From flossing to fillings dentists reveal everything you need to create perfect smile

Missing routine dental and hygienist appointments – along with too much time spent looking at our own reflection on Zoom during the lockdowns – left many determined to do something about their smile.

Michele O’Connor asks dentists for their professional opinion on some of the most pressing oral care quandaries

Electric or manual toothbrush?

“There’s no comparison,” says Dr Mervyn Druian, co-founder of The London Centre for Cosmetic Dentistry
( londoncosmeticdentistry.co.uk ).

“You need really good dexterity to use a manual toothbrush as effectively as an electric brush.

“Most people end up scrubbing, which, over time, causes deep grooves and gum damage and increases sensitivity.”

So let the brush do the work for you.

Karen Coates, adviser at the British Dental Health Foundation ( dentalhealth.org ), adds: “Studies show electric toothbrushes – not battery operated ones that lose power – are up to 45 per cent more effective at cleaning than manual.”

Look for one that oscillates and pulsates, has an in-built timer and includes a pressure sensor that buzzes or flashes if you brush too hard. Pick age-appropriate models for children aged three and above.

Floss, inter-dental brush or an air/water flosser?

“The most important thing is that it has to be easy for you or you won’t do it,” warns Hannah Woolnough of the British Dental Association ( bda.org ).

What you use depends on your teeth and personal preference. However inter-dental brushes – like mini bottle brushes that slot between the teeth – with good friction are probably the most effective way of removing plaque from between the teeth, particularly if you have gaps or widely-spaced teeth.

“Floss is effective where a gap is very small or teeth are overlapped,” she explains.

As a general rule, tape is slightly easier and more effective than string at cleaning between the teeth and around the gum line, says Mervyn.

“Air and water flossers are perfect for those with reduced dexterity in their hands,” Hannah adds.

Ask your dentist or hygienist for advice on which products are best for your teeth.

White or silver fillings?

While amalgam – or silver – fillings are durable, strong and easy to place in cavities of all sizes, they are being phased out for environmental, not safety, reasons.

“I personally haven’t used amalgam fillings for many years,” says Mervyn.

“The new, white filling materials are now far longer lasting and are also radio-opaque, which means we can see what’s going on underneath on X-rays.”

However, these white fillings are a slightly more skilled procedure and are more expensive, only available on the NHS forchildren.

But amalgam fillings should only be replaced if there is a definite clinical need, stresses Mervyn.

In-chair whitening or custom-made trays?

Whitening treatment should always be done professionally, says Mervyn.

Your teeth need to be assessed first – particularly if you have dental restorations such as crowns, bridges, implants or porcelain veneers.

For these reasons, it’s illegal for beauty salons and spas to offer professional whitening.

In-chair whitening (power or laser whitening) is popular with people seeking a fast result but there’s an increased risk of sensitivity and the results aren’t as predictable or long-lasting.

“The preferred method is a custom-made tray made from impressions of your teeth to whiten teeth gradually at night over the course of two weeks,” he explains.

“For sensitive teeth, there’s the option of desensitising products and using the trays every second day instead of daily.”

But, whichever method you choose, it’s important to avoid staining fluids, such as coffee and red wine, and foods like curry for at least 48 hours.

Dental aligners or braces for straightening?

The critical thing is to have your teeth assessed by an orthodontist (a dentist that specialises in straightening), advises Hannah.

“It’s essential that your teeth and gums are healthy before you start any treatment because if you have undiagnosed gum problems, moving the teeth can make this worse and you could end up losing teeth in the long term.”

For simple tooth movement, clear plastic ‘invisible’ aligners, such as Invisalign, are incredibly efficient, says Mervyn .

They fit over the teeth but can be removed for special occasions and cleaning. Treatment length can be anywhere between six and 12 months.

Even for major work, modern fixed braces are now far less visible, with no surrounding brackets or fine wires on the outside. They need adjusting at regular intervals and can only be removed by the orthodontist. Expect to wear them for six to 24 months.

Orthodontics isn’t generally available to adults on the NHS and prices vary according to practitioners.

Bridge or implant for a missing tooth?

The decision depends on where the gap is, teeth condition either side and your budget, explains Hannah.

“Generally, implants are the best way of replacing a tooth, because it is like having your own tooth,” she says.

A dental bridge spans the gap where a tooth once was with a false one bonded to your natural teeth on either side. An implant, on the other hand, consists of a titanium screw fixed into your jawbone and topped with a crown (a replacement tooth).

While implants can last as long as natural teeth if you look after them, a bridge can weaken over time and will eventually require restoration.

A bridge is a band 3 NHS dental treatment (£282.80) while implants cost from £2,000 and require more time in the dental chair.

Veneers or composite bonding for a better smile?

“Again, the condition of your teeth determines the best option for you,” says Hannah. But, generally, if teeth have no decay or fillings, it’s better to have as little done to them as possible.

“A veneer usually involves a permanent change to the structure of your tooth, ie the removal of a thin layer of your enamel and will have to be redone throughout your life.”

Bonding uses white enamel, like that used in fillings, to reshape the tips of teeth, doesn’t remove any existing tooth and looks more realistic.

“If the shape of the tooth is good, cosmetic bonding is far less invasive and is great for disguising small imperfections, such as gaps, chips and cracks,” says Mervyn.

Expect to pay around £375 per tooth compared to up to £1,000 per porcelain veneer.