Secondhand Smoke

Emma's friend Megan lights up a cigarette every chance she gets — while she's cruising around with their friends on Friday nights, during breaks at the pizza place, before soccer scrimmages, even as she babysits her brother. Emma's worried — both for her friend's health and for her own. She's not sure Megan realizes how her habit could be affecting the health of the people she smokes around.

Everyone knows smoking is a bad idea. And by now you've probably heard that breathing in someone else's secondhand smoke is also hazardous to your health.

What Is Secondhand Smoke?

Secondhand smoke comes from both the smoke that smokers exhale (called mainstream smoke) and the smoke floating from the end of the cigarette, cigar, or pipe (called sidestream smoke).

It may seem pretty harmless, but secondhand smoke actually contains thousands of chemicals — from arsenic and ammonia to hydrogen cyanide — many of which have been proven to be toxic or to cause cancer (called carcinogens). High concentrations of many of these chemicals are found in secondhand smoke. In fact, secondhand smoke significantly increases a person's risk for:

• respiratory infections (like bronchitis and pneumonia)
• asthma (secondhand smoke is a risk factor for the development of asthma and can trigger attacks in those who already have it)
• coughing, sore throats, sniffling, and sneezing
• cancer
• heart disease

So secondhand smoke doesn't just impact a person in the future. It can cause problems right now, like affecting someone's sports performance or ability to be physically active.

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Inhalants

Most people think harmful drugs are only found on street corners or in local pharmacies, not cleaning cabinets or garages.

But sometimes items commonly found in millions of homes aren't used for their intended purposes. Some people inhale the chemical vapors produced by common household substances — known as inhalants — to get high. What many of them don't realize is how dangerous this really is.

Why People Use Inhalants

Inhalants might seem like an alternative to other mood-altering drugs because they are cheap, can be purchased legally, and are easy to obtain. But that doesn't make them safer. When used as directed, household products are safe for cleaning, painting, and the other things they're meant to do. But as inhalants, they can be deadlier than street drugs.

Different Kinds of Inhalants

There are four main types of inhalants: volatile solvents, gases, aerosols, and nitrites. Volatile solvents, gases, and aerosols can alter moods and create a high. Nitrites are believed to create sexual stimulation and enhancement.

Here is what else you need to know about the types of inhalants:

• Volatile solvents are liquids that become a gas at room temperature. Some examples are paint thinners and removers, gasoline, glues, and felt-tip marker fluids.
• Gases include medical gases (ether, nitrous oxide) and household or commercial products (butane lighters, propane tanks, whipped cream dispensers that contain nitrous oxide, and refrigerants).
• Aerosol sprays are some of the most prevalent inhalants in the home and include spray paint, deodorant and hairsprays, vegetable oil cooking sprays, and static cling sprays.
• Nitrites include cyclohexyl nitrite, amyl nitrite, and butyl nitrite. On the street, they're called "poppers" or "snappers." They're found in some room deodorizers and capsules that release vapors when opened.

Effects on the Body

People inhale chemical vapors in several ways, including sniffing, snorting, or spraying the inhalant directly into the nose or mouth, putting it into a bag or other container and then inhaling from there, putting the vapor onto a rag, or inhaling nitrous oxide from balloons.

Because the high from inhalants only lasts a few minutes, some people may inhale over and over again for long periods of time to maintain the high, increasing the amount of dangerous chemicals entering and damaging the body.

Inhalants can cause many changes in the body. Once the vapors enter the body, some are absorbed by parts of the brain and nervous system. All of the inhalants (except nitrites) slow down the body's functions, similar to the effects of drinking alcohol. At first someone gets excited, but then gets tired, has trouble speaking clearly or walking well, gets dizzy, loses inhibitions, and may get agitated. It can sometimes take up to 2 weeks for the chemical to completely pass from the body.

Other short-term effects of inhaling chemicals include:

• increased heart rate
• hallucinations or delusions
• losing feeling or consciousness
• nausea and vomiting
• loss of coordination
• slurred speech

Because inhalants are found in most homes, people don't realize they are incredibly addictive. People who become addicted to using inhalants are likely to become long-term users. This puts them at risk for these health problems:

• brain damage (toxic chemicals may make people become slow or clumsy, have trouble solving problems or planning ahead, suffer from memory loss, or become unable to learn new things)
• muscle weakness
• depression
• headaches and nosebleeds
• loss of sense of smell or hearing

Nitrites work differently. Instead of slowing down the brain and the spinal cord, they increase the size of blood vessels and relax the muscles.

How Inhalants Kill

Like most street drugs, inhalants can be deadly. Someone can die from abusing inhalants after trying it only once. Causes of death include:

• "Sudden Sniffing Death" — This is the most common cause of death from inhalant use. The heart beats quickly and irregularly, and then suddenly stops (cardiac arrest). This can happen even the first time a person tries an inhalant and is experimenting.
• Asphyxia — Toxic fumes replace oxygen in the lungs so that a person stops breathing.
• Choking — A user can choke on his or her vomit.
• Suffocation — When vapors are inhaled from a plastic bag placed over the head, the bag can block air from entering the lungs.
• Injuries — Since people high on inhalants often make poor decisions, they might try to drive under the influence or do something irrational, such as jump off a roof. They could also get burned or start explosions if a spark ignites flammable inhalants.
• Suicide — Some people become depressed when their high wears off.

Signs of Inhalant Abuse

Inhalants, like other drugs, have noticeable effects on those using them. Someone on inhalants may suffer from a number of different ill effects, including:

• mood swings
• extreme anger, agitation, and irritability
• exhaustion
• loss of appetite
• frequent vomiting
• hallucinations and illusions
• facial rashes and blisters
• frequent runny nose and cough
• dilated pupils
• glazed or watery eyes
• extremely bad breath

Of course, some of these things are signs of other health problems, not necessarily inhalant use. If you're worried about a friend or loved one, talk to a parent, school counselor, or your doctor or school nurse.

Getting Help

If you think you — or a friend — may be addicted to inhalants, talk to your doctor, school counselor, or nurse. They can help you get the help you need.

Several kinds of treatment are available for drug addiction; the two main categories are behavioral (helping a person change behaviors) and pharmacological (treating a person with medication).

Treatment for inhalant addiction is primarily behavioral. An expert in drug treatment teaches people how to function without drugs — handling cravings, avoiding situations that could lead to inhalant use, and preventing and handling relapses.

As with any addiction, it can be difficult to stop without professional help and treatment. Overcoming an addiction is not something that can be done alone; everyone needs support. The experts who help people with addictions are trained to help, not judge. To find a drug treatment center in your area, check online, check out the yellow pages, or ask a counselor for advice.

Reviewed by: Yamini Durani, MD
Date reviewed: January 2012
Originally reviewed by: Michele Van Vranken, MD

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Dealing With Addiction

Jason's life is beginning to unravel. His grades have slipped, he's moody, he doesn't talk to his friends, and he has stopped showing up for practice. Jason's friends know he has been experimenting with drugs and now they're worried he has become addicted.

Defining an addiction is tricky, and knowing how to handle one is even harder.

What Are Substance Abuse and Addiction?

The difference between substance abuse and addiction is very slight. Substance abuse means using an illegal substance or using a legal substance in the wrong way. Addiction begins as abuse, or using a substance like marijuana or cocaine.

You can abuse a drug (or alcohol) without having an addiction. For example, just because Sara smoked pot a few times doesn't mean that she has an addiction, but it does mean that she's abusing a drug — and that could lead to an addiction.

People can get addicted to all sorts of substances. When we think of addiction, we usually think of alcohol or illegal drugs. But people become addicted to medications, cigarettes, even glue!

And some substances are more addictive than others: Drugs like crack or heroin are so addictive that they might only be used once or twice before the user loses control.

Addiction means a person has no control over whether he or she uses a drug or drinks. Someone who's addicted to cocaine has grown so used to the drug that he or she has to have it. Addiction can be physical, psychological, or both.

Physical Addiction

Being physically addicted means a person's body actually becomes dependent on a particular substance (even smoking is physically addictive). It also means building tolerance to that substance, so that a person needs a larger dose than ever before to get the same effects.

Someone who is physically addicted and stops using a substance like drugs, alcohol, or cigarettes may experience withdrawal symptoms. Common symptoms of withdrawal are diarrhea, shaking, and generally feeling awful.

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I Think I May Have a Drinking/Drug Problem. What Should I Do?

My friend thinks I have a drinking and drug problem. What should I do?
- Taylor*

Using alcohol or drugs regularly is usually just a step away from addiction (where you depend on these substances to feel good or get through your day).

Here are a few warning signs that someone may have a substance abuse problem:

• relying on drugs or alcohol to have fun, forget problems, or relax
• having blackouts
• drinking or using drugs while alone
• withdrawing or keeping secrets from friends or family
• losing interest in activities that used to be important
• performing differently in school (such as grades dropping and frequent absences)
• building an increased tolerance to alcohol or drugs — gradually needing more and more of the substance to get the same feeling
• lying, stealing, or selling stuff to get money for drugs or alcohol

It's usually hard for people to recognize they have a problem, which is why friends or family often step in. Quitting is hard to do, and many people find they can't do it without help. The best thing you can do is to talk to someone you trust — preferably an adult who can support you — so you don't have to deal with your problem alone.

Lots of resources are available for people with substance abuse problems. Alcoholics Anonymous and Narcotics Anonymous offer information and recovery programs for teens. The Alcohol and Drug Information hotline is (800) 729-6686.

Reviewed by: Julia Brown Lancaster, MSN, WHNP-BC
Date reviewed: January 2013

*Names have been changed to protect user privacy.

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Prescription Drug Abuse

Angie overheard her parents talking about how her brother's ADHD medicine was making him less hungry. Because Angie was worried about her weight, she started sneaking one of her brother's pills every few days.

Todd found an old bottle of painkillers that had been left over from his dad's operation. He decided to try them. Because a doctor had prescribed the pills, Todd figured that meant they'd be OK to try.

Both Todd and Angie are taking risks. Prescription painkillers and other medications help lots of people live more productive lives, freeing them from the symptoms of medical conditions like depression or attention deficit hyperactivity disorder (ADHD). But that's only when they're prescribed for a particular individual to treat a specific condition.

Taking prescription drugs in a way that hasn't been recommended by a doctor can be more dangerous than people think. In fact, it's drug abuse. And it's just as illegal as taking street drugs.

Why Do Some People Abuse Prescription Drugs?

Some people experiment with prescription drugs because they think they will help them have more fun, lose weight, fit in, and even study more effectively. Prescription drugs can be easier to get than street drugs: Family members or friends may have them. But prescription drugs are also sometimes sold on the street like other illegal drugs.

Prescription drug abuse continues to rise. In 2012, 24% of teens surveyed said they have taken a prescription drug without a doctor's prescription.

Why? Some people think that prescription drugs are safer and less addictive than street drugs. After all, these are drugs that moms, dads, and even kid brothers and sisters use. To Angie, taking her brother's ADHD medicine felt like a good way to keep her appetite in check. She'd heard how bad diet pills can be, and she wrongly thought that the ADHD drugs would be safer.

But prescription drugs are only safe for the individuals who actually have prescriptions for them. That's because a doctor has examined these people and prescribed the right dose of medication for a specific medical condition. The doctor has also told them exactly how they should take the medicine, including things to avoid while taking the drug — such as drinking alcohol, smoking, or taking other medications. They also are aware of potentially dangerous side effects and can monitor patients closely for these.

Other people who try prescription drugs are like Todd. They think they're not doing anything illegal because these drugs are prescribed by doctors. But taking drugs without a prescription — or sharing a prescription drug with friends — is actually breaking the law.

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5 Facts About Goal Setting

These practical tips on goal setting can help make it easier to set and reach goals:

1. Specific, realistic goals work best. When it comes to making a change, the people who succeed are those who set realistic, specific goals. "I'm going to recycle all my plastic bottles, soda cans, and magazines" is a much more doable goal than "I'm going to do more for the environment." And that makes it easier to stick with.
2. It takes time for a change to become an established habit. It will probably take a couple of months before any changes — like getting up half an hour early to exercise — become a routine part of your life. That's because your brain needs time to get used to the idea that this new thing you're doing is part of your regular routine.
3. Repeating a goal makes it stick. Say your goal out loud each morning to remind yourself of what you want and what you're working for. (Writing it down works too.) Every time you remind yourself of your goal, you're training your brain to make it happen.
4. Pleasing other people doesn't work. The key to making any change is to find the desire within yourself — you have to do it because you want it, not because a girlfriend, boyfriend, coach, parent, or someone else wants you to. It will be harder to stay on track and motivated if you're doing something out of obligation to another person.
5. Roadblocks don't mean failure. Slip-ups are actually part of the learning process as you retrain your brain into a new way of thinking. It may take a few tries to reach a goal. But that's OK — it's normal to mess up or give up a few times when trying to make a change. So remember that everyone slips up and don't beat yourself up about it. Just remind yourself to get back on track.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: April 2012

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Drugs: What You Should Know

These days, drugs can be found everywhere, and it may seem like everyone's doing them. Lots of people are tempted by the excitement or escape that drugs seem to offer.

But learning the facts about drugs can help you see the risks of chasing this excitement or escape. Here's what you need to know.

The Deal on Substances

Thanks to medical and drug research, there are thousands of drugs that help people. Antibiotics and vaccines have revolutionized the treatment of infections. Medicines can lower blood pressure, treat diabetes, and reduce the body's rejection of new organs. Medicines can cure, slow, or prevent disease, helping us to lead healthier and happier lives. But there are also lots of illegal, harmful drugs that people take to help them feel good or have a good time.

How do drugs work? Drugs are chemicals or substances that change the way our bodies work. When you put them into your body (often by swallowing, inhaling, or injecting them), drugs find their way into your bloodstream and are transported to parts of your body, such as your brain. In the brain, drugs may either intensify or dull your senses, alter your sense of alertness, and sometimes decrease physical pain.

A drug may be helpful or harmful. The effects of drugs can vary depending upon the kind of drug taken, how much is taken, how often it is used, how quickly it gets to the brain, and what other drugs, food, or substances are taken at the same time. Effects can also vary based on the differences in body size, shape, and chemistry.

Although substances can feel good at first, they can ultimately do a lot of harm to the body and brain. Drinking alcohol, smoking tobacco, taking illegal drugs, and sniffing glue can all cause serious damage to the human body. Some drugs severely impair a person's ability to make healthy choices and decisions. Teens who drink, for example, are more likely to get involved in dangerous situations, such as driving under the influence or having unprotected sex.

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How Can I Quit Smoking?

First, congratulate yourself. Just reading this article is a big step toward becoming tobacco free.

Many people don't quit smoking because they think it's too hard, and it's true that for most people quitting isn't easy. After all, the nicotine in cigarettes is a powerfully addictive drug. But with the right approach, you can overcome the cravings.

Where to Start

Smokers often start smoking because friends or family do. But they keep smoking because they get addicted to nicotine, one of the chemicals in cigarettes and smokeless tobacco.

Nicotine is both a stimulant and a depressant. That means it increases the heart rate at first and makes people feel more alert. Then it causes depression and fatigue. The depression and fatigue — and the drug withdrawal from nicotine — make people crave another cigarette to perk up again. Some experts think the nicotine in tobacco is as addictive as cocaine or heroin.

But don't be discouraged; millions of people have permanently quit smoking. These tips can help you quit, too:

Put it in writing. People who want to make a change often are more successful when they put their goal in writing. Write down all the reasons why you want to quit smoking, like the money you'll save or the stamina you'll gain for playing sports. Keep that list where you can see it. Add new reasons as you think of them.

Get support. People are more likely to succeed at quitting when friends and family help. If you don't want to tell your family that you smoke, ask friends to help you quit. Consider confiding in a counselor or other adult you trust. If it's hard to find people who support you (like if your friends smoke and aren't interested in quitting), join an online or in-person support group.

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Alcohol

Getting the Facts

Just about everyone knows that the legal drinking age throughout the United States is 21. But according to the National Center on Addiction and Substance Abuse, almost 80% of high school students have tried alcohol.

Deciding whether to drink is a personal decision that we each eventually have to make. This article provides some information on alcohol, including how it affects your body, so you can make an educated choice.

What Is Alcohol?

Alcohol is created when grains, fruits, or vegetables are fermented. Fermentation is a process that uses yeast or bacteria to change the sugars in the food into alcohol. Fermentation is used to produce many necessary items — everything from cheese to medications. Alcohol has different forms and can be used as a cleaner, an antiseptic, or a sedative.

So if alcohol is a natural product, why do teens need to be concerned about drinking it? When people drink alcohol, it's absorbed into their bloodstream. From there, it affects the central nervous system (the brain and spinal cord), which controls virtually all body functions. Because experts now know that the human brain is still developing during our teens, scientists are researching the effects drinking alcohol can have on the teen brain.

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Are Steroids Worth the Risk?

Dominic has baseball on the brain. Just being good isn't enough — he wants to be the best. He dreams of playing in the majors someday, but worries about the intense competition for a position on a major league team. His girlfriend, Deborah, is also a highly competitive athlete whose appearance and performance are very important to her. She wants to stand out — both physically and athletically.

Because of the pressure they each feel to excel, Dominic and Deborah wonder whether steroids would help them. They've heard rumors about the bad side effects of steroids, but they don't have many facts. Here's the scoop on steroids.

What Are Steroids?

Steroids, sometimes referred to as "roids" or "juice" are the same as, or similar to, certain hormones in the body. The body produces steroids naturally to support such functions as fighting stress and promoting growth and development. But some people use steroid pills, gels, creams, or injections because they think steroids can improve their sports performance or the way they look.

Anabolic steroids are artificially produced hormones that are the same as, or similar to, androgens, the male-type sex hormones in the body. There are more than 100 variations of anabolic steroids. The most powerful androgen is testosterone (pronounced: tess-TOSS-tuh-rone). Although testosterone is mainly a mature male hormone, girls' bodies produce smaller amounts. Testosterone helps build muscle and promotes the masculine traits that guys develop during puberty, such as deepening of the voice and growth of body hair. Testosterone levels can also affect how aggressive a person is.

Athletes sometimes take anabolic steroids because of their testosterone-like effects.

Another group of steroids, sometimes called steroidal supplements, contains dehydroepiandrosterone (DHEA) and/or androstenedione (also known as andro). For the most part, steroidal supplements, which used to be found at health food stores or gyms, are now illegal and require a prescription. DHEA is one of the few exceptions and can still be bought over the counter.

Steroid supplements are weaker forms of androgen. Their effects aren't well known, but it's thought that, when taken in large doses, they cause effects similar to other androgens like testosterone. Here's what is known about steroidal supplements: Companies that manufacture them often use false claims and very little is known about the long-term effects some of these substances have on the body. That's one reason why the government took action to protect citizens by passing laws controlling steroid distribution.

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E-Cigarettes

What Are E-Cigarettes?

E-cigarettes look high tech, so it's easy to believe the hype that they're a safe alternative to smoking. Unfortunately, they're not: E-cigarettes are just another way of putting nicotine — a highly addictive drug — into your body.

Electronic cigarettes are battery-powered smoking devices often designed to look and feel like regular cigarettes. They use cartridges filled with a liquid that contains nicotine, flavorings, and other chemicals. A heating device in the e-cigarette converts the liquid into a vapor, which the person inhales. That's why using e-cigs is known as "vaping."

Because e-cigarettes don't burn tobacco, people don't inhale the same amounts of tar and carbon monoxide as they would with a regular cigarette. But anyone using an e-cig still gets an unhealthy dose of nicotine and other chemicals.

Electronic cigarettes started out being marketed to smokers as a way to help them quit. Now that e-cigarettes have gone mainstream, regulators and scientists are taking notice. Expect to see more information coming out about e-cigarettes and their health effects.

What's the Danger?

E-cigarettes don't fill the lungs with harmful smoke, but that doesn't make them a healthy alternative to regular cigarettes.

When you use ("vape") an e-cigarette, you're still putting nicotine — which is absorbed through your lungs — into your system. In addition to being an addictive drug, nicotine is also toxic in high doses. It was once even used as an insecticide to kill bugs.

Nicotine affects your brain, nervous system, and heart. It raises blood pressure and heart rate. The larger the dose of nicotine, the more a person's blood pressure and heart rate go up. This can cause an abnormal heart rate (arrhythmia). In rare cases, especially when large doses of nicotine are involved, arrhythmias can cause heart failure and death.

After its initial effects wear off, the body starts to crave nicotine. You might feel depressed, tired, or crabby (known as nicotine withdrawal), and crave more nicotine to perk up again. Over time, nicotine use can lead to serious medical problems, including heart disease, blood clots, and stomach ulcers.

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Get rid of bad breath

Bad breath is something we all worry about but are too polite to mention when we notice it in others.

Video: preventing bad breath

Everyone has bad breath from time to time, but for one in four adults in the UK it’s a regular problem. Persistent bad breath can be embarrassing. It can make people feel shy, awkward and self-conscious.

It’s easy to spot bad breath in others but you can never quite be sure about your own. If you think you might have bad breath, there’s a simple test you can do. Lick the inside of your wrist and sniff. If the smell is bad, you can be pretty sure your breath is too.

Or, ask someone you trust unreservedly to smell your breath. Don't be offended if they tell you there's a problem. Wouldn’t you rather know? 

Generally, bad breath (also called halitosis) isn’t serious. In most cases it's caused by poor dental hygiene.

Bits of food that get caught between the teeth and on the tongue will rot and can sometimes cause an unpleasant smell.

Strong smelling food such as garlic, onions, some milk-based products (such as cheese), coffee, smoking and some types of medication can all cause short-term bad breath.

The build-up of decaying food and other bits of debris on the surface of your tonsils, known as tonsil stones, is another source of bad breath.

Bad breath can be caused by some medical conditions, such as dry mouth; diabetes; gastritis; infections in the throat, nose or lungs; as well as liver and kidney problems.

Tips for fresh breath

• Brush your teeth twice a day. Use a fluoride toothpaste. Correct and regular brushing is very important to keep your breath smelling fresh. 
• Brush or scrape your tongue. A soft rubber wiper called a tongue scraper can remove bacteria at the back of the tongue, which brushing can miss.
• Floss your teeth. Brushing alone only cleans up to about 60% of the surface of your teeth. Flossing removes food trapped between teeth, which would otherwise turn stale and smelly. Another product you can buy to clean between your teeth is an interdental brush.
• Use an antibacterial mouthwash. The best time to use mouthwash is just before bedtime. There are many different types of mouthwash. Most are alcohol-based. Alcohol can dry out or irritate your mouth, so if you have problems, switch to an alcohol-free brand that contains chlorhexidine or hydrogen peroxide.
• Use sugar-free gum. The chewing stimulates saliva and stops your mouth drying out. A dry mouth can lead to bad breath. But gum is not a substitute for proper oral hygiene. Always clean your teeth thoroughly, even if you've chewed gum.
• Have a check-up with your dentist at least once a year. It’s a chance to have a deep clean of your teeth and review your oral hygiene practices. You’ll also get a definitive answer on whether you’ve got bad breath.
• Quit smoking. If you smoke, your breath is likely to smell of stale smoke. Smoking cigarettes also increases your risk of getting gum disease, which is another cause of bad breath.  

If you have persistent bad breath, try keeping a diary of all the foods you eat, and list any medicines you're taking. Take this diary to your dentist – they may be able to suggest ways to solve the problem.

If your breath doesn't improve no matter what you do, you might not even have bad breath. Some people are convinced they have bad breath when they don’t. This is a condition known as halitophobia.

People with halitophobia are paranoid about the smell of their breath. They become fixated with cleaning their teeth, chewing gum and using mouth fresheners.

Treatment for halitophobia involves talking therapies and cognitive behavioural therapy (CBT) to help the person overcome their paranoia about the smell of their breath.

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Dental treatment abroad

If you’re considering dental treatment abroad, do your research and be aware of the potential risks.

'You may not get all the information or reassurance you would normally get from your dentist at home,' Damien Walmsley, professor of restorative dentistry at the University of Birmingham

There are no official statistics on the number of people travelling abroad for dental treatment. However, a 2007 survey by the consumer association Which? found that dentistry is one of the most popular types of planned treatment for UK residents.

Damien Walmsley, professor of restorative dentistry at the University of Birmingham and scientific adviser to the British Dental Association (BDA), believes that most of the work carried out abroad is advanced treatments such as crowns, bridges, veneers and larger reconstructions involving implants.

His impression, based on talking to other dentists and patients who have been abroad, is that most people seem happy with the treatment they have received but a few encounter problems. The main difficulties are communication and aftercare.

Walmsley says he has seen cases where there has been an exceptionally hard sell from an agency in the UK or a practice abroad telling potential clients that every aspect of the treatment will be problem-free.

“Prospective patients then take a leap into the unknown and risk not having their expectations met," says Walmsley.

“The communication difficulties are not just because of the language difference, there are also cultural differences. You may not get all the information or reassurance that you would from your dentist at home.”

Aftercare can also be a problem. “When people seek follow-up care in the UK, sometimes several years after the surgery was carried out, it can be very difficult for dentists over here to treat them if they don’t have full documentation about the way procedures were carried out. For example, more than 50 different systems can be used for dental implants.” 

Unfinished treatment abroad

How to minimise the risks

• do your homework
• have a consultation with a qualified dentist in the UK
• speak to your own dentist
• think of your aftercare
• don't underestimate the communication difficulties

To illustrate the type of problems faced by people who have treatment abroad, Walmsley gives the example of a woman who was referred to him after having dental surgery abroad.

Sue* had lost all her teeth at a young age because of various dental problems. By the time she was 50 she was fed up with wearing dentures and wanted fixed teeth or dental implants instead.

Having found out that she wouldn’t be eligible for the treatment she wanted on the NHS, Sue contacted a private specialist near her home. The cost of the treatment, however, was too much.

She then searched on the internet and found an agency in London that arranged for her to go abroad for treatment.

“She soon got on a flight, without any cooling-off time to think about her options,” says Walmsley.

Shortly after she arrived, Sue had the operation under local anaesthetic. During the procedure to place implants in her lower jaw, she felt very uncomfortable but didn’t know how to communicate this, as the dentist's spoken English was poor. 

Then, for some reason, the surgeons were unable to proceed with the implants in her upper jaw. There was a heated discussion between them that she couldn’t understand and that made her feel uneasy.

Sue was due to stay on for further treatment but the next day she felt very sore. She hadn’t been warned that this might be the case and became anxious.

“Because of the communication problems, she no longer trusted the overseas practice and decided to return to Britain without completing the treatment,” says Walmsley.

Back in the UK, Sue saw her local dentist, who referred her to Walmsley.

“As far as I could see, although she was very uncomfortable, it was all healing up,” he says.

“I don’t think there was anything wrong with the way the procedure itself was carried out, but things were not properly explained to her before, during or after the operation. She hadn’t been told about the discomfort she might experience and as a result she got scared and lost confidence.”

In the end, Sue went to the private specialist she had initially contacted in this country to have the rest of the reconstructive work done.

*The name has been changed

How to minimise the chance of a problem

Do your homework

Anybody travelling outside the UK for treatment needs to do some research. Check the qualifications of the dentist who will treat you and make sure he or she is properly registered. For more advice on how to do your research if you’re considering treatment overseas, see Risks of treatment abroad and Questions to ask the surgeon or dentist.

Have a consultation with a qualified dentist

The General Dental Council (GDC) says that you should always be assessed by a qualified dentist before being given a treatment plan and cost estimate.

Speak to your own dentist

The GDC also advises people to speak to their own dentist as they may be able to offer advice based on your dental history. Your dentist will also need to be aware of your plans in case of any complications. 

Think of your aftercare

Ensure you have proper documentation in English about your procedure in case you need follow-up treatment in the UK.

Don’t underestimate the communication difficulties

Consider how you would deal with a potential language barrier. There may also be cultural differences.

You could find that your expectations of how a doctor or dentist should communicate with a patient are not met. You may also feel more vulnerable in an environment that is unfamiliar, especially if you can’t easily ask questions.

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10 dental myths exploded

Fact or fiction? Are white teeth healthier? Is there fluoride in our tap water? Here is the truth behind 10 dental myths.

MYTH No one uses NHS dentists any more

FACT Almost 30 million people (more than half the population of England) saw an NHS dentist between 2009 and 2011. This is an increase of more than a million since March 2006.

Find an NHS dentist.

MYTH Children today have terrible teeth

FACT The dental health of British schoolchildren is steadily improving. Six out of ten children start school with no tooth decay. But it's important to introduce a good dental health regime as early as possible.

Read more about how to care for children's teeth.

MYTH White teeth are healthier teeth

FACT We may think they look better, but teeth aren't meant to be pure white. You can help keep your teeth as white as possible by brushing regularly with a fluoride toothpaste and flossing. Avoiding food and drinks that can stain teeth, such as tea, coffee and red wine, will also help to keep them white.

MYTH I have to see a dentist every six months

FACT Your dentist will tell you how often you should come in for a dental check-up, and if you have very good oral health, this may be no more than once every two years.

MYTH There is fluoride in our water supply

FACT Only around 10% of the UK's water supply has enough fluoride in it to benefit your dental health. You can find out if there's fluoride in your water from your water supplier. 

MYTH Baby toothpaste is better for young children

FACT Some baby toothpaste brands don’t have enough fluoride in them to help prevent tooth decay. Choose a brand that contains at least 1,000ppm fluoride. Check the packaging to see if it contains enough fluoride.

MYTH Only the sugar in sweets, cakes, fizzy drinks and chocolate is bad for my teeth

FACT While all these foods are bad for your teeth (and your general health), dried fruit, fruit juice and honey contain natural sugars that can cause tooth decay. Limit the amount of these foods that you eat, don't have them between meals and brush your teeth twice a day.

Read more about how to get your children to care for their teeth.

MYTH There's no need to brush milk teeth

FACT Even though your child will lose their milk teeth, they still have to be brushed. Establishing good habits early in life helps ensure life-long dental health. Brush your baby's teeth twice daily from the moment their first tooth cuts through.

Read more about how to brush your teeth properly.

MYTH I'll need false teeth when I'm older

FACT Improvements in dental hygiene mean that more of us keep our natural teeth into old age. In 1968, 37% of adults had no natural teeth. By 1998, the figure had fallen to 12%.

MYTH Bad breath is only caused by not brushing your teeth properly

FACT Most cases (up to 90%) of halitosis (bad breath) are caused by bad oral hygiene.

Regular brushing, flossing, eating and drinking healthily, and taking plenty of exercise are the best ways to avoid bad breath.

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Teeth facts and figures

Teeth are vital to our overall health, helping us to bite and chew food. How much do you know about them?

Milk teeth

Babies' teeth begin to develop before they are born, but in most cases don't come through until they're between 6 and 12 months old. Most children have a full set of 20 milk or baby teeth by the time they're three years old. When they reach five or six, these teeth will start to fall out, making way for adult teeth.

Adult teeth

By the age of 12 to 14, most children have lost all their baby teeth and have their adult teeth. There are 32 adult teeth in total, 12 more than in the baby set. The last four of these, called wisdom teeth, usually emerge later than the others, generally between the ages of 17 and 21.

Wisdom teeth removal

If wisdom teeth don't come through properly, or at all, it may be necessary to have them removed.

Read more about wisdom tooth removal. 

What are teeth made of?

The part of the tooth that you can see above the gum is called the crown. This is covered in hard, shiny enamel. Enamel is the hardest substance in the body and protects the more sensitive inner parts of the tooth.

Underneath this is the dentine, a sensitive substance that makes up most of the tooth. Dentine is a hard substance, though not quite as hard as enamel.

Dentine protects the inner part of the tooth, called the pulp. The pulp is where each tooth's blood supply and nerve endings are found. The blood supply is what keeps the teeth alive and healthy. The nerve endings send messages to the brain, such as whether you're eating something hot or cold or if you have a decayed or damaged tooth.

The pulp goes all the way into the root of the tooth, which is hidden under your gum. Cementum covers the root of the tooth, and periodontal fibres connect the tooth to the jawbone. 

Types of teeth 

There are four different types of teeth:

• Incisors. These are your four front teeth on the top and bottom jaw. They’re used for cutting and chopping food.
• Canine teeth. These are sharp, pointy teeth. You have one on each side of your incisors on your top and bottom jaw, making a total of four. They help to tear food.
• Premolars. Next to your canine teeth are your premolars (also called bicuspid teeth). You have eight premolars in total, four on your top jaw and four on the bottom. They are bigger and wider than your incisors and canine teeth, and are used for crushing and grinding food.
• Molars. You have eight molars, four on top and four on the bottom. These are your strongest teeth and work with your tongue to help you swallow food, mashing it up until it's ready to be swallowed safely.

Common Q&As

Read the answers to the most common questions people have about dental health, including:

• How do I complain about my dental treatment?
• What can I expect from my NHS dentist?

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Kids' teeth Q&As

Get your children to care for their teeth from a young age and you could help them enjoy trouble-free teeth for life.

Establishing good habits can help your child avoid oral health problems, such as tooth decay and gum disease. 

Can I let my child have sweets?

Most children want sweets, but you can help prevent problems by making sure they don't have a large amount or very often, and particularly not before bed, when saliva flow reduces. 

Try not to give sweets or sweet drinks as rewards.

What are the best snacks to give my child?

The best snacks are fruit and raw vegetables. Try tangerines, bananas, pieces of cucumber or carrot sticks. Other good snacks include toast, rice cakes and plain popcorn.

Dried fruit is a concentrated source of sugar and tends to stick to teeth, so only give it occasionally as a snack to children.

Should I let my child have fizzy drinks?

Fizzy drinks can contain large amounts of sugar, which will increase the risk of tooth decay. All fizzy drinks (both those containing sugar and sugar-free or "diet" versions) also contain acids that can erode the outer surface of the tooth.

Find out about healthier drinks.

What are the best drinks for my child's teeth?

The best drinks for children over one year old are plain still water or plain milk. Cow's milk is not suitable as a drink for babies under 12 months of age.

Your child should have full-fat milk (whole milk) from the age of 12 months to two years. Semi-skimmed milk can be introduced from the age of two, as long as your child is a good eater and growing well for their age. Skimmed milk can be given to children aged five and over.

Is it OK to drink fruit juice?

Even unsweetened juices contain sugars and acids, so although it can contribute towards your 5 A DAY, try to drink no more than one glass (about 150ml) of fruit juice each day and only at mealtimes.

If your child is thirsty, it's better to give them water than to encourage a taste for sweet drinks. 

Try to avoid giving babies fruit-flavoured "baby juices", and never give them in feeding bottles. Fruit juice should not be given to babies under six months.

Read more about healthy drinks to give your children.

Will milk at bedtime damage my child's teeth?

Teeth are at most risk at night because there is less saliva in the mouth to protect them.

Water is the best drink to give at bedtime, but if you do give milk, don't add anything to it. Chocolate-flavoured drinks and milkshake powder usually contain sugars, which will increase the risk of decay.

Are sugar-free medicines better for my child's teeth?

Yes. Always ask if a sugar-free medicine is available and remind your doctor about this if you're being given a prescription for your child. This is especially important if your child is taking long-term medication.

When should my child give up bottles?

Your child should begin moving off the bottle and on to a free-flow feeder cup at six months. Bottles should be given up completely by the age of one because the teats and spouts encourage children to suck for long periods of time, which can mean the drinks that cause tooth decay stay in contact with your child's teeth for a long time.

Are sippy cups good for teeth?

There's no need for a child to use a sippy cup. These are similar to a bottle, in that they require the child to suck to make them work. A free-flow feeder cup is better as it doesn't have valves and the flow of liquid is unrestricted. This means children learn to drink normally rather than by sucking. 

Read more about cups for children.

Will a dummy or thumb sucking harm my child's teeth?

No, but they will encourage an open bite, which is when teeth move to make space for the dummy or thumb. They may also affect speech development. That's why you should avoid using dummies after 12 months of age. 

Thumb sucking and dummies won't cause permanent problems as long as the habit stops by the time your child gets their second teeth, but it can be a hard habit to break. 

Discourage your children from talking or making sounds with their thumb or a dummy in their mouth, and don't dip dummies in anything sweet, such as sugar or jam.

What is fluoride varnish?

Fluoride varnish can be applied to baby teeth and adult teeth. It involves painting a varnish containing high levels of fluoride on to the surface of the tooth about every six months to prevent decay.

It works by strengthening tooth enamel, making it more resistant to decay. From the age of three, children should be offered fluoride varnish twice a year. Younger children may also be offered this treatment if your dentist thinks they need it.

Read more about how to care for your child's teeth.

Common dental Q&As

Read the answers to the most common questions people have about dental health, including:

• How do I complain about my dental treatment?
• How can I look after my child's teeth? 
• What can I expect from my NHS dentist?

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Lifestyle tips for healthy teeth

Taking care of your general health and your mouth is the key to making the most of your smile.

Brushing your teeth twice a day (last thing at night before you go to bed and on one other occasion) with fluoride toothpaste and having regular check-ups with a dentist can help keep your teeth healthy. Diet, smoking and drinking alcohol also have an effect on dental health.

A healthy diet is good for your teeth

What you eat and drink can cause tooth decay, so a healthy diet is important for your teeth.

A healthy, balanced diet includes plenty of fruit and vegetables, as well as starchy foods such as bread, rice, potatoes and pasta (choose wholegrain versions and eat potatoes with their skin where possible).

You should also eat sources of protein such as meat, fish, eggs, beans or other non-dairy sources of protein, and some milk and dairy foods (ideally lower fat options).

Only eat small amounts of food and drinks high in fat and sugar. The eatwell plate shows how the different types of food should make up your diet.

Find out more about how to eat a balanced diet.

Reduce sugar to prevent tooth decay

Limiting the amount of sugar you eat and drink is important to prevent tooth decay.

A lot of the sugars we eat and drink are in food and drinks such as:

• sweets, chocolate, cakes and biscuits
• sugary drinks, including soft drinks, fizzy drinks, milky drinks with added sugar, and alcohol
• fruit juice, including fresh fruit juice
• buns, pastries and fruit pies
• sponge puddings and other puddings
• table sugar added to food or drinks, such as tea
• sugary breakfast cereals
• jams, marmalades, honey and syrups
• ice cream and sorbets
• dried fruit or fruit in syrup
• syrups and sweet sauces

Try to cut down on the added sugar you have in your diet.

Stick to one glass of fruit juice a day

Sugars occur naturally in foods such as fruit and milk, but we don't need to cut down on these types of sugars.

But when fruit is juiced or blended, as in smoothies, the sugars are released from the structure of the fruit. Once released, these sugars can damage teeth, especially if you drink fruit juice frequently.

Even unsweetended fruit juice is sugary, so try not to drink more than one glass (about 150ml) of fruit juice each day.

Read more about how to cut down on sugar.

How smoking damages teeth

Smoking can stain your teeth yellow, cause bad breath, and increases your risk of gum disease, breathing problems, lung cancer and mouth cancer.

If you smoke 20 or more cigarettes a day, you're six times more likely to develop mouth cancer than someone who doesn't smoke. So giving up smoking is important if you want to look and feel better.

Find advice on how to stop smoking.

Alcohol and oral health

Alcohol misuse has been linked to an increased risk of developing mouth cancer. According to Cancer Research UK, 75-80% of mouth cancer patients say they frequently drink alcohol.

The most important risk factors for mouth cancers are the combined effect of smoking and drinking alcohol.

It's estimated that heavy drinkers and smokers have a 38 times increased risk of developing mouth cancer than people who neither drink nor smoke.

Alcohol can also erode the outer surface of the teeth, leading to a loss of enamel. If this happens, you may need to go to the dentist for a filling. 

Read more about how to cut down on drinking.

Read more articles on how to stop smoking.

Eat right for a whiter smile

Some substances, foods and drinks can stain your teeth. Wine, cigarette smoke, tea and coffee are all teeth-staining culprits. Keep them to a minimum to stop your teeth becoming stained.

Your dentist or hygienist will be able to give your teeth a professional clean, which may help reduce the staining. 

If you want to find out about other options, such as tooth whitening, have a chat with your dentist.

Read more about tooth whitening. 

Common Q&As

Read the answers to the most common questions people have about dental health, including:

• How do I complain about my dental treatment? 
• What can I expect from my NHS dentist?

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Children's teeth

From brushing their first tooth to their first trip to the dentist, here's how to take care of your children's teeth.

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A regular teeth-cleaning routine is essential for good dental health. Follow these tips and you can help keep your kids' teeth decay free:   

• Start brushing your baby's teeth with fluoride toothpaste as soon as the first milk tooth breaks through (usually at around six months, but it can be earlier or later). It's important to use a fluoride paste as this helps prevent and control tooth decay. 
• All children can use family toothpaste containing 1,350-1,500ppm fluoride as long as you supervise brushing until the age of seven and make sure they don't eat or lick toothpaste from the tube.
• Children under the age of six who don't have tooth decay can use a lower-strength toothpaste if you prefer, but make sure it contains at least 1,000ppm fluoride. Check the toothpaste packet for this information or ask your dentist.
• Below the age of three years, children should use just a smear of toothpaste.
• Children aged between three and six years should use a pea-sized blob of toothpaste. Check the toothpaste packet for this information or ask your dentist.   
• Brush your child's teeth for about two minutes twice a day: once just before bedtime and at least one other time during the day.
• Encourage them to spit out excess toothpaste but not to rinse with lots of water. Rinsing with water after tooth brushing will wash away the fluoride and reduce its benefits.
• Supervise tooth brushing until your child is seven or eight years old, either by brushing their teeth yourself or, if they brush their own teeth, by watching how they do it. From the age of seven or eight they should be able to brush their own teeth, but it's still a good idea to watch them now and again to make sure they brush properly and for about two minutes.

Making sure they brush properly

• Guide your child's hand so they can feel the correct movement.
• Use a mirror to help your child see exactly where the brush is cleaning their teeth.
• Make tooth brushing as fun as possible by using an egg timer to time it for about two minutes.
• Don't let children run around with a toothbrush in their mouth as they may have an accident and hurt themselves.

Taking your child to the dentist

• Take your child to the dentist when the first milk teeth appear. This is so they become familiar with the environment and get to know the dentist. The dentist can help prevent decay and identify any oral health problems at an early stage. Just opening up the child's mouth for the dentist to take a look is useful practise for when they could benefit from future preventative care. 
• When you visit the dentist, be positive about it and make the trip fun. This will stop your child worrying about future visits.
• Take your child for regular dental check-ups as advised by the dentist. NHS dental care for children is free.

Find your nearest dentist.

Fluoride varnish and fissure sealants

• Fissure sealants can be done once your child's permanent back teeth have started to come through (usually at the age of about six or seven) to protect them from decay. This is where the chewing surfaces of the back teeth are covered with a special thin plastic coating to keep germs and food particles out of the grooves. The sealant can last for as long as 5 to 10 years.
• Fluoride varnish can be applied to both baby teeth and adult teeth. It involves painting a varnish that contains high levels of fluoride on to the surface of the tooth every six months to prevent decay. It works by strengthening tooth enamel, making it more resistant to decay.
• From the age of three, children should be offered fluoride varnish application at least twice a year. Younger children may also be offered this treatment if your dentist thinks they need it.

Ask your dentist about fluoride varnish or fissure sealing.

Read more tips on how to look after your children's teeth.

Common dental Q&As

Read the answers to the most common dental health questions people have, including:

• How do I complain about my dental treatment?
• How can I look after my child's teeth? 
• What can I expect from my NHS dentist?

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Dental treatments

This is a guide to the main treatments carried out by dentists. Some are readily available on the NHS, while some may only be available on the NHS in certain circumstances. Some may only be available from a specialist working in a dental hospital.

Always ask your dentist whether the treatment they're recommending is available on the NHS and how much it will cost before you go ahead.

Bridges

A bridge is a fixed replacement for a missing tooth or teeth. It's made by taking an impression of the surrounding teeth, which will eventually support the bridge. A bridge is usually created from precious metal and porcelain and will be fixed in your mouth (unlike dentures, which can be removed).

Bridges are available on the NHS (band 3) and cost up to £219.

Crowns

A crown is a type of cap that completely covers a real tooth. It's made from either metal, or porcelain and metal, and is fixed in your mouth. Crowns can be fitted where a tooth has broken, decayed or been damaged, or just to make a tooth look better.

To fit a crown, the old tooth will need to be drilled down so it's like a small peg onto which the crown will be fixed. It can take some time for the lab to prepare a new crown, so you probably won’t have the crown fitted on the same day.

Crowns are available on the NHS (band 3) and cost up to £219.

Fillings

Fillings are used to repair a hole in a tooth caused by decay. The most common type of filling is an amalgam, made from a mixture of metals including mercury, silver, tin, copper and zinc. Your dentist will offer the most appropriate type of filling according to your clinical needs. This includes white fillings, if appropriate. 

Amalgam fillings and some white fillings are available on the NHS (band 2) and cost £50.00 per course of treatment.

Root canal treatment

Root canal treatment (also called endodontics) tackles infection at the centre of a tooth (the root canal system).

When the blood or nerve supply of the tooth has become infected, if root canal treatment is not carried out, the infection will spread and the tooth may need to be taken out.

During treatment, all the infection is removed from inside the root canal system. The root canal is filled and the tooth is sealed with a filling or crown to stop it from becoming infected again. Root canal treatment usually requires two or three visits to your dentist.

Root canal treatment is available on the NHS (band 2) and costs £50.00.

Read more about root canal treatment.

Scale and polish

This is when your teeth are professionally cleaned by the hygienist. It involves carefully removing the deposits that build up on the teeth (tartar).

Scale and polish is available on the NHS depending on your clinical need, and costs (band 1) £18.50.

Braces 

Braces (orthodontic treatment) straighten or move teeth to improve the appearance of the teeth and how they work.

Braces can be removable, so you can take them out and clean them, or fixed, so that they're stuck to your teeth and you can't take them out.

They can be made of metal, plastic or ceramic. Invisible braces are made of a clear plastic.

Braces are available on the NHS for children and, occasionally, for adults, depending on the clinical need, and cost (band 3) up to £219.

Read more about braces (orthodontics).

Wisdom tooth removal

The wisdom teeth grow at the back of your gums and are the last teeth to come through, usually in your late teens or early twenties. Most people have four wisdom teeth, one in each corner.

Wisdom teeth can sometimes emerge at an angle or get stuck and only emerge partially. Wisdom teeth that grow through in this way are known as impacted.

Impacted wisdom teeth can be removed on the NHS. Your dentist may perform the procedure or may refer you to a dentist with a special interest (DwSI) or to a hospital's oral and maxillofacial unit.

You will usually have to pay a (band 2) charge of £50.50 for wisdom tooth removal. If you are referred to a hospital for NHS treatment, you will not have to pay a charge.

Your dentist can also refer you for private wisdom teeth treatment if you wish.

Find out more about wisdom tooth removal.

Dental implants

Implants are a fixed alternative to removable dentures. They may be the only option if the loss of teeth has caused the mouth to shrink so that it can no longer support dentures. You can use implants to replace just a single tooth or several teeth.

To fit an implant, titanium screws are drilled into the jaw bone to support a crown, bridge or denture.

Replacement parts take time to prepare. This is to ensure that they fit your mouth and other teeth properly. Therefore, they may not be available on your first visit to the dentist.

Implants are usually only available privately and are expensive. They're sometimes available on the NHS for patients who can't wear dentures or whose face and teeth have been damaged, such as people who've had mouth cancer or an accident that's knocked a tooth out. 

Dentures or false teeth

More commonly known as false teeth, dentures are fitted in place of natural teeth. A full set is used to replace all your teeth. A part set is used to replace one or more missing teeth. Dentures are custom-made using impressions (mouldings) from your gums. They're usually made from metal or plastic.

They're removable so you can clean them, although part dentures can be brushed at the same time as your other teeth. A full set needs to be removed and soaked in a cleaning solution.

Dentures are important if you lose your natural teeth as losing your teeth makes it difficult to chew your food, which will adversely affect your diet and may cause your facial muscles to sag.

Dentures are available on the NHS (band 3) and cost up to £219.

Read more about dentures and false teeth.

Broken or knocked out tooth

It's common to break, chip or knock out a tooth.

If the tooth is just chipped, make a non-emergency dental appointment to have it smoothed down and filled, or to have a crown.

If the tooth has been knocked out or is badly broken, see a dentist immediately. Your dentist may fit a denture or bridge. If you need an implant, you'll be referred to a dental hospital.

Treatment of whatever type can be provided by an NHS dentist and the cost covered on the NHS.

Read more about broken or knocked out teeth.

Teeth whitening

Teeth whitening involves bleaching your teeth to make them a lighter colour. Teeth whitening can’t make your teeth brilliant white, but it can lighten the existing colour by several shades.

Standard teeth whitening involves several visits to the dentist plus sessions at home wearing a mouthguard containing bleaching gel. The whole process takes a couple of months.

A newer procedure called laser whitening or power whitening is done at the dentist's surgery and takes about an hour. 

Teeth whitening is cosmetic and therefore generally only available privately.

It is occasionally available on the NHS if you have a clinical need, for example to whiten a tooth that's gone black because the nerve has died.

Read more about teeth whitening.

Dental veneers

Veneers are new facings for teeth which disguise a discoloured (rather than a damaged) tooth. To fit a veneer, the front of the tooth is drilled away a little. An impression is taken, and a thin layer of porcelain is fitted over the front of the tooth (similar to how a false fingernail is applied).

Veneers are generally only available privately unless you can show a clinical need for them.

Treatment costs

Read in detail about the cost of NHS dental treatments.

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How to keep your teeth clean

Brush your teeth with fluoride toothpaste twice a day for about two minutes to help keep your teeth and mouth healthy.

Plaque is a film of bacteria that coats your teeth if you don't brush them properly. It contributes to gum disease and tooth decay. Tooth brushing stops plaque building up. Try to make sure you brush every surface of all your teeth.

Toothbrush tips

• Replace your brush or brush attachment every three months
• Never share your toothbrush, as this can spread infections
• Brush your teeth twice a day with fluoride toothpaste for about two minutes

When should I brush my teeth?

Brush your teeth for about two minutes last thing at night before you go to bed and on one other occasion everyday.

Your dentist or hygienist may give you further advice based on your own dental health and needs.

Should I use an electric or manual toothbrush?

It doesn't matter whether you use an electric or manual toothbrush. They're both equally good as long as you brush all the surfaces of all your teeth and you use fluoride toothpaste. However, some people find it easier to clean their teeth thoroughly with an electric toothbrush. 

What should I look for in a toothbrush?

For most adults, a toothbrush with a small head and a compact, angled arrangement of long and short round-end bristles is fine. Medium or soft bristles are best for most people.

If you're using an electric brush, one with an oscillating or rotating head may be more effective than a manual toothrush.

However, making sure you thoroughly clean your teeth at least twice a day is more important than the type of brush you use. If in doubt, ask your dentist. 

What type of toothpaste should I use?

It's important to use a toothpaste with the right concentration of fluoride. Check the packaging to find out how much fluoride each brand contains.

• All children can use family toothpaste containing 1,350-1,500ppm (parts per million) fluoride, providing you supervise brushing up until the age of seven and make sure children don't lick or eat toothpaste from the tube. Children under six who don't have tooth decay can use a lower-strength children's toothpaste, but make sure it contains at least 1,000ppm fluoride. 
• Below the age of three, children should use just a smear of toothpaste.
• Children aged between three and six years should use a pea-sized blob of toothpaste.
• Children over the age of seven and young adults should use a toothpaste that contains 1,350-1,500ppm fluoride.
• Adults should use a toothpaste that contains at least 1,350ppm fluoride.

Your dentist may advise you or your child to use a toothpaste with a higher concentration of fluoride if you need it.

It's fine for babies and children to use the family toothpaste rather than a special children's toothpaste, provided it contains the right concentration of fluoride. Don't let children lick or eat toothpaste from the tube. 

How to brush your teeth

Make sure you brush all the surfaces of all your teeth, which should take about two minutes. Remember to brush the inside surfaces, outside surfaces and the chewing surfaces of your teeth.

After brushing, spit out any excess toothpaste, but don't rinse your mouth with water or mouthwash.

If you need any more information on your toothbrushing technique, speak to your dental team. 

Children need to be helped or supervised brushing their teeth until they're at least seven years old.

How to floss

Flossing isn't just for dislodging food wedged between your teeth. Regular flossing may also reduce gum disease and bad breath by removing plaque that forms along the gum line. It's best to floss before brushing your teeth.

• Take 12-18 inches (30-45cm) of floss or dental tape and grasp it so you have a couple of inches of floss taut between your hands.
• Slip the floss or dental tape between the teeth and into the area between your teeth and gums as far as it will go.
• Floss with 8-10 strokes, up and down between each tooth, to dislodge food and plaque.  

Read about why it's important to floss.

How to use interdental brushes

You can use interdental brushes or single-tufted brushes instead of flossing, especially if there are gaps between your teeth. The brush should fit snugly between the teeth.

Never use toothpicks to remove trapped food from between your teeth as you may damage your gums, which could lead to an infection.

Your dentist or hygienist will be able to advise you on the best way to use interdental cleaning for your teeth.

Read more about interdental brushes.

Should I use mouthwash?

Using a mouthwash that contains fluoride can help prevent tooth decay, but don't use mouthwash straight after brushing your teeth. Choose a different time, such as after lunch. And don't eat or drink for 30 minutes after using a fluoride mouthwash.

Common Q&As

Read answers to the most common questions that people have about dental health, including:

• How can I look after my teeth?
• How can I look after my child's teeth?

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Fear of the dentist

One in four of us dreads a visit to the dentist, but there are ways to overcome your fear.

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Being afraid of the dentist means different things to different people. Maybe it's the thought that treatment will hurt, or that the sounds and smells bring back memories of bad experiences as a child.

The good news is that more and more dentists understand their patients’ fears. With a combination of kindness and gentleness they can do a lot to make dental treatment stress free.

Karen Coates, a dental adviser at the British Dental Health Foundation, says the organisation’s dental helpline receives many calls about fear and phobia. "People who are scared of the dentist often call us for help because they’re at the end of their tether. Their teeth don’t look nice any more or they’re in a lot of pain with toothache, and they want to make the first step to seeing a dentist and getting their teeth sorted out.

"Some people have such bad dental phobia that they haven’t seen a dentist for years. It’s common for us to hear from someone in their twenties or thirties or even older who hasn’t been to the dentist since childhood. Recently, a 16-year-old girl whose mother has a dental phobia called the helpline. The mother had never taken the daughter to the dentist – and now the girl desperately wanted to have a dental check-up."

Dental advances

If you haven’t seen a dentist for several years because of fear or anxiety, be reassured that you should find the experience more bearable nowadays.

"Most people who are scared of the dentist have bad memories from childhood of the smells and sounds of the surgery," says Karen. "Modern dental surgeries are much friendlier environments, with flowers in the waiting room, art on the walls, a pleasant reception area and polite staff.

"It’s altogether a gentler experience. Of course, you’ll still have the smells and sounds of the dental surgery but these are less noticeable than they used to be with instruments hidden from sight and background music playing. Even drills aren’t as noisy as they used to be," she adds.

Advances in technology have also improved dentistry. Treatment can now be completely painless. The dental wand (a computerised injection system that looks like a pen and delivers the anaesthetic very slowly so it is painless) is great for anyone with a needle phobia. A numbing gel can also be used to numb your gums before an injection so you don’t feel the needle.

8 tips to ease dental fear

If you’re anxious about seeing the dentist, here are Karen’s tips to ease the fear:

• Find an understanding dentist. Ask friends and family if they can recommend one or look for someone who advertises themselves as an expert with anxious patients. Search for your local dentists here.
• Once you've found someone you think may be suitable, visit the surgery to have a look around, meet the receptionist and dentist and see the environment. Tell the dentist that you're anxious so they know beforehand.
• Pick an appointment time early in the morning so you have less time to dwell on it.
• The first appointment will simply be a check-up so don’t worry that you’ll be launched into having a filling, the drill or a needle. See this first visit as your chance to get to know the dentist.
• Take a friend with you to your appointment. The dentist won’t mind if they accompany you throughout the check-up or treatment.
• Agree a sign with the dentist to signal that you need a break and want them to stop. It can be as simple as pointing your finger, and will help you feel more in control.
• If you think it will help, start gradually with a clean and polish then work up to more extensive treatment once you’ve built up trust and rapport with your dentist.
• Take a personal stereo with you to listen to music during your visit. It will help you relax.

NHS sedation clinics 

If you're extremely nervous, ask your dentist to refer you to an NHS sedation clinic. These clinics are specifically for nervous dental patients. 

Some people find simple inhalation sedation very helpful to relax them for dental treatment. This is a bit like gas and air given during childbirth, but instead of being delivered through a mask it comes through a nosepiece.

If you're extremely nervous you may prefer intravenous sedation (through an injection into your hand or arm) during treatment. The drugs won’t send you to sleep – you’ll be awake and able to talk to the dentist – but they’ll calm and relax you so deeply you probably won’t remember much of what happened.

Common dental Q&As

Read the answers to the most common dental health questions people have, including:

• How do I complain about my dental treatment?
• How can I look after my child's teeth? 
• What can I expect from my NHS dentist?

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Tooth decay Share: Save: Print: Print this page

Introduction 

Tooth decay is a common problem that occurs when acids in your mouth dissolve the outer layers of your teeth.

It is also known as dental decay or dental caries.

Although levels of tooth decay have decreased over the last few decades, it is still one of the most widespread health problems in the UK.

It's estimated that around one in every three adults in England have tooth decay and a survey of five year old children carried out in 2012 found that more than one in four had some degree of tooth decay.

Signs and symptoms

Tooth decay may not cause any symptoms until it has reached an advanced stage. As the problem develops, symptoms of tooth decay can include:

• toothache
• tooth sensitivity – you may feel tenderness or pain when eating or drinking something hot, cold or sweet
• grey, brown or black spots appearing on your teeth
• bad breath
• an unpleasant taste in your mouth

If left untreated, tooth decay can lead to further problems such as a cavities (holes in the teeth) gum disease or dental abscesses (collections of pus at the end of the teeth or in the gums).

When to see your dentist

Toothache is a warning that something is wrong and that you should visit your dentist as soon as possible. If you ignore the problem it may get worse, and you could end up losing a tooth.

Even if you don't have any noticeable problems with your teeth, it is still important to have regular dental check-ups so your dentist can check for early signs of decay. Tooth decay is much easier to treat in its early stages.

Adults over 18 should have a check-up at least once every two years and people under the age of 18 should have a check-up at least once a year. Your dentist may suggest having more frequent check-ups if you have had a history of dental problems, or you are thought to be at a higher risk of developing tooth decay.

Dentists can usually identify tooth decay by examining your teeth, although occasionally an X-ray may be carried out to check for any cavities or abscesses.

What causes tooth decay?

Your mouth is full of bacteria that combine with small food particles and saliva to form a sticky film known as plaque.

When you consume food and drink high in carbohydrates – particularly sugary foods and drinks – the bacteria in plaque turn the carbohydrates into energy they need, producing acid at the same time.

If the plaque is allowed to build up, the acid can begin to break down the outer surface of your tooth and can eventually enter and damage the soft part at the centre of the tooth.

Read more about the causes of tooth decay.

How to prevent tooth decay

Although tooth decay is a common problem, it is often entirely preventable. The best way to avoid tooth decay is to keep your teeth and gums as healthy as possible.

To do this, you should:

• brush your teeth with a fluoride toothpaste twice a day, spending at least two minutes each time
• use floss or an interdental toothbrush at least once a day to clean between your teeth and under the gum line
• avoid rinsing your mouth with water or mouthwash after brushing because this washes the protective toothpaste away – just spit out any excess toothpaste
• cut down on sugary and starchy food and drinks, particularly between meals or within an hour of going to bed

Read more about preventing tooth decay.

How tooth decay is treated

If you see your dentist when the decay is in the early stages, your dentist may apply a fluoride varnish to the area to help stop further decay.

If the decay has worn away the outer layer of your tooth and caused a cavity, your dentist will remove the decay and refill the hole in your tooth with a filling. If the nerve in the middle of your tooth is damaged, you may need root canal treatment, which involves removing the nerve and restoring the tooth with a filling or crown.

If the tooth is so badly damaged that it cannot be restored, it may need to be removed.

Read more about treating tooth decay.

Rate your dentist

You can now comment on your NHS dentist and share your experience with others. Rate your dentist here.

Page last reviewed: 30/05/2014

Next review due: 30/05/2016

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