Treatment Information

Cavity Fillings:-
Cavity fillings are biocompatible material used for filling up the cavities, which are intentionally cut on the infected part of the tooth surface. These cavities are prepared in a scientific and a principled manner in order to achieve a strong and a long lasting filling.
The main idea of preparing a cavity is to remove the infected position of the tooth so as to prevent the further spread of decay and hence the ultimate loss of the tooth.

The cavities are prepared using high speed drilling equipment, which is controlled by the dentist. Patient may not have any discomfort initially but as the drill bit move closer to the center of the tooth (where the nerves are located), the patient begins to experience sensitivity. This can be avoided if tooth is anesthetized, which of course means having to take an injection
If the cavity prepared is very deep, a layer of medicated cement is used to line the floor of the cavity to help in healing of the tissue.

In case of metal based filling material a base is given. This base is nothing but a thick coat of cement lining the floor of the cavity. The base not only adds to the strength of the over lying filling but also insulates the tooth from sharp variation in temperature, caused by the increased thermal conductivity of the metal filling.

The term cement, which is frequently used, is a mix of a chemical powder and liquid. This mix, which is initially soft, turns hard over a period of time resembling the common cement used for construction.
For cavity preparation, which is not very deep, a cement base may not be required.

Cavity Fillings:
Filing of a prepared cavity depends upon a lot of factor such as.
Site (for an anterior tooth a metal filling may not be acceptable)

Function of a tooth (A posterior tooth might require a very strong filing to withstand the forces produced while chewing food)
Amount of remaining tooth structure: Too much of a hard filling material and very little amount of remaining tooth structure can cause the fracture of the tooth
Type of material used to fill the opposing tooth( when two different metals are used to restore two opposing teeth small amounts of galvanic currents are produced which can be painful for the patient.

Filling materials can be of 2 types:
Tooth colored - Glass inomer, composites etc.
Non tooth colored - Amalgam, Gold

Each material has its own advantages for e.g. Amalgam is much more strong & tougher than the tooth colored composite hence ideal for posterior teeth where as composite filling material require very little cavity preparation and hence saves a lot of tooth cutting there by preserving as much natural tooth material as possible.


Dental Anaesthesia:-
Teeth And Anesthesia:
Pain is the most common manifestation of dental disease and as such the advent of anesthesia may be regarded as a cornerstone in the development of modern dentistry.

Historically, dental pain or a toothache is regarded as the worst thing experienced by man since times immemorial. Despite the development of modern equipment and technical expertise, if there is one thing that dentists have been unable to control, it is the pain that presents itself in a variety of ways. In fact the nerve in the tooth or the pulp as it is called has fibers that can transmit only pain as a response to any stimulus. These fibers are unique to the body in this regard. A visit to a dentist is the scariest experience for some people, while others are able to sail through it relatively unscathed. It is here that anesthetic agents have served as a blessing to dentists and patients alike.

History Of The Development Of Dental Anesthesia:
The history of dentistry is somewhat chequred and is littered with unimaginable anecdotes. For example, the whole process of pulling out a tooth before anesthesia was known makes for interesting reading. The patient or in this case the victim was lead to an open field and a thread was tied around the offending tooth. Two burly lads held the patient down while the thread was pulled by a horse galloping at full speed! Later on barber dentists arrived and the process of getting a tooth pulled became more civilized. It must be pointed out though that anesthesia is used not only for extraction of teeth, but also for procedures that cause pain such as drilling cavities or cleaning the teeth deep into the gums.

Modern Anesthetics:
The modern anesthetics owe a lot to cocaine, which was the first natural anesthetic to be used. Although, it is no longer used in dentistry, it is worth noting that the loss of sensation caused by it was quite adequate. For that matter most of the drugs used today in dentistry are synthetic in nature. They belong to two groups, namely, Ester or Anilide group.

Ester group Anilide group
* Cocaine * Bupivacaine
* Benzocaine * Etidocaine
* Procaine * Lidocaine (most commonly used)
* Tetracaine * Mepivacaine

Most of these agents produce adequate loss of sensation, but some of them have more adverse reactions than the others and are hence not in common use. Lidocaine happens to be the most commonly used anesthetic agent in dentistry today.

A typical anesthetic solution contains lidocaine, adrenaline, methyl paraben, sodium meta-bisulphate, sodium chloride and water to make the solution. Adrenaline is a vasoconstrictor, meaning that it constricts the vessels, thereby prolonging the action of the anesthetic. The other chemicals are reducing agents to lidocaine hydrochloride and adrenaline.

Procedures:
Basically, anesthetic solutions in dentistry are administered in two routes,
* Intra-oral, meaning into the mouth and
* Extra-oral, meaning outside the mouth on certain areas on the face.

The intraoral route is by far the commonly used route of anesthetic administration in dentistry. Again, depending on the procedure to be performed, the areas of administration vary. If a single and very mobile tooth is to be pulled out, then the area around the tooth is singularly anesthetized. Where as multiple extractions or complex surgical procedures require one side of the face to be anesthetized. This is done by injecting the solution close to the nerve, which supplies these areas of the mouth. The effects of the anesthesia last from 2-4 hours though it can either last longer or shorter depending on the concentration of the anesthetic agent.

Contraindications and complications:
As such there is no absolute contraindication to the administration of anesthetic agents. There however exist some conditions where it is not advisable to give the full concentration of the drug. High blood pressure or hypertension is one such condition where adrenaline is not included in the anesthetic solution. All the other components are the same. Another condition is allergy to the solution. If the allergy is acute then local anesthetics are abandoned and general anesthetics are chosen. Complications of dental anesthesia mainly have to do with the inadvertent injection into a blood vessel. In such a case, a hematoma develops with subsequent swelling and pain. This however is treatable and goes away in no time.

Latest activity in the field:
Jet injectors have been developed so that even the pain of the needle prick is not felt. Since the administration of the injection is basically a blind process in that dentists actually do not know if the needle has gone into a vessel, efforts to incorporate a microchip connected to a monitor are being pursued. This will allow dentists to actually see where their needle has gone and could cut down the risk of injecting into a blood vessel.


Root Canal Treatment:-
What is a Root Canal?
To know about a root canal we have to understand the basic structure of the tooth.

The portion of the tooth seen in the oral cavity is called the crown of the tooth and portion which is anchored within the jaw bone is called the root. Depending on the size location and function a tooth may have one or more roots. The tooth has this inner core of soft tissue called pulp. The pulp comprises of all the nerves and blood vessels, which keep the tooth alive. In the crown, the pulp is present within a chamber called pulp chamber and it extends into the root via a narrow tapering canal called root canal. The blood vessels and nerves, which travel through this canal, leave the tooth through a small opening present in the lower end of the tooth ultimately joining with the other major blood vessels and nerves running within the jawbone.

How does the pulp get infected?
Sometimes the pulp inside your tooth becomes inflamed or infected. This can be caused by deep decay, repeated dental procedures on the tooth, a crack or chip in the tooth, or a blow to the tooth .The most common cause is tooth decay.

What happens when a pulp gets infected?
Tooth decay if left untreated spreads into the substance of the tooth ultimately infecting the pulp. Once the pulp becomes infected with more bacteria than it can handle, it begins to degenerate. As with any infection there is formation of pus, which tends to get accumulated at the tip of the roots within the jawbone, forming a "pus-pocket" called an abscess. This abscess not only causes pain and swelling but also affects the jawbone.

What is a root canal treatment?
Root canal is the treatment in which the infected pulp is removed from the tooth and the space occupied by it is cleaned and filled with a special filling material. Even though the pulp has been removed from the inside of the tooth, the tooth is still embedded in a living jaw structure. The root canal tooth will not feel hot or cold. However the tooth would still retain normal sensation to touch or pressure.

Why is a root canal treatment done?
For years, teeth with diseased or injured pulps were removed to prevent or to treat the consequences mentioned above. Today, root canal treatment has given dentists a safe way to save teeth. Based on the results obtained so far it is safe to say that more than 90% of endodontic cases respond to root canal treatment. If carried out.

How is the root canal treatment done?
Contrary to popular belief root canal treatment is not painful .It is carried out under local anesthesia which makes the tooth numb. Only after the dentist has confirmed that the patient has no pain will he /she begin the treatment. The duration of the treatment depends on the amount of infection present. The treatment can be completed in a single appointment or may require more than three appointments.

Root canal treatment has three steps:

1. Access opening: This is the first step where an opening is created in order to reach the infected pulp area using a dental drill. After the access is gained, the infected contents of the pulp chamber are carefully removed using special instruments. An anterior tooth has only root where as a posterior tooth may have more than three roots. There fore it is necessary to remove the infected pulp from all the root canals present in a single tooth.

2. Biomechanical preparation: In this step the hollow space which once contained the infected pulp is cleaned and shaped. Cleaning is usually done with the help of saline water and thin dental files. These files are moved along the surface of the root canal making it large and smooth. This procedure not only removes traces of bacteria from the root canal, but also makes the root canal more receptive to the filling that is to follow.

3. Obturation: Once the canals have been cleaned with the files, the canals are filled with a special filling material. The purpose of this filling material is to seal the canals and prevent future infections inside the tooth.

After the canals have been filled, the tooth is covered by a crown. This protects the now fragile tooth from fracture. It is important that the crown be placed soon after the root canal is finished otherwise once the tooth fractures, saving the tooth becomes near impossible.


History Taking and General Examinations:-
As patients we always wonder why the dentist always starts off, asking questions regarding general health and medical problems, rather than directly treat the problem we present with. Question regarding blood pressure, diabetes, prior hospitalization, drugs consumed etc, may sound irrelevant or, if not frightening to us. However this does carry a great deal of significance to the dentist. Correct information regarding our general health is an important factor determining the success of any dental treatment.
Mentioned below is the relevance of a few common medical conditions prevalent among the Indian population, to dental treatment.

Increased Blood Pressure or Hypertension:
High blood pressure or Hypertension is a condition where the pressure exerted by the flowing blood against the blood vessels is more than the normal range. The normal range for a young patient in 120/80 can increase to 160/90 age advances. Any Blood pressure recorded beyond 160/90 is considered as hypertension. In a patient with high Blood pressure dental surgical procedure which an acceptable amount of bleeding such as tooth removal or gum surgeries can result in increased and uncontrollable bleeding. The amount of bleeding can be frightening to the patient.
To avoid such a situation the patient should religiously control his or her Blood pressure before visiting a dentist for any treatment.

Diabetes mellitus:
It is a common condition seen among middle aged and the older population. Wound created by a dental procedure such as tooth removal in a patient having increased blood sugar, carries an increased risk of infection as well as longer period of wound healing. This can result in pain & discomfort for quite a long period following the procedure. Therefore it a vital to control our blood sugar levels if it is high.

Jaundice:
Any damage to the liver and its related structures, or its functions will show the symptoms of jaundice. Unhealthy liver poses two problems, which concern dental treatment.
There is failure in the breakdown and removal of the drugs taken, before during and after the procedure. This results in poisoning of the body due to increased circulation of the drugs in the system.
Liver produces certain substance, which help in the normal clotting of blood. Thus damage to the liver can also result in increased bleeding.
Therefore it is essential to test the normal functioning of the liver following an episode of jaundice to avoid the above mentioned complication.

Drug Allergies:
Allergic reaction to any drug should be mentioned to the dentist well in advance. Allergic reaction can range anywhere from a simple rash on the body to loss of life within a few minutes after the intake of the drug. If the patient has any fear regarding the medication, allergy tests can be taken to confirm their fear.

Disorder relating to the heart:
Heart problems such as heart valve disorder, birth defect in the heart, heart attacks etc needs to be seriously evaluated before taking up any dental procedure, which involves bleeding.
For e.g. Dental treatment particularly tooth removal will have to be postponed for a period of six months following an episode of heart attack.

The stress experienced during a dental treatment in such a patient is sufficient to trigger off another attack on the dental chair.
The other medical problems other than above mentioned conditions are, Bleeding disorder, Epilepsy, Asthma, Ulcer, Tuberculosis, HIV, Hepatitis, hormonal disorders, Transplants etc.

History Taking and General Examinations
To make a dental treatment safe and comfortable it is absolutely necessary to render full co-operation when questions regarding medical history is put forth .It is our duty to patiently comply to the physical examination and tests requested by a dentist.

IMPORTANCE OF ORAL EXAMINATIONS:
complete examination of the mouth and the structures present within is a must once every 6 months. When a dentist examines the oral cavity he systematically covers all the structures. He looks for any changes in the size, shape, color & texture of the tissue. Picking up these changes early can at times save our lives.
For eg. Oral Cancer, which develops due to persistent smoking and pan chewing shows change in the inner check, tongue and the gums much earlier than the actual lesion. These changes if picked up early can be treated and restored to normalcy there by preventing the disfiguring and life threatening lesion which is bound to follow.

Similarly, measles can be spotted much earlier by a dentist rather than by a physician. This is because of the small spots or boils called koplik spots, which develop a couple of weeks in advance on the inner cheek.
So the next time you visit a dentist allow, him/her to examine the oral cavity completely.


Scaling:-
Scaling is the process by which plaque and other deposits are removed from the tooth surface, both above and below the gum margin. The primary aim of scaling is to restore the gingival health by completely removing from the tooth surface elements that provoke inflammation and further destruction of the gum. Scaling is normally done without any anesthesia but if there is pain or discomfort local anesthesia can be applied over the area of proposed treatment.

Scaling can be done in two ways:
Scaling using special hand instruments, which are designed for the purpose.

Ultra sonic hand scaling equipment which uses which use vibratory forces to dislodge the hard deposits and stains present on the tooth surface.
The ultra sonic method of scaling is more commonly used among the two. For patients with mild deposits on the tooth surface, a single appointment is usually enough. But for patients with thick, tenacious deposits and stains more than two appointments may be required to perform scaling on all the teeth present.
Deposits on the root of the tooth, makes the root surface rough and irregular, which latter become the breeding grounds for bacteria. The procedure, which smoothens the root surface, is known a root planning and is usually carried out with scaling.

Following scaling and root planning the patient may experience mild pain or sensitivity for a day or two, which can be controlled by taking some pain relievers.

A commitment to maintaining good dental health is essential to the successful treatment of periodontal disease. The outcome of this treatment is very much dependent on how well the patient maintains a regular schedule of brushing and flossing.


Orthodontic Removable Appliances:-
What are removable orthodontic appliances?

Contemporary orthodontic treatment involves the use of both fixed and removable appliances. Fixed appliances, also known as braces, forms a major part of the orthodontic treatment. Although removable appliance play only a supporting role in comprehensive treatment, they are important in the orthodontic treatment of children.

Removable appliances are appliances, which can be easily removed and reinserted into mouth. They consist of wires and screws held together by a plastic base and are used to move teeth and jaws into better relationships using gentle force.

What are the uses of these appliances?
They are useful when small amount of orthodontic correction is required

It is sometimes possible to change the way the jaws grow, using orthodontic appliances. A special kind of removable appliance called functional appliance harness the power of the jaw muscles and can help with certain types of problem.

After tooth movement using braces is complete, a retainer (which is a kind of removable appliance) must be worn to hold the teeth and jaws in their new and proper position. The retainer must be worn for approximately one year to help prevent the teeth or jaws from falling back to its original or starting position.

What are the parts of a removable functional appliance?
The removable appliance consists of an active element or elements (i.e. metal wires and/or screws), which exert orthodontic forces on the teeth, and retentive elements (i.e. clasps), which help, in retaining the appliance in the mouth. A plastic plate holds these two sets of elements together. It is more commonly used in the correction of teeth in the upper jaw.

How are the appliances made?
Unlike braces the removable appliances are made in the dental lab. A plaster model is created from an impression of the patient's jaw, over which the appliance is designed and made. The finished appliance is then fitted on the patient.

What are the advantages of using a removable appliance?
-It is inexpensive
-It is relatively simple to adjust, requiring little clinical time.
-If the appliance causes the appliance any irritation the patient can remove it.
-It can be removed for cleaning; therefore oral hygiene is seldom a problem.
-It may be removed for contact sports; therefore damage to the patient (and appliance) is reduced to a minimum.
-What are the disadvantages of using a removable appliance?
-It tends to be rather bulky and takes sometime to get used to.
-It is unsuitable for most treatment in the lower arch, as the shape of the lower teeth does not allow the appliance to be satisfactorily retained.
-Removable appliances can only carry out tipping movements and other drastic movements like the complete rotation of the tooth is not possible.
-Co-operation of the patient is very essential for the success of the treatment.
-Results occur much slower when compared to Braces.
-How are removable appliances maintained?
-It must be worn constantly to derive early and good results. It should be removed only during bedtime.
-When outside the mouth it should be stored in a cup of cold water. Exposure to heat can alter the shape and fitting of the appliance.
-It should be removed in advance before any contact sports.The appliance has to be removed and inserted carefully to avoid breaking the plastic or deforming the wires.
-The appliance has to be kept clean. A toothbrush is convenient for this purpose.


Impacted Wisdom Tooth Removal:-
What is an Impacted tooth?
A tooth is called impacted if it does not assume its proper position and function within its normal eruption time.
Lack of space in the jaw is one of the chief causes for impacted teeth. In an attempt to erupt, the tooth ends up in haphazard positions.

Why is there Impaction of teeth seen?
Anthropologists state that the constant increase in size of brain in a man has resulted in the increased size of his brain case at the expense of his jaws. Also the fact that a softer and a more refined diet is being adopted by man has made the need for a powerful chewing system unnecessary resulting in decreased size of jaws .The above-mentioned causes has resulted in an increased tendency for wisdom tooth impaction in the human population.

Should the Impacted tooth be removed?
Not all impacted wisdom teeth give trouble to the patient. It is only the partially erupted wisdom teeth and the ones leaning on the adjacent normal teeth, which giving the maximum trouble. Trouble can be in the form of infection of the tooth and the gum, pain, swelling, inability to open the mouth and in extreme cases tumor growing on a trapped wisdom tooth. Therefore it is advisable to remove a potentially problematic wisdom tooth much in advance than actually waiting for the problem to occur. Removal of a tooth is much easier in a younger patient; therefore putting of the removal for a much later age is not a good idea.