EDUCATION & FACILITY
Introduction
Fillings/Restorations
Periodontal Treatment Ultra Sonic Scaling [Cleaning], Gum Surgery & Bone grafting
Gum Disease
Root canal treatment
Crowns and Bridges
Dentures
Dental Radiography
TMJ Disorders
Oral & Maxillofacial surgery
Orthodontic Treatment (Clips & Braces)
Cosmetic Dental Treatment [Smile Designing]
Bleaching / Teeth Whitening
Maxillofacial Prosthesis
Dental jewels
Introduction
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The purpose of introduction is to provide basic information about various dental subjects. In dentistry the mouth is divided into the Upper and Lower arches and each arch is divided into the Left and Right side resulting in the four Quadrants of the mouth.
Permanent (adults) teeth are number 32, and primary (baby) teeth are number 20.
2.Fillings/Restorations
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Fillings are dental restorations used to repair a tooth damaged by decay (caries). It is common for a tooth to have decay but
not cause any sensitivity or discomfort, or cause minor discomfort, such teeth are candidates for fillings. When tooth decay
reaches the point of causing pain a crown and possibly a root canal maybe be needed. Regular dental checkups will catch any
decay while it is still minor in nature and your best means to avoid root canal.
With a filling, the decay is removed from the tooth and the cavity created is then prepared or shaped to accommodate a
filling material. This preparation will ensure a proper seal and bonding of the material and the tooth.
There are many types of filling material in common use today (amalgam, composite, ceramic, gold) and each has different
preparation requirements.
Amalgam is a metallic gray, silver & mercury alloy which hardens or cures overtime after placement.
Composite is a tooth colored resin which is light cured after placement.
Gold is a soft metal, which is pressed into the cavity and forms a seal as a result of this placement pressure, no curing is involved.
Inlay and onlay are indirect restorations, which are used in large cavities and are tooth colored.
It is common to experience some sensitivity and possibly some gum irritation for a few days after treatment. These side effects will be most noticeable a few hours after the procedure and diminishing in nature until gone.
3.Periodontal Treatment Ultra Sonic Scaling [Cleaning] & Gum Surgery & Bone grafting
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"Perio" means around and "dontal" means tooth. Periodontal disease is an infection that gradually destroys the tissue
surrounding your teeth and the jawbone that supports them. Nearly 3 out of 4 people will be afflicted with some form of gum
disease at sometime in there life. This, if left untreated, often progresses to Periodontitis and eventual tooth loss.
Gum Disease or periodontal disease is when the gums start itching bleeding and pulling away or receding from the teeth. This
can eventually lead to bone loss and then tooth loss. The gums start receding when plaque and calculus build up around the
base of the teeth. Plaque will build up daily on teeth and this build up can be controlled by regular daily brushing and
flossing. As this plaque builds up overtime it hardens and becomes calculus. Studies show that mouth rinses are effective at
inhibiting plaque build-up, but not removing it. Built-up plaque and calculus can only be removed by professional cleaning.
Regular ultrasonic scaling by a dentist or hygienist with proper daily brushing and flossing, can prevent periodontal disease.
Common causes of gum disease:
. Poor oral hygiene: plaque.
. Diet: Nutritional deficiencies (e.g. Vit. C deficiency), excessive alcohol consumption.
. Habits: Smoking, pan chewing, tobacco chewing, excessive use of toothpicks.
. Dental causes: Large unattended cavities, irregular teeth ill-fitting dentures, malallinged teeth and ongoing braces treatment.
. Medical Causes: Diabetes, pregnancy, use of oral contraceptives, steroids, anti hypertensives etc.
3. Gum Disease
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Stage 1: GINGIVITIS
Poor brushing and flossing habits allow dental plague to build up on teeth. Plague contains germs, which cause gum disease. Early signs of gingivitis may include itching, swelling, bleeding, tenderness or bad breath. At this point, gums may be loose, but are still attached high on the teeth. This inflammation of the gums is called gingivitis and is the first stage of gum disease.
Stage 2: PERIODONTITIS
When gingivitis is left untreated, plague is allowed to accumulate and it begins to classify (harden) and forms calculus or tartar. This calculus slowly begins to break down the gum and bone support of the teeth, leading to pocket formation and destruction. As the disease a progress, more bone gets destroyed; the teeth loosen and eventually fall out or may need to be extracted. Periodontitis is a silent disease, where the bacterial infection of the gums and supporting tissues usually occurs without pain.
Signs of periodontitis include:
Bad breath
Food between teeth
Red or swollen gums
Itching gums
Loose teeth
Sensitive teeth
Pus coming from around the teeth
Pain of chewing
Tender gums
Bleeding gums
Sudden appearance of spaces between teeth
Stage 3: ADVANCED PERIODONTITIS
You may experience receding gums with exposed roots darker calculus, pus if you press on your gums, and some symptoms from stages 1 and stage 2.
TREATMENT OPTIONS
Treatment of periodontal disease depends on how much damage the disease has caused. Since periodontitis affects more than just the gums, it can't be controlled with regular brushing and flossing. Treatment of periodontal disease is often extensive. The primary goals of all professional treatment are to promote reattachment of healthy gums to teeth to reduce swelling the depth of pocket and the risk of infection, and stop farther damage.
Treatment options may be non-surgical or surgical.
NON-SURGICAL OPTIONS
1. Scaling and root planning
Scaling: this is a type of cleaning with ultrasonic instruments. It removes plaque and tartar from teeth and below the gum line.
Root planning: the dentist smoothens the root surfaces so that supportive tissues can re attach to the tooth surface. Local anesthesia may be used, as this procedure goes deeper then regular cleaning. Your tissue with a procedure called soft tissue curettage.
2. Antibiotics and anti-inflammatory
3. Bite correction
4. Splitting [using adjacent strong teeth to support the weak or mobile teeth]
Consult your dentist for more information on specific procedures.
SURGICAL OPTIONS
In latest stages of the disease, depending on the severity, any of the following procedures may be indicated.
1. Gingivectomy
This procedure removes an overgrowth of gum tissue taking the gum label back to its original position.
2. Flap surgery
During this procedure an incision is maid, a "flap" is lifted. The gums are gently separated from the tooth, creating an access to the infected pocket and root surface. Deep deposit of plaque and tartar are then removed.
During the time of surgery grafting is also possible, bone graft helpful to increase the vertical height of the bone which helpful in good foundation for the tooth.
4.Root Canal treatment
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If a tooths pulp, which contains nerves and blood vessels, becomes infected or damaged because of decay or injury, root canal treatment is often the only way to save your tooth and repair the damage..
How can I have pain after the nerve is dead or removed?
Much of the time pain is due to infection, pressure or irritation of the bone and ligament outside the end of the root of the tooth (deep within the jaw), rather than the nerve itself. This can happen during or after the root canal therapy, even though the tissue has all been removed. Rarely, the canals diverge abruptly, and the tissue in the canals cannot be removed. This can become an irritant. Sometimes the tooth is actually fractured and since the symptoms are often the same as a nerve problem, it may go undetected and continue to cause pain with chewing.
Indications for Endodontics:
Spontaneous pain or throbbing pain during or after chewing
Sensitivity to hot and cold foods or liquids.
Severe decay or an injury (which can lead to an abscess or infection).
Treatment usually takes from one to three appointments, depending on the tooth and circumstances.
Root canal therapy is simply the removal of diseased or non-viable nerve and blood supply tissue from inside the tooth and roots.
Technique
1. An opening is made from the top of the tooth into the pulp chamber.
2. The canal opening(s) is/are identified.
3. The canal(s) is/are shaped with progressively thicker files to remove diseased tissue. These files are smaller than a typical needle.
4. X-rays are taken to be sure we have reached the end of the canal(the bottom of the root) with the files.
5. The canals are then shaped to allow access for filling material to seal the end of the tooth(final shaping).
6. The canals are sealed with Gutta Percha (a thermoplastic material)and a cement.
7. The tooth is built up for a crown or the opening is temporarily sealed. A crown will eventually be needed.
Myths about RCT:
The pain is unbearable: In most cases RCT almost becomes a non-event, modern anesthesia makes it painless.
It's a long procedure: single sitting RCT can be done in required cases.
Severe infected teeth need as many as 2-3 sittings.
Once RCT is done, its over: This procedure is followed by placement of a custom made crown (cap) available in different materials like ceramic, metal or combination to give additional reinforcement to weakened tooth.
Crowns and Bridges
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Crowns and Bridges are example of prosthetic dentistry
Crowns are used to replace parts of teeth and Bridges are used to replace whole teeth that are missing from an arch. Each involves taking models and sending them to a dental lab were crowns and bridges are custom fabricated for each patient.
Crowns
A crown or cap is usually placed because the remaining tooth structure is not capable of adequately supporting or retaining a regular filling. In addition, a crown will help hold together and support the remaining tooth structure, thus minimizing the chance that a tooth could fracture.
The other indications are:
To restore fractured teeth.
To protect weak teeth from fracturing.
To support a large filling when there isn't enough tooth remaining.
To conceal badly shaped or discoloured teeth.
To strengthen teeth following a root canal (teeth tend to become brittle and are more prone to fracture).
To disguise extensive damage caused by decay.
To attach a bridge.
To cover a dental implant.
Placing a crown usually involves two visits after decay and old filling are removed. In the case of a severely damaged tooth a core may be needed to hold the crown in place.
The first visit involves preparation (shaping) of the tooth to make room for the crown, making an impression (mold) for the lab to fabricate the crown.
Temporary crowns of acrylic can be placed until permanent crown is cemented.
A second visit is needed to fit and permanently cement the crown .
Types of crowns
Metal crown
Metal ceramic crown/PFM (porcelain fused to metal crown)- tooth colored.
Zirconia crown- is tooth colored made of zirconia.
Procera crown -is tooth colored.
Acrylic crowns- tooth colored, used for temporary purposes.
Composite crowns- tooth colored.
Bridges
Bridges are used to replace missing teeth. Why is that important? Because teeth in front of space will drift back, creating spaces in between front teeth. Teeth behind the missing tooth space will tilt forward. And the tooth above the missing tooth space will grow down (erupt) down into the tooth space.
Because these teeth drift out of position, several conditions may occur; severe occlusal (bite) problems that could lead to clicking of the jaw, headaches, and jaw pain ; hard to clean areas are created which will lead to tooth decay, gum disease, and bone loss; a change in facial appearance.
There are several ways to place or secure a bridge. Some of the more common types are:
Fixed Bridge:
A fixed bridge is either cemented in place over the adjacent teeth just like a single crown or bonded to adjacent teeth, depending upon the circumstances.
Implant supported bridge- Implants are used to support the bridge.
Cantilever bridge- only one tooth is used to support the bridge. Is done only in selected circumstances.
Types of bridges
Metal bridge
Metal ceramic bridge/PFM (porcelain fused to metal) bridge- ls tooth coloured.
Zirconia bridge- is tooth coloured bridge ceramic made of zirconia.
Procera bridge-is tooth coloured ceramic bridge.
Acrylic bridge - tooth coloured, used for temporary purposes.
Composite bridge - tooth colored.
6.Dentures
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Dentures and partials are examples of prosthetic dentistry. They are used to replace a large number of consecutively missing teeth (i.e. and entire quadrant or arch). Generally partial and full dentures are not fixed appliances and can be removed for cleaning.
A properly fitting denture should not require any adhesive to hold it in place. If a denture fits loose it usually needs to be relined. It is a good practice to see your dentist at least once annually for a checkup and cleaning of your full denture.
Complete Dentures- they are full set of teeth in upper and lower jaws. They may be made out of many types of materials- acrylic dentures, metal base dentures, flexible dentures, monomer free dentures, etc.
Before denture insertion
After denture insertion
Immediate dentures they are dentures given immediately after removal of natural teeth. The patient is never without teeth. They become loose in 6 to 8 months due to healing of wounds and bone shrinkage. Relining should be done and new dentures have to made after a year.
Overdentures they are dentures placed on remaining natural teeth and tooth roots, which are root canal treated. These teeth roots act to support the denture and reduce bone shrinkage in jaws.
Before treatment
After treatment root covered with metal caps
After treatment denture on metal caps
Partial dentures
They are dentures made for replacement of a few missing teeth. They may be made out of many types of materials- acrylic dentures, metal base dentures, flexible dentures, monomer free dentures, etc.
Some suggestions for proper denture care are:
ALWAYS rinse your dentures inside and outside after each meal.
ALWAYS clean inside and out with a soft denture brush and a mild soap before putting them in your mouth in the morning and after taking them out at night.
ALWAYS put your dentures in water with or without denture cleanser at night. Follow cleanser instructions.
ALWAYS clean your dentures over a soft surface or basin of water. This will help avoid breakage if dropped.
ALWAYS massage your gums morning and night with a soft brush or cotton gauze.
ALWAYS see your dentist for any denture adjustment.
NEVER use scouring powders or strong detergents. These may damage the dentures.
NEVER put dentures in hot water.
NEVER let dentures dry out.
NEVER use adhesives unless advised to do so by your dentist.
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7.Dental Radiography
Dental X-rays necessary, they often provide information essential for detection, diagnosis, and treatment of conditions that can threaten your oral and general health. Many diseases of the teeth and surrounding tissues cannot be seen when your dentist examines your mouth. If X-rays are not used, small cavities between teeth, abscesses, cysts, tumors, and other diseases may be impossible to detect until obvious signs and symptoms have developed and serious damage has been done to your health.
Your dentist will first review your history, examine your mouth, and then decide whether you need X-rays. If you are a new patient, the dentist may ask you to have complete X-rays to determine the present health of your mouth. Afterwards, you may need X-rays only when information is needed about a particular problem. Children may need X-rays taken more often (every 6 months) than adults because their teeth and jaws are still developing.
If I am pregnant or think I may be pregnant, should dental X-rays be postponed? Not necessarily. Tell your dentist that you are, or think you may be, pregnant. When a pregnant woman wears a leaded apron during dental X-rays it is unlikely that the developing baby receives any detectable radiation from outside the body.
What are the different types of X-rays:
1. Bitewing- These show the crowns of several upper and lower teeth on one small film. This type of X-ray is especially useful for showing cavities between teeth and changes in bone caused by periodontal disease.
2. Periapical- This X-ray shows entire teeth, including all of the roots and surrounding tissues on one small film. These X-rays show many kinds of disorders, including impacted teeth, fractures, abscesses, cysts, tumors.
3. Full-mouth series- This is a complete set of bitewing and periapical X-rays that show all of the teeth, roots, and related areas of the jaws. The number of pictures taken varies depending on the size and shape of the mouth and teeth. Generally, at least 18 X-ray pictures are needed, but a full-mouth series may consist of as few as 6 or as many as 21.
4. Panoramic- A panoramic view X-ray shows all the upper and lower teeth, large portions of the jaws and other structures in one large picture. It is often used to find unerupted teeth, cysts, fractures, retained root fragments, and other conditions of the jaw. It does not generally show enough detail to be useful for detection of decay and bone loss from periodontal disease.
5. Cephalometric- These X-rays are sometimes called headfilms. They show all of the bones of the face and skull. This type of X-ray is used to evaluate growth, development, and skeletal relationships.
There is a lot of confusion and concern about the radiation from dental radiographs. People are exposed to natural background radiation all their lives. This radiation comes primarily from outer space (cosmic radiation) and secondarily from naturally radioactive substances in the earth's surface. It has been estimated that the average person receives about 80 millirem (mrem) of radiation every year. Natural background radiation cannot be directly compared to X-ray examinations, however, because background radiation affects the entire body continuously, while diagnostic X-rays affect only a small part of the body for a very short time.
Exposure to large amounts of X-radiation is harmful. But with modern techniques and equipment, the amount of radiation received in a dental examination is extremely small, so small in fact that most states no longer regular dental radiography. The new digital radiograph systems produce less than 1/5 the radiation that the older film systems use. In our office we use the DC Radiograph system. The other factor is the type of tissue exposed to radiation. Radiation damage is mostly only a consideration with rapidly dividing tissues such as reproductive organs, bone marrow, etc. The tissues exposed to dental x-rays (teeth, jaw, cheeks) are not as susceptible to radiation damage. Therefore, the risk of harmful effects from dental X-rays is negligible.
DC X-ray machine
8.TMJ Disorders
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Temporomandibular Joint
If you place your fingertips against your face in front of the ears and move your jaw up and down, you can feel the movement of your temporomandibular joints. These are similar to hinges and connect the lower jaw to your skull. If the jaw is to perform properly, the upper and lower teeth must mesh properly when you close on the back teeth in a fixed or "normal" bite.
What is TMJ Syndrome? What are the Symptoms?
TMJ problems have their primary base in the (TMJ) joint mechanism. The actual malfunction may involve the ligaments, muscles or the joint bone itself. For this reason, dentists now usually refer to these problems as myofacial or craniomandibular pain dysfunctions, indicating a much broader involvement of tissue. Symptoms are popping, clicking, or cracking near the ear, soreness of the jaw, severe pain in the joint area, dizziness, headaches, backaches, eye pain and chronic fatigue - to name a few.
The causes may be external, internal, or both.
EXTERNAL causes might be a blow to the face or jaw- or some sort of injury; for example, whiplash is a common cause of externally produced trauma to the TMJ.
The most common INTERNALLY-produced trauma arises from occlusal disharmonies (traumatic occlusion), commonly called "poor bite". Missing teeth not replaced can also produce disharmonies. Forms of arthritis also may be internal causative factors. Further, poorly fitting dentures and partial dentures or fixed bridges which have outlived their usefulness can create TMJ problems.
If a person suspects this type of disorder, he/she might try these things:
1. Press the area directly in front of the center of the ear. Pain or tenderness might indicate inflammation of the Temporomandibular Joint.
2. Insert the little fingers in the ears with the nails facing back. Press forward gently. If the joint is inflamed, pain might be felt.
3. Watching the chin in a mirror, open the mouth wide, then close. Does the chin move straight up and down? If it deviates to one side, it may indicate possible TMJ problems.
4. Are there clicking sounds when opening or closing the mouth?
5. Is there clenching or grinding the teeth during the day or during sleep?
TMJ Disorders Have Been Called the Great Impostor Syndrome. Consider the incredible amount of use the jaw gets everyday in talking, eating, and even swallowing. It is not surprising that the pivotal point (the Temporomandibular Joint) should often be subject to problems. But the Great Impostor problem is that the pain itself may surface or radiate almost anywhere- head, neck, shoulders, ex; masquerading as acute or chronic diseases. This includes severe headaches, backaches, ringing in the ears or vertigo problems, etc. Because of its genius for disguise, the TMJ problem has been called the Great Impostor. Part of our function in dentistry is to develop techniques to help us catch the Great Impostor at its nasty game.
Stress is often a factor. People under emotional stress may unconsciously try to reduce tension by grinding the teeth at night (called "bruxing"). This creates abnormal wear and, subsequently, may interfere with alignment of the upper and lower teeth, resulting in bite problems. If stress is a contributor to the TMJ syndrome, professional counseling, as well as dental treatment, may be needed to correct the problems.
Treatment
If external injury can be ruled out- the problems then may very possibly stem from traumatic occlusion. This bad bite situation can result in stress induced muscle spasms in the Temporomandibular Joint area. These muscles are used whenever you chew, talk, swallow or otherwise move your jaw. In more difficult cases, muscle relaxants may be used to ease the tension on the involved muscles. We try to do the least invasive and most reversible treatments first, and progress from there if necessary. The almost universal first step is a splint. This splint is a clear piece of plastic which fits over the top of the teeth to keep the upper and lower teeth from touching. This eliminates the pain within two weeks 90% of the time. Some people cope well with the problem just using the splint occasionally or just at night. Sometimes we must correct the bite through adjustments by reshaping the teeth by orthodontics, or by replacing bridges and dentures. If all of these treatments fail, the final step may be some sort of surgical correction. This is a rarely-used treatment.
9. Oral & Maxillo-Facial Surgery
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A specialty concerned with the treatment of the mouth, jaws, facial bones and associated structures. Maxillo-facial means: Pertaining to the maxilla and mandible (upper and lower jaws andtheface.
Anesthesia
Modern Anesthesia techniques make it possible to perform intricate surgery in our office with no discomfort and with substantial financial savings compared to hospital surgery. Local anesthesia (Lidocaine), nitrous oxide (laughing gas), intravenous (IV) sedation (twilight sleep) are available.
Commonly treated problems:
1. removal of teeth
2. removal of wisdom teeth
3. Cysts
4. Cancer and tumour reconstructive surgery
5. Bony ridge preparation or preservation
6. Grafting procedures to preserve or increase jaw bones
7. Salivary gland problems
8. Corrective jaw surgery
9. Dental implants
10. Traditional oral surgery
11.Facial injuries
12.Temporo-mandibular joint disorders
1.Removal of teeth:
Teeth may need to be removed throughout life for many reasons.
Gross decay.
Orthodontic reasons.
Mobile teeth.
Tooth removal is the most common surgical service provided by an oral and Maxillo-facial surgeon. Oral surgeons have the skill and experience to remove single or multiple teeth with little or no discomfort to the patient. Extractions can be performed with local anesthesia (numbing injections) alone or local anesthesia in combination with IV anesthesia. We will discuss your anesthetic options with you and help you choose the technique that is best for you.
If esthetics are a concern, we can arrange for a temporary or provisional partial denture to be made before you extraction appointment. Temporary replacement teeth can be in place when you leave our office immediately after the teeth are removed, so you are at no time without teeth.
2.Removal of Wisdom teeth:
Your wisdom teeth, or third molars, are the last teeth to emerge from your gums during your late teens, or "age of wisdom", which gives them their name. But wisdom teeth are not really so wise. They often become impacted or trapped in the jaw bone and gums and fail to erupt as straight and fully functioning teeth. Impacted wisdom teeth nearly always have to be removed.
Why do we have wisdom teeth at all if they have to be removed so often? Human beings once had tougher diets. As our diets became softer and more refined, we no longer needed jaws for strenuous chewing. The jaws failed to develop, leaving little room for third molars. In addition, due to mixing of gene pools, some adults never develop wisdom teeth at all and some end up with more teeth than jaw. Perhaps in the distant future, we won't have to worry about them at all. Today, most people experience at least one impacted wisdom tooth.
Why Remove Wisdom Teeth? Wisdom teeth that are not painful seem harmless enough. But if they are not removed early, they often cause problems such as:
1. INFECTION (PERIOCORONTIS): The mouth is full of bacteria that normally do not get past the protective layer of gums. But when an impacted tooth breaks through the gum surface, bacteria can get in causing an infection in the gums around the crown of the tooth. This infection can cause severe pain, swelling, jaw stiffness, and even general illness.
2. DESTRUCTION OF THE NEXT TOOTH: An impacted tooth may still try to grow where it has no room, eroding the tooth next to it. This is called RESORBTION. Eventually, this could lead to the loss of both teeth.
3. PAIN: Infection in a decayed wisdom tooth or in the gum around an impacted tooth can cause pain. If a decayed wisdom tooth is not situated in a healthy position, or if it is not restorable, we may recommend its removal. An impacted tooth can also cause pain if it presses against a nerve or the next tooth.
4. CROWDING: An impacted tooth can crowd nearby molars out of alignment. If you are undergoing orthodontic care, we may recommend that your impacted wisdom teeth be removed.
5. CYSTS: When a tooth is impacted, the sac of tissue around the crown remains in the bone. Occasionally, the sac fills with fluid forming a cyst that can readily destroy or enlarge the bone and endanger surrounding structures.
Why should tooth be removed early. Before you reach adulthood, the roots of your teeth are not totally formed and the surrounding bone is softer. Therefore, there is less chance of damaging nerves and other nearby structures during surgery. The operation itself may be more difficult as you get older. The risks are greater and the healing is slower. If you wait until your wisdom teeth cause you trouble, you may have to be treated for complications such as infection, before they can be removed. In short, early removal of your wisdom teeth is likely to prevent problems later on. In addition, we may recommend that opposing healthy wisdom teeth be removed at the same time if they are impending on the opposing jaw. A recently completed clinical study of more than 9,500 patients revels that the optimal time for extraction is between the ages of 12 and 24 years. In general, difficulties increase with age.
Oral examination:
With an oral examination and x-rays, the position of the wisdom teeth can be evaluated and predicted if they may present future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. The surgery is performed by a maxillofacial surgeon under modern local anesthesia or general anesthesia as desired by the patient.
3. Cysts
They may be benign or malignant, can be diagnosed by simple examination or xrays.
Surgical enucleation (removal of cyst) or Marsupilization (reducing the cyst and removal gradually in case of very large cyst).
4.Cancer and tumour resective and reconstructive surgery:
Your doctor will decide on your treatment, depending on the type and size of the cancer, and whether it has spread, also taking into account your age and general health. Your treatment will also depend on whether you have already had treatment for a cancer of the head and neck that has come back (recurred) in the same place or in a different place.
It is important to ask any questions you may have about your treatment. It may help to make a list of questions before you see your doctor and to take a relative or friend with you. The different types of treatment may be given alone, or in combination with each other. They include:
Radiotherapy
Surgery
Chemotherapy
Photodynamic therapy.
Some of these treatments (surgery, radiotherapy) can be used only once in one place (such as the mouth or nose), and others chemotherapy, photodynamic therapy) can be used more than once.
You may find that other people with the same cancer are receiving different treatments from you. This is because the same type of cancer can take different forms that require different treatments. Also, doctors have their own views about treatment. Most doctors will be pleased to refer you to another specialist so that you can obtain a second opinion if you feel this will help you decide what to do.
Pre-operative
Post-operative stent
Patient model
5.Salivary gland problems:
Saliva is required to moisten and digest the food before swallowing. It is produced by glands that are sometimes blocked or infected. These glands can be unblocked or removed when required.
6.Bony ridge preparation:
Sometimes the existing bony ridges may not be able to support the dentures, due to sharp spicules of bone hence the bone may need to be reshaped. This allows a more smooth ridge to support the dentures with out any pain or discomfort.
7.Grafting procedures to preserve or increase jaw bones
In case of loss of teeth the bone shrinks after a while the remaining bone may not be sufficient to support a denture or may not look good under a bridge. Grafting of bone is done to increase the existing bone which can better support the prosthesis.
This also gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore function and esthetic appearance. The bone graft procedures are referred to as
Examples:
Sinus lift procedure
Ridge-augmentation
Nerve repositioning
8.Corrective jaw surgery:
Orthognathic (from the Greek words orthos, meaning straight; and gnathos, which means jaws)
The facial bones and associated teeth are repositioned to improve the function of the jaws and create a more balanced facial appearance.
Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics, and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
People who can benefit from Orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and, in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health, and appearance. Injury to the jaw and birth defects can also affect jaw alignment. While orthodontics alone can correct bite problems if only the teeth are involved, Orthognathic surgery may be required if the jaws also need repositioning.
Before any treatment begins, a consultation will be held to perform a complete examination with x-rays. During the pre-treatment consultation process, please feel free to ask any questions that you may have regarding your anticipated treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.
If you are a candidate for Corrective Jaw Surgery, several doctors will be involved and provide a solution using a 'team approach'. Specialists involves are : your general dentist, orthodontist, cosmetic dentist, maxillo-facial surgeon and anesthetist . The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.
9.Dental implants:
Dental implants are changing the way people live! The provide teeth with implants acting as roots, hence the artificial teeth look, feel, and function like natural teeth. The individual who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours are preserved.
Implants improve bone density, reduce bone shrinkage, maintain bone for longer and so you can stop aging due to loss of bone support.
A natural tooth consists of a crown (the part you see above the gum), and the root (the part hidden under the gum, within the jawbone). It is the root that actually holds the natural tooth in place.
A dental implant is an artificial tooth root (synthetic material) that is surgically anchored into your jaw bone to hold a replacement tooth or bridge in place. The benefit of using implants is that they don't rely on neighboring teeth for support, they are permanent and stable.
Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: one stage surgical and two stage types, cylinder, screw or plate type. The prosthesis can be fixed or removable, depending on the number of implants.
Traditional oral surgery
These services are commonly performed in our office and include: routine dental extractions, biopsy of face and mouth, care of oral/facial abscesses, surgical root canal treatment (apicoectomy), pre-prosthetic surgery (preparing the jaws for good fitting dentures
Facial injuries:
These include:
Facial lacerations
Intra oral lacerations
Avulsed (knocked out) teeth
Fractured facial bones (cheek, nose, or eye socket)
Fractured jaws (upper and lower jaw)
Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a "hands on" experience and an understanding of how the treatment provided will influence the patient's long term function and appearance.
Maxillo-facial Trauma:
There are a number of possible causes of facial trauma. Motor vehicle accidents, falls, sports injuries, interpersonal violence and work related injuries account for many. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bony injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
Soft Tissue Injuries of the Maxillo-facial Region:
When soft tissue injuries such as lacerations occur on the face, they are repaired by "suturing". In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat, injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). A plastic surgeon may also be called to facilitate maximum healing and minimum scarring.
Bone Injuries of the Maxillo-facial Region:
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or a leg is fractured, a "cast" is often applied to stabilize the bone and allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. However, certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small "plates and screws" at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of "rigid fixation" has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. Importantly, the patient's facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is "hidden".
Injuries to the Teeth and Surrounding Dental Structures:
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which have been displaced or "knocked out". These types of injuries are treated by one of a number of forms of "splinting" (stabilizing by wiring or bonding teeth together). If a tooth is "knocked out", it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to "wipe the tooth off", since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
The proper treatment of facial injuries is now the realm of specialists, well versed in the emergency care, acute treatment and long term reconstruction and rehabilitation of the patient.
TMJ (temporomandibular joint) disorders
TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a "clicking" sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.
No one treatment can resolve TMJ disorders completely and treatment takes time to be effective.
Trouble with Your Jaw?:
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. Or, you may have a damaged jaw joint due to injury or disease. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide.
Self-evaluation test:
The more times you answered "yes," the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they're treated.
Do You Have a TMJ Disorder?
Are you aware of grinding or clenching your teeth?
Do you wake up with sore, stiff muscles around your jaws?
Do you have frequent headaches or neck aches?
Does the pain get worse when you clench your teeth?
Does stress make your clenching and pain worse?
Does your jaw click, pop, grate, catch, or lock when you open your mouth?
Is it difficult or painful to open your mouth, eat or yawn?
Have you ever injured your neck, head or jaws?
Have you had problems (such as arthritis) with other joints?
Do you have teeth that no longer touch when you bite?
Do your teeth meet differently from time to time?
Is it hard to use your front teeth to bite or tear food?
Are your teeth sensitive, loose, broken or worn?
Treatment
Splints
Stents
Trainers
There are various treatment options that improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, the proper course of treatment will be determined. It is important to note that treatment always works best with a team approach of self-care as well as professional care.
10.Orthodontic Treatment [Clips & Braces]
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Orthodontic braces are often used to correct cosmetic or structural defects and flaws:
Under bites, overbites, cross bites and open bites
crooked teeth
to widen the palate or jaws
create spaces between teeth or shape the teeth and jaws
Better appearance of teeth, smile and face
Improved self-esteem, confidence, well-being and feeling of acceptance
A more even bite
Easier to clean teeth
Reduce risk of injury to protruding front teeth
Improve growth in a positive manner
Correct harmful habits
Better jaw alignment, proportion and function
Better chewing and digestion
Improvement of facial profile.
If your child requires dental braces, early intervention can make a real difference. That is when we see the best results with orthodontic treatment that would be impossible once your child's face and jaw have completely developed.
Also, when started early, completion of orthodontic treatment at a later age is much easier. During an initial examination, your dentist will evaluate your child's facial growth, spacing between teeth, crowding, extra or missing teeth. And they will look for habits like tongue-thrusting and thumb-sucking that may hinder normal growth and development. These problems can change tooth alignment as well as alter facial appearance. If your child doesn't require dental braces, most dentists will schedule periodic follow-up exams while the permanent teeth are coming in and the face and jaws continue to grow.
Orthodontic treatment can bring your child's teeth, lips and face into harmony. And we all know that a pleasing appearance and beautiful smile give children, and adults, a big advantage in life.
The orthodontic dentist will advise the parent as to when to schedule an evaluation. It generally will be when the child is between the ages of seven and ten.
An early consultation is advised to identify any potential problems that require treatment. Delaying treatment can multiply some orthodontic problems.
Between the ages of 8 and 12, jaws are still growing; after that, the jawbones begin to harden and it may be more difficult to correct certain conditions and facial profile.
How Dental Braces Work
The teeth move due to the use of force. The force applied by dental braces through the arch wire pushes the tooth in a particular direction.
The jaw bone is created on one side of the moving tooth and resorbed on the opposite side (bone remodeling).
Treatment Times and Procedures
Usual treatment times vary from six months to two years depending on the difficulty and types of problems.
The tooth to be braced will be cemented with a bracket. An arch wire will be threaded between the brackets and affixed with elastic or metal ligatures. The arch wire will creating constant light force on the teeth.
Elastics are used to create a stronger force to pull teeth or jaws in the desired direction. Brackets with hooks can be placed to affix the elastic to.
If required, orthodontic spacers may be inserted between the back teeth to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick.
If there is lacking space in the mouth for all the teeth to fit properly, there are two main procedures to make extent. One is tooth extraction: teeth are removed to create more space. The second is expansion: the palate or arch is made larger by using an expander.
For some patients, the Invisalign system might be a practical choice to braces. This system uses a series of clear plastic trays to move teeth into their position. However, Invisalign requires a longer treatment time, because the appliance is removable.
Types of Dental Braces
Traditional braces are stainless steel, sometimes in combination with nickel titanium, and are the most widely used. Usual stainless steel brackets include conventional braces that require ties and newer self-tying (or self-litigating) brackets.
Ceramic braces offer a less visible alternative. They blend in more with the natural color of the tooth. But ceramic brackets are slightly larger, are not as strong as metal and may require longer treatment time.
Gold-plated stainless steel braces are for people allergic to nickel (a component of stainless steel), but may be also chosen because some people simply prefer the look of gold over the silver-colored braces.
Lingual braces are fitted behind the teeth, and are not visible. This braces can be more difficult to adjust.
Smart brackets braces are containing microchip capable of measuring the forces applied to the bracket/tooth line. This braces could significantly reduce the treatment times and to set the non-harmful applied forces.
Clear braces are an esthetic option to silver braces. While clear braces are still visible (because they are on the outside of the teeth), they are much more attractive than silver braces.
Ceramic versus metal braces
Lingual braces
CERAMIC VERSUS PLASTIC BRACES:
Material Composition Diffferences
Ceramic braces are far superior to white Plastic braces for multiple reasons. All reasons stem from the basic material composition of the braces. Ceramic braces are made from Aluminum Oxide, while Plastic braces are made from Polycarbonate.
ESTHETIC WIRES WITH CLEAR BRACES:
Esthetic wires are white. More specifically, an inert white colored phenolic coating is placed on the outside of a silver wire (surface treated to adhere to the phenolic bond).
White wires in clear braces are quite esthetic. Unfortunately, there are very few wires available by different manufacturers. As such, orthodotists are forced to utilize silver wires in clear braces. White wires may also flake off the white phenolic, exposing the silver subsurface. This usually happens if the patient is an aggressive tooth-brusher.
Even with silver wires in clear braces, the esthetics of clear braces are far greater than silver braces and silver wires.
Braces Care: Proper Tools and Best Products
Plaque develops easily when food is retained in and around braces. Plaque is the reason that patients need to be on the alert about dental hygiene during orthodontic treatment.
If plaque is left on teeth and around braces, patients may develop gum disease (swollen gums), bad breath, scarred and discolored teeth, and tooth decay (cavities).
To help fight against bacterial plaque, dentists recommend the following tools and dental products:
1. TOOTHBRUSHES:
2. FLUORIDE TOOTH PASTE
3. DENTAL FLOSS:
4. INTERDENTAL or BETWEEN TEETH CLEANINGS:
5. FLUORIDE RINSE:
Dental Braces: Complications
Tooth pain after adjustment, mouth sores, allergic reaction to the latex rubber in elastics or to the metal, punch the back of the patient's cheek from the arch wire may be produced by components of the braces.
Many products, including protective oral rinse, aloe containing toothpaste, dental wax or dental silicone, and merchandises could heal sores.
Latex-free elastics and ceramic braces can be used instead.
Eating soft foods during this period can help avoid additional pressure on the teeth, gum, and soft tissues.
Braces can also be damaged if proper care is not taken, orthodontic brackets may pop off due to the forces involved, or due to cement weakening over time. Several damage to braces can prolong treatment.
It is important to wear a mouth guard to prevent breakage when playing sports.
Chewing gum and certain sticky or hard foods, such as raw carrots large hard pretzels, and toffee should be avoided because they can damage braces.
The orthodontist or dentist should be contacted immediately for advice if braces damage occurs. In most cases the bracket is replaced.
Bone loss due to gum disease or periodontal disease may lead to tooth loss during treatment.
Some degree of root resorption could be noticed in a few cases during the teeth displacement.
Dental Braces: After Treatment
Retainers and pre-finishers are required to be worn once treatment with braces is complete:
A Hawley retainer - An Essix retainer - A bonded retainer - Rubber pre-finisher similar to mouthguard
If a patient does not wear the retainer or pre-finisher as recommended, the teeth might move towards their original position (relapse).
Retainer and pre-finishers are the temporary appliances and can be moved in and out of the mouth.
11. Cosmetic Dental Treatment
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[Smile Designing]
Cosmetic Dentistry is an "art form" devoted to the enhancement of smiles. A thing of beauty is joy forever.Your dentist evaluates the health and appearance of your teeth, recommending the best type of treatment for you, and thus crafting a more beautiful smile. A smile is a curve that sets everything straight.
BONDING: over time, little things can conspire to damage your smile - a crack, discoloration, noticeable fillings in your front teeth, and small gaps between teeth, teeth that are uneven or fractured teeth. Fortunately, there is a simple, pain free, long-lasting and cost-effective dental procedure that can restore the beauty of your smile. Bonding is a direct, chair side procedure involving tooth coloured composite material.
Indications of bonding:
Close small gaps between front teeth.
Repair chips and cracks.
Conceal discoloration.
Protect exposed roots caused by gum recession.
Restore decaying teeth (the tooth-coloured bonding material is an excellent and undetectable filling).
Seal and protect children's teeth from cavities.
CROWNS: Crowns, or "caps", are coverings that fit over your teeth and restore each tooth to its normal shape and size, while both strengthening and improving its appearance. A crown could be made of natural looking porcelain/ceramic, metals, acrylic or composite resins or combination of any of these.
VENEERS: Veneers are wafer-thin shells of porcelain, which are bonded onto the front side of teeth and can be an excellent cosmetic solution for crooked, chipped, discoloured or worn teeth and also spacing between teeth.
Involves no anesthesia, only 0.3mm of existing enamel is ground and the veneer is cemented in place.
Available in various ceramic materials impress, procera, cercon, and others.
They are highly resistant to permanent staining from coffee, tea, red wine, cigarette smoke, and even chewing tobacco. What's more, with the regular care and maintenance of a normal tooth, porcelain veneers can last well over a decade.
You can have a smile make over, the colour, shape, size and position of teeth can be recreated by veneers to best possible esthetics to give you a flawless smile.
POST TREATMENT CARE OF VENEERS
Look after your veneers well. Brush and floss as you regularly do. Use non-abrasive toothpaste to help maintain the shine and gloss of your veneers. Normal diet will not herm your veneers. Avoid any shearing force on these teeth [like biting a sugarcane]. Regular check ups will ensure your veneers are in excellent shape. Well maintain veneers should last you for many years and give you a long lasting and beautiful smile.
12.Bleaching/ Teeth Whitening
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Before Bleaching
After Bleaching
Everyone wants a bright, white, radiant smile that lightens up the whole face. Dental surveys show that 80% of people would like to have whiter teeth. Today the answer is teeth whitening through a simple and safe procedure called dental bleaching. Bleaching lightens and brightens teeth and is tough on stains but gently on your teeth.
Dark, stained or discolured teeth can be a source of great embarrassment to many. It can often prevent you from smiling widely or even talking confidently. Today you no longer need to accept this aesthetic barrier. You can opt for a highly popular and successful treatment to whiten your teeth.
CAUSES OF TOOTH DIS COLORATION?
The commonest discoloration is due to smoking or tobacco.
Food and beverages such as tea, coffee, colas and red wine can be the culprit.
Age can cause a natural darkening of teeth.
Certain medications such as tetracycline, taken at a very young age.
Increased exposure to fluorinated water.
Dental infection, faulty or old fillings, and dental treatment such as a root canal treatment.
DENTAL BLEACHING?
Dental Bleaching is a procedure where by certain bleaching agents are applied to the teeth in order to remove external and internal stains thus leaving the teeth several shades lighter. Various concentrations of carbamide peroxide and hydrogen peroxide are available for this use.
ADVANTAGES
This mode of treatment has solely been developed to lighten teeth in a simple and comfortable manner. It can bring about a dramatic change in almost everyone's smile by changing a dull smile and yellow teeth to a bright smile with white teeth.
Bleaching of healthy teeth is the safest and most conservative cosmetic treatment available for today teeth today.
It generally requires no grinding of your teeth
It does not require any anesthesia and is painless and well tolerated.
The time taken for bleaching is relatively less considering the number of teeth that can be done at one sitting.
Bleaching works very well even when combined with other cosmetic treatment options to enhance the aesthetics of your teeth.
The cost of bleaching is less when compared to other full mouth cosmetic treatment options.
Bleaching does not damage your teeth on change the structure of your teeth, nor does it change the shape or form of your teeth.
TYPES OF BLEACHING
Bleaching is basically of 2 types:
Office Bleach : this is done by your dentist at the clinic using a higher concentration of bleaching material.
Home Bleach: This is done by yourself at home using bleaching material and a special tray dispensed by your Dentist.
Depending on your type of dental staining and your time restriction, the dentist will advise either one or a combination of both of them.
HOW IS BLEACHING DONE?
Your dentist will clean and polish your teeth and check their current shade.
Office Bleach: After protecting your gums and lips, the dentist will apply the bleaching agent on the teeth to be lightened and leave it there for a specific period of time. Intermittently, your teeth may be exposed to a special light, which will accelerate the bleaching process.
Alternatively, you may be given a tray containing the bleaching agent to wear while
In the dental office.
Home Bleach: As part of your combination bleaching procedure or as an independent Procedure you may carry out this type of bleaching at home. This requires you to to wear a custom made tray containing a lower concentration of the bleaching agent, dispensed by your dentist, for a few hours everyday or few nights at home.
Office Bleach: Each sitting of bleaching done at your dentist's office can take between 30-60 minutes. The total number of sittings is usually 1 to 2, though this can vary depending on the severity of the staining. e.g. Tetracycline staining.
Home bleach: this is generally done during the nights for 3 days. Certain materials also allow to do the bleaching for a certain period of time twice a day. Your dentist will tell you which one is suitable for you.
PRECAUTIONS
Side effects of Bleaching is minimal and transient sensitivity. Beware of over-the-counter bleaching kits available. These can prove to be abrasive to your teeth in the long run and they may do more harm than good.
POST TREATMENT CARE
Your diet and habits will largely determine how long the bleaching effects will last. With good oral hygiene and a close watch on the exposure of your teeth to external stains from tobacco, beverages, etc., your bleached teeth should maintain their colour for a long time. If you choose, regular touch up sessions can be carried out once a year to ensure your teeth look their best.
13.Maxillofacial Prosthesis
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This deals with replacement of parts of head and neck which are lost due to trauma, road accident, cancer surgery or missing by birth. They may 2 types-
Intra oral like speech aid, jaw replacement or tongue prosthesis.
Extra oral like eye prosthesis, ear prosthesis, lip prosthesis and others.
Eye prosthesis Pre-operative
Eye prosthesis Pre-operative
Eye prosthesis Pre-operative
Eye prosthesis Pre-operative
Intra oral defect Speech aid prosthesis
14.Dental jewels
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They are small synthetic decorative pieces which are fixed on the enamel of the teeth. They are fixed without grinding the teeth, and can be removed by the dentist.
