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Dental Handbook

  • General
    • Extraction 

      Teeth extractions are done for a variety of reasons. Below are some examples.
      • Very large cavity/ caries that cannot be restored with cements.
      • Periodontal diseases or in simple words diseases of the gums.
      • Fractured or broken teeth
      • Teeth that are traumatized leading to infection and inflammation of the pulp
      • Teeth that fail to erupt or are unable to erupt into the mouth and are deep inside the bone. They are called impacted teeth and may have to be removed.
      • Abscessed teeth are teeth in which the infection has spread to the underlying bone.
      • Teeth that are abnormal in development i.e., structure, shape, size, etc.
      • Teeth that are involved in cysts or tumors.
      • Ectopic teeth that have erupted in a wrong place.
      • Sometimes the orthodontist may remove some teeth to correct crooked teeth. 

      Root canal treatment

      Basically tooth is made of three layers, outer strong and hard enamel, intermediate tough dentin and inner soft pulp that contains the nerve ending, blood vessels and others cells which maintain the vitality of the tooth. When dental decay is allowed to progress, it results in a deep cavity that may reach the pulp thereby exposing the pulp to the exterior. Exposure of the pulp may also occur due to erosion or trauma like fracture of the tooth. Whenever the pulp is exposed to the exterior, it develops inflammation and infection. A tooth that has its pulp exposed by decay, trauma, etc has two treatment options; extraction of the tooth or retain the tooth by undertaking a root canal treatment. Such an endodontically treated tooth can function normally in mouth. If untreated, the tooth develops pain, swelling, etc, and the infection can spread deeper into the bone

      Fillings

      Although cavities in teeth need not be treated as an emergency, (unless associated with an abscess), they should be filled as early as possible since, decay is a slow progressive process and without many symptoms until the tooth is grossly destroyed. Sometimes even a small spot may show massive destruction below it. Treating the decay at the initial stage helps to conserve tooth structure.

      Wisdom tooth removal 

      Teeth that fail to erupt or are unable to erupt into the mouth and are deep inside the bone. They are called impacted teeth and may have to be removed.

  • Preventive
    • Oral prophylaxis (full mouth cleaning) 

      In a mouth that is not kept clean by regular oral hygiene practice, a thin, soft, sticky colorless layer is constantly formed on the surface of teeth and it is called dental plaque. Dental plaque is just layers of growing mass of various types of bacteria that are present in the mouth. Dental plaque in small quantities is almost invisible, but in large quantities it can be felt with a tongue as a fuzzy unclean coating. If plaque is not completely removed everyday by tooth brushing and flossing, the remaining plaque becomes a stony crust called calculus/tartar. Calculus clings to the teeth with such force that only a dentist or a hygienist with the help of special instruments can remove it.

      Fluoride application

      Studies have shown that fluorides can prevent decay by up to 50% if they are supplemented and monitored in water, food and tooth paste. In addition the patient should maintain good oral hygiene

      Pit and fissure sealants 

      Sealants are a safe and painless way of protecting your teeth from decay. A sealant is a protective plastic coating, which is applied to the biting surfaces of the back teeth. The sealant forms a hard shield that stops food and bacteria getting into the tiny grooves in the teeth and causing decay. The sealant forms a smooth, protective barrier by covering all the little grooves and dips (pits and fissures) in the surface of the tooth. Dental decay easily starts in these grooves. Sealants are only applied to the back teeth - the molars and premolars. These are the teeth that have pits and fissures on their biting surfaces. Your dentist will tell you which teeth should be sealed after examining them, and checking whether the fissures are deep enough for sealing to help. Some teeth naturally form with deep grooves which can be sealed, others form with shallow ones which may not need sealing. Sealants are often applied as soon as the adult teeth start to come through. This is usually between 6 and 7 years of age. The rest are usually sealed as soon as they appear which can be any time between 11 and 14.Sealing is usually quick and straightforward, taking only a few minutes for each tooth. The tooth is thoroughly cleaned, prepared with a special solution, and then dried. The liquid sealant is then put onto the tooth and allowed to set hard - usually by shining a bright light onto it.
  • Growth modification therapies
    • When a growing child has jaw bone imbalances such that one jaw is bigger or smaller than the other, Two Phase Growth Modification Treatment can help.

      This treatment is a very specialized process that harnesses the growth potential of a child and re-directs jaw growth to rebalance facial harmony!

      The biggest advantage of Growth Modification is to maximize growth opportunity to achieve ideal healthy, functional, aesthetic results. This leads to less complicated treatment in future by minimizing bony discrepancy early.

      Growth Modification can treat reverse bites in a child, protruded front teeth, some types of crooked faces, open bites and deep bites. Patients with front teeth that protrude out severely are at increased risk of teeth fracture during a fall. Growth modification can help reduce this danger.

      If your child has a jaw imbalance, waiting for complete eruption of permanent teeth and having only one phase of treatment means missing the important growth window.

      Once this window of growth has passed, treatment may become more complicated later; may need jaw surgery or if treating with braces only, mean a compromise in aesthetics and stability. First Phase Treatment: Build your child’s facial foundation from the beginning.

      Growing and developing children sometimes exhibit early signs of jaw problems.

      An upper or lower jaw that is growing too much or too little can be recognized at an early age.

      If your child is 6 years and older with jaw imbalances, they can benefit from early orthodontic treatment.


      Resting Period and monitoring your child's teeth’s progress

      In this phase, the remaining permanent teeth are allowed to erupt because at the end of Phase One treatment, teeth are usually not in their final positions.

      Regular 4- 6 monthly recall appointments for observation are necessary to ensure that the rest of the adult teeth are erupting in the correct sequence and position.


      Second Phase Treatment: 

      Building an even better smile from strong foundations

      The second phase is started when almost all permanent teeth have erupted, and usually requires braces for a period of time. The first phase moulds the face, while the second phase focus on the arrangement of teeth.

      Retainers are worn at the end of treatment to maintain your child’s beautiful, new smile and new look.

  • Cleft lip & Palate Management
    • The complex needs of a child with cleft lip and cleft palate are best met by an interdisciplinary team of professionals from various specialties who work together. This is a standard of care that begins soon after the child's birth and continues to adulthood. 

      The members of the cleft lip and palate treatment team include:

       Geneticist

       Pediatrician

       Plastic Surgeon

       Ear, Nose, and Throat physician (otolaryngologist)

       Oral surgeon

       Orthodontist

       Dentist

       Speech-language pathologist

       Audiologist

       Nurse

       Social worker

       Psychologist

       Team coordinator

      The frequency of team visits will depend on the child's needs and can range from two to three times per year to once every 2 to 3 years.
  • Orthodontic
    • Not many of us are blessed with well arranged teeth or so called ideal occlusion. We very often come across many children and adults having teeth that are protruded or crowded or spaced etc. These irregularities of teeth are called malocclusions and are an important factor in robbing one of a good smile. Orthodontics is the specialization of dentistry, which deals with correcting the bite and arrangement of teeth, therefore improves the smile and function.

      Removable appliance

      When it comes to dental treatment, permanent dental solution isn't always an option -- imagine wearing an orthodontic retainer or a night guard 24 hours a day, seven days a week! Or not being able to remove your dentures for cleaning. In these cases, removable dental appliances may be a better choice. 

      There are many different types of removable dental appliances, covering a wide range of products and services. Removable dental appliances are used to restore and protect your teeth, as well as to keep them from shifting out of place. Some removable dental appliances are used solely for cosmetic purposes.

  • Rehabilitation
    • Oral rehabilitation is defined as the restoration of the functional integrity of the dental arches by the use of inlays, crowns, bridges and partial dentures. Occlusal rehabilitation therefore involves restoring the dentate or partially dentate mouth. The aim is to provide an orderly pattern of occlusal contact and articulation that will optimize oral function, stability and esthetics

      Crowns:

      A crown is a restoration that covers the entire tooth like a cap. It can be made of porcelain or acrylic. Crowns are used to restore teeth that are discolored, have multiple decays or are fractured.

      Dentures:

      Dentures are artificial substitutes used to replace all or some of the lost teeth and adjoining tissues to maintain function, health and esthetics of the tissues. So in simple words dentures help to replace lost teeth.

      Implants:

      Dental Implants are artificial devices used to replace missing teeth. Implants come in many different sizes and shapes and they are placed into the bone to act as support for a prosthetic crown. These are the most modern method of replacing missing teeth. They are basically substitutes for the natural tooth roots and are made of titanium and will usually be cylindrical in size. 

      Benefits

      Dental implants have given countless patients many amazing benefits including

      · Natural tooth like feeling

      · Improved appearance, comfort, speech

      · Eat better, enjoy more foods, better nutrition

      · Convenience

      · Improved self-esteem

      Dental implants are a great value for your investment. Implants look much better, and feel better, than traditional removable bridges, and offer the same force for biting as bridges that are fixed in place. Implants will last your lifetime.

      Applications of Implant Dentistry

      In many cases, dental implants are incorporated into an overall treatment plan that might focus on the replacement of several teeth. Some patients have the option of replacing each affected tooth with a new implant, depending upon the condition of the bone. Other treatment plans may require implants for anchoring bridges and dentures.

      PROCEDURE

      STAGE ONE 

      The Implant Procedure

      The implant procedure is the same whether one or all teeth are missing. In this example, there is only one missing lower tooth. For the purpose of demonstration we will assume the patient is healthy and is a candidate for this procedure. 

      Placing the Implant

      Involves the placement of specific size and shape implants at strategic locations in the mouth. This is performed under local anesthesia and the entire procedure takes approximately 45 minutes to one hour. Usually the healing is uneventful as the patient is on the prescribed drugs. Implants can also be placed immediately after extractions. 

      The Healing Process - Osseointegration 

      The healing process takes two to three months. This is the amount of time it usually takes for the implant to become part of the lower jaw, commonly referred to as osseointegration. (Osseo - bone; the bone starts forming around the implant and the implant gets integrated into the bone tissue). 

      STAGE TWO

      Attaching the Abutment

      Today's technologies often include zirconium abutments attached to the implant post, to assure that the new porcelain tooth possesses translucency properties similar to a natural tooth. 

      Placing the Crown

      After impressions are taken a crown is made and shaded to match your existing teeth. The crown is then slipped over the post and cemented. 

      The Completed Implant 

      The final prosthetic crown appears as a natural tooth.

      Bridges and bone grafting 

      A bridge is a prosthetic appliance that replaces missing teeth by permanently getting attached to the adjacent remaining teeth... fixed partial dentures or FPD are tooth replacements that are fixed permanently in the mouth and cannot be removed for routine cleaning by the patient. These dentures are made to take support from adjacent natural teeth. Unfortunately these dentures can replace only a few missing teeth. When a large number of teeth are missing one has to go in for a removable partial denture or RPD.

  • Gum Treatments
    • Your gum tissue is like a frame that provides form and shape to the top of your tooth. A less than attractive smile results when the integrity of the gum is compromised or the actual gum between your teeth becomes weak. Usually due to poor hygiene (gum disease), you actually begin to lose gum tissue. Cosmetic dentistry provides many cosmetic solutions such as composite resin bonding, crowns, and veneers to create a great smile. These solutions are usually part of an overall strategy which may involve cosmetic gum surgery. Used to correct a 'gummy smile' (a significant portion of your gum is exposed when you smile), cosmetic gum surgery is the procedure of lengthening your teeth from the neck of the tooth upwards. Your teeth then appear to be longer and much less gum is seen when you smile.

      Cosmetic gum surgery, or periodontal plastic surgery, can correct almost any deformity or gingival problems preventing you from a beautiful smile. As we age, our gums may shrink and recede which makes our teeth look longer. While this is often age-related, it can also occur due to a incorrect bite. A cosmetic dentist or a Periodontist can correct this to such an extent, that you'll have a very youthful appearing smile. The "Gummy Smile" - This is a problem where your teeth appear to be too short. Gum sculpting is often the solution. To solve this, a dentist uses a laser to remove the excess tissue of your "gummy" smile, which then exposes more of your tooth.

      There are two primary procedures for cosmetic gum surgery, depending on your current smile.

      "Gummy Smile" (Excessive Gingival Display) 

      A "Gummy Smile" can occur due to wear of teeth from teeth grinding, a short upper lip, or having a longer than usual upper jawbone. This smile is when your teeth appear too small and your gums appear too large.

      "Long Tooth Smile" (Gum Recession)

      As your gums recede, your teeth appear longer than normal. While "long teeth" may result in an unattractive smile, you should also be concerned with root sensitivity and possible tooth loss. Recent advances in techniques and materials have resulted in significant improvements in comfort, predictability and esthetics.
  • Dental Care for Children With Special Needs
    • Bi-yearly dental checkups are imperative no matter your age, but they are particularly important for children, especially those with special needs. It is very common for people to develop fears of seeing an oral care practitioner therefore it’s imperative for your child to develop a good relationship with their dentist early on to prevent and treat any issues with their teeth, gum or mouth. In fact, even if you help your children take excellent care of their teeth and gums, there still may be issues that they don’t feel or you don’t see. This is particularly true for special needs kids as they may have unique issues that are tied to their medical condition. For example, many special needs kids require medication that contain high levels of sugar, which can cause tooth decay if teeth are not properly brushed and flossed. Also, there may be dietary issues involved that prevent your child’s teeth from growing properly if deficiencies exist in certain vitamins, minerals, and nutrients. Oral sensitivity is another common problem. Unfortunately, dental care often takes a backseat to primary care physicians or specialty doctors with special needs children, especially when serious medical issues are top of mind. But it’s imperative to not jeopardize your child’s dental health by forgoing regular dental visits.

      It’s important to seek out a pediatric dentist who is not only specialized in working with children, but also has experience working with special needs children. Make sure to look for an office that is staffed with friendly faces and inquire about the hygienist’s experience as well as the dentist’s when researching the right office for you and your child. It should also be an inviting atmosphere so your child feels as comfortable as possible. Your pediatrician is a wonderful resource for recommendations, and you’ll want to speak with both the dentist and the pediatrician about conditions to watch out for.

  • Trauma Care
    • Chipped or Fractured Teeth

      Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or “cap” may be needed to restore the tooth.

      If the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medications or ointments, or place aspirin on the affected areas to eliminate pain symptoms.

      Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction
      .

      Dislodged (Luxated) Teeth

      During an injury, a tooth may be pushed sideways, out of or into its socket. Your Endodontist or general dentist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.

      Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, an Endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.

      Knocked-Out (Avulsed) Teeth

      If a tooth is completely knocked out of your mouth, time is of the essence. See an Endodontist or dentist immediately! Handled the knocked-out tooth very gently, avoiding touching the root surface and follow these steps to protect the tooth.

      Your Endodontist or dentist will carefully evaluate the tooth, place it back in its socket and examine you for any other dental and facial injuries. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or Endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.

      The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or Endodontist may discuss other treatment options with you.

      Root Fractures

      A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.

      Do traumatic dental injuries differ in children?

      Chipped primary (baby) teeth can be esthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a knocked-out primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.

      Children’s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist or Endodontist to stimulate continued root growth.

      Endodontist have the knowledge and skill to treat incompletely formed roots in children so that, in some instances, the roots can continue to develop. Endodontist will do all that is possible to save the natural tooth. These specialists are the logical source of information and expertise for children who are victims of dental trauma.

      Will the tooth need any special care or additional treatment?

      The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response all affects the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption.

      Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or Endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. It has to be noted that some types of resorption are untreatable.