooth, ‘so take some painkillers until you can see a dentist’.
Dark side of veneers and teeth whitening treatments
The cost of private cosmetic dentistry in the UK has led to a boom in dental tourism, particularly in Turkey, where it can be 50 per cent cheaper.
However, UK dentists are having to pick up the pieces when things go wrong, says dentist James Goolnik.
‘It’s a false economy going overseas unless you get follow-up care and guarantees on how long the work will last,’ he says. ‘I’ve had patients who come to see me after their veneers fall off after only after a few weeks.
‘Others are having healthy teeth drilled down for veneers which will need replacing in ten years.’
Here is our expert guide to what to expect if you’re paying for cosmetic procedures:
Clear aligners
These invisible braces that look like a clear ridged gumshield are popular. You wear each set of aligners for one or two weeks for 22 hours a day, only removing them to eat or brush your teeth. Your progress is monitored and new aligners provided as needed.
It takes about six to nine months to complete. You then need to wear a retainer for life.
Cost: Only available privately, from £1,800 to £5,500.
Whitening
Teeth darken naturally with age and can also be stained by smoking, foods and highly pigmented drinks, such as tea, coffee and red wine.
Tooth whitening is not usually available on the NHS.
The kits you can buy in shops have very low levels of hydrogen peroxide (under 0.1 per cent), a bleaching agent that breaks down molecules that stain teeth.
By law, only dentists on the General Dental Council register can supply stronger products (up to 6 per cent hydrogen peroxide).
‘The problem is that many teeth-whitening products sold online exceed the legal and safe levels of peroxide, potentially leading to damage to teeth and gums,’ says dentist Julia Coelho.
Getting whitening done at the dentist also means you will have trays custom-made to fit your teeth which won’t leak and damage your gums, she adds.
Another option is laser whitening: here a bleaching product is painted on to your teeth and a laser light shone on them to activate the whitening.
Cost: With hydrogen peroxide, £300 to £1,000; laser whitening, £500 to £1,000.
Composite bonding
Material such as resin can be added to reshape or rebuild damaged teeth and cover cracks.
Rizwan Mahmood, a dentist at Ruh Dental Clinic in London, says: ‘There’s been a boom in this area with cheap offers, but sometimes I’ve seen patients who’ve been treated elsewhere who need composite bonding replaced within a few months due to staining.
‘Or they have gum disease and the dentist didn’t tackle this problem first.’
While composite bonding is primarily a cosmetic procedure, it’s sometimes done on the NHS if teeth are affecting a person’s ability to eat or speak, or they have severe dental trauma.
Cost: £50 to £350 per tooth, privately.
Veneers
This involves drilling your natural teeth enamel down and attaching porcelain covers to the front.
They usually last ten years (they’re not available on NHS unless there is a clinical reason, such as trauma or cancer).
‘It’s a big investment but they can change the shape of your face,’ says dentist Nilesh Parmar.
‘The downside is that they will need replacing at some point; they can also cause gum disease, bad breath and serious infections if not done properly. I spend 20 per cent of my time putting work done abroad right.
‘I saw one young man who’d had all his teeth filed for veneers, when all he’d really needed was white fillings and aligners. He had to have all his teeth taken out and was looking at a £50,000 bill for implants.’
Krystyna Wilczynski, a dentist in London, adds that for healthy young people with no cavities, drilling their teeth to fit veneers is condemning them to the restoration cycle for life. ‘I will only do them on older people whose veneers have failed, or their composite bonding has had its day.’
Cost: £800 to £1,000 per tooth, privately.
For more than 50 years, child psychotherapist Julie Lynn Evans, 67, a mother and grandmother, was so afraid of the dentist she would ‘kick the drill out of their hands’ or worse, actually kick the dentist.
The issue stemmed from a traumatic childhood experience: ‘I was at a boarding school and, aged eight, I needed a filling, which was done without pain relief. ‘I was in so much pain and tried to say so, but no one listened. I was so terrified I wet myself,’ recalls Julie (pictured), who lives with husband Stephen, 76, in London and Oxfordshire. ‘After that, I developed a phobia of the dentist.’
While she didn’t avoid going completely, she says: ‘I’d make myself go once a year, but each visit was an ordeal. I wouldn’t sleep for two days before and I became a kicking, screaming baby in the dentist’s chair.
‘It got so bad that, on several occasions, I had to pay for a doctor to sedate me with a Valium injection before
I had something done such as root canal – at £950 a time just for the sedation.’
Julie’s phobia is far from unusual.
One 2018 survey suggested that 53 per cent of Britons fear visiting
the dentist and, for 17 per cent, that fear is ‘a true phobia, and they don’t go to the dentist at all’, says Safa Al-Naher, a dentist at Serene Dental and Facial Aesthetics in London.
She uses a combination of meditation techniques and nitrous oxide (gas and air) to calm anxious patients.
‘I’ll always spend at least half an hour with a patient talking to them about their fears,’ she explains.
Julia’s phobia, which thankfully didn’t extend to her children (‘dentists were a lot more child-friendly by then’),
is now being managed with a combination of nitrous oxide and visualisation techniques. She’s braved having some teeth capped, deep gum-cleaning and had clear aligners fitted, plus tooth whitening. She’s also about to have an implant to replace a tooth.
‘I am still on edge when I hear the drill but I’m able to use these techniques to overcome it,’ says Julie.
‘And for the first time in my life I have white, straight teeth – not yellow snaggly ones and I’m not scared to have work done if I need it.’
Do you really need an £800 toothbrush?
Manual toothbrushes cost as little as 25p, hi-tech electric versions as much as £800, but ‘it’s still about how you use the toothbrush and how often, not how much you spend on it’, says hygienist Caitlin Miller.
If you go for a manual one, she recommends a small, oval head with medium-strength bristles.
‘Small heads are better as you can concentrate on one tooth rather than trying to clean three at once less effectively,’ she says. ‘Medium-strength bristles are better than soft, which just aren’t effective enough.’
Some cheap toothbrushes are too hard on the gums, she adds.
‘The most important thing about manual toothbrushes is that you change them every three months.’
If you can, she suggests buying a rechargeable electric toothbrush: ‘They’re more powerful and therefore more effective; the good ones also have pressure sensor lights which can tell you if you’re brushing too hard.
‘Don’t be tempted by cheaper battery-operated brushes, as they’re not very effective.’
Then there are the ‘super’ brushes, such as Oral-B iO Series 10 Magnetic Technology (£300 on offer, boots.com).
This gives feedback (colour sensors flash if you’re brushing too hard or soft, or just right) and teeth tracking to guide your brushing via an app.
‘This might be useful to motivate you, but you can get a decent electric toothbrush for a lot less, for around the £50 to £100 mark,’ says Miller, who advises you look for: