General & Preventative

Preventative Dentistry

A check-up and a clean, every six months

Preventative dentistry is the least interesting thing we do and the reason most of the rest never becomes necessary. A check-up every six months, a clean, and a look at anything that has changed since last time.

The economics are worth stating plainly. Almost everything found at a check-up is smaller, quicker and cheaper to deal with than the same thing found once it hurts, and most health funds cover the examination in full precisely because it lowers what they pay out later.

This page is longer than the others on this site because prevention is mostly something you do at home, between appointments. What happens in the chair is half an hour twice a year. What happens at the bathroom sink is roughly three hundred and sixty-five days of it.

What happens in a six-month examination

A regular dental examination is the foundation to great oral health. Every six months you get a thorough examination, a soft-tissue review, and a scale and polish. That combination catches problems while they are still small, before they turn into painful and costly repair work.

A look at every surface of every tooth
Including the ones you cannot see and cannot reach: the biting surfaces of the back teeth, the contact points between neighbours, and the margins of any existing fillings and crowns.
X-rays, when they are due
Usually every two years for an adult with a stable mouth, sooner if there is a reason. Digital X-rays here mean the image is on the screen beside you within seconds, at a fraction of the radiation of the old film.
A soft-tissue review
Cheeks, tongue, floor of the mouth, palate and throat. This is the part nobody thinks of as dental, and it is the part that finds the things that are not teeth.
A scale and polish
Removing the hardened calculus a toothbrush cannot shift, then polishing the surfaces so the next lot of plaque has less to grip.
A conversation about what we found
On the intraoral camera, on the screen, in words rather than tooth numbers. If nothing needs doing we say so and book you for six months' time.

If you have private health insurance, your fund will generally cover most of the cost of a dental examination. Funds do this to encourage regular attendance, because it lowers what they pay out later. In some cases, your health insurer may cover 100% of this preventative appointment. We are preferred providers for HBF, Medibank, nib, HCF, Bupa and CBHS, and we claim through HICAPS at the desk so you pay the gap rather than the whole fee.

Why the six-month interval exists at all

Six months is not arbitrary and it is not a marketing interval. It is roughly how long it takes for early decay to travel from the outer enamel into the dentine underneath, and roughly how long gum inflammation takes to progress from something reversible to something that has already cost you bone. Catch either inside that window and the treatment is small. Miss it and the treatment is a crown or a root canal.

It is also the interval at which a dentist can compare rather than guess. Every finding at a six-month appointment is measured against the same finding six months ago, so a shadow on an X-ray that has not changed in two years is treated very differently from one that appeared since January. If it has been a long while since your last visit, that first appointment is simply the one that sets the baseline. It takes a little longer and involves more X-rays, and everything after it has something to be measured against.

Six months is a default rather than a rule. Some people are genuinely low risk and are told twelve months is fine. Some are told three. The interval should come out of the examination, not off a wall chart.

What we are actually looking for

Six things, in roughly the order they cost you money if they are missed.

Decay: Tooth decay is the most common disease in the world. Most cavities start in the pits and fissures on the chewing surfaces of the back teeth — grooves too narrow for toothbrush bristles, where food stays trapped after every meal and saliva and fluoride cannot reach to neutralise the acid.
Gum disease: Plaque irritates the gums (gingivitis), making them red, tender and quick to bleed. Left alone the gums pull away from the teeth, bacteria colonise the pockets that opens up, and the bone around the tooth is destroyed. Severe gum disease causes at least a third of adult tooth loss.
Cracks and wear: Grinding, clenching, and a lifetime of chewing flatten and split teeth slowly enough that nobody notices. A crack found while it is confined to enamel is a very different problem from the same crack once it reaches the nerve.
Old restorations: Fillings and crowns do not last forever, and they fail at the margin where they meet the tooth. Decay that starts under an existing filling is invisible to you and obvious on an X-ray.
Soft tissue: Cheeks, tongue, palate and throat. Most of what turns up here is harmless. The point of looking every six months is that the things that are not harmless are far more treatable early, and produce no symptoms at all at the stage where that is true.
Bite and jaw: How the teeth meet, whether the joint clicks or locks, whether one tooth is taking load meant for four. Often the explanation for a tooth that keeps cracking, or a headache nobody has connected to the mouth.

Brushing, in the detail that actually matters

Teeth cleaning is the removal of dental plaque and tartar to prevent cavities, gingivitis and gum disease. Almost everyone does it. Rather fewer do it in a way that reaches the surfaces that decay.

Twice a day, two minutes, with a fluoride toothpaste. Two minutes is much longer than it feels — most people stop at forty seconds.
Spit, do not rinse. Rinsing washes away the fluoride that was about to do the work. This is the single easiest change most adults can make.
Angle the bristles into the gum line rather than scrubbing across the middle of the tooth. Decay and gum disease both start at the margins, which is exactly where a horizontal scrub does not go.
Soft bristles, light pressure. Hard brushing does not clean better; it wears notches into the necks of the teeth and pushes the gums back, and both are permanent.
An electric brush with a pressure sensor is genuinely easier to use well than a manual one, mostly because it stops you pressing too hard.
Last thing at night matters more than any other brush of the day. Saliva flow drops while you sleep, so whatever is left on the teeth at bedtime has eight uninterrupted hours to work.

Dental sealants are the other half of this. Applied by a dentist, they cover and protect the fissures and grooves on the chewing surfaces of the back teeth, so food cannot become trapped in the one place a brush was never going to reach. They are most useful on children's adult molars, in the first couple of years after those teeth arrive.

Between cleanings, this is the whole of prevention. Professional cleaning twice a year removes what has already hardened; careful brushing and flossing is what stops it hardening in the first place.

Flossing, and why a brush cannot do it

Your toothbrush reaches three of the five surfaces of a tooth. Floss is the only thing that reaches the other two, and those two are where both gum disease and decay usually start.

Floss removes plaque and decaying food from between the teeth. Left there, it irritates the gum until it bleeds easily, and the acid from it demineralises the enamel on two surfaces you will never see in a mirror. By not flossing you are missing two of the five surfaces of every tooth in your head.

Floss once a day, before you brush, so the fluoride can reach the gaps you have just cleared.
Use enough — around twenty-five centimetres, wound onto the middle fingers, with three or four centimetres held taut between the thumbs.
Curve the floss around each tooth in a C and slide it under the gum margin. That is where the plaque is.
Move to a clean section of floss for each gap.
Expect some bleeding for the first week or two if you are starting again. Gums that bleed are gums that need flossing; they settle.

Do not

Saw the floss straight down onto the gum. Gum is far more sensitive than enamel and it does not grow back.
Skip the back of the last molar because there is no tooth next to it. It decays like any other surface.
Give up because it bleeds. Bleeding is the symptom of the problem flossing fixes.
Substitute mouthwash. It rinses; it does not disturb the biofilm, and the biofilm is the point.
Assume interdental brushes are cheating. If the gaps are large enough for one, they clean better than floss does.

Your tongue and your gums

Clean your tongue as part of daily oral hygiene. The white or yellow coating on the top of the tongue is a mix of bacteria, decaying food, fungi and dead cells, and it is the main source of bad breath — considerably more so than the teeth. Cleaning it also removes some of the bacterial species that drive tooth decay and gum problems. A scraper works; the back of a toothbrush works nearly as well.

Gums want stimulation rather than protection. Massaging them with the bristles as you brush the gum line is generally recommended, and gums that have been left alone for years because they bleed are gums that will keep bleeding. The bleeding stops when the plaque at the margin goes, usually within a fortnight.

Diet, and the thing almost nobody is told

How often you eat sugar matters more than how much of it you eat.

Every time sugar reaches the teeth, the bacteria in plaque convert it to acid and the enamel starts losing minerals. Saliva then spends roughly the next half hour neutralising that acid and putting the minerals back. A whole chocolate bar eaten at once is one acid attack. The same bar eaten one square at a time across an afternoon is eight, and the enamel never gets a full recovery period between them.

Which is why grazing, sipping soft drink at a desk, and a sports drink nursed through a training session do far more damage than their sugar content suggests. It is also why the standard advice is to keep sweet things to mealtimes rather than to give them up: at a meal, there is more saliva and the attack is over sooner.

Acid without sugar does the same thing. Sparkling water, citrus, wine, kombucha and diet soft drink all sit well below the pH at which enamel dissolves. Eating a balanced diet and limiting snacks between meals prevents both tooth decay and periodontal disease, and it costs nothing.

Common questions