Smile – we’ve got an oral medicine expert to answer your questions in our next webchat 

This one hour web chat took place at:
11am - 12 noon on Wednesday 11 June 2014.

If you’ve got problems with your mouth, salivary glands or jaws, you might not feel like smiling this ‘National Smile Month’, but we had an expert on hand to answer any questions you might have in our ‘ask an expert’ series of webchats.  Dr Tim Hodgson is the clinical director of the world renowned Eastman Dental Hospital, which treats over 85,000 patients per year and is at the forefront of research into oral conditions and diseases.  Dr Hodgson is an oral medicine expert with over 50 articles published in medical journals.  His special areas of interest include oral conditions associated with other diseases, like HIV or Crohn’s disease as well as potentially malignant oral lesions.

Smile – we’ve got an oral medicine expert to answer your questions 

10:33 UCLH: 
Good morning and welcome to our web chat. We will begin at 11am but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 11am.

Dr Tim Hodgson will be joining us to take your questions on ‘Oral Medicine’ and will try to answer as many questions as possible within the hour long web chat.
10:55 Dr Tim Hodgson: 
Welcome to our web chat on the subject of oral medicine. My name is Dr Tim Hodgson, Clinical Director at the Eastman Dental Hospital and I am ready and waiting to take your questions.
10:56 [Comment From SallySally: ] 
Hi my husband grinds his teeth at night constantly! What can be done about this?
10:58 Dr Tim Hodgson: 
Hi Sally, Grinding and clenching are common and can disturb sleep of the individual or partner. It may be a manifestation of stress. A guard can be made to prevent tooth wear and decrease the noise. Sometimes medicines may help, your dentist should be able to advise regarding a soft splint or refer on to a specialist service.
10:59 [Comment From JoyJoy: ] 
What are the long term effects of having veneers on your teeth? I am tempted but a bit scared of what might happen in a few years.....I am 35.
11:01 Dr Tim Hodgson: 
Hi Joy, Sometimes veneers are the only option to mask tooth discolouration. But tooth substance has to be lost to make sure that the veneer doesn't look too bulky. This can never be replaced. So it is important to discuss with your dentist if this is really the correct option for you.
11:02 [Comment From LucieLucie: ] 
Is there a difference between grey and white fillings, apart from how they look?
11:05 Dr Tim Hodgson: 
Hi Lucie, Grey fillings have been around for many years. White fillings have been introduced more recently. The main difference is that the white fillings stick to your teeth, whereas the grey fillings just fill the hole. Some of the white fillings also leak fluoride which prevents decay occurring around the filling. You may be aware that silver fillings contain mercury but this does not leak out and effect your general health. Sometimes the white fillings shrink on setting and this can cause pain and discomfort.
11:06 [Comment From SarahSarah: ] 
Hi I have a question for Dr Hodgson. I am 28years old and have ehlers danlos type 3. I have had a clicky jaw for many years now but in the last year it has become very bad. My jaw clicks and clonks, but also it now locks on opening a small amount, when this happens I can close it but just cant open wider unless I push on the right side of my jaw near to my ear, which seems to release it most times, but sometimes it wont for about 15minutes. Im wondering what is actually happening in my jaw and what I should do to help it or who I should see for it? It is uncomfortable all the time now. Many thanks Sarah
11:08 Dr Tim Hodgson: 
Hi Sarah, Great question. Ehlers danlos effects all the soft tissues and as you describe can lead to problems with the jaw joint. The jaw joint is very complex and has a disc within it that can get trapped. This is more common in people with ehlers danlos. You would benefit from specialist advice at a local oral surgery or oral medicine clinic. Ask your dentist or GP to refer.
11:09 [Comment From SamSam: ] 
My 96 year old grandmother suffers from lichen planus episodes. She has been given steroid cream but it returns and is very uncomfortable for her. Is there anything she can do in between episodes to prevent it?
11:13 Dr Tim Hodgson: 
Hi Sam, Lichen Planus is a chronic disease and the aim of treatment is to dampen down symptoms and improve quality of life. She should use her steroid cream as often as she needs it and not be worried about using it all of the time. Steroid creams don't tend to thin the skin on the inside of the mouth unlike when used on external skin. It may be that the cream she is using is not potent enough to control her symptoms or she may benefit from a different method of administration. She should discuss that she has not got adequate symptom control with her clinical team and look for alternatives.
11:13 [Comment From SorayaSoraya: ] 
I am on a diet and very embarrasingly, have bad breath (my husband told me)- I am brushing my teeth more but what else can I do?
11:17 Dr Tim Hodgson: 
Hi Soraya, Bad breath can be a real problem for both you and those close to you. If you are on a really strict diet it may be that your body is producing ketones which you can smell on your breath. The other thing to be aware of is that eating and drinking repeatedly cleanses the mouth and therefore if you do not drink sufficient volumes of water you end up with debris collecting which can also give bad breath. Most products available over the counter will mask bad breath but you really need to address the cause to completely eliminate it.
11:17 [Comment From GuestGuest: ] 
I have a very dry mouth, mostly noted when i wake up and have noticed a metallic taste. What can be causing this?
11:22 Dr Tim Hodgson: 
Hi Guest, During the night your salivary glands shut down and do not produce as much saliva. If you sleep with your mouth open any moisture evaporates and you can wake up with a really dry mouth. Saliva is also important to transport food molecules to the taste receptors so lack of saliva is often associated with altered taste. It is really important to work out if you have a low salivary flow which can predispose to dental decay and recurrent mouth infections or a problem with the nerves in the mouth that are sensing dryness when in fact you have a reasonable amount of saliva present.
11:22 [Comment From RoyRoy: ] 
Are mouth ulcers a sign you are run down? I have a flare ups which tend to occur after drinking lots of alcohol at weekends etc
11:26 Dr Tim Hodgson: 
Hi Roy, Good question. There are lots of reasons for mouth ulcers including skin, gut and immune causes. Many of our patients will say their ulcers get worse with increased stress and fatigue. You need a strategy to prevent them becoming worse after drinking alcohol. Talk to your dentist about different mouth washes that may help.
11:26 [Comment From CarmenCarmen: ] 
My question is - is it better to clean your teeth before breakfast or afterwards? I have children and am keen to establish good habits! Also should kids floss? Gwyneth Paltrow mentioned it and I have never even considered it for my children aged 10 and 12.
11:30 Dr Tim Hodgson: 
Hi Carmen, Interesting question. Kids are often not sufficiently dexterous to use floss without causing damage. In children effective tooth brushing is all that is needed to maintain good dental health. Theoretically, after eating the mouth becomes more acidic and leads to softening of the tooth surface and if brushed vigorously may cause mild irreversible damage. In reality as long as teeth are brushed twice a day, dental health will be maintained.
11:31 [Comment From Jun DongJun Dong: ] 
Hi Mr Tim,My name is Jun Dong.I have infection in mouth for long time.This problems always bother me and I found that my lips are getting purple.what can i do now?
11:33 Dr Tim Hodgson: 
Hi Jun Dong, There are lots of different infections of the mouth. It is really important that any infection is diagnosed and treated. Purple lips may be associated with breathing problems. You need to be seen by a dentist to get diagnosed and treated.
11:33 [Comment From SarahSarah: ] 
I also had veneers fitted last year to my top front six teeth, since then two have fallen off! I wear a night splint, but my dentist is saying it wasn't a bonding issue its my grinding, but I was in Singapore when the first fell off and the dentist out there said it was bonding issue. Im now scared more will fall off. And should they feel slightly as though the those teeth move when I for example clean my teeth? Sorry long question.
11:36 Dr Tim Hodgson: 
Hi Sarah, Veneers need to be carefully planned in people who grind their teeth as a heavy bite can lead to them failing. They should be redone with any potential complicating factors accounted for. Sometimes the bonding agent can fail. All teeth move slightly within their sockets. This will increase if there is any gum disease present.
11:36 [Comment From SarahSarah: ] 
Thank you very much
11:37 Dr Tim Hodgson: 
Hi Sarah, You are welcome.
11:37 [Comment From DarrenDarren: ] 
I've had an ulcer on the side of my tongue for ten days that doesn't seem to be healing. What should I do?
11:38 Dr Tim Hodgson: 
HI Darren, Any long standing ulcer also needs to be accurately diagnosed if it is not healing. See your dentist in the first instance. You may require referral to a specialist centre.
11:38 [Comment From KatherineKatherine: ] 
My teeth are heavily stained. Is there anything I can do to return them to their normal colour?
11:42 Dr Tim Hodgson: 
Hi Katherine, You and your dentist need to work out what is causing the teeth to be stained. The most common reasons for staining is dietary. Tea, coffee, red wine and some spices can leave a surface stain. Smoking can also lead to discoloured teeth. Your dentist or hygenist can remove this superficial staining but it will recur if you continue the habit or dietary factor. Sometimes staining is deep within the structure of the tooth and this can be decreased by various methods and this should be discussed with your dentist.
11:43 [Comment From ViteshVitesh: ] 
My 7 year old daughter has been found to have some missing adult teeth, what can be done to correct this?
11:45 Dr Tim Hodgson: 
Hi Vitesh, Sorry to hear your daughter has some missing teeth. This is more common than you may think. Discuss with your dentist how many teeth are missing and it may require the specialist services of a childrens dentist and orthodontist to get the best possible outcome.
11:45 [Comment From JenniferJennifer: ] 
I have rheumatoid arthritis, will this cause any issues with my mouth?
11:48 Dr Tim Hodgson: 
Hi Jennifer, Both the disease and its treatment can lead to mouth problems. The arthritis can effect the jaw joint and you may develop a dry mouth. Some of the medicines can lead to an increased risk of oral thrush or mouth ulcers. It is important to visit your dentist regularly to prevent any issues related to the above.
12:00 Dr Tim Hodgson: 
Here are some useful links:

Referring to services at the Eastman Dental Hospital (EDH)

Oral medicine at EDH

Oral surgery EDH

Restorative dentistry at EDH

Orthodontics at EDH

Childrens dentistry at EDH
12:01 [Comment From GuestGuest: ] 
Hello. My name is Hephzibah. One of my front teeth has been moving out and out over a number of years. I am worried that I might loose it eventually. What would yoh recommend? Many thanks .
12:03 Dr Tim Hodgson: 
Hi Hephsibah, Teeth move because the support holding them in gets destroyed by inflammation. You need to see a dentist to work out why this is happening and to try and stop any further destruction. It may be that this tooth has lost so much support it needs to be replaced.
12:04 Dr Tim Hodgson: 
Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered.

 Useful links