What is an implant?

These are great educational videos that we found on Youtube:
They explain the implant process and show the consequences of tooth loss. 

In order for an implant to heal well, and be a success, we need:

-adequate bone width and height to be present at the site of implantation

-no infection present at the bone site or around the adjacent teeth

-good overall health of the patient 

-good oral hygiene

-no smoking, tobacco habits, or excessive alcohol consumption 

-regular check ups and maintenance appointments post treatment.

Dr Elena Demetriou

Paphos Dental Surgeon

Smoking can lead to implant failure!

A study was published in the February 2007 issue of the Journal of Periodontology, which reported that smoking harms dental implants and causes them to fail, more often than in a non smoker. Researchers involved in this study, found that smoking is a high risk factor in tooth loss and dental implant failure.


One reason for this is could be because smokers are at a greater risk for infection following surgery, and they heal more slowly. Smokers also suffer more bone loss around teeth and are more prone to developing severe periodontal (gum) disease. Another reason could be because smoking negatively affects the blood flow to the bone and gums, which impairs healing, causing the implant to fail (ie. the implant fails to integrate with the surrounding bone and is mobile).


Smokers also absorb less vitamin C than non smokers. Vitamin C is required for healing of the gum and bone tissues, as it assists in the production of collagen, which is needed for cells to repair and heal.


Therefore, if you want healthy gums and your implants to last for many years, do yourself a favor and give up smoking for good!


Dr Elena Demetriou
Paphos Dental Surgeon

Denture Care Instructions for Patients (Thanks to Wits university Dental school)

1. Success of new dentures depends on many factors including patient's personal attitude, temperament, health, shape and size of mouth and dental arches, length of time of edentulousness (ie. missing teeth), condition of bone and soft tissues etc.

2. Full denture patients please note: the lower denture can never be equal to the upper as far as retention, stability and ability to withstand biting pressure is concerned. It only has a small rim to grip/rest on, and has the tongue to disturb it. Whereas the upper denture has the entire roof of the mouth, which is free from interferences, to support it.

3. Dentures won't remain permanently satisfactory. Saliva, foods and other fluids cause material deterioration over time. At the same time the supporting tissues and underlying bone are in constant state of change. These changes continue throughout life, although the greatest changes take place within the first 6 months after tooth loss, ie shrinkage of underlying bone. Thus to maintain full use and appearance, the dentures may need to be altered/relined periodically to meet these changes, or even remade. The cost of such alterations are not included in the original charge.

4. Learning time:
- Talking and eating will improve with practise and time ie. a few weeks, after a new denture is inserted. Patient's may prefer to eat alone in the initial days, so as to become accustomed to their denture and not prone to laughing or criticism from family members.

- Appearance too needs time to become ideal, as the muscles relax and the patient's lips adapt themselves to the new dentures, the oral musculature will smooth out and look more natural.

- Patient's who have been edentulous (without teeth) for some time, will exhibit a shortening of the face and collapsing of the lips. This nose to chin appearance is a gradual process which takes place over time, so that friends and family members are not usually aware of it. Therefore the changes brought about by the new dentures ie. repositioning the lips and restoring the former vertical dimensions, may seem great in appearance initially. Patients need to persevere with the new look for a while until they become accustomed to it.

The mouth was not intended to bear the stresses of mastication by artificial dentures, therefore at the beginning patients must expect some irritation and discomfort of the oral tissues.

- If irritation or pain occurs, the dentures must be removed and the mouth allowed to heal. Patients must not become discouraged. Adjustments will be made at the follow up appointments to make the dentures more comfortable.

5. Denture care:
- Dentures may be left out the mouth for short rest periods, and should not be worn at night so as to allow the blood circulation to rebuild the tissues of the denture bearing area. Your gums need rest just as feet need to be relieved from the pressures of wearing shoes.

- Dentures should be brushed daily with a soft brush and dishwasing detergent/gel (not toothpaste). They should be washed over a bowl of water so that if they slip or drop they will land in the water and not break.

- Special attention is needed inside clasps of partial dentures and to the natural teeth which the clasps contact, to avoid tooth decay.

- Denture cleaners ie. steradent should not be used on a daily basis as they may discolour/corrode denture materials.

-When acrylic dentures are outside the mouth they should be kept in a cup of (preferably distilled) water.

Are you a candidate for dental Implants?

The ideal patient for a dental implant is someone with good general and oral health. The patient must have adequate bone width and height in their jaw, in order to support the implant, and the gums must be healthy and free from periodontal disease.

Implants can be used to replace a single missing tooth, or several missing teeth. Implants replace the lost teeth and roots. Implant supported bridges or dentures can also be made to replace several missing teeth. The benefit of implants is that, unlike bridges, the neighboring teeth are not drilled, when replacing the missing tooth. Dental implants may also support a partial or full denture, eliminating the need for denture adhesives or metal clasps.

Once the implants have been placed in the jaw bone, there is a waiting period of two to six months, to allow the implant to bond securely with the surrounding bone. In the meantime a temporary prosthesis is provided to replace the missing teeth.

Some patients may need bone grafting procedures, in areas where the bone is not adequate enough to support an implant. Bone substitutes (either synthetic or natural) are placed under the gums, and over a period of six to twelve weeks, these materials stimulate new bone growth.

Patients should have excellent oral hygiene and they require regular dental visits, in order to keep the implants clean and plaque free.

What causes tooth decay?

I will attempt to explain the process of tooth decay (also known as tooth caries) in a simple way:

Unclean Tooth + food + Germs =  Acid => Tooth decay => Cavities

 OR

Unclean Tooth + food + Germs =  Tartar => Gum disease

If the teeth are not properly brushed, acid produced by bacteria softens the tooth enamel and causes the tooth to decay. This leads to the formation of cavities. When food sticks to the teeth it forms a sticky layer called plaque. Plaque is made up of food and germs. Germs metabolize sugars and starches in food and form acids, which cause teeth to decay. If you scratch an unclean tooth with your fingernail, you remove plaque. If this plaque layer is left on the tooth for more than three days, it hardens and forms tartar (calculus), which eventually leads to gum disease (gingivitis).

Therefore, take your time when brushing your teeth, and make sure all the tooth surfaces are clean i.e. front, top and back of teeth. If you scratch your finger nail on your teeth after brushing, no plaque should appear and they should feel smooth and squeaky clean!

Brush twice a day for at least 3 minutes, in a circular motion, after breakfast and just before bed time. It should be the last thing you do before hopping in bed. At night time the mouth is drier and germs can multiply more rapidly. And don't forget to floss to remove the plaque from the in between surfaces. Flossing will reduce cavities forming in between the teeth. Don't forget to brush your tongue to remove even more bacteria and freshen your breath. Happy brushing!

Dr. Elena Demetriou

Paphos dentist

Smoking and oral health

 (Article written by the British Dental Health Foundation)

1. How can smoking affect my oral health?

Most people are now aware that smoking is bad for our health. It can cause many different medical problems and, in some cases, fatal diseases.

However, many people don't realise the damage that smoking does to their mouth, gums and teeth.

Smoking can lead to tooth staining, gum disease, tooth loss and in more severe cases mouth cancer.

2. Why are my teeth stained?

One of the effects of smoking is staining on the teeth due to the nicotine and tar content. It can make the teeth yellow in a very short time, and heavy smokers often complain that their teeth are almost brown after years of smoking.

3. How will smoking affect my gums and teeth?

Smoking can also lead to gum disease. Patients who smoke are more likely to produce bacterial plaque, which leads to gum disease. The gums are affected because smoking casuses a lack of oxygen in the bloodstream, so the infected gums fail to heal.

Smoking causes people to have more dental plaque and for gum disease to progress more rapidly than on non-smokers. Gum disease still remains the most common cause of tooth loss in adults.

4. How is smoking linked with cancer?

Most people know that smoking can cause lung and throat cancer, but many people are still unaware that it is one of the main causes of mouth cancer too.

Every year thousands of people die from mouth cancer brought by smoking

5. Are there special dental products I can use?

There are special toothpastes for people who smoke. They are sometimes a little more abrasive than ordinary pastes and should be uses with care. Your dentist may recommend that you use these toothpastes alternately with your usual toothpaste.

There are several whitening toothpastes on the market. Although they do not affect the natural colour of your teeth, they may be effective at removing staining and therefore may improve the overall appearance of your teeth.

6. What about mouthwashes?

People who smoke may find they are more likely to have bad breath than non-smokers. Fresh breath products susch as mouthwashes may help to disguise the problem in the short term, but will only mask it.

7. How often should I visit my dentist?

It is important that you visit your dentist regularly both for a normal check up and a full mouth examination so that any other conditions can be spotted early.

You should visit your dentist regularly, as often as they recommend. People who smoke are more likely to have stained teeth, and therefore may need appointments more often with the dental hygienist.

8. What can my dentist do for me?

Your dentist will carry out a regular examination to make sure that your teeth and gums and whole mouth are healthy.

Your dentist will also examine your cheeks, tongue and throat for any signs of other conditions that may need more investigation.

They may also be able to put you in touch with organisations and self- help groups who will have the latest information to help you stop smoking.

9. Will I need any extra treatment?

Your dentist may also refer you to a dental hygienist, for further treatment, thorough cleaning and to keep a closer check on your oral hygiene.

Your dental hygienist will be able to advise you on how often you should visit them, although this should ususally be every three to six months.

How efficient are lasers in treating periodontal disease ?

A few dental reps. approached me to buy their expensive dental lasers. I was told that they were a great tool for treating periodontal disease. After listening to their sales talk and marketing, I decided to do a bit of my own research. I discovered that the use of lasers in treating periodontal disease remains controversial. Published dental literature indicates that the best way to stop and control periodontitis is by effectively removing toxins and calculus from the affected root surface. Currently, there is minimal evidence to support the benefit of using lasers to debride root surfaces.

According to a statement made by the American Academy of Periodontology, the use of lasers as an adjunct to scaling and root planning, has little to no benefit, beyond scaling and root planning alone. So far, dental studies suggest that the best way to control and treat periodontitis is by effectively debriding root surfaces, and not by removing the soft tissue lining of the pocket (which is what most lasers do and is called curettage).

According to the evidence, lasers do not reduce more bacteria in a subgingival pocket, than a scaling and root planning. According to the AAP the Er:yag laser is the only laser that can remove calculus (tartar) and minimise endotoxins, but it has the potential to damage the root surface in the process. For more information see the statement posted on the website of the American Academy of Periodontology.

I have come to the conclusion that dental lasers need a lot of improvement, before they can replace the scaler and the dental drill. When the benefits are greater than the side effects, I will definately invest in one!

Dr Elena Demetriou
Dentist Kato Paphos Cyprus

How does your heart condition affect Periodontal Diseases?

When you think about your own risk for heart diseases, many things may come to mind such as fatty foods, lack of exercise, and genetics.
However, there is another possible factor, namely the periodontal diseases. Periodontitis is a bacterial infection of the gum and bone that support your teeth. Recent studies have suggested that people with periodontitis have twice the risk of having a fatal heart attack as those without periodontitis.

How does this happen? In the presence of gum disease, chewing or brushing your teeth allows bacterial toxins to enter the bloodstream and irritate the blood vessel linings. The inflammation caused by periodontitis may also release chemicals into your blood that contribute to the buildup of fatty deposits inside your heart arteries.

Periodontal disease appears to trigger the liver to make certain proteins that inflame arteries and cause blood clots that can lead to heart attacks.

Periodontal diseases can also aggravate certain kinds of existing heart conditions, especially when there has been previous damage to the heart. According to the American Heart Association, patients at risk for a disease called infective endocarditis may need to take antibiotics prior to dental procedures. Your cardiologist will determine if your heart condition requires use of antibiotics prior to dental procedures.

Because a healthy mouth and gums lead to a healthier body, see your dentist, or periodontist for a periodontal evaluation as soon as possible and begin taking care of your oral health today.

The importance of a scale and polish and root planning



Before Scale and Polish

After Scale and Polish

Scaling and root planning is a meticulous cleaning of the root surfaces below the gum line, to remove toxins like nicotine, plaque and tartar from the root surfaces of the teeth. This procedure is very important to prevent and treat periodontal (or gum) disease.
Polishing of the teeth, is the removal of external tooth stains and plaque, above the gum line, with a polishing paste and a dental polishing brush, in order to obtain a clean smooth surface. It is recommended that patients have a scale and polish every six months, or every three to four months if there is periodontal disease present.

If you require root planning and have very sensitive teeth, your dentist or periodontist may numb the area prior to treatment. Research shows that scaling and root planing, and use of chlorhexidine based mouthwash, reduces gingival inflammation and probing depths, and the number of bacteria living in deeper pockets, resulting in healing of the gums. Scaling and root planing is usually the first mode of treatment recommended for periodontal patients.

In severe periodontitis, antibiotics are prescribed before or after these procedures. Each time you take an antibiotic you increase your chance of developing drug resistant bacteria, so it is important to take antibiotics only when necessary.

How can oral health affect pregnancy?

During pregnancy, the body experiences crazy hormonal changes. These changes can affect many of the tissues in the body, including the gums. The gums can become sensitive and inflamed, when there is tartar or dental caries present. Without proper oral care and treatment, mild gum problems may turn into early periodontitis. Studies have showed that pregnant women who experience periodontal disease during their pregnancies are twice as likely to have a premature delivery.

They may also experience preclampasia, which presents with high blood pressure and the presence of protein in the urine. Periodontitis can increase inflammatory cells and levels of biological fluids in the body, which can induce preterm labor.

Scientific data also suggests that women whose periodontal conditions worsen during pregnancy are at risk of having a low birth weight baby. Recent studies have shown that pregnant women who have periodontitis may be up to seven times more likely to have a baby who is born too early and too small. If the periodontitis is treated during or before pregnancy it significally reduces the risks of a preterm birth.

The American Academy of Periodontology recommends that women considering pregnancy should include a periodontal evaluation as part of their prenatal care. A healthy mouth is important to keep mother and baby happy.