TREATMENT INFORMATION:-

BLEACHING:-
Bleaching of teeth is a procedure which is useful in lightening discolorations which have accumulated on the tooth surface over a period of time. This process causes the whitening of teeth with the help of a mild bleaching solution. This method is ideal for stains caused by age or food.

--What causes staining of teeth?
The most common causes include aging, consumption of staining substances (coffee, tea, colas, tobacco, betel nut etc.), and old discolored fillings in the teeth. During tooth formation, consumption of the antibiotic tetracycline or excessive fluoride may also cause tooth discoloration.

--How is bleaching done?
Bleaching is performed by two separate methods.

1. One is the In-office bleaching and the other is a commercially available tray system.
2. With the in-office bleaching technique, a bleaching gel is applied over the teeth and a special light is used to activate the bleaching gel so as to begin the whitening process. The facility for this method is available only in the dental clinic.
3. In tray bleaching system, trays are usually provided along with the commercial teeth whitening pack. These trays are designed so as to cover the tooth surface when placed in to the mouth .The bleaching gel is carried to the tooth surface with the help of these trays. The trays are usually worn for a few hours every day for a period of 7 to 10 days. Although slower, the results achieved are usually comparable to the in-office bleaching.
4. For the maximum whitening, a combination of the two techniques is recommended.

--Is the process safe?
YES. All clinical studies have shown that tooth whitening is a safe process when done under the supervision of a dentist. Reports that claim that the bleaching gel will destroy your teeth are not true. The bleaching process causes no long-term harmful effects to your teeth or gums.

--How long does it take?
With in-office bleaching the results are instantaneous. With tray bleaching most people will notice a change in the color of their teeth the first night they bleach. Tray bleaching takes about 7-10 days to show complete results.

--Are there any side effects?
Some people may experience a transient sensitivity to cold items during the process of bleaching. This disappears soon after the treatment is finished. However you can decrease the frequency of wearing the trays to cut down or eliminate the symptoms. Your dentist may also choose to prescribe a fluoride gel that you can wear in the trays for extreme sensitivity. It is important to note that all symptoms are temporary while you are bleaching. There are no long-term harmful effects to bleaching.


--How long do the results last?
Teeth will stay bleached permanently. However depending on your habits, you may need a touch up treatment once every 6 months. If you smoke, drink tea, or coffee your teeth will stain faster therefore requiring more frequent treatment.

BRACES:-
Braces - 'Look A Little Ugly Today But Beautiful Tomorrow'
The word 'braces' brings to mind a 'pimply teenager' with a mouthful of wires. This need not be the case though, for increasingly beauty or personality conscious people are going in for braces. This treatment is technically referred to us orthodontic treatment. However some doubts persist as to whether all the pain in the mouth as well as to the purse is really worth it. That really is ultimately the judgment of the individual concerned for all a dentist can do is reassure the patient that his/her teeth and indeed the looks would be enhanced if the teeth were in proper positions and alignment with respect to the rest of the face. Braces are so designed so as to be able to slowly move the teeth to their right positions in the oral cavity in relation to their surrounding neighbors like the tongue, the lips, the cheeks and the palate

--Need For Braces
Braces are not needed routinely is all the cases. Some children inherit a perfect set of teeth from their parents and some inherit a somewhat deformed set. The decision to be given braces should be taken early in adolescence once all the temporary teeth have fallen off and the permanent teeth appear. Look at the picture of the famous singer Celine Dion when she was a teenager and look at her face now to understand the value of braces. I am sure she had the best dentists work on her face.

There are certain conditions where braces are a must or at least a dental consultation is mandatory -
*Teeth that is inclined either towards the lips or far away from them.
*Teeth that are placed inwards towards the tongue.
*Short lips, meaning that your upper lip does not meet the lower lip when at rest.
*Lower jaw placed ahead of the upper jaw giving rise to the 'classical handsome looks' that most models die for, but this condition is technically not ideal.
*Front incisor teeth placed too far apart, giving rise to gaps between them.
*Crowded teeth - or teeth overlapping each other, most often seen in the lower jaw.
*Cleft lip and cleft palate.

--Timing Of The Treatment:-
This is most often the question that parents ask of dentists. Ideally, orthodontic treatment utilizes the growing period so as to harness the muscular forces to achieve the desired result. If this is taken into consideration, the ideal time for intervention is between -

* 14-18 years for girls
* 14-21 years for boys.

The difference is primarily due to the fact that the growing period for males extends upto 21 years, while it is 18 years for girls. This does not mean that older individuals cannot go in for braces. Almost anyone can opt for braces at any age, but the duration of the treatment is generally longer for older individuals.

--Nature of the Treatment:-
Braces or Orthodontic treatment is usually either -
* Removable
* or fixed

The fixed type of braces dominates among a large percentage of patients.
Removable appliances are given when minor corrections are required like tipping a tooth towards its neighbor or even the lips.
For conditions that cannot be adequately corrected by removable braces, fixed ones are advised. This again depends on the nature of the malocclusion prevailing in the mouth.
Fixed appliances are bale to deliver forces that are sustained over long periods of time unlike the removable ones.
Currently fancy wires called optical wires are in vogue. These wires conceal the fact that you are wearing braces since they mimic the colour of the teeth.

--Duration of Treatment:-
This generally depends on the severity of the malocclusion, that is the number of teeth that are away from their ideal positions.
* Simple malocclusion - treatment lasts for about 6-8 months
* Complex cases - treatment requires 12 months
* In complex cases many teeth are crookedly placed and have to be extensively moved .
* Individuals over 25 years and above - the treatment lasts for about 18 months.

After this there is a period of retention where a holding appliance is given to make sure that bone forms around the teeth that are newly moved.

--Problems and Foods to Avoid:-
The main problem during the initial days when braces have been placed is the difficulty in chewing.
It is advisable to avoid fine food like minced meat or mashed food for these get stuck in the braces making it very difficult for the wires to perform their task accurately.
Contrary to popular belief the wires in the mouth do not cause cancer. These wires are usually made of an alloy called Niti, Nickel and Titanium and are generally safe for use in the mouth.

--Costs of Braces
The pricing varies from region to region depending on the number or dentists in the area as well as the presence of dental colleges in the area.
The costs are considerably lower in dental institutions. An approx estimate is as follows:
Government Dental Colleges - Relatively Free
Private Dental Colleges - Generally charge about Rs 6,000/- for the whole treatment.
Private clinics charge anywhere between Rs 8,000/- to
Rs 12, 000/-

FAQs
1. Which Dental specialist should I choose if I need braces?:
Ans. See a Dentist who has specialized in Orthodontics.

2. Will the wires prick my gums?
Absolutely not. These wires are only to be put on to your teeth rather than the gums and only move your teeth into the desired positions and do not prick your gems.

3. Will my teeth become loose after treatment?
To a degree, yes. The force on your teeth will move them through the hard bone and until new bone forms around the tooth roots, you'll feel as if the teeth are loose. However, this is no cause for worry as the strength will return once the new bone around it forms.

4. What is the ideal age to get the treatment done?
14-18 years for girls and 14-21 years for boys. These are the ages when the maximum growth occurs and dentists prefer to take advantage of this.

5. What should I do if a piece of the wire comes off?
No need to panic. This is normal given the fact that the wires are bathed in saliva at all times. Call your dentist, fix up an appointment and relax.

6. How should I brush my teeth during the treatment duration?
This is the most important step in the whole treatment. You have to keep your teeth as clean as possible. It will be difficult in the initial days and you will be given a special orthodontic brush, which will help you keep your teeth clean during this period.

Glossary:
Orthodontics: It is that branch of dentistry that is concerned with maintaining the balance of the face with respect to the teeth in the most acceptable manner to the patient as well as the dentist.

Malocclusion: A term describing the crooked arrangement of the teeth in the oral cavity. Even if a single tooth is out of line malocclusion occurs.

Cleft lip and palate: Developmental defects where the two halves of the lips and the palate fail to fuse.

CROWNS:-
--What are dental crowns?
Teeth are often restored using fillings of silver or composite plastics. These materials are more than adequate to restore the part of the tooth that has been destroyed by tooth decay. However, there comes a point where there is so much damage to the tooth structure, that it cannot hold a filling. The ideal treatments for such type of teeth are the usage of crowns. A Crown is a cap like covering that is fitted over a tooth to restore its natural size and shape. A crown strengthens the tooth, protects the remaining tooth structure and can improve appearance. The tooth is trimmed so that the cap can be placed over the tooth like a hat on a head. The crown also forms an important unit of a fixed bridge which is used for the replacement missing of teeth.

--What are they made up of?
Crowns can be fabricated from different materials depending on the location, color and function of the tooth. Metals are more commonly used to fabricate the crowns for posterior teeth, although material such as ceramics and other plastic like material are also used

--Why do we need crowns?
A crown is placed for a number of reasons:
*To restore fractured teeth.
*To protect weak teeth from fracturing.
*To support a large filling when there isn't enough tooth remaining (the tooth structure becomes weakened and can no longer support the filling).
*To conceal badly shaped or discolored teeth, Gaps between teeth and also crooked teeth
*To strengthen teeth following a root canal treatment (teeth tend to become brittle and are more apt to fracture following root canal treatment).
*To disguise the extensive damage caused by the tooth decay.
*To attach a bridge.
*To cover a dental implant.

--How are crowns prepared and fitted over the tooth?
The procedure may require two to three office visits On the first appointment the tooth is prepared by removing 1-1.5mm of outer tooth material called enamel so as to create space to accommodate the crown. Old filling, decay and unsupported tooth are also removed to ensure a solid foundation for the new crown. An impression of the prepared tooth is made, and the appropriate shade of the crown is determined to match the patient's tooth color. A temporary crown is cemented on the prepared tooth until the permanent crown is ready. The permanent crown is fabricated in the dental lab and might take a couple of weeks.
At the second visit, the crown is tried on for fit, shape and color. The bite is checked and adjusted. If all is satisfactory, the crown is bonded to the tooth

--What are the common problems faced following the fitting of a crown?
Some time patients may come back with a few problems after the fixation of the crown. These usually include pain on biting and sensitivity in which case another appointment is required for minor adjustments of the crown.

FIXED BRIDGES:-
--What are fixed bridges?
Missing teeth can be replaced in three ways
*By placing artificial teeth that can be removed by the patients according to their convenience. E.g. Partial and complete removable dentures
*Using fixed bridges where in the artificial teeth are fixed to the adjacent normal teeth present on either side of the empty space.
*Implanting small metal post in to the jawbone on to which the artificial teeth are fixed. A bridge is a replacement tooth that is supported and attached by a Crown on either side of the space. The two side teeth (anchor teeth) or Abutments are prepared to provide support for the bridge

--Why is replacement of missing teeth essential?
Teeth in the oral cavity depend on each other and on the adjacent soft tissues (e.g. tongue and cheek) to remain in place. When a permanent tooth is lost due to tooth decay or due to injury, the adjacent normal teeth drift in to the space created by the missing tooth making them more prone to tooth decay and gum problems (due to difficulty in maintaining hygiene).

The other problems faced are:
*Difficulty in chewing
*Reduced clarity in speech
*Changes in the facial appearance due to the collapse of facial features.

HABIT BREAKING APPLIANCES:-
--What are the different habits that can be encountered in children?
This can be thumb sucking, finger biting, nail biting, lip biting, mouth breathing, tongue thrusting etc.,

--What are habit breaking appliances?
These are an appliance that is made by a dentist to combat the above mentioned habits in children. They can be either a fixed or removable type.

--What are the deleterious effects of these habits?
If these habits are continued for a prolonged period of time that can result in gum disease, change in position of teeth and change in shape of the jaws.

--Is there any ideal age when these habits can be corrected?
No. whenever the habit is first noticed it is better to consult a pediatric dentist. He may give suggestions depending upon the habits.

--Is there any common cause for these habits?
One can probably assume that there may be some kind of psychological disturbance in the child's mind. This must be identified and rectified at an earlier stage whenever possible because these kinds of things can affect the child's overall development.
Sometimes the first child starts thumb sucking once the second child is born because of lack of attention.

ROOT CANAL TREATMENT OF MILK TOOTH:-
--Is Root Canal Treatment of Milk Tooth necessary?
There was a time when countless milk teeth were extracted stating that they are just "temporary tooth" or "milk teeth know, anyhow it is going to fall" and for so many other reasons. But the milk teeth are there for a specific purpose. Each and every milk tooth has to stay for a particular period of time. The changes in dietary habits have resulted in a lot of milk teeth getting decayed at an earlier stage than before. These milk teeth have to be preserved whenever possible. They are the natural SPACE MAINTAINERS which are there to preserve the space for permanent teeth. Whenever a milk tooth is decayed badly, where a normal filling cannot be placed root canal treatment has to be considered before removal of tooth is considered.

--How many sittings it will require to perform root canal treatment for a milk tooth?
It can be performed in single as well as multiple sittings. The pediatric dentist will decide the best method depending upon the situation.

--Is the procedure painful?
No, it is not painful. If necessary the pediatric dentist can anesthetize the tooth and carry out the procedure.

--After root canal treatments will the milk tooth will fall on its own?
Yes, after root canal treatment the tooth is almost like a natural tooth. It will fall on its own.

--After root canal treatment is follow up necessary?
Yes, after root canal treatment the tooth has to be monitored atleast once in every six months.

--Is there any way to prevent this?
Yes, and the only way is to detect tooth decay early and treat it. If we detect tooth decay early we can save the tooth by a normal filling. It is better not to wait until pain develops; because once pain develops then preserving the tooth needs extensive treatment like root canal treatment. Hence it is always better to start the FIRST DENTAL VISIT when the first milk tooth erupts into the mouth (between 8-12 months of age). If the first dental visit has taken place at this stage one can completely prevent tooth decay if the parents strictly follow the pediatric dentist’s instructions.

ORTHOGNATHIC SURGERY:-
--What is Orthognathic Surgery?
Orthognathic surgeries are cosmetic surgical procedures performed on the face to improve the esthetics and appearance. People are becoming more conscious about their looks and are more open to procedures, which helps in improving their appearance. More and more people visit an Orthodontist to improve the alignment of their teeth and there appearance. But there are limitations to what an orthodontist can do, and that is when the role of an Oral and Maxillofacial surgeon comes into play in the form of Orthognathic surgeries.

--How is the procedure carried out?
Orthognathic surgeries are basically surgeries of the jaws. These surgical procedures alter the architecture of the facial body skeleton and align then in suitable positions so as to attain a final facial profile that is pleasing or infact even more beautiful to look at. Some of these procedures are very simple where as there others that are more time are consuming, complicated and expensive. The duration of surgical procedures varies from one hour to five hours under normal circumstances. Commonly treated deformities of face include severely protruding or stunted upper or lower jaw, correction of deformity of nose etc.

--What are the complications and problems associated with Orthognathic surgery?
Orthognathic surgeries like any other surgical procedures have its own complications, although these complications are not as alarming.
Fatal complications as a result of Orthognathic surgery is very rare, how ever the regular risk of undergoing any surgical procedure under general anesthesia cannot be ruled out.
The first and the fore most problems that an oral and maxillofacial surgeon often comes across is the acceptance by the patient. Sometimes patients find it difficult to get accustomed to his or her new face.

Another common problem faced is refusal of the patient to undergo subsequent surgery done improve the appearance of his nose which may hamper the overall result.

--How is Orthognathic surgery better than braces?
As mentioned earlier, if the problems are purely dental, an orthodontist might be able to rectify the problem. But skeletal problems needed to be addressed by Orthognathic surgeries.

The advantage of 0rthognathic surgery over braces is the speed at which the results are achieved. Immediate results is the greatest advantage of this surgical procedure where as braces need to be worn for at least a period of 1 year before noticeable results are seen.

--How are the results of this surgery?
The results achieved after an Orthognathic surgical procedure is immediate and is usually well appreciated by the patient.
Facial disproportion like protruding retruding jaws can be corrected with good functional results. Few cases show recurrences or relapse after a few years, but to a milder degree when compared to the original deformity.
Orthognathic surgeries hold the key to many youngsters who go through a lot of psychological stress over their facial appearance.

PIT AND FISSURE SEALANTS:-
--What are pit and fissure sealants?
Pit and fissure sealants are clear plastic substances, which protect tooth surfaces, which are more prone to tooth decay from getting affected.

--How does the pit and fissure sealants work?
Most often, chewing surfaces of the posterior teeth prone to more amount of decay. This is because these teeth have numerous pits and grooves on it. Even if a child brushes carefully, it is difficult to clean the small grooves and pits, which is present on these teeth. Food debris and bacterial products tend to accumulate on these surfaces making them more prone to decay. Pit and fissure sealants are material introduced to fill these grooves so as to resists the accumulation of food debris within it.

--For how long do the sealants last?
Research shows that sealants can last for many years. If a child is capable of maintaining good oral hygiene and can avoid biting hard objects it can retain the sealants for a substantial amount of time.

--How are sealants placed?
The procedure for sealant application is painless, quick and simple.

--Which are the teeth that are usually sealed?
Though the primary and permanent molars are sealed routinely, any teeth with susceptible grooves and fissures can be sealed as a preventive measure.

--After sealant placement does the child have to brush regularly?
Brushing, flossing and regular dental visits are essential even after sealant placement.

CONSCIOUS SEDATION AND GENERAL ANESTHESIA IN PEDIATRIC DENTISTRY:-
--What is the need for sedation and general anesthesia in pediatric dentistry?
Under certain circumstances a dentist encounter children who are very uncooperative for various reasons. for example this uncooperativeness can be because of fear of unknown previous traumatic dental experience mentally or physically handicapped children medically compromised children pampered adamant children fear of separation from the parents child with severe pain related to tooth or recent trauma fear of tooth removal etc.
Under these circumstances the dentist first tries to identify the cause for the inappropriate behavior. Most often, once the cause is found the chances for providing dental treatment increases. When this is not possible and there is an URGENT NEED to provide dental treatment a pediatric dentist can opt for this kind of management.

--What is conscious sedation and general anesthesia?
In conscious sedation the patient is fast asleep but not completely unconscious. These procedures are usually used for short dental procedures like one or two teeth removal or few fillings etc..
In general anesthesia the patient is completely unconscious and not aware of what is happening to her or him. Under general anesthesia one can perform extensive dental procedures like multiple extractions (tooth removal) ,multiple fillings ,root canal treatment, stainless steel crowns etc..

--What are the primary objectives of these procedures?
*The first and the most important objective is the psychological well being of a child. One traumatic dental experience at a younger age will last ones entire lifetime. If some untoward dental experience happens during young age, the child is going to be aversive to dentistry throughout his or her lifetime.
*The second objective is to provide highest quality dental care to children even though they are uncooperative. One cannot deny dental health just because the child is uncooperative. Every child has a fundamental right to obtain good oral health.

--Are these procedures safe?
All patients must undergo a thorough physical examination by a physician or pediatrician, anesthetist evaluation, opinion from the concerned specialist (if the child has any other associated medical condition) ,and few investigations. Once the patient is evaluated well then the chances for any untoward instances are remote. Medical research has shown high degree of success using these procedures.

SPACE MAINTAINERS:-
-- What are Space Maintainers?
Space maintainers are small appliances which are either fixed or removable type, used to maintain space in the jaws if a milk tooth is lost or removed prematurely.

--What are the advantages of having Space Maintainers?
Once Space maintainers are placed they prevent the adjacent tooth from moving into the space created by the premature loss of milk tooth. This in turn preserve the space for the permanent tooth as well as prevent malocclusions from developing. It has been estimated that 60% of malocclusion is because of premature loss of milk tooth and lack of space maintenance.

--Can we say that Space Maintainers will prevent all malocclusions?
No. Placing space maintainers will not completely prevent the development of malocclusion. But it definitely reduces the severity of malocclusion which in turn will decrease the duration of the treatment period drastically at a later stage.

--Is periodic recall necessary after placement of Space Maintainers?
Yes. Every six months space maintainers have to be removed and checked for its fit, and any associated decay with it.

--Does it need any extra efforts to maintain these appliances?
Yes. One has to take a little extra effort to keep the area clean while brushing. In other words one has to clean these space maintainers and the associated tooth very well to prevent further decay from these retentive areas.

--Is there any Space Maintainer if there is any multiple teeth loss?
Yes. There are different kind of space maintainers for single tooth loss and multiple tooth loss. The pediatric dentist will suggest you the best space maintainer depending upon the situation present.

STAINLESS STEEL CROWNS:-
Stainless steel or chrome steel crowns are one of the most durable restorative (filling) material used in pediatric dentistry. They are usually made of stainless steel and hence the name. They are biocompatible and do not corrode in the moist atmosphere of the oral cavity even after many years.

--When do you need stainless steel crowns?
Stainless steel crowns are indicated for the following conditions:
*Tooth decay involving more than two surfaces of a tooth (where the normal filling materials do not stay)
*Tooth treated with root canal treatment etc.,
*Sometimes these crowns are used as space maintainers
*Other developmental problems in which the form of the tooth is affected badly

--What are the chances for a child to swallow the crown?
Normally the crown is verified for its tight fit and then bonded tightly to the tooth with a cement. Hence the chances for the crown to be dislodged is remote.

--Will a crowned milk tooth fall off normally or do we have to remove it after some time?
The crowned tooth is as good as a natural tooth and usually fall of normally

--Do stainless steel crowns have any advantage over the conventional filling materials?
Definitely yes, they are the best restorative materials whenever there is extensive decay affecting a single tooth.

--Is the tooth preparation painful for a child?
No the procedure is not painful for a child. The tooth preparation is minimal and even if it causes some amount of sensitivity the pediatric dentist can anesthetize the area and carry out the procedure.

VENEERS:-
--What is Veneer in Dentistry?
A Veneer is a thin wafer of tooth colored material that is permanently bonded on the front surface of the anterior teeth in order to cover and esthetically restore an unsightly tooth. A veneer can either cover a portion of the front surface or the entire front surface of the tooth depending on the requirement.

--When are the Veneers needed?
Veneers are used to correct the following conditions:
*Teeth with facial surface that is malformed during its growth and development.
*Permanent discoloration of the teeth that cannot be removed by just cleaning or polishing the tooth.
*Tooth with a discolored and a broken filling on the facial surface area.
*Teeth which get abraded and eroded by wear and tear.
*To cover up small gaps seen among the anterior teeth.

--What are these Veneers made up off?
Veneers are made from a thin shell of porcelain that is then bonded on a prepared tooth surface. Veneers can also be made using a type of plastic dental material called composites.
A composite resin filling may be used when only a small amount of tooth structure needs replacement. A porcelain veneer is indicated when a portion of the front surface of the tooth needs a complete aesthetic restoration.

--How are the Veneers placed on the teeth?
Veneers are bonded and cemented directly to the existing tooth structure. At the first veneer appointment the tooth surface will be reduced by about 0.5mm so as to create room for the porcelain veneer. An impression of the prepare tooth will be taken, to make an exact replica of the prepared teeth. During the second veneering appointment, the tooth will be wetted with a mild acid solution and the veneers are bonded with a tooth colored liquid resin material.

--What are the advantages of the porcelain Veneer?
The porcelain veneer can be crafted in such away so as to bear an esthetically pleasing naturalness that is unsurpassed by other restorative options. The amount of tooth substance that has to sacrificed in order to fix a porcelain veneer is very minimal.
The porcelain veneer is stain free and therefore is not easily affected by items like coffee, tea, tobacco etc, which severely stain the natural teeth or veneers made up of composites.

--What are the disadvantages of the porcelain Veneer?
One of the more significant disadvantages associated with porcelain veneers is the fact that they do have the potential for coming off or breaking, and of course this will no doubt occur at the most inopportune of times. If a porcelain veneer has broken there is no way for your dentist to repair it, their only option will be to make you a new one. This means that you will have to endure the cost of having the new veneer made, as well as endure the time it takes for the new veneer to be fabricated and ultimately bonded into place. If a porcelain veneer has simply come off there is a chance that your dentist will be able to reattach it to your tooth.

--How long will the porcelain Veneer last?
With good home care and by exercising good judgement, it seems likely that a porcelain veneer could last well in excess of ten years.

- -What do I expect from the porcelain Veneer?
Have realistic expectations. Porcelain veneers are reasonable facsimiles of natural teeth, not perfect replacements. It is not uncommon to see slight variations in the color of porcelain veneers upon close inspection, as this occurs even in natural teeth. Nevertheless, this procedure can greatly enhance your smile, and can heighten inner satisfaction and self-esteem.

DISEASE INFORMATION

BAD BREATH:-
Many people worry about bad breath, either their own or someone else’s. The advertising media have made much of the social stigma arising from ‘offensive breath’ to their own advantage. Bad breath or halitosis may indicate a dental problem, but this may not always be the case.

CAUSES
The odour may be caused by factors in the mouth or by changes occurring in other parts of the body.

Local factors:
· Decaying food particles on or between the teeth
· A coated tongue covered by growing microorganism.
· Unclean dentures
· Smell of tobacco
· Alcohol
· Gum diseases with pus production involved
· Healing wounds after a surgery or extraction causes arising away from the mouth.
· Head cold with infected nasal air passages
· Acute inflammation of air spaces present within the facial
bones (often filled with a great deal of pus )
· Tonsillitis.
· Many waste products are broken down from food and drink
are excreted through the lungs and this applies to alcoholic
drinks as well as pungent foods like onion, garlic etc.
· Diabetes in which the patient has a sweet acetone breath.
Bad breath is not a disease; it is rather a symptom, which indicates the presence of disease either within the mouth or away from the mouth. Odours, which may appear unpleasant to many, may not be the same to some e.g. People in the Mediterranean area are accustomed to the scent of garlic, a scent which many people around the world find obnoxious.

SWOLLEN GUMS:-
Change of gums from a thin, well-adapted, continuous covering around the teeth to a thick swollen red mass, may not only appear unsightly, but also acts as a platform for further destruction of healthy teeth and supporting bone.

CAUSES
1. Most common cause is infection of the “gingiva”, by a thin covering of food and bacteria on the tooth surface called “Plaque”. The bacterial content of this plaque trigger a response from the gingiva, which results in a swelling. The swelling is caused by accumulation of white blood cells and fluids, which in turn counteracts the action of the bacteria.
2. Due to certain normal condition such as pregnancy and puberty, there is swelling of the gingiva seen. This swelling is an abnormal response to the normal bacteria present in the mouth. The abnormal response is a result of hormonal changes or variation seen during the above-mentioned conditions.
3. Certain disease or deficiency condition may also result in swollen gingiva
E.g.
- Vitamin C deficiency.
- Leukemia
- Tumors or abnormal growth on the gingiva, which may
be harmless or, can be cancerous.
4. Certain drugs used by the patient may result in increased size of the gingiva as a side effect.
E.g. 1. Phentoin used in epileptic Fits. 2. Nifidipine used for blood pressure.

SYMPTOMS
1. Pain may or may not be present.
2. If the cause is infection then, the initial stage is
indicated by the presence of bright red gingiva.
- As the infection progresses the color changes from red to bluish red to deep blue.
3. The gingiva becomes soft and spongy; rarely it may become thickened due to formation of scar tissue.
4. Bleeding of the gingiva is another common symptom in the advanced stage.
5. Swelling caused by the drugs is usually very hard and thick. The gingiva will become swollen even after treatment of the swelling. The swelling occurs only when the drug is administered for a certain period of time.

DIAGNOSIS
The sight of the gingiva itself is sufficient to diagnose the condition.
Bleeding of the gums is seen, when a sharp thin metal instrument is passed along the margin connecting the tooth and the gingiva. This bleeding indicates inflammation.
--Gingival fluid measurement tests:
In this test, the increase in amount of gingival fluid is measured which is usually not seen in a healthy gingiva.
Gingiva fluid is a fluid produced by the gingiva in the space between the teeth and the gingiva called gingival sulcus.
Special instrument and techniques are required to measure the minute increase in the amount of gingival flood. This is a specialized test for confirming swelling due to infection.

TREATMENT
- In case of swelling due to inflammation, good care of the
teeth and the gums by proper and timely brushing and
usage of mouth washes can reduce the swelling.
- If collection of plaque or food debris is in large amount
then professional help is required to remove the deposits,
which are firmly stuck to the teeth.
- If swelling is due to drugs, stoppage of the drug
automatically causes a reduction of swelling.
- In case of swelling due to general illness correction of the
health problem . Usually results in an improvement.
- If swelling is a tumor then surgical removal is the only
answer.
- Incase if thick fibrous growth of gingiva a treatment
called gingevectomy.

MORE INFORMATION
Gingiva can sometimes swell at such a fast rate that it may cover most surfaces of the teeth. In such cases surgical procedure to reshape the gingiva to normal size and shape is available.

FAQ’s
Can a swollen gum cause any discomfort?
It is usually associated with a mild constant gnawing pain, or may cause no pain at all The swelling may hamper the normal brushing, resulting in the increased accumulation of bacteria and hence cause more inflammation and destruction of gum tissue.

GLOSSARY
Gingiva: A soft tissue layer covering the bone supporting the teeth.
Plaque: Thin layer of food debris and bacteria, which covers the tooth surface

BLEEDING GUMS:-
Bleeding gums is among the common conditions affecting the oral cavity. The Chinese might have noticed bleeding gums as early as 2500 BC. They termed the associated diseases as “Ya-Kon” which means diseases of soft tissue surrounding the teeth. This problem still continues to affect us even with so many modern facilities available in the field of oral care.

--what are the causes for bleeding gums?
1. Long standing information for gums: Poor maintenance of the teeth, such as inadequate brushing or failure to rinse the mouth after meals results in a thin layer of food and bacteria covering the tooth surface. This bacterium is the chief culprit behind the inflammation. The gums during the stage of infection become soft, spongy and swollen. Trauma to the gums by hard brushing or tooth picking with sharp objects result in gingival bleeding.

2. Bleeding can also be due to injury of the gums by any sharp food item e.g., fish bone.

3. Hot food and chemicals can end up burning the gums, further resulting in bleeding. For e.g. Some people still follow the practice of placing pain relieving tablets on the gum adjacent to the painful tooth, which invariably causes burns.

4. Certain rapidly spreading infections can damage the blood vessels of the gums resulting in bleeding. One such disease is ANUG.

5. Deficiency of Vitamin C causes problems with the blood vessels, hence causing bleeding in the gums. Ancient sailors were known to suffer from this problem until some one came up with the bright idea of stocking the ships with oranges during travel. As we know oranges are a rich source of Vitamin C.

6. Certain general illness of the body can also precipitate gingival bleeding.
They are the following.
a. Allergic reaction.
b. Increase in number of cells called platelets. These are
cells, which join together to form a plate that blocks the
bleeding from an injured vessel.
c. Failure in Blood clotting mechanism due to deficiency of a
few important components.
d. Cancerous condition called leukemia.
e. Certain drugs such as aspirin and anti-coagulants, which
prevent the normal clotting mechanism of the blood.

--How does the condition present itself?
Bleeding of the gums may occur with or without associated pain .The pain if present is usually dull in nature. Bleeding is usually noticed during brushing, or in the saliva,while spitting.
Eating of any coarse food items may induce bleeding.

--How it is diagnosed?
The dentist, using an instrument called probe, diagnoses this condition. This instrument is a sharp thin metal which , when passed along the margin between the tooth and the gum causes spontaneous bleeding. Blood tests taken show any problems with the clotting mechanism, if present.

--How are bleeding gums treated?
If long standing inflammation is the cause of bleeding then removal of the source of bacteria will result in improvement of the situation. If the source is mild to moderate in collection. Proper maintenance of the teeth by the patient is more than sufficient. If the source is moderate to severe in collection then professional help is required. Serious systemic problems might have to be treated to correct bleeding from these diseases.

MORE INFORMATION
Bleeding gums are indication of a slowly progressing disease of the gums, which may further involve the bone supporting the tooth and ultimately result in tooth loss.

FAQ
--Is bleeding of the gum a serious problem?
Yes, bleeding gums is a serious problem. It is either indicating the beginning of the destructive process involving the supporting tissue around the tooth or some serious underlying systemic problems, which could be fatal.

--Is there any medication for bleeding gums?
Liquid solutions are available across the counter, which can be self administered by patient. When applied over the gums it either stops or reduces bleeding. But long lasting result s are obtained only by treating the cause.

GLOSSARY
Leukemia - Cancer of a certain type of white blood cells.
Oral hygiene - Proper care of the teeth and its associated structures.
ANUG- It is a rapidly spreading destructing disease of the gum

DENTAL ABSCESS:-
WHAT IS AN ABSCESS?
An abscess is the collection of pus following any infection, occurring within the body. When pus accumulates in relation to a tooth it is known as dental abscess. It can occur following an infection around the root of a tooth, in the gums or within the jawbone.

CAUSES
1. The most common cause is tooth decay. Tooth decay is a slowly progressing infection destroying the tooth and its contents. This infection descends down from the pulp to the tip of the roots and spreads into the surrounding bone. The pus formed is a result of this infection.
2. Injury to a tooth from a fall or blow can also result in a dental abscess.
3. Bacteria or food particles trapped within the gums or between the tooth and the gum can cause an infection resulting in an abscess. Medical problems such as diabetes can result in frequent occurrence of dental abscess.

SYMPTOMS
1. Pain associated with or without chewing
2. Redness and swelling in relation to the concerned area
3. Difficulty in swallowing
4. Foul tasting discharge within the mouth
5. Foul breath
6. Fever

WHAT HAPPENS IF THE ABSCESS IS NOT TREATED?
If left untreated the bag of pus break's open into the mouth or the face causing recurrent discharge of pus. This can result in foul breath, foul taste or an ugly scar on the face.
At times the infection spreads within the face and the neck region resulting in certain life threatening conditions.
HOW IS THE DENTAL ABSCESS TREATED?
The main principle of treatment is to drain the accumulated pus and remove the source of infection. This can either be done through the tooth by doing a Root canal treatment or via the gums by incising and draining the abscess. This is followed by a complete course of antibiotics and pain relievers. If the infection still persists the patient is referred to an oral surgeon for the surgical removal of the infected area.

WHAT CAN BE DONE TO PREVENT THE SPREAD OF A DENTAL ABSCESS?
The best way to prevent an abscess is to visit your dentist twice a year. At these appointments, your dentist will:
1. X-ray your teeth once a year to check for decay between
the teeth and to evaluate the health of your jaw bone.
2. Examine your teeth and mouth.
3. Remove any plaque and tartar that have built up on your
teeth.
4. Teach you how to care for your teeth and maintain good
oral health.5. Alert you to any problem areas.
6. Recommend any needed treatments.

RECEDING GUMS:-
--Do your teeth appear longer than usual?
Are you teeth sensitive when you drink anything hot or cold? . If yes, you might actually be the victim of receding gums. A condition normally seen occurring with age, but can also occurs in younger individuals.

CAUSES
1. Age: Gradual changes of the gingiva due to minor trauma and infection over the years can lead to down ward displacement of the gingiva.
2. Faulty brushing techniques may also result in receding gums.
3. Abnormally tilted teeth.
4. Strong band of muscles in the mouth may be attached to the gingiva, the constant contraction of which may result in receding gums. e.g. A small strip of muscle band is present between & above the two upper central anterior teeth. If this strip of muscle is too thick it can cause an upward displacement of the gingiva resulting in exposure of the roots of the teeth.
SYMPTOMS
An unsightly smile due to exposure of the roots of the teeth as a result of downward displacement of gingiva.
- Sensitivity of the teeth to hot or cold food items.
- Food getting stuck between the roots of adjacent
teeth.

DIAGNOSIS
The level of the gingival in relation to the tooth diagnoses this condition. If the level of gingiva is below the line, which separates the crown of the tooth from the root, it is diagnosed as gingival recession.

TREATMENT
Treatment of this condition is by a small surgical procedure. The displaced gingival is repositioned by detaching the gingival and tying it up at the optimal level. - But before this surgery all the regular procedure to create a healthy gingival is undertaken such as regular brushing, scaling, root planning, gum surgeries etc.,

MORE INFORMATION
When more amount of tooth surface is exposed to the saliva in the oral cavity, the rate of tooth to decay is also high. Thus covering of the teeth by the gingiva is very essential.

FAQ
Can receding gum occurring in relation to all the teeth in the mouth be treated?
Receding gum can be treated in relation to a few teeth, but treatment of all the teeth is not possible. But prior treatment will definitely improve the condition and prevent further occurrence.

GLOSSARY
Gingiva - soft thin tissue covering the bone supporting the teeth.

THUMB SUCKING:-
Thumb sucking in children has always caused embarrassment to many parents. The parents were more concerned over the social embarrassment caused by this habit rather than the actual physical damage caused by it.
This silly habit as it appears to many parents not only causes abnormally arranged teeth but also implicates the mental state of the child.

CAUSES
Thumb sucking can either be a non-compulsive act or a compulsive oral habit.
Non-Compulsive act:
As children grow, they pick up or drop habits depending on its acceptability. These habits are usually called non-compulsive habits or acts. Thumb sucking can be one such habit, which can be seen from birth to the age of 16. On an average most of the children stop this habit by the age 4. There are some children, however, who can continue the habit to as late as 12-15 years. In these children, thumb sucking is usually a way to relieve the frustration of hunger.

Compulsive Act:
Thumb sucking can be called compulsive when it has acquired a fixation in the child to the extent that he retreats to the practice of this habit when ever his security is threatened by events, which occur in his world. Unlike the non-compulsive habit, the child tends to suffer from increased anxiety when he attempts to correct the habit. The habit becomes his safety valve to release emotional pressure, whenever it becomes, too much to cope with. Lack of love and affection by the parents towards the child plays a major role in making the child emotionally insecure and thus making him resort to habits like thumb sucking.

SYMPTOMS
- If the habit is discontinued before the permanent teeth eruption, it can be considered harmless.
- Continuous thumb sucking leads to many ill effects. The main symptoms of this problem is shown by the teeth and they are:
- Displacement of the child’s permanent teeth due to the
uneven forces placed on the teeth by the thumb.
- The upper and lower front teeth may not approximate with each other.
- The upper front teeth may flare out.
- The open bite or lack of approximation of upper and lower front teeth may result in speech difficulties during pronunciation.
-As a result of the flared out or
protruding front teeth the child may end up fracturing these teeth more often.
- Protruding and uneven teeth change the facial appearance. This can cause an inferiority complex in the young mind.

DIAGNOSIS
Any child above the age of 4 with protruding anterior teeth may be affected by thumb sucking. A detailed history about the habit is very helpful. The frequency and duration of this habit can help in evaluating the extent of the habit.
The thumb used by the child normally appears to be very clean compared to the other finger.

TREATMENT
It can be treated by psychological methods also.
1. Psychological Method:-
The child is guided by the dentist and parent to consciously put an end to the thumb sucking habit over a period. This is possible only if the child is psychologically willing and wants to stop the habit.
Children often combine thumb-sucking habit with other secondary habits such as hair pulling or nose probing.
Frequently making the secondary habit impossible to perform can break the primary habit.
It is very important not to criticise the child. The child needs a lot of support and affection. He should be told about the ill effects of sucking the thumb to reinforce his determination to stop thumb sucking.

2. Extra oral method:-
The other simple methods are:
-Painting the child’s thumb or finger with an unpleasant tasting substance.
-Tapping the thumb with plaster so as to prevent thumb sucking.
-The above-mentioned methods will succeed depending upon the attitude of the parent. The parents should in someway reward the child for “growing out of the habit” during the procedure both by their action and by a small token prize.
-This will make a deep impression on the child and orient him towards completely breaking of the habit. The parent should also be warned that there is always the possibility that a more deleterious habit will spring up in its place if the present one is suppressed.

3. Intra oral methods:--
This is done by fabricating appliances, which are then fitted into the mouth of the child by the dentist. They are normally viewed as punishment devices by the child there by sometime producing severe emotional disturbances. If the appliances are going to convert a happy youngster into a nervous child overnight, it is not worth it.

MORE INFORMATION
There are other oral habits, which should be brought to the notice of the child’s dentist. These habits are lip sucking, tongue thrusting, nail biting, mouth breathing and bruxism.
All the above-mentioned habits will definitely takes its toll on the teeth. Therefore, early identification and treatment of these habits are necessary to ensure a good set of teeth and a lovely smile.

FAQ’s
Is thumb sucking a natural habit?
Yes, thumb sucking a natural habit until the age of 4. Continuation of the habit beyond the age of 6 will result in mal-alignment of teeth. Most children will give up this habit by themselves, but in cases where this doesn’t occur a dentist should be consulted.
Is there any other effect of thumb sucking other than that on the teeth?
Sucking on a dirty finger can make the child prone to infection, as during this stage children normally tend to play with sand or dirt.

GLOSSARY
Bruxism- Grinding of teeth.

TOOTH DISCOLORATION:
Poetry compares teeth to pearls. But teeth unlike pearls, are exposed to a variety of elements in day-to-day life. All these exposures are bound to take its toll on teeth color. They are also called the sentries of the digestive system.

CAUSES
The tooth discolouration can either be on the tooth surface (extrinsic) or be present within the substance of the tooth(intrinsic).
1. Intrinsic causes
In a tooth with an intact blood and nerve supply, the causes are:--
Hereditary disorders.
Tetracycline medication.
Excessive fluoride intake in drinking water.
High fevers associated with early childhood disease.

The loss of blood supply and nerve supply can by itself cause discoloration of the tooth.

2. Extrinsic causes
Stains from tobacco smoking.
Bacteria producing colored pigments.
A salivary protein layer covering the tooth surface.
The tinted remnants of a certain membrane seen on the teeth surface as the teeth, initially erupt out into the mouth.
Tooth decay or a broken down filling.

SYMPTOMS
Intrinsic causes are usually seen at the time of teeth eruption.
- In hereditary conditions like erythroblastosisfetalis and porphyria the teeth are colored in a brownish blue and a brownish red respectively.
- Tetracycline administration durin pregnancy can lead to discoloration of teeth as the tooth erupts in the newborn.
- Depending on the severity, discoloration can range from yellow -orange in mild cases and bluish gray in the most severe cases.
- Flurosis is a condition seen in places with increased fluoride content in the drinking water. Beyond a certain level, fluoride can cause yellow staining of teeth.
- High fever due to childhood infections can lead to areas of poor calcification within the teeth resulting in the appearance of prominent white spots.

Extrinsic stains can be classified based on color of the stain into:
- Brown stains: It is caused by a thin translucent, bacteria free layer covering the teeth. It is seen in individuals who do not brush their teeth adequately, or in those who use toothpaste with inadequate action.
- Tobacco stains: Dark brown or black surface accompanied by brown discoloration of the tooth
substance is seen. These stains results from coal tar combustion present in the tobacco and also due to the diffusion of tobacco juices into the substance of the teeth.
- Green stains: Green to greenish yellow stains, sometimes of considerable thickness is seen in
children. It is usually seen in upper anterior teeth and has been attributed to florescent bacteria and fungi.
- Orange stains : Occurs in front teeth, and is caused by color producing bacteria.
- Metallic stains: Caused by metals and metallic salts, which may be introduced into the oral cavity by metal-containing dust inhaled by industrial workers.

Examples of stains caused by various metals are:
Copper dust
Greenish Stain
Iron
Brown Stain
Silver
Black Stain
Mercury
Greenish Black

DIAGNOSIS
Diagnosis is made based on the color of the stain. If the stain still remains after meticulous cleaning of the teeth by the dentist, it is understood that the stain is present within the substance of the tooth. A careful history taking can be useful in differentiating between an internal stain and an external stain.

TREATMENT
- Many people have definite aesthetic problem from internal or external stains, where as others worry needlessly about the overall color of their teeth. In the latter instance the dentist must decide if the color of the teeth can be improved enough to justify treatment even though the patient insists on having something done. For e.g. person with light complexion may believe that their teeth are too dark when actually they are normal in color. A Sun tan, darker makeup or a darker lipstick will usually make teeth appear much whiter by increasing the contrast between the teeth and thesurrounding facial features
- Most external stains can be removed by thorough cleaning of teeth, with an instrument called “ ultrasonic scaler”.

This instrument removes most of the stains caused by tobacco, food debris or bacteria. If a broken down filling or a cavity is the cause, filling the defect will improve the discoloration. Discoloration resistant to cleaning can be corrected or greatly improved through conservative procedures such as Bleaching, Micro abrasion or Veneering.
- Stains caused by tetracycline medications are usually much difficult to treat, and might require a radical approach.

MORE INFORMATION
- Most bleaching techniques are some form of derivative of hydrogen peroxide in different concentrations and are applied by different application techniques.
- The lightening of the color of the tooth through application of a chemical agent, which tends to decolorize the pigmentation present on the tooth, is referred to as bleaching.
- Bleaching technique may be classified as to whether they involve a living tooth or a tooth with no blood and nerve supply. The procedure can be carried out within the dental clinic or by the patient at his residence.
- Bleaching generally has an approximate life span of 1 – 3 years, although this change may be permanent in some situations.

FAQ’s
Is there anyway of preventing stains from smoking?
Yes, there is a way. Quit smoking, because there are no cigarettes available in the market, which do not cause staining. Usage of filters could reduce staining to a certain extent.

GLOSSARY
Micro abrasions: It is a method of elimination of discoloration when the stained areas in abraded away. This technique does result in the physical removal as tooth substance and therefore are indicated only for stains that do not extend beyond a few tenths of a millimeter in depth.

TOOTH MOBILITY:-
Mobility of teeth is caused by disease or injury to the gum and the bone which supports the teeth.

CAUSES
1. Infection: when there is accumulation of food debris and bacteria on the tooth. There is inflammation of gingival. Infection is the main cause of inflammation. Inflammation from the gingiva spread to the fibrous tissue between the teeth and bone and finally it hits the bone. Inflammation and destruction of bone affects the foundation on which the teeth stands causing tooth mobility.
2. Increased amount and uneven forces during chewing when transmitted to the teeth, causes tooth mobility.
3. A tumor of the bone, which causes destruction to the bony architecture, results in tooth mobility.
4. Blunt injury to the tooth structure can also cause looseness of teeth.

SYMPTOMS
1. Patient complains of discomfort while chewing of food.
2. Pain may accompany the mobility of teeth
3. The tissues around a mobile tooth are invariable red, swollen and damaged.

DIAGNOSIS
- Certain amount of tooth movement is always present. This movement is felt when the teeth are clenched.
- Mild moderate movement of teeth is usually diagnosed by manually pushing the tooth in question on either side with the help of probing instruments. Fingers are never a reliable source for the diagnosis for such movements.

TREATMENT
Cleaning the mobile tooth of all bacterial sources may reduce mobility to a certain extent.
- Teeth which are mobile by just a millimeter are so can be splinted to the adjacent teeth.
- Teeth which are loose and which move in all direction may have to be extracted.

MORE INFORMATION
Splinting is usually done using a thin steel wire, here the mobile teeth is bond to the adjacent stable teeth in a specific pattern, so as to attain maximum stabilization of the loose tooth. This procedure might be slightly pain full. New methods have been devised to completely eliminate pain.

FAQ
What level of teeth mobility can be stabilized?
Mobility of 1mm can be treated successfully, but anything beyond this level reduces the chances of success. Also teeth loosened due to trauma have a better chance of success than teeth loosened due to infection.

Is splinting painful?
This procedure is normally done under local anesthesia; hence pain will not be a problem.

GLOSSARY
Splinting: stabilization of the mobile tooth by drawing support from the strong adjacent teeth.

ORAL CANCER:-
- Cancerous growth occurring within the structures of the oral cavity is known as Oral Cancer The oral cavity includes the mouth and all the structures within it ,such as the tongue, teeth ,gums ,lower jaw etc
- Cancer is an abnormal disorganized growth of cells in the tissue of a person . Cancer cells keep on multiplying without paying head to the body’s command to stop. This abnormal growth of cells destroys the normal structure and the function of the affected tissue and the body in general .
- Among other cancers oral cancer is one of the most common causes of death. In male, oral cancer represents 4% of total body cancer and in female; it is 2% of all cancers. Majority of the oral cancers affect the outer layer of mucous membrane covering the oral cavity.

Causes:
Cancer in the mouth does not occur overnight. It occurs as a series changes within the tissue , which eventually promotes the development of cancer.

The factors involved are:
1. Tobacco
2. Alcohol
3. Syphilis (a sexually transmitted disease caused by a bacteria)
4. Nutritional deficiencies.
5. Virus infection
6. Sunlight
7. Other miscellaneous factors such as trauma, heat, and irritation from sharp teeth, poorly restored fillings and ill-fitting dentures.

Signs and Symptoms:-
Oral cancer may initially present without any symptoms. Patients are most often identified only after a significant progression of the disease. Discomfort is the most common symptoms that compels a patient to seek medical care.

Patient may present with any of the following symptom:
· Awareness of a mass present or growing within the Oral Cavity.
· Difficulty in swallowing.
· Toothache.
· Pain in the ear.
· Limited mouth opening.
· Excessive bleeding which is not seen that commonly.
· A non-healing ulcer in the oral cavity.
· Swelling on the gums interfering with the seating of the dentures in the mouth.

Majority of oral cancers involve the tongue, the posterior region of the oral cavity and the floor of the mouth. The lips, gums, the under surface of the tongue and the palate (bones separating the mouth from the floor of the nose) are less frequently involved.

Warning signs of Oral Cancer:-
Certain pre-cancerous lesions occurring in the oral cavity may indicate the person’s susceptibility to cancer. These lesions can be in the form of white patches in the mucous membrane covering the oral cavity and along the lateral border of the tongue, which cannot be removed by rubbing the affected area.
· Red patches seen on the mucous membrane lining the mouth and the tongue.
· Increase in fibrous content of the mucous membrane lining the cheek, which presents itself as thick fibrous bands running along the inner aspect of the cheek. Commonly seen in betel nut chewers this condition results in inability to open the mouth.

All the above lesions will cause a burning sensation when consuming spicy food.

DIAGNOSIS:-
1. Thorough examination of the oral cavity and the neck region conducted without neglecting any area may show hard lumps of tissues, which may indicate cancer. The patient is assessed for any suspicious tissue changes, which may include a white, red or a mixed white or red lesion.
2. Imaging the lesion using x-ray films, CT scan and advanced diagnostic techniques such as MRI helps in defining the location and extent of the cancerous growth.
3. Microscopic examination of a tissue specimen from the suspected lesion is the best method to confirm or rule out oral cancer. It gives the exact type and nature of cancer.

TREATMENT:-
- The principle objective is to cure the patient of cancer. The choice of treatment depends upon factors such as cancer cell type, amount of changes in the cell, size and location of the cancerous growth.
- Surgery or radiation is used with curative intent in treatment of cancer. Chemotherapy (Medicines) is used as an additional form of treatment. In early lesion either surgery or radiation as a form of treatment would suffice. But in an advanced condition, a combination of both surgery and radiation is required.
- There is rarely a second chance available for cure. Hence the initial approach of treatment is critical. The survival rates after early detection and treatment of cancer have been noted to be 70%. Chemotherapy (Medicines) is a weak substitute for the above-mentioned treatment.

More Information:-
Tobacco utilization either in the form of smoking or chewing is an important factor in the development of oral cancer. About 97% of oral cancer victims are known to be associated with tobacco either in the form of smoking or chewing. Pipe smoking and cigar smoking have been known to increase the risk levels by a few folds. Among the various habits associated with tobacco, tobacco chewing is known to cause oral cancer more rapidly than any of the other habits. This is because of the direct and repeated contact of the tobacco with the mucous membrane of the oral cavity.

FAQs:
--Do all betel nut or tobacco chewers get oral cancer?
Betel nut and tobacco chewers are definitely more prone to oral cancer than those who do not have this habit, but there are also other factors such as genetics, diet, environment and the person’s immune system.

--Will stopping the habit improve the condition?
There are certain lesions seen frequently in the mouth of betel nut and tobacco chewers. These lesions precede oral cancer. If these preceding lesions are identified in time, then stopping the habit will definitely improve the lesion or maybe even cure it.

--Is pain an early sign of Cancer?
Not always. Pain is usually a late symptom of cancer. People often think that persistent pain such as headache or constant pain in the region of the face means cancer, but this is rarely the case. However pain should not be ignored.

--What are the side effects of treatment?
There are side effects to all forms of treatments involving oral cancer.

--Surgery
If the lesion is small then there are usually no side effects, but if the lesion is large the it may require the removal of the affected structure resulting in the speech defects difficulty in swallowing and also facial deformities. These conditions can rehabilitated by speech therapy and by physiotherapy.

--Radiation therapy
During and after radiation therapy the patient develops mouth sores. The patient also suffers from reduced secretion of saliva, which causes difficulty in swallowing and makes the patient more prone to teeth decay and other forms of infection.

--Chemotherapy
Side effects depend on the kind of drug used. The usual side effects are loss of hair, ulcers in the mouth and in the stomach, reduced resistance to infection, loss of appetite, nausea, vomiting, and lack of energy.

GLOSSARY CT SCAN
It is an advanced diagnostic technique using x-rays to three dimensionally identify the site and extent of a lesion.
MRI: It is more advanced technique, which uses magnetic force to diagnose both bony and soft tissue lesions.

FIBROUS DYSPLASIA OF THE BONE:-
About Fibrous dysplasia of the bone:
Fibrous dysplasia (FD) of the bone is a peculiar condition that affects either all bones or a single bone in the body.

Most cases are diagnosed in adolescence and young adulthood and remain unchanged throughout life. The initial manifestations of fibrous dysplasia are most commonly found in persons aged 3-15 years. In the past, many conditions that could not be satisfactorily explained have been included under this disease. The bone in this condition is fibrous or plastic in quality and is defective in form as well.

TYPES
Fibrous dysplasia of the bone is divided into two types:
1· Monostotic fibrous dysplasia
2· Polystotic fibrous dysplasia
In monostotic type only one bone is involved, and hence the prognosis of this type is definitely better. In polystotic type, more than one bone or a group of bones is involved, and the prognosis is poorer.

Monostotic Fibrous dysplasia of the bone:
This condition affects mostly people in the age group 10-30. It involves excessive growth of hard fibrous tissue that replaces normal bone tissue in a single bone. Approximately 70-80% of FD cases are monostotic, occurring most frequently in the rib (28%), femur (23%), tibia, craniofacial bones (10-25%), and humerus. With monostotic disease, patients as old as 20 or 30 years are asymptomatic.
The cause of this condition is unknown although several theories have been proposed. One theory attributes this disease to abnormal activity in the bone forming tissues prior to birth. Another theory says any localized infection or trauma gives rise to this disease. In some cases, Monostotic FD of the bone has occurred as an autosomal recessive trait.

SYMPTOMS
The first sign of the disease is a painless bulging in the affected jaw. As the lesion is constantly expanding, they could lose their balance of contacting the teeth in the opposite jaw, and as a result, there may be disturbance in the teeth as well. . When Fibrous dysplasia occurs in the upper jaw of the maxilla, Monostotic FD is a serious condition. The lesion extends into the maxillary sinus, and on the face. At times it may extend to the base of the skull and obstruct vital nerves, causing irreparable damage.

TREATMENT
The treatment of Monostotic FD of the bone is usually radical surgery. This surgery mutilates the entire bone involved, sometimes necessitating block resection as well. In some cases, this condition could lead to osteosarcoma or cancer of the bone.

Polyostotic fibrous dysplasia:-
This condition affects a number of bones in the body, mostly the long bones. About 20-30% of FD cases are polyostotic. Two thirds of patients exhibit symptoms before the age of 10. Polyostotic FD frequently involves the skull and facial bones, pelvis, spine, and shoulder girdle. The sites of involvement are the femur (91%), tibia (81%), pelvis (78%), ribs, skull and facial bones (50%), upper extremities, lumbar spine, clavicle, and cervical spine, in decreasing order of frequency.

SYMPTOMS
- There is a thickening of the long bones and the patient usually complains of persistent bone pain.
- Often, the initial symptom is pain in the involved limb and, spontaneous fracture, or both. Leg-length discrepancy is present to varying degrees in 70% of patients with limb involvement. The weight bearing bones become bowed due to weakening of the structural integrity of the bone.
- The bones of the face and the skull are involved in a majority of the cases and sometimes are unilateral in distribution. If this happens, there is an obvious deformity of the face.
- Sometimes brown lesions called the "cafe-au-lait" spots are present on the skin. Vaginal bleeding is another feature of this condition. Teeth do not erupt into the oral cavity on time. Several hormonal disturbances are also commonly seen. The thyroid, parathyroid and the pituitary as well as the ovary are involved.

TREATMENT
Mild cases are satisfactorily treated with surgery. But in severe cases, radiation therapy has been tried with limited success. The lesions have a high potential to turn malignant.

FAQs
--What is Fibrous Dysplasia (FD)?
Fibrous dysplasia (FD) is a disease of the bones characterized by abnormal growth areas or lesions in one or more bones. FD can occur in any bone, including the skull, legs, arms, and the ribs.
--Which doctor do I consult about FD?
A bone specialist is to be consulted.

--What is McCune-Albright Syndrome?
McCune-Albright Syndrome is named after the two physicians who described it over 50 years ago. About 10 % of those with polyostotic FD have some associated endocrine (hormonal) problems including early puberty and areas of increased skin pigmentation called cafe-au-lait marks. These birthmarks have irregular borders, again primarily on one side of the body. The combination of polyostotic fibrous dysplasia, endocrine disorders, and café-au-lait marks is called McCune Albright Syndrome (MAS).

--Is FD hereditary?
No. FD is not hereditary.

--Why does one get FD?
The cause of FD is still unknown. The gene responsible for FD appears to be especially susceptible to mutations. Though rare, FD occurs in males and females and in people of all races across the globe. It is possible that the mutation occurs randomly.

--Is FD cancer?
FD is not cancer. Many people use to term "lesion" to mean any defect to avoid confusion of FD with malignant bone tumors. However, an FD bone lesion can turn cancerous; but this is very rare—in less than 1 % of FD cases.

--Is there a permanent cure for FD?
In general, FD cannot be cured today, unless it is only one lesion in one bone that can be completely eliminated by surgery. There are often unidentified FD cells in several bones and all cannot be eliminated by surgery. Some drug treatments can significantly diminish bone pain in long bones and cause some good bone to fill in the defects. Bisphosphonate drugs such as alendronate (Fosamax) that is used for treating osteoporosis or pamidronate (Aredia) have helped some people. However, these drugs do not work for all FD patients. Research is in progress to find other possible treatments.

DEVELOPMENTAL DISTURBANCES OF THE TONGUE:
About Tongue
The tongue is an important organ that occupies a large area in the oral cavity covering the floor of the mouth. It is below the palate, and is surrounded by teeth on either side. Together with the palate, it performs the function of swallowing. It is rightly said that the tongue is a gateway to the esophagus. A host of things can go wrong with the formation of the tongue, since it develops from multiple sources, rather than a single progenitor process. Most of the developmental disturbances of the tongue are related to its size and shape, though structural defects also exist.

Defects related to the size of the tongue:-

Microglossia:
This is a condition where the size of the tongue is abnormally small. Cases of complete absence of the tongue have been reported. Fortunately, it is a rare condition. Obviously, a tiny tongue will pose many difficulties related to speech and swallowing. There is no treatment for this condition, and the affected person will have to train their tongue to the best of their abilities.

Macroglossia:
This is a much more common condition than microglossia, where the tongue is highly enlarged. An enlarged tongue may be congenital, when it is associated with generalized muscular hypertrophy or hemi hypertrophy. Secondary macroglossia is that condition that occurs in conjunction with some other conditions like a tumor of the tongue, hemangioma and acromegaly. Acromegaly is a hormonal disturbance where growth hormone is secreted in excess of the requirements of the body. The reason behind the enlargement of the tongue in this case is related to the relaxation of the muscles that support the lower jaw, and there is no support to keep the tongue in position.
As a rule, macroglossia causes disturbances in the teeth as well. Due to the continuous pressure exerted by the heavy tongue, teeth begin to move away and the tongue occupies these spaces between the teeth, giving it a scalloped appearance. Macroglossia is a prominent feature in Beckwith's hypoglycemic syndrome, where neonatal hypoglycemic predominates along with umbilical hernia and post-natal gigantism. The treatment of macroglossia involves the removal of the cause that gives rise to this condition. At times, surgical stripping of the tongue to reduce the heavy musculature is also warranted.

Ankyloglossia:
Ankyloglossia occurs as a result of the fusion of the lingual frenum to the floor of the mouth. However, complete fusion rarely occurs; a partial ankyloglossia or "tongue-tie" is a much more common condition. This leads to a myriad of speech problems such as lisping and stuttering. The treatment is to surgically sever the connection between the frenum and the floor of the mouth.

Fissured Tongue:
This condition is also referred to as scrotal tongue since the tongue often resembles the scrotum in this state. Here a transverse groove is present on the tongue from which numerous smaller grooves radiate all over the surface of the tongue. The condition is usually painless and the only problem is with the food debris gets stuck in the grooves. These have to be cleaned by gauze or a toothbrush.

Median Rhomboid Glossitis:
This condition is a classic developmental disorder of the tongue. It is a failure of the developmental apparatus during the organogenesis of the fetus. A structure called "tuberculum impar" is supposed to withdraw when the two halves of the tongue come close to each other during development. When this does not happen, the structure gets trapped in between the two halves of the tongue, thereby creating an area, which looks like a bald patch on it. Median Rhomboid Glossitis has also been strongly linked with the fungal infection caused by Candida albicans, where the tongue has an ovoid patch just before the entry into the esophagus. Sometimes a flat-raised area can also be discerned. This condition is reportedly thrice as common in men as in women. The exact cause for this occurrence is not known, although hormonal links have been suggested.There is no known treatment for MRG, though doctors have tried to administer anti-fungal agents with mixed results.

Cleft tongue:
Cleft tongue is a condition where the tongue has a cleft running right across it horizontally or vertically, although reported cases have had vertical clefts. Complete clefting is extremely rare, and occurs as a result of lack of developmental forces to push both halves of the tongue towards each other. Partial clefting presents as a deep groove in the middle of the tongue and is a common feature in the oro-facial-digital syndrome. Cleft tongue is of little importance other than causing difficulty in eating as food gets stuck in the cleft.

Benign Migratory Glossitis:
This condition is also called a Geographic Tongue due to the behavior of the lesions, which tend to "migrate" from one area of the tongue to another. The exact cause for the condition remains unknown, although it tends to occur with more intensity in cases of emotional stress. Females are twice as affected as males, but no racial differences have been observed. The lesions here are yellowish-white or deep red in color depending on the papillae that are affected.
The area of the lesion loses its epithelial lining, making hot foods seem hotter. The areas of desquamation (epithelium peel-off) persist for a while, regress spontaneously, but reappear over time. Patients with this condition are usually asymptomatic and the lesions themselves are an incidental finding during routine check-up. Again there is no known treatment for the disease, but some doctors have reported moderate success with vitamins and mineral supplements.

Hairy Tongue:
This is a condition characterized by the hypertrophy of the filiform papillae of the tongue as well as desquamation of the area where this occurs. If the papillae become stained with tobacco, they appear black in color and look like hair on the tongue. The tongue could also appear yellowish-white if foodstuff is trapped within these papillae. Anemia and gastric troubles are said to have a significant bearing on the development of this condition. Antibiotics like penicillin and Aureomycin are also responsible for the staining of the papillae. Smoking remains the biggest cause for the occurrence of the condition. Sometimes, head and neck irradiation after cancer may also produce this condition. The only treatment of the condition is to keep the tongue as clean as possible by using a toothbrush.

FAQs
--My tongue burns whenever I take chilli-hot food. What is the cause and treatment of this problem?
Burning sensation on the tongue could be due to some drugs commonly taken for diabetes and hypertension. More often, it is a result of sloughing away of the epithelial lining of the tongue. If this is the case, you should avoid taking chilli-hot food till it regenerates.

--I have a large tongue. What are the chances of getting it surgically reduced?
A large tongue develops primarily due to hormonal disturbances. Make sure that this is not the case before opting for surgery. Otherwise the chances of surgical reduction are excellent.

--My son has a lisp when he speaks and I have noticed that his tongue has limited movement. What should be done?
The boy is suffering from a condition called Ankyloglossia, more commonly tongue-tie. A simple surgical procedure should take care of the problem. Please consult your doctor as well as an oral surgeon for the needful

--I have just recovered from a bout of malaria and find that food does not taste the same. What should I do?
The loss of taste is temporary and has come about because of the strong drugs that you have taken. The tongue will recover over time and the taste apparatus should be all right in a fortnight’s time.

Vacations in the college

From June 1, the college is on vacations. Classes will remain suspended for every one ,while the 3rd years, final years and the interns will have to attend the clinics as per schedule.

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.