Dr Nishan Dixit
Latest posts by Dr Nishan Dixit (see all)
- Dr Dixit is the new President of British Academy of Cosmetic Dentistry - 28 May 2020
- Does Invisalign hurt? - 9 March 2020
- How Long Does Invisalign Take? - 27 February 2020
Blog posts and articles about general dentistry treatments from Dr Nishan Dixit, your Harrow dentist
“Please make me look nice for my daughter’s big day!” These were the words of a loving mother who desperately wanted nice teeth for what was going to be one of the most important days of her life, her daughter’s wedding. For most of her life, she had lived with a smile she was very unhappy with. Her top teeth were very uneven and discoloured. The old existing crowns towards the back of the mouth had began to deteriorate, as well as a tooth which had become very stained and unsightly. The gap in between her front two teeth always seemed to draw attention to her not so great smile. This made her feel very self conscious and even embarrassed. She would never smile in front of the camera, and even in general conversation, she would raise her hand to cover her mouth. Friends and family always thought she was very quiet, but in reality, she lacked so much confidence that smiling, laughing and even talking was something she found very difficult. She wanted a smile that would make her look and feel great.
With careful thought and planning, Dr Dixit achieved this transformation by using a combination of all ceramic crowns and veneers. To make the teeth brighter , the teeth were whitened using the home whitening system. The heavily filled teeth were protected with new crowns and the new veneers helped to improve the shape and position of the teeth. The colour was matched exactly to the patients new teeth colour. The crowns and veneers were made to look as natural as possible.
The patient was very pleased with the results. It had given her so much confidence that she felt like a new woman. She looked and felt amazing. The discoloured front tooth and filling had gone and the visible black lines were no longer there. She finally had the smile she always wanted.
Many people are looking for that brighter, whiter smile but did you know that research (1) seems to indicate that it’s not actually a white smile which people find attractive, rather, it is a yellow smile which people find unattractive.
The researchers found that:
Whitening had no effect beyond that produced by natural colouration. This indicates that these colour induced alterations in ratings of attractiveness are mediated by increased/decreased yellowing rather than whitening per se.
As we get older our teeth yellow with age and whitening them back to their natural colouration is all that is required to achieve the most attractive smile, so what is the best way to whiten your teeth?
Here’s a simple list:
The first step to enjoying whiter teeth is to maintain good oral hygiene. Firstly this will help keep your natural teeth as white as possible, if plaque (2) is kept at bay then staining is less likely to build up on your teeth. Secondly, before you have any of the other teeth whitening treatments you’ll need to ensure that your teeth and gums are in good condition. Most dentists will not offer any form of cosmetic or whitening treatment if you’re oral hygiene is not up to scratch!
There are many products available to buy over-the-counter in your local pharmacy, However, the Daily Mail (3) says:
Experts warn that some products which claim to whiten could actually harm your teeth, gums and even your stomach lining.
While some of these products may work their effectiveness and safety isn’t monitored by a dental professional and therefore they come with some risk if you use them at home.
Another trend in teeth whitening is to go to beauty salons or other establishments other than a dental practice. Whilst this may be cheaper than going to a dentist it is also illegal! Teeth whitening falls under the category of “the practice of dentistry”, the General Dental Council (4) says:
The practice of dentistry is limited to GDC registrants. It is the Council’s view that applying materials and carrying out procedures designed to improve the aesthetic appearance of teeth amounts to the practice of dentistry. So too does the giving of clinical advice about such procedures. Therefore all tooth whitening procedures, including bleach and laser treatment, are seen as the practice of dentistry by the General Dental Council.
It is important to know the teeth whitening products contain an amount of peroxide, this peroxide can be dangerous if not used correctly and it is for this reason that we recommend you only visit a suitably qualified dental professional for your teeth whitening.
When you have home teeth whitening you will be provided with a custom made and closed fitting bleaching tray, into this tray you will apply the bleaching gel which is held against your teeth.This bleaching tray has some unique features:
These design features are extremely important to ensure that the treatment is not only effective but safe too, only a qualified dental professional is able to prescribe one of these trays.
Something to watch out for, the bleaching tray is made from a thermoplastic, this means you will need to keep tray away from hot/warm water as it could distort.
In some extreme cases with very dark teeth conventional teeth whitening is not able to lighten the teeth enough.
As you can see from the case above these teeth were particularly dark and the patient wanted them particularly liked, there was also another complication, and existing Crown on the front tooth. Dental crowns and veneers cannot be lightened with teeth whitening techniques, so if you have an existing restoration then this will need to be replaced as part of the whitening process.
This lady wanted to improve her smile, have it more natural looking and whiter than it was before so we prepared her teeth for porcelain crowns to achieve an excellent result, what do you think?
>> Read more about this case here
Many times a combination of treatments can be used to whiten your teeth, you may have a single tooth which is too dark to whiten using the bleaching method, but we may be able to whiten the surrounding teeth and then use a single dental veneer or crown on the very dark tooth to whiten that the same shade.
The cost of teeth whitening treatments will also vary enormously depending on the complexity of your case. To give you an idea of dental fees please visit our fee guide. By far the cheapest way of maintaining unnaturally bright smile is to keep your teeth in excellent dental health. This will keep plaque at bay and ensure that the buildup of any staining on your teeth is kept to a minimum. The next most cost-effective method is to consider teeth bleaching however this is not always suitable for the reasons already stated.
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Blue Court Dental Centre is a local dentist in the heart of Harrow, Middlesex. They offer a range of dental treatments including teeth whitening, dental veneers and oral hygiene programs to help keep your teeth looking fresh and bright for life.
One of the main reasons people decide to have orthodontic braces to get straighter teeth is because straight teeth look better, but from a purely dental and health point of view this is not the main reason you should consider straighter teeth. Did you know that straight teeth are easier to clean? And being easier to clean means they are healthier…
Recent research has shown a link between oral bacteria and a flareup of irritable bowel disease, The research identified that the bacteria invaded the bloodstream which then aggravated any existing irritable bowel causing the flareup, these bacteria are commonly found in the mouth! This research is linked to additional research which shows that the bacteria associated with gum disease and the more severe periodontitis can act as a keystone bacteria, this means their presence can instigate other processes and pathogens in the human body which can lead to Colon cancer and other inflammatory diseases.
So it’s clear that not only will keeping your teeth clean ensure that your teeth are healthy, it also helps to promote overall body health… So where do straight teeth fit in?
Straighter teeth are far easier to clean as you can get into those difficult to reach areas between your teeth. If your teeth are crooked or overlapping then it is harder to reach these areas, particularly with floss. This can lead to a buildup of these harmful bacteria which could eventually lead to the onset of other inflammatory diseases around the body.
So now that you know the importance of straighter teeth, let’s look at some of your options if you decide to have braces.
CFast is one of the most modern option for orthodontic braces in our Harrow dental practice. These braces is a combination of tooth coloured wires and clear brackets to straighten the front 6 teeth on the top and bottom jaw only.
Because we are only straightening these front teeth we can move them much faster than standard braces which may also be moving the back teeth also. This makes CFast excellent for cosmetic orthodontics and also helps to straighten the teeth making them easier to clean.
Six Month Smiles is is one of those orthodontic systems which does exactly what it says on the tin, straighter teeth in approximately 6 months!
Once again, this is the modern alternative to classic train track braces and works with a trademarked clear bracket which is bonded due tooth.
These brackets are barely visible and are able to achieve a predictable result using low forces with short overall treatment times which means the treatment is more comfortable, safe and allows you to keep your teeth cleaner, which is great if your overall body health.
The results with six months miles can be quite amazing.
The Inman aligner offers an alternative type of orthodontic brace. Both of the options above are fixed orthodontics, the Inman aligner is a removable option. This has the advantage of being able to use different forces in the way of springs to move your teeth.
As you can see in this image these braces push and pull your teeth at the same time, working from inside your mouth and outside in unison with one another. This unique way of using braces means we can achieve a straighter smile in approximately 12 to 16 weeks, much faster than any other orthodontic system.
You would need to ensure that the where these braces for a minimum of 20 hours per day, removing them only to eat and clean your teeth. This means your commitment to wearing braces needs to be high with you strongly motivated to achieve your straighter smile.
Once again, the Inman aligner is only used for the front six teeth to straighten them out providing you with an easier to clean smile.
These braces, once again, do exactly what they say on the tin, they are clear! These clear braces work by applying a small amount of pressure to your teeth in the direction required to move them. Once this small amount of movement has been achieved you will replace the removable clear brace with a new one. Typically replacing each race every two weeks.
Treatment times are approximately one year with this system, depending upon how much your teeth need to move. Once again we are normally only moving the front six teeth into a straighter alignment to achieve a more cosmetic result which is easier to keep clean.
As with the Inman aligner you will need to wear your clear braces for approximately 20 hours per day, only removing them to eat and clean your teeth. You can even continue to wear them in full view of the public, perhaps whilst teaching or giving a presentation, nobody else will ever know!
We recommend that you do some research online before deciding which dentist to go to to have orthodontics. The systems described above require that your dentist is certified to use them, we suggest you ask to see this certification at your initial consultation. Many dentists offer an initial consultation either at a discounted rate or for free, do spend some time looking at their website to see if this is on offer at the dental practice local to you.
We also recommend that you ask the dentist for a series of reviews of their practice, this will leave you with peace of mind knowing that you have found a practice that other people like.
A good dentist should also have a range of before and after photographs to show you, please ask to see them when you go for your initial consultation. The photographs should be presented nicely and you should clearly be able to see the difference between the before treatment and after treatment photographs. Seeing these images allows you to know that the dentist you have found can actually do what they say they can and achieve the results that you want. Most dentists will have a range of photographs, so asked to see photographs which are similar to your own situation.
If you live in the Harrow HA1 area of Middlesex Then why not pop in to see us on the Watford Road. We are a modern dental practice offering a range of orthodontic braces to help you achieve a straighter and healthier smile… And we also offer a free consultation to anyone considering braces, please click here to download a voucher entitling you to this free assessment.
This young gentleman came to us when he started noticing something very odd about his tooth. It appeared to be changing colour. It started off as a greyish shadow, and as months went by, it became darker and more obvious. A large groove had developed and every time the patient laughed or smiled, he would raise his hands to cover his mouth (picture 1). For a very sociable young man, his confidence had started to drop.
After a consultation between the patient and Dr Dixit, it was found that the patient had a high sugar diet consisting of fizzy drinks, cakes and biscuits. The frequency of the sugary foods and the inability to clean affectively caused his tooth to decay close to the gum margin. To restore this badly decayed tooth, the decay was cleaned out (picture 2) and replaced with a composite tooth coloured filling material (picture 3) .
The filling material blended in with the patients existing tooth colour. The patient was very pleased with the result. His confidence had been regained and he no longer covered his mouth when he laughed. He felt very proud and happy to show off his natural looking new tooth.
As a board member and scientific director and education chair of the British Academy of Cosmetic Dentistry, our very own Dr Nishan Dixit is often asked to publish articles on successful cases so that others in the dental profession can learn from his successes. Here is one such article published in The Dentist, Issue 76, April 2014.
Nishan Dixit describes a non-invasive composite restoration using a multi-layer technique.
67 year old male patient presented with a lingual cusp fracture in his lower right first pre-molar, which had an old amalgam restoration. He was not experiencing any pain, but was aware of the rough edge. Since the fracture had occurred, the patient had also become more self-conscious about the discolouration of the tooth.
The treatment options were discussed with the patient. The tooth could either be restored with a direct composite or an indirect laboratory-manufactured restoration. The patient decided on the composite option, as this would provide a more immediate and less disruptive solution. I prefer to offer composite treatment, rather than more invasive procedures, when the clinical situation allows. This is more affordable for the patient, and the durability of the material makes it a realistic long-term alternative.
Having been a provider of cosmetic dentistry for almost 20 years, I have observed a number of improvements in materials. Long-term studies have proved the reliability of modern composites. The latest developments have produced composites that are more resistant to wear and have better colour stability, combined with reduced polymerisation shrinkage rates.
For a number of years,I have used the Heraeus Venus range of composites exclusively, due to their handling properties and the results achievable. For this case, I chose to use Venus Pearl. It gives high aesthetic outcomes using a multi-layer technique, providing excellent colour adaptation and a natural finish. The material is easy to use, masks well and is highly sculptable and polishable. Compared with earlier technologies, the cured composite is more flexible under stress and more durable over time.
Venus Pearl includes super-fine nano-hybrid filler particles. This provides even more natural light refraction and supreme aesthetic appearance, combined with a creamy application.
At the treatment appointment, local anaesthetic was administered and the tooth was isolated with rubber dam and a clamp system. The old amalgam restoration was removed and the cavity was rendered caries free. The preparation margins were smoothed and the enamel margins bevelled. A matrix band was then adapted to the tooth. The prepared cavity was etched with 37 per cent phosphoric acid using a total etch technique. The cavity was thoroughly washed, gently dried and primed. Then a bonding agent was placed and polymerised.
Venus Pearl OMC (Opaque Medium Chromatic) was applied to the cavity in 2mm increments. The composite was adapted to the cavity, using a microbrush in a ‘patting’ motion, then polymerised . Approximately 20 per cent of the cavity was filled with OMC and the remaining 80 percent was filled with the Venus Pearl A3 shade. The build-up of the composite was done on a cusp-by¬cusp basis, gradually creating the tooth shape and fissure pattern. During the incremental build-up a small amount of dark brown stain was applied in the fissure areas using an explorer.
Finally, the restoration was polished with Venus Supra discs and a silicone carbide brush. The outcome was a restoration with good aesthetics, achieved with minimum loss of tooth substance and completed in one short visit. The patient was extremely pleased with the end result, leaving him feeling like he had “a new, natural-looking tooth”. He had absolutely no post operative sensitivity or pain. Subsequent recall appointments have shown this has continued to be the case. The treatment has left a healthy tooth and a happy patient.
In the dental profession we have been warning about the intake of too much sugar for many years, but why is this? It was originally the ancient Greeks that noticed that if they ate too many soft sweet things it destroyed their teeth, at first they thought it was the sugar which was directly responsible for attacking the teeth however we know today that this is not the case.
When you eat sugar not only does it act as a food for you, it acts as a food for the streptococcus bacteria in your mouth. As these bacteria feed on the sugar they excrete acids and it is these acids which eat away and attack the enamel outer layer of your teeth. These bacteria can be found in the plaque which often collects in between teeth or around the tooth/gum margin, this is why it is important to keep your teeth cleaned daily, flossing and rinsing to ensure that the plaque does not build up and give somewhere for the bacteria to hide.
So, back to our original question..
The Journal of Dental Research carried out a systematic review to inform WHO guidelines on the effects of restricting sugar intakes in various age groups. The research looked at % of sugar in a daily diet and its relationship to the onset of decay. The problem has been that the research has been interpreted misguidedly.
Various newspapers have unfortunately taken the step of converting this % of sugar into a spoonful amount, probably to make it easier for the general public to work out how much sugar they should be having. These Papers have converted this into between 5 and 7 teaspoons per day. Unfortunately doing this leads people to assume that they can have 5 or 7 teaspoons per day on their cereal, coffee , tea or anywhere else they add sugar.
The biggest problem is they forget that most of the sugar we eat daily is hidden within foods, not added by us afterwards. If we only count the spoonfuls of sugar we add to our food then we will be dramatically exceeding the recommended amounts!
The research reported the following results in their abstract:
So it seems that the research is suggesting if we keep our sugar intake below 10% of calorie intake then there is ‘moderate quality’ evidence to show a lower risk of dental decay… So perhaps we should start doing that!
We thought we’d give a rough guide to the amount of sugar contained within various food stuffs so that you can be sure to keep your intake ideally less than 10%.
Statistics taken from Sugar Stacks – They have included all forms of sugar in these statistics and have simply turned it into a ‘spoonfuls’ amount to make it easier to understand.
Research over the years has clearly shown that Eating too much sugar will directly impact oral health, the only question lies around exactly how much is too much. The new research seems to suggest that when we keep sugar intake below 10% (Or around 5 to 7 spoonfuls of all sugar intake per day) there is moderate quality evidence showing a lower risk of dental decay, and that can only be good.
Our advice therefore is to look at the quantity of sugar in the food that you eat, remember that sugar can be from many sources and it’s not just the sugar which we add to food that counts.
So how much sugar do you eat per day? Let us know in the comments section below this blog post, and then tell us what you’re going to do to cut down…
How to Look After Your Teeth
There are lots of things you can do to maintain your dental health and achieve a fresh and attractive smile. Here are a few top tips to get you going….
01 Brush your teeth at least twice a day. When you brush, don’t rush. Take enough time to do a thorough job – two minutes is recommended.
02 Use toothpaste that contains flouride to help prevent cavities.
03 Consider using an electric or battery-operated tooth brush, especially if you have arthritis or other problems that make it difficult to brush effectively.
04 Practice good technique. Hold your toothbrush at a slight angle against your teeth and brush with short back-and-forth motions. Remember to brush the inside and chewing surfaces of your teeth, as well as your tongue. Avoid vigorous or harsh scrubbing, which can irritate your gums.
05 Know when to replace your toothbrush. Invest in a new toothbrush or a replacement head for your electric toothbrush every two to three months – or sooner if the bristles become frayed.
06 Cleaning between the teeth at least once a day is important as it removes food and plaque from between the teeth where even the best toothbrush can be ineffective. For most people, doing this once a day is enough and the best time to do it is after your last meal of the day. Clean between your teeth before or after brushing, but rinse your mouth afterward to wash out everything that has been dislodged.
07 Brush your tongue as well as your teeth to help eliminate mouth-borne bacteria and to keep your mouth and breath fresh.
08 A mouthwash can help with oral health. Mouthwashes with alcohol can dry out the mouth, so try to use brands that contain no alcohol.
09 Always wait 20-30 minutes before you brush your teeth after eating or drinking acidic food or drink, such as oranges, as this can erode the enamel on your teeth.
10 Avoid eating too much sugar and drinking sugary drinks such as soda, sweetened teas, or fruit juices, particularly in between meals.
11 Nuts, dairy foods such as cheese, and meats are all good dietry choices that can help strengthen enamel because of the calcium and vitamins they provide.
12 Chewing sugarless gum after a meal is a good way to substitute brushing inbetween meals; it can help remove food particles for between the teeth and produces saliva which counteract the bacteria.
13 Make sure you visit your dentist every six months and a hygienist visit to look after your teeth and gums.
14 If you have a toothache, it is important to seek emergency dental care immediately as this could be a potential infection or abcess.
There you are a range of Six Month Smiles videos that have been uploaded to the Internet and so to help you in your search we thought it was a good idea to post a few of them here. Six Month Smiles is a revolutionary new orthodontic technique which allows you to have tooth coloured braces that can move your front teeth into a more cosmetic and aesthetically pleasing alignment.
Up until recently the only option for braces was to have the metal train track type – well, no longer is this the case with 6 Month Braces.
Our dental practice is the only provider of Six Month Braces in Harrow
This first video shows what can change in six months…
People are often asking for personal reviews of six months braces and how this treatment could work for them as an individual. Here is one such story of Mia who underwent straight teeth treatment with six month smiles.
Another video on six-month smiles
This video shows some patient reviews of the treatment, and then talks to a dentist about the treatment with braces and whether it could be right for you.
The Videos above have been taken from the six month smiles YouTube channel, however here is another video, again taken from YouTube, but this time taken from a private channel of a happy patient having six-month smiles… Here she gives her own case review.