DENTAL CARE

Our face is what we are identified by in our society,a trademark and reflection of our body, mind and soul. A face that can launch a 1000 ships, a face that can send your soul soaring to majestic heights, a face, your face, that epitomises you in all your glory , all your simplicity. A healthy, blemished, glowing face not only transmits the right kind of aura around us, it is also a tremendous self-confidence booster. However, dental problems and teeth derangements can often be great inconvenient disfigurement of an otherwise sparkling personality.

To help you realise your full personality potential, we take care of your dazzling smile. Some of the treatments available with us to keep you confidently smiling are listed below.

Implantology

As we enter the third millennium, an age of technological and medical advancement, with people living longer and healthier lives, lost teeth replaced by removable dentures will become a thing of the past, reserved for the history books.

Dental Implant

Dental Implants are man-made replacements for natural teeth. The implants themselves are designed to be similar to tooth roots. They are anchored in the jaw bone and replacement teeth are permanently secured upon them.

The Implant Placement Procedure

The Two-Stage Procedure

• First Stage - Surgical placement (can be done with a local anesthetic)
• Second Stage - Uncovering of the implant

Step 1

The implant is screwed or tapped into a surgically prepared site. The gum tissue is closed over the implant.

Step 2

The implant remains under the gum for 3 to 6 months. The patient continues to wear their denture during this period

Step 3

(3 to 6 months later) The implant is exposed by removing a small amount of gum tissue. An insert can be screwed or cemented down into the implant.

Step 4

The secured insert can accommodate various attachments upon which overdentures, bars, crowns, or bridges may attach.

The One - Stage Procedure

In step 2, the implant, which is placed, has an additional component which protrudes through the gum tissue. This extension of the implant then does not become covered over during the healing phase. Step 3 (above) is therefore not needed. Step 4 is readily achieved (3-6 months later) by unscrewing the additional component which was placed at the surgery and replacing it with the type of insert that is needed for your case.

Firstly, the titanium implant is placed in the jawbone during a minor surgical procedure. The implant will remain covered under the gum for 3-6 months and during this time the implant will become integrated with bone, forming a very strong bond. This process is known as osseointegration.

Once osseointegration has taken place, the ends of the implants are uncovered and connections are attached so that replacement teeth can be put in place.

Since implanted teeth are fixed in the mouth like natural teeth rather than being removable like dentures, they allow the patient to return to the functions associated with natural teeth.

Requirement of dental Implant

If you are missing a tooth or teeth, or even parts of your jaw, these could be replaced with dental Implants. Implants work best when there is enough dense, healthy jawbone in a mouth that will support an implant.

Healthy, disease-free gum tissues are also necessary. The long term success of a dental Implant depends upon keeping the gums and bone around the Implant healthy. People who have Implants must keep them clean and should return regularly to their dentist for checkups, because any problems that might threaten the health of the implant must be corrected.

Gum Problems

The Gums

The teeth remain embedded in jawbone which is covered from outside by gums. Healthy gums are coral pink in colour. They remain firmly attached to the underlying bone. Healthy gum can be identified by thin margins firmly adapting over the respective tooth and it does not bleed easily.

Gum Diseases

Gum problems can be divided into two stages:

• Gingivitis
• Periodontitis

Gingivitis

As mentioned earlier, normal gums are coral pink in colour with the edges firmly attached around the tooth, and does not bleed on normal brushing. The earliest sign of gum inflammation is bleeding from the margins of gums during brushing, without any pain. The margins of gums appear red. If proper brushing is not done, the disease may progress deep inside the gums. They may swell, become soft and bleed even on slightest touch, The bleeding may even occur spontaneously. Even at this late stage, the condition maybe painless. This condition is known is Gingivitis

Periodontitis

If not treated, the disease may progress to involve the surrounding bone, leading to pocket formation around the tooth. Now the disease is called periodontitis or pyorrhea. At this stage, the patient may complain of bleeding, itching sensation and dull constant ache in gums, increased hot and cold sensitivity, food impaction, and even loose teeth. There may be bad odour from the mouth, migration of teeth and exposed root surfaces. Some people may have the urge to dig deep in between the teeth to get relief from the dull ache. All these symptoms suggest that quick attention and professional help is required. If the disease is not treated, ultimately it may result in loss of teeth one after the other. Periodontal disease is the most important cause of tooth loss in our country.

Causes of gums and periodontal diseases

The gum diseases are also caused by plaque accumulation. The bacteria present in plaque form toxic substances that may cause inflammation of gums. If plaque is not removed regularly, it may harden to form calculus (tartar). This tartar with its rough surface, attracts further deposition of plaque and bacteria, sustaining the inflammation and destruction of supporting bone.

Tartar removal

The dentist cleans the hard deposits on your tooth with the help of special instruments. This procedure is called as scaling of tooth.

Neglecting gum diseases

If the gum diseases are not treated in time, the infection from the gums can spread to involve the underlying bone and may cause loosening or migration of the tooth. The involved tooth/teeth may eventually be lost. Sometimes the infection may cause pus formation that can involve adjoining tissues and may cause swelling, pus discharge, bone infection etc. Chronic gum diseases where pus oozes out of the gum margins (pyorrhea) can affect the general health of a person. Recent scientific studies have shown that the gum infections are associated with heart and lung diseases. In pregnant women, it can lead to low birth weight babies and pre-term labour. Therefore, it is very important that gum diseases are prevented and treated early.

Prevention of gum diseases

Mechanical Method

This method is most important in plaque control. The mechanical method means use of toothpaste and brush or any other indigenous method such as datun etc. Proper cleaning of teeth is very important by any form i.e. it may be toothpaste and brush or datun etc.

Teeth should be cleaned in such a way that upper teeth are cleaned in downward motion and lower teeth in upward motion, both from outside and inside. On chewing surfaces, circular motion of brushing helps to clean the pits and fissures. The key is to take care to clean all the surfaces of all the teeth in both the jaws.

The other aids of mechanical cleaning of teeth include dental floss, inter-dental brushes, rubber tips and tooth picks, water pick etc. They help to clean those areas in between the teeth that are normally not accessible during normal tooth brushing. They are specially indicated for crowding and abnormal spacing between the teeth.

Chemical Method

There are certain chemicals such as chlorhexidine and fluoride that help in reducing bacterial population of plaque. They are available as mouth rinses. They should be only used on advice of the doctor for limited periods.

Veneers

Porcelain veneers can be described as looking like'false finger nails for teeth'- but permanently placed. They can be used to correct crowding or mal alignment of teeth or to disguise a badly discoloured tooth cannot be corrected by whitening methods alone. They can also be used to close gap between teeth. Veneers require the removal of a very tiny amount of tooth structure and can provide a quick and permanent cosmetic restoration of stained, unsightly front teeth that are otherwise in good condition.

Veneers - A "Mask" For Your Tooth

• Enamel is removed from the front and side surfaces of the tooth and an impression is made.
• The veneers are fabricated in a laboratory and bonded to the tooth.

The veneer is fixed in place permanently and looks very natural.

Veneers Bonding

Bonding falls under the second category of the three Rs - restoration. In recent years, it has proved to be highly effective treatment for closing shapes between the teeth.

Treatment time

One to two hours per tooth

Patients Maintenance-

Professional cleaning three or four times yearly. Avoid hard foods on front teeth. Bonding to fill in a space is more susceptible to chipping. Proper use of floss daily is required. One problem with most direct bonded restorations is that they can stain or chip. Expect to have some re polishing or repair as necessary.

Results of treatment-

Most spaces can be filled in to look very natural

Average Range of Treatment life-

Expectancy Five to eight years. Professional refinishing once every year or so.

Advantages

• Little or no reduction of tooth structure
• No anesthesia required
• Reversible Procedure
• Economical, more so than crowning
• Teeth can also be lightened

Some of the disadvantages

• Can chip or stain more easily than crowns.
• Has limited esthetic life.
• Treatment may involve extra teeth to obtain proportionate space closing.
• Teeth may appear somewhat thicker.

Hypersensitivity Relief

A common cause of hypersensitivity

Receding gums can lead to hypersensitivity. As gums recede, sensitive root surfaces can be vulnerable to decay. Exposed root surfaces contain microscopic tubules in the dentin that lead into the tooth's center. These tubules channel stimulation from cold, heat, acids and sweets into the tooth's nerve center. This nerve stimulation results in pain.

Treatment for sensitivity

Medicated tooth pastes & mouth washes containing stannous fluoride/sodium mono-fluoro phosphate & strontium chloride builds protection against painful sensitivity of the teeth due to cold, heat, acids, sweets or contact.

With daily use, they uniformly occludes dentinal tubules, building up a protective layer to provide optimal sensitivity relief. The advantage in stannous fluoride formulation is that it creates a densely mineralized layer, formed from stable stannous fluoride and salivary minerals, across the dentinal surfaces. This blankets exposed roots in a protective luoridated covering which helps make them more resistant to demineralisation. The blocking of open tubules leads to effective pain relief.f

This also builds a protective fluoridated layer, the fluoride is incorporated into the dentin to help fight caries and keep teeth healthy.

The minor or major abrasions are then restored with the tooth colored restorative materials viz.L.C. GIF or L.C. Composites

---

Orthodontics

Orthodontics, often called as Dentofacial orthopedics, is a special branch of dentistry that deals with correction of crowded and crooked teeth and altering bone growth to produce a natural, regular arrangement and a beautiful smile. Dentists who are specially qualified in this area of expertise are referred to as Orthodontist.

Now age is no barrier to Orthodontic treatment. People of all ages can enjoy healthier teeth and gums, which boosts their confidence and self image.

Top

---

Crown & Bridges

Sometimes teeth have been so badly damaged by decay or wear that cosmetic fillings are no longer a viable option. Under these circumstances the tooth can be saved and protected by a crown or a cap.

Crowns can also be used on either side of a gap so that a bridge can be constructed to replace one or more missing teeth without the use of implants.

Occasionally, patients who have crowded or mal aligned teeth and who are unable to commit themselves to orthodontic treatment can have their problems solved by the use of crowns or veneers which can be used to disguise the appearance of the teeth and provide a beautiful smile for life.

Many of our patients come to see us very unhappy at the appearance of crowns or bridges, fitted by another dentist. Their crown are often of good quality but have failed to please the patient because of simple error - lack of communication between the various people involve in their construction. At Sahaj Dental Clinic we pride ourselves in our team approach. We believe that constructing a crown is a combination of technical expertise and artistic flair. From the outset we involve our highly skilled technician in the planning and designing. We encourage as much communication as possible among the patient, technician and dentist to ensure that the final result is exactly as expected.

Often we begin by constructing models of the finished restorations so that the patient is able to see what his or her mouth would look like before any work is started.

We actively encourage friends or family to attend with the patient so that they can contribute to the final result. Thus patients are able to feel relaxed with the knowledge that we will achieve their desired appearance

Naturally, if the desired appearance is not achievable (which only happen occasionally) we would explain the problems and suggest alternatives.

Tooth crowning or capping

• Front view of the tooth to be crowned.
• One half of the tooth has been prepared so you can see approximately how much tooth structure has been reduced.
• The tooth has now been fully prepared to make room for the porcelain (and most times an underlying layer of metal for support). Then two sides of the tooth are prepared with only a slight taper to help hold the crown in place.
• The new crown is being put into place. Notice the way it will fit up under the gum tissue to hide the margin ( junction ) between tooth and crown.
• The final crown is shaped as much as possible like the natural tooth to look and feel good. It is attached with special dental cements.

Top

---

Root Canal Therapy

The mere mention of root canal therapy sends a shudder through most patients. However, with advances in modern dental technology and effective use of analgesia even this most feared of dental treatments has been transformed into a pain free and acceptable procedure and we are now to save many of the most heavily destroyed teeth and avoid extractions.

Any discomfort associated with root canal treatment is in fact usually felt prior to an intervention by the dentist. Usually the tooth has died or is dying as a result of extensive decay or trauma. During the dying period the root become irritated and this produces the pain that makes most patient seek advice from the dentist. Once the tooth has died the nerve endings and blood vessels in the tooth can become infected and subsequently form a abscess, causing a build-up of pressure and associated pain.

The aim of root canal therapy is to relieve any discomfort, not create it and in fact we achieve this in a painless and relaxed manner. After gaining access to the tooth, which is simply like having a normal filling, all the canals are cleaned out thoroughly with special antiseptics. The void created is then completely filled up with a plasticised material which renders the whole canal system inert, stable and therefore pain free.

The treatment is usually carried out over two visits and during each appointment the tooth is isolated with use of a rubber dam. Between appointments the tooth is dressed temporarily so as to remain pain free functional. After the root canal treatment the tooth can be restored to a natural looking and normal state, usually bycrowing,toincrease its overall strength and longevity.

Top

---

Fillings

Fillings or restorations are necessary in cases of tooth decay.

Teeth decay

The initial attack of bacterial acid is on enamel and the dissolution starts. During this time, it may appear as brownish or black discolouration of tooth. On progression, this converts into a cavity or a hole in the tooth. At this time the usual complaint is that the food gets impacted between the teeth. Further progression of this lesion leads to involvement of dentin. During this time, the patients complain of sensitivity to hot and cold or sweet and sour things.

Filling

At this stage when tooth decay in the enamel or dentin the tooth can be restored to its original form and function by the dentist.

The dentist removes all the decayed part of the tooth. Next he fills the tooth. Filling materials are of four types.

• Silver Amalgam
• Glass Ionomer
• Light Cure Glass Ionomer
• Light Cure Composite Resin

Silver Amalgam

Silver dental fillings have been described as a toxic time bomb.

"The World Health Organisation states that the largest estimated daily intake and retention of mercury and mercury compounds in the general public is from dental amalgam fillings. WHO has stated that there is no safe dose of mercury. Mercury is a poison at any level, whether or not the level of toxicity is sufficient to produce recognisable symptoms." - A Textbook of Dental Homeopathy by Dr. C. B. Lessell.

Did you know that the use of mercury fillings has been abolished in Sweden and that the UK government has banned its use during pregnancy? Despite mounting evidence against the use of mercury many dentists are still using mercury fillings, blissfully ignoring the growing volume of scientific evidence which points to many chronic and debilitating conditions which occur through such use.

Careful precautions have to be taken when removing old amalgam fillings.

Rubber dam isolates the tooth from the rest of the body and acts as an effective barrier against swallowing or inhalation of mercury fumes. We also recommend taking dietary supplements, such as Vitamins C and E and Selenium to negate traces of toxicity even after the amalgam has been removed and to guard against any traces of mercury in the system.

Glass Ionomer

Normallyused as a filling for deciduous (milk) teeth in child patients.

Top

---

Extraction & Surgeries

EXAMINATION OF TEETH

1. Tooth to be extracted

• Is the tooth carious?
• Is it abraded?
• Does it contain large filling?
• Does the tooth have artificial crown?
• Size of the tooth.
• Formation size and number of roots.
• Hypercementosis present on the root or roots.
• Is there on area of condensing or infective osteitis?
• Condition of roots.
• Position of roots.
• Relationship with adjacent teeth, tuberosity and maxillary sinus, mandibular canal.

2. Dental radiographs and extraction of teeth

• Radiographs are an invaluable aid to the surgeon in preventing untoward incident such as fracture of mandible, tearing of floor of the maxillary sinus.
• Intelligent planning of the proposed surgery.
• Small intra-oral filling are necessary to take extra oral views to completely visualize impacted molars.Also necessary to localize position of the teeth.

3. Examination of the supporting hard and soft tissues

4.Age of the patient: In elder patient teeth is brittle and is more dense and opposite is the case in younger individuals.

5. Previous Extraction

IMPACTION —

A tooth which fails to erupt in normal anatomical position either due to lack of space or due to obstruction from tooth, bone or soft tissue.

Causes

Local

• Irregularity in the position and pressure of an adjacent tooth.
• Density of the overlying or surrounding bone.
• Chronic inflammation with resultant fibrosis of the overlying mucosa.
• Lock of space due to under developed jaws .Unduly over retention of the deciduous teeth.
• Premature loss of deciduous teeth.
• Acquired disease such as necrosis due to infection.
• Inflammatory changes in the bone due to exanthematous diseases in children, like, Chicken pox, Parotiditis.

a.Prenatal

• Heredity
• Miscegenation
• Syphilis
• Tuberculosis
• Malnutrition

b. Post Natal

• Rickets
• Anemia
• Endocrine dysfunctions.
• Diseases of jaw and surrounding tissue

Rare Conditions

• Cleidocranial dysostosis
• Oxycephaly
• Progeria
• Achondroplasia
• Cleft palate

Apicoectomy also called as root resection or root amputation is the ablation of the apically infected portion of the tooth and curettage of all periapical necrotic and inflammatory tissue.

Indications

• Maxillary or mandibular anterior teeth with periapical infection.
• Teeth in which the destruction of the investing alveolar bone does not extend over one third the length of the root.
• Teeth with apical resorption.
• Teeth with well circumscribed periapical granular tissue.
• Tooth in young patients which is an etiologic factor in the production of radicular cysts or which has been devitalized by extension of cysts.
• Teeth in which root has been fractured by trauma.

Contraindicatio

• When general health of the patient is below par especially those who have had rheumatic fever or are suffering from rheumatism, nephritis, diabetes, cardiac disease, thyrotoxicosis.
• In teeth with deep periodontal pockets and excessive mobility.
• In cases where tooth approximates important anatomic structures.
• In inaccessible areas.
• In cases where it is necessary to remove too much tooth structure.
• When traumatic occlusion cannot be corrected.

Reasons of failure

• Improper selection of teeth.
• Negligence of pre operative measures.
• Operation of tooth with partial root filling without refilling the canal.
• Faulty technique.
• Lack of surgical asepsis.
• Removal of tooth along with the cortical plates. This retards healing as there is an opening created.
• Traumatic occlusion.
• Failure to incise properly, this prevents good visibility of the field.

Top