Ask a doctor: Can I permanently replace my knocked out front teeth?

Dr Linus Ndegwa, a dentist and chairman of Kenya Dental Association answers questions on dentistry that were frequently asked by our readers.

My child’s permanent teeth have some discolouration from the borehole water we get.  What are some home tips I can do to bring them back to proper white colour?

Tooth discolouration of permanent teeth caused by the consumption of water which has excess fluoride is known as dental fluorosis. The discoloration from dental fluorosis depends on the severity and can present as simple white spots on the surface of the tooth to dark brown to black broken down teeth.

Any home solutions are not safe to use for any form of discolouration because they involve abrasion to the surface, which can lead to further breakdown of the tooth structure and leave it weak and exposed. 

To minimise the risk of dental fluorosis, children up to the age of 10 should avoid consumption of water with excess fluoride, which includes water for drinking, brushing teeth, and cooking both at home and school. Also, use age-appropriate toothpaste for brushing teeth. These are readily available commercially.

My friend uses baking soda and hydrogen peroxide to whiten her teeth at home. Is that safe?

Hydrogen peroxide is the whitening compound in that combination. For desired outcomes, it needs the right concentration and contact time with the tooth surface.

Baking soda is an abrasive compound and is like sandpaper for the tooth. These two are used as a mixture to brush the teeth for two minutes in order to achieve bleached teeth. This method may whiten your teeth because of the abrasiveness of baking soda but leave you with sensitivity due to loss of the outer protective tooth surface. 

The peroxide, at its highest safest concentration, needs a minimum of 20 minutes of controlled contact time with the tooth. Therefore, two minutes is hardly enough. Besides, the uncontrolled use of a high concentration of peroxide can severely burn the gums, cheeks, or tongue. My advice would be to seek professional whitening from your dentist.

I want to do teeth bleaching but I am told it isn’t permanent. Is there any permanent whitening?

Professional whitening is normally done until the patient is satisfied with the shade achieved. There are different shades of white. Clinical pictures will be taken before and after treatment to demonstrate the difference. 

Due to the natural process of ageing and day to day diet needs, the shade may change over a short period of years but will not relapse to the original discolouration. An alternative to whitening is porcelain dental veneers. These are artificial coverings on the tooth that can maintain your shade for longer.

I have seen natural toothpastes that are fluoride free. Who needs fluoride free toothpastes and is that a characteristic we should be looking for in toothpastes?

Fluoride-free toothpaste is beneficial in children less than 10 years of age at risk of getting dental fluorosis. These are children unable to control the consumption of water with high fluoride levels. This age group is particularly important because this is the tooth development phase of the permanent teeth, where excess fluoride has the most harmful effects. All the rest should use age-appropriate toothpaste, where the main difference is the concentration of fluoride. Fluoride makes your teeth stronger and prevents dental cavities.

My two front teeth were knocked out in an accident. I don’t like it. What options are available for me?

Replacement of teeth generally has three options. Two are fixed options, while one is removable. Removable means daily removal of the artificial teeth from your mouth, commonly in the evening, and replacing them the following day. The fixed options are known as dental bridges and dental implants. When done well and with proper maintenance, they can last up to 20 years and more. Even after that, they may not need new ones.

An average dental bridge starts from Sh20,000, depending on the number of teeth that need replacement and the design. One implant is typically charged from Sh100,000 depending on the extra surgical process required to prepare the replacement site.

In your daily work, which is the most common dental problem you deal with?

Dental cavities are the most common problem. Most patients present with a toothache from untreated cavities. It is prevalent because of the lack of proper dental hygiene, predominant sugary diet, and not visiting your dentist regularly. Other non-modifiable factors, such as genetics and environment, play a minor role.

My gums are bleeding every time I brush my teeth. What could be the problem?

Bleeding gums is a common sign of gum disease. The disease could be bacterial, viral or fungal in nature. The force used while brushing can contribute to bleeding through the trauma of the gums. Other causes would be underlying medical conditions. The solution to the problem depends on identifying the exact problem. Visit your dentist at your earliest opportunity for further review.

My parents are aged and are considering dental implants. Would you recommend them and how much do they average in Kenya?

Dental implants can be placed safely in old age. In fact, tooth replacement enables the patient to chew better and look better, which is a great benefit, especially in old age. They range from about sh100,000 to Sh300,000 per implant, depending on the need for additional minor surgical procedures that need to be done to prepare the replacement site for the implant.