Tackling Mouth Cancer

November is Mouth Cancer Awareness Month and this is a topic we take very seriously.

Did you know that every time you visit the Dentist for your routine check up, this includes screening for the signs of Mouth Cancer?

In the UK 38,000 people are living with a diagnosis of head and neck cancer.

Around 60,000 people in the UK will be diagnosed with Mouth Cancer over the next decade.



We can’t ignore the facts, the statistics are scary but be assured, we are looking out for you.

So what can you expect in your dental examination?


  1. Observation of the face and neck, looking for swellings, skin abnormalities, moles or anything unusual or asymmetrical.
  2. Looking for changes in the colour or texture of the border of the lips and mouth.
  3. Feel of the lymph nodes in the neck, checking for enlargements or abnormalities.


  1. Examine the inner surface of the lips.
  2. Look at the inside of the cheeks.
  3. Check the margin of the cheeks, where they meet the gums.
  4. Survey the tongue at rest.
  5. Survey the tongue protruded, asking you to stick your tongue out to check the colour, texture, symmetry and mobility.
  6. Inspecting the lateral borders of the tongue.
  7. Asking you to lift the tongue to the roof of the mouth, so the floor of the mouth can be clearly seen.
  8. Looking at the soft and hard palate.
  9. Depressing the tongue and asking you to say ‘Ahhh’ so the throat can be clearly observed.

https://youtu.be/7mv073MJzlg           It’s not so different across the pond.

It’s up to you too! Find out the facts, know the risks, be aware of your lifestyle choices and keep vigilant to anything suspicious in your mouth.

Signs and symptoms.

  • sore mouth ulcers that don’t heal within several weeks
  • unexplained, persistent lumps in the mouth that don’t go away
  • unexplained, persistent lumps in the lymph glands in the neck that don’t go away

Other symptoms may include:

  • pain or difficulty when swallowing (dysphagia)
  • changes in your voice or speech problems
  • unexplained weight loss
  • bleeding or numbness in the mouth
  • a tooth, or teeth, that becomes loose for no obvious reason, or a tooth socket that doesn’t heal
  • difficulty moving your jaw
  • red or white patches on the lining of your mouth – these are common and are very rarely cancerous, but they can sometimes turn into cancer, so it’s worth seeing a specialist if you have them.                                                                                                                                                                                      For more information visit: https://www.nhs.uk/conditions/mouth-cancer/

Increase your awareness.

  • Mouth Cancer can affect anyone but is strongly associated with age and gender.
  • Twice as many men as women are diagnosed.
  • The over 40s are those who are statistically more at risk.
  • More than 9 in every 10 cases are linked to lifestyle risk factors such as
    • Tobacco – which transforms saliva into a deadly cocktail that damages cells in the mouth and turns them cancerous
    • HPV (the Human Papilloma Virus) – the virus that causes genital warts, the world’s most commonly sexually transmitted virus, acquired through oral sex.
    • Alcohol – where excessive use is linked to more than 1/3rd of Mouth Cancer cases in men and 1/5th in women. While heavy drinkers and smokers are up to 35x more at risk!
    • Diet – a good healthy diet with daily fruit and veg actually reduces the risk of developing Mouth Cancer.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      SPOT A CASE = SAVE A LIFE




‘State of Care’ Report.

In a recent press release, the British Dental Association (BDA) welcomed the latest Care Quality Commission (CQC) ‘State of Care Report’, which gave dental services in England a big thumbs up.

Within the report

  • 100% of dental practices inspected by the CQC in 2016/17 met their standards for caring and responsiveness to their patients’ needs.
  • 99% were found to be ‘effective’ in achieving good health outcomes.
  • 96% were found to be ‘safe’.
  • 89% were considered to be ‘well-led’.

This is really good news to us and should be good news for you too, knowing you are receiving a good service from your dental practice.

But what do you think defines a good service?

CQC inspections put us under intense scrutiny, a process we dread yet at the same time relish as an opportunity to showcase the high standard of care we deliver here.

It truly matters to us that peoples’ experience of our service is great.

We want to but we don’t always get it right!

We encourage and monitor patient feedback and proactively review our service delivery. We always learn more from the mistakes, when things haven’t quite gone to plan and it’s these moments that create positive changes for future improvements.

Dental professionals are also regulated by the General Dental Council (GDC), who have set out clearly defined standards of conduct, performance and ethics, to which we adhere closely.

The GDC also sets out what patients can expect from a dental professional, visit the ‘Information for patients’ section of their website.


Standards are important but aren’t they just a baseline above which we should be setting our goals for achieving a ‘five star’ service?

If you had to complete a ‘State of Care’ report for St Paul’s Dental Practice, how would you rate us?

Dental Implants from a Hygienists’ Perspective.

You’re never too old to care about your appearance or quality of life. With the population living longer, more people of an older age are choosing dental implants as a preferred option to having dentures.

Choosing Dental Implants


Your dentist will help decide whether the implant option is suitable in your individual circumstances, based on your general medical health, your oral health and your ability to maintain a good oral environment to protect your dental implants in the future. Any factors that may impede the success of implants, such as smoking, certain medication or a history of gum disease, will be taken into consideration.

It is extremely useful for you also to see a hygienist before your implants are placed. They will

  • help create a healthy environment in your mouth
  • establish a good oral hygiene routine with you for you to continue at home
  • assess and advise on the impact any other health problems such as a dry mouth, might have on the health of your mouth
  • assess and advise on any limitations, such as restricted movement in your hands, that may impact on your ability to keep up with a good oral hygiene routine
  • advise you on the most appropriate oral hygiene appliances to maintain a clean mouth and maintain implant health
  • determine who will be responsible for your maintenance programme. If this will be a carer, advise and teach them the skills they need to assist you

Why is hygiene maintenance so important?


The main purpose of cleaning your mouth, around your teeth and any implants, is to disturb and remove plaque and biofilm.

Plaque is a soft, sticky film (biofilm) that builds up on your teeth and contains millions of bacteria. The bacteria in plaque cause tooth decay and gum disease.

Failure to keep your implants clean and healthy can lead to their failure to integrate in to your jaw bone and subsequent loss.

Ongoing hygiene appointments will help monitor your implants, the effectiveness of your maintenance programme and keep on top of any periodontal or peri-implant disease.

Dental care products

Our hygienists recommend the following dental care products for your armoury

  • a toothbrush, preferably an electric toothbrush. These provide more effective brushing and prevent over-brushing.
  • a single tufted toothbrush. For specific focused areas.
  • dental floss. For cleaning between tight spaces.
  • interdental brushes. For hard to reach places.
  • a tongue cleaner
  • mouth wash. Effective against the bacteria in your mouth.

For anyone having difficulties managing their oral hygiene maintenance programme, we would recommend more frequent visits to see the hygienist. Three monthly reviews may be appropriate in some circumstances.

For practical problems like poor dexterity, adapted dental appliances will help. You can speak to our dental nurse with special care training if you need advice.

Should you get into any trouble keeping your implants thoroughly clean, our hygienists have the right instruments and expertise to undertake deep cleaning treatment below the gum level to the peri-implant tissues. Ensuring the best possible longevity of the implants.



Protecting our pregnant patients.

Are you worried that dental treatment during your pregnancy might not be safe?

Let us put your mind at rest. Make sure you inform your dentist and they will consider all the options available to safely provide an appropriate dental care plan throughout your pregnancy.

However, while it may be far from your mind right now, this is a very important time to think about the health of your teeth and mouth. In fact, your mouth may need extra attention during your pregnancy, as the changes in hormone levels may increase your risk of dental problems.

What are the increased risks to oral health that pregnant women can experience?

  • Enamel erosion – morning sickness can be damaging to the surface of the teeth, due to the contact from stomach acid. Our advice is to rinse with water or a non-alcohol based mouth wash after being sick and do not brush your teeth straight away as they will be softened by the acid from your stomach. Wait about an hour before doing so.

  • Cavities –  if your cravings are for sweet things, the increased acidity in your mouth will put you at higher risk of tooth decay. Snacking leads to a sticky film of bacteria forming on your teeth, also known as plaque. The bacteria convert sugar and starch that remain in the mouth after eating to acid that attacks tooth enamel. The longer the sugars remain in your mouth, the longer the acids attack. Repeated acid attacks result in tooth decay.

    This is why brushing twice a day, with a fluoride toothpaste is essential to remove soft plaque.

  • Gum disease – Inflammation shown as redness or bleeding of the gingiva (gums) during pregnancy can lead to gum disease. Gingivitis during pregnancy may be due to high levels of the hormone oestrogen.

    If gingivitis leads to periodontitis, this can set off a chain of reactions interfering with normal body workings and result in a preterm or low birth weight baby.

    Research has shown that women who are successfully treated for their periodontal disease have significantly lower incidence of these outcomes.

    Studies have also shown that pregnant women with periodontal disease are more likely to develop gestational diabetes mellitus than those with healthy gingiva.

    Gestational diabetes itself can lead to pre-term delivery and put mothers at greater risk of developing type-two diabetes in later life.

    Research has also found a link between periodontitis and pre-eclampsia, a condition that can put both mother and baby at considerable health risk, even with fatal consequences.

    More tips available here http://www.colgate.com/en/us/oc/oral-health/life-stages/oral-care-during-pregnancy/article/pregnancy-prenatal-care-and-oral-health

If you require X-rays during your pregnancy, rest assured your dental professional will assess the risk against the need. However our modern digital technology significantly reduces the radiation exposure, so safe for you and safe for baby.


The key take home message is don’t shy away from visiting your dentist because you are pregnant. Dental care and your oral health are especially essential at this time.

A good dental care routine will control plaque and reduce the risk of gingivitis, keeping you and your baby healthy.

Visit your Dentist/Hygienist regularly and follow their advice about how to properly care for your teeth.

They will be able to offer you the best advice at this time and discuss any concerns you may have. 

‘Chewing the fat’.

Chewing is probably not something we think about much, more likely something we take for granted most of our lives unlike eating, which holds a huge significance.

Our attention is constantly consumed (forgive the pun) with matters relating to food.

  • How much we eat, in terms of how we look. Do we eat too much or too little?
  • Where we eat and who with, as a meal can be such a social event, whether entertaining friends at home or eating out.
  • Are we getting the whole ‘foody’ experience?
  • With more than ever TV shows inspiring us and turning meal preparation into a major pastime.

However chewing does start to matter when there’s a problem such as pain, lost or broken teeth or missing teeth. Good job you’ve got prompt access to our dental service to put things right.

But there are a few more things about chewing we’d like to share.

Chewing can protect you against infection?

Did you know, according to a recent study, the act of chewing can stimulate the release of cells in the mouth, called Th17 cells.

These cells form part of the adaptive immune system and use specific antigens to defend against potentially harmful pathogens. They are produced through the presence of friendly bacteria.

The mechanical force involved in mastication (chewing) causes abrasion to the lining of the mouth, stimulating the release of Th17 cells. The degree of chewing required, determines how much abrasion occurs. Hence hard food material would have a greater effect and cell release than soft foods.

The down side is too many Th17 cells can increase the risk of gum disease (periodontitis).

And then there’s chewing gum, (sugar-free of course).

According to the World Health Organisation, oral disease costs the world economy billions every year and yet tooth decay is one of the most preventable oral diseases!

A new study, undertaken by Wrigley’s and the Peninsula Dental School, Plymouth determined that chewing just one additional piece of sugar-free gum each day could save billions world wide as a preventive measure for tooth decay.

How chewing sugar-free gum helps.

It increases the production of saliva, which helps to wash away food particles and restore optimum pH levels in the mouth, reducing the risks from acid attacking our teeth and causing enamel erosion.


Everything in moderation!

A word of warning from one of our resident Dentists, to follow the Oral Health foundations’ advise on frequency of chewing gum.

Our teeth are only designed to last one lifetime and we are all living longer and longer, excessive chewing could exacerbate the mechanical wearing down of the biting surface of teeth, from tooth to tooth contact.

Excessive chewing could also cause jaw muscle imbalance, particularly if you have a preference to chewing on one side more than the other and could lead to temporo-mandibular joint disorders.


So chewing is essential, for preparing food as it enters our digestive tract, for stimulating saliva to help keep our mouths healthy and for boosting our immune system. The important thing, like any mechanical system, is that it remains well maintained for optimum, trouble free function.

Regular visits to see your Dental team will keep your teeth chewing at their best.

Call us if you need advice.

Focus on Dental Hygiene

Our Hygienists.

There is a full time Hygiene service available at St. Paul’s Dental Practice. This is because we are totally on board when it comes to the vital role the Hygienist has in supporting you to take care of your teeth.


Regular visits to the Hygienist are key to maintaining your Oral Health and preventing disease. They are also the best placed professional, within the dental team, to treat gum disease through their specialised training.

When you visit the Practice, your Dentist and Hygienist will decide with you when your next appointment should be, according to your individual dental needs.

This decision is based on clinical reasoning and health grounds. It may even be that on clinical need only, your Dentist doesn’t feel they need to refer you because your oral health is very good.

Something to smile about.

But there are additional benefits to visiting the Hygienist, such as that great feeling of clean teeth, fresh breath and a bright sparkling smile after a scale and polish, when all those everyday stains are removed.

Our oral health is vital to our overall health but likewise the smile we wear is key to our wellbeing. The power of a confident smile should not be underestimated and can make all the difference, be it to secure a new job or a successful date.

Direct Access.

This is why we believe you should be able to make an appointment when you feel you want one. There may be an important event coming up in your life like a wedding or an interview and so we offer open access to our Hygienists.

If you haven’t seen the Hygienist here before, your initial appointment would be an extended time (40 mins), to allow for a full assessment of your needs and these self referred, ‘Direct Access’ appointments would incur a private fee but are great value and competitively priced. (See our website for prices).

For more information about Direct Access as well as other useful downloadable leaflets visit our website http://www.stpaulsdentalpractice.co.uk/downloads.html

(Picture courtesy of Alan Levine via Flickr)

Newsletter – Expanding our Private Practice.

Things are always changing in the world of Dentistry as they do also in the world of St Paul’s Dental Practice. So as we embark on a new year, now seems a very good time to let you know what we are expecting in 2017.

We remain determinedly committed to providing a good NHS service, fulfilling our contract with Devon NHS Commissioning board and providing NHS dentistry to 6,300+ local residents.


The NHS contract has remained unchanged over the past 8 years although there has been much change in the health regulations, determining how we provide dentistry.

An example of this is Health Technical Memorandum 01-05, introduced by the Department of Health in 2013, which sets out best practice for decontamination in primary care dental practices. We strive to achieve best practice in all areas of service provision but with greater regulation comes greater cost.

We built a state of the art decontamination room as recommended, invested in the  required equipment and took on board the additional costs of service and validation contracts,  single use instrumentation, packaging, staffing and consumables.

But our main reason for change was because we truly thought it would mean a better ‘in surgery’ experience for our patients.

Unfortunately we can’t weather all these additional expenses without generating greater income somewhere! We can’t take on any more NHS patients and exceed our contract quota, we wouldn’t get paid for it!

We can however take more patients on a private basis and we have competitive private fees and a very dedicated, talented Dentist to fulfil all your dental requirements from routine examinations to extensive mouth transforming treatments.


As Practice owner, Nick would like to increase his private patient list but can only achieve this through sharing more of his NHS caseload amongst our Associate Dentists.

Over the next few months, you may be asked if you would be prepared to see either Neil Black or Rachel Cruickshank in future. Both our Associate Dentists have been with us for many years and are dedicated to St Paul’s Dental Practice’s quality standards and protocols.

So whoever you see will provide you with the usual good dentistry you are used to receiving here and we appreciate your cooperation in this matter.

More of other upcoming news in the next blog.

Merry Christmas

Wishing you all a very Merry Christmas and a Happy New Year.

It’s hard to believe another year is coming to an end but here at St Paul’s we will end this year satisfied with all we have achieved, helping so many of you maintain a healthy smile, so you can look forward to a peaceful festive holiday without any tooth aches (but only if you hold off on the toffees!)

However rest assured should you have any cause for concern or a dental emergency, you will have access to a dentist over the Christmas and New Year bank holidays and we will be providing an emergency service to cover the days between.

Check out our Festive opening times on our website or via our Facebook page.



What have we achieved so far this year?

In 2016 it amounts to –

  • 8,714 examinations
  • 6,507 scale & polishes
  • 3,242 cavities filled
  • 1,260 dentures made
  • 489 fluoride varnishes
  • 436 teeth extracted
  • 211 teeth crowned
  • 156 root canal treatments
  • 4 Calling birds
  • 3 French hens
  • 2 Turtle doves

and a Partridge in a pear tree!

We hope that Santa brings you everything you desire on 25th December, but if ‘all you want for Christmas is your two front teeth’, then St Paul’s Dental Practice is definitely the right place to be, as Nick and the team have all the skills required to place dental implants for you. http://www.stpaulsdentalpractice.co.uk/dental-implants-devon.html

Our National Elf Service, transforming smiles. national-elf-service

Cheers and here’s to a happy, healthy and prosperous 2017


Need to Know about Mouth Cancer!

November is Mouth Cancer Action Month mcam_date_ohf%20edit%20boadrer


The Oral Health Foundation is passionate and committed to increasing awareness of the disease and reducing the number of lives lost to it every year. There is a wealth of important information on mouth cancer as well as many other interesting dental health topics on their website http://www.dentalhealth.org


But it’s not just down to organisations like the Oral Health Foundation or a single month in the year. Part of the responsibility of being a Dental Care Professional is raising awareness, educating our patients not just about how to care for their teeth and maintain their oral health but sharing essential information about how to prevent diseases like mouth cancer and how to determine the difference between a healthy or unhealthy mouth.

In fact we are champions in the battle against this disease that claims the lives of nearly 2,000 people in the UK every year. Many of the deaths due to mouth cancer could be prevented if the cancer was diagnosed early enough and we are best placed as educated dental professionals because we are performing oral examinations on a daily basis and every single patient who attends a routine dental appointment here receives essential screening for mouth cancer.

What does your mouth cancer screen involve?

Your dentist will –

  1. Observe the face and neck looking for swellings, skin abnormalities, moles and asymmetry.
  2. Look for any changes in the colour or texture of the border of the lips and mouth.
  3. Feel the lymph nodes in the neck feeling for any enlargement or abnormality.
  4. Look for changes in colour and texture of the inside surface of the lips and cheeks.
  5. Examine the tongue at rest and protruded for changes in colour, texture, symmetry and mobility.
  6. Inspect and feel the lateral borders and underside of the tongue.
  7. Depress the tongue and examine the soft and hard palates. Ask the patient to say “Ah” and inspect the tissues at the very back of the mouth.

All of this will take less than a couple of minutes!

Your responsibility.

  • Attend your dental check up. Regular screening results in early detection which could save your life.
  • Know what the risk factors, that predispose someone to developing mouth cancer are.
  • Know about the signs and symptoms of mouth cancer, so you know what to look for and when to seek help.
  • If in doubt, get checked out!



In our Practice, fortunately not many of our patients are diagnosed with mouth cancer but that never means we take it any less seriously. If we see anything suspicious, we will immediately refer you for a specialist opinion.


Poor posture can have a direct effect on your oral health.

Dentistry isn’t just about teeth and gums.

It encompasses your entire oral health, which has a direct relationship with your overall health and well-being.

Dentist v GP?

All too often people will visit their GP with problems like headaches and facial pain, when they might be missing a Dentist’s help.

We need to make people more aware of how we, as dental professionals, can help determine the cause of dental, facial, or head pain and give them the necessary tools to relieve their symptoms and improve their quality of life.


Could  a problem with your Temporomandibular Joint/s (TMJ) be causing your Headaches?

More than 10 million people in the UK get headaches regularly, making them one of the most common health complaints.

90% of headaches could actually be caused by disorders in the facial muscles and nerves.

One cause of headaches that warrants investigation by your Dentist, is Temporomandibular Joint Dysfunction/Disorder (TMJD).

More information can be found via the following links:



Up to 25% of the population are affected by TMJD symptoms, but only 5% seek help, the remainder simply ‘put up with’ it.


Symptoms of TMJD such as pain, locking and stiffness of the jaw can occur at any age, but are more common among women and those between the ages of 20 and 50. They can range from a slight nuisance to severely debilitating as it can impact your ability to eat, talk and sleep. They may occur on one or both sides of the face. Other symptoms include fatigue, ringing in the ears, neck tension, sinus congestion and ear infections.

But what causes TMJD?

There are many possible causes of TMJD but one important element that is so often overlooked is bad posture.

Poor posture can result from occupational factors such as prolonged desk work at an incorrectly set up computer station, lifestyle factors such as being more sedentary, obese, stressed, pregnant, having poor muscle tone, psychological factors such as self esteem and confidence or physical factors such as spinal deformities (scoliosis).

Currently trending, is the aptly named ‘iPad neck’, where looking down for long periods at tablets and mobile phones, causes pain, stiffness and long term postural changes. It stands to reason the jaw joint will also be affected by this.

The Posture Theory.

From an alignment perspective, the human head is meant to sit directly on top of the shoulders.

side-posture  poor-posture1

When the head moves forward, in front of the shoulder joint, especially during sedentary activities, the muscles of the TMJ along with the neck and shoulder muscles have to work hard to support the weight of the head, holding it up against gravity, exerting high forces because the head is no longer in a balanced, energy efficient position, supported by the rest of the body.bambach1

The fine and complex musculature responsible for the movement of the jaw are not designed to perform heavy lifting.

The forward head and neck position triggers a righting reflex in the brain, cocking your head back to level the eyes with the horizon but unless we rebalance the head’s position on our shoulders, this only makes the neck more extended and the extensor muscles working even harder.

This extra effort from the jaw muscles pulls the mandible back and down, the mouth wants to hang open which results in the powerful jaw closing muscles working even harder to prevent this. Under the stress of supporting the head in an incorrect position, the jaw muscles go into lock down and the jaw loses its ability to move smoothly and freely.

What we end up with, is abnormal mandibular positioning, nerve compression, ligament strain and disc compression. No wonder it hurts!

The Solution.

Primarily we must deal with the cause, the head-forward posture. Corrective exercises will restore the jaw joint’s ability to glide freely and remove the pressure on the surrounding musculature.

  • make a conscious effort to stand, sit and lie down properly.
  • always practice ‘head up’ walking.
  • if you are reading for prolonged periods, keep your mobile, book etc held up in front of you, level with your eyes.
  • if you have to sit for long periods, at a computer or desk, take frequent breaks (about every 20 mins.) to look up; sit up or get up and stretch.
  • stay active, take regular good exercise.

Do this exercise often:

  • Stand up straight, look straight ahead. Keeping your head and chin level.
  • Gently lengthen your neck upwards as you tuck in your chin, drawing your head back over your shoulders.
  • Bring your shoulder blades down and back towards your spine.
  • Pull in your lower tummy muscles to maintain a natural curve in your lower back.
  • Hold for 3-5 seconds. Repeat 10 times.
  • DO NOT allow the head to return forward past neutral.
  • Do not elevate your chin or shoulders.


More good advice can be found here:


and download our Exercises to improve the function of the Temporo-mandibular Joint from our websites’ download page.


Symptoms can also be treated with pain medication or your Dentist may decide to refer you to a specialist. Other treatments include injecting the jaw joint with a long-lasting local anaesthetic and steroid; fitting a bespoke oral appliance, such as a bite guard to help align the teeth, relieve pressure, prevent damage to teeth and rest the jaw.

It is also important to attend to any required dental work, to maintain the stability and integrity of your bite, such as addressing loose crowns, bridges or ill-fitting dentures.

Take home message.

Visit your Dentist regularly, your oral health is of paramount importance to your well being.

If you suffer from headaches or jaw problems, discuss this with your dental team. They will be able to help. Finding the cause of the problem is half way to a solution.