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.