Wednesday, 11 December 2019

Avulsion Management

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis.Tooth avulsion or exarticulation is a traumatic injury of dental tissue characterised by complete displacement of the tooth out of its socket. Successful treatment outcome of such an injury is dependent on the survival of the viable periodontal ligament cells attached to the tooth root surface. The viability of the periodontal ligament cells is best preserved either when the tooth is immediately replanted into its socket or if it is stored in an appropriate storage /transport medium till a time, the tooth can be replanted into its socket.


Outcomes Of Avulsion
The speed with which the avulsed tooth is replanted is the most important factor for success. There are several possible effects on the root surface and attachment apparatus of an avulsed tooth.

Case Report
This case report  of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. 10-year-old girl presented with avulsed maxillary central incisors due to trauma occurring 14 hours earlier.
His parents had let the avulsed tooth dry in a piece of paper and brought it to the clinic. 
After informing the parents of the patient about possible risks, treatment procedure started.
Treatment
Hold the tooth by the crown & Clean the root surface  with a stream of saline.
Administer local anesthesia.
Rinse the socket with saline and Chlorhexidine.
Reposition the tooth very gently in the dental socket with a light digital pressure.
Verify normal position of the replanted tooth clinically and radiographically.
In cases of soft tissue lacerations, suturing should be done to stop the bleeding
Apply a flexible/semirigid splint for 7 to 10 days.
 In cases of bone fracture, the tooth should be splinted for a longer period, (1 or 2 months), depending on the clinical situation
Administer systemic antibiotics .
It is recommended to prescribe antibiotic therapy to avoid the onset of infection during the first week after replantation The administration of systemic antibiotic prevents the development of external root resorption.

Patient instructions
Soft food for up to 2 weeks.
Brush teeth with a soft toothbrush after each meal.
Chlorhexidine rinses  prescribed and strict hygiene instructions given, for the entire splinting period.
 The parents were informed about the importance of regularly returning for clinical and radiographic follow-up. 
Follow-up
Splint removal and clinical and radiographic control after 2 weeks.
As the tooth has been out of the socket and kept dry for more than 1 hour, the calcium hydroxide filling was done for a long follow-up period to evaluate the rate of the replacement root resorption.
Clinical followup examination 1 week, 2  weeks,  4 weeks, 3 months, and then  6 months done.

Tuesday, 10 December 2019

Root Canal Treatment of Cacified canals

CALCIFIED CANALS.
Totally or partially calcified canals present a constant challenge in clinical endodontics with high risk of procedurals accidents, such as perforation and instrument separation, however under the magnification ,illumination provided by a microscope,ultrasonic tips and patience  the whole procedure could become very predictable.

Patience , time, 
diagnostic xray is important , read it before you start, straight line access, Try Keep it simple n sequentially #8 ,10,15 K files, remember U WILL NEED DOZENS, precurve (preflaring)where ever required MULTIPLE rvgs to access progress of files, Coronal Flare, 17% edta , glyde,   hypo irrigation.. 

Monday, 9 December 2019

Pediatric Dental FAQs

Below are common questions and our answers about the best way to care for children’s teeth.When should I schedule my child’s first visit to the dentist?We recommend that you make an appointment to see the dentist as soon as your child gets the first tooth. A child should be seen by six months after his/her first tooth erupts or by one year old, whichever comes first.
What happens during my child’s first visit to the dentist?
The first visit is usually short and simple. In most cases, we focus on getting to know your child and giving you some basic information about dental care. The doctor will check your child’s teeth for placement and health, and will look for any potential problems with the gums and jaw. If necessary, we may do a bit of cleaning. We will also answer any questions you have about how to care for your child’s teeth as they develop.
How can I prepare my child for his first dental appointment?
The best preparation for your child’s first visit to our office is maintaining a positive attitude. Children pick up on adults’ apprehensions, and if you make negative comments about trips to the dentist you can be sure that your child will fear an unpleasant experience and act accordingly. Show your child the pictures of the office on the website. Let your child know that it’s important to keep his/her teeth and gums healthy, and that the doctor will help to do that. Remember that your dentist is trained to handle fears and anxiety, and our staff excels at putting children at ease during treatment.
How often should my child visit the dentist?
We generally recommend scheduling checkups every six months. Depending on the circumstances of your child’s oral health, we may recommend more frequent visits.
Baby teeth aren’t permanent. Why do they need special care?
Although they don’t last as long as permanent teeth, your child’s first teeth play an important role in development. While they’re in place, these primary teeth help your little one speak, smile and chew properly. They also hold space in the jaw for permanent teeth. If a child loses a tooth too early (due to damage or decay) nearby teeth may encroach on that space, which can result in crooked or misplaced permanent teeth. Also, your child’s general health is affected by the oral health of the teeth and gums. If decay on a primary tooth encroaches onto the nerve, an infection may result causing pain and swelling. Bring your child in for an assessment, and we’ll let you know if there are any areas of concern and how best to look after your child’s teeth.
What’s the best way to clean my baby’s teeth?
Even before your baby’s first tooth appears, we recommend you clean the gums after feedings with a damp, soft washcloth. As soon as the first tooth appears, you can start using a toothbrush. Choose a toothbrush with soft bristles and a small head. You most likely can find a toothbrush designed for infants at your local drugstore, or we have some to give you complimentary at your dental visit.
At what age is it appropriate to use toothpaste to clean my child’s teeth?
Once your child has a few teeth, you can start using a paste on the brush. Use only a tiny amount for each cleaning, and be sure to choose toothpaste without fluoride for children under two, because ingesting fluoride can be dangerous for very young children. Always have your children rinse and spit out toothpaste after brushing, to begin a lifelong habit they’ll need when they graduate to fluoride toothpaste. Children naturally want to swallow toothpaste after brushing, and swallowing fluoride toothpaste can cause teeth to stain, a condition called fluorosis. You should brush your children’s teeth until they are ready to take on that responsibility, which usually happens by age six or seven.
What causes cavities?
Certain types of bacteria live in our mouths. When these bacteria come into contact with sugary foods left behind on our teeth after eating, acids are produced. These acids attack the enamel on the exterior of the teeth, eventually eating through the enamel and creating holes in the teeth, which we call cavities.
How can I help my child avoid cavities?
Be sure that your child brushes his/her teeth at least twice a day with toothpaste. Flossing daily is also important, because flossing can reach spots between the teeth that brushing can’t. Avoid sugary foods and drinks, limit snacking, and maintain a healthy diet. And finally, make regular appointments so that we can check the health of your child’s teeth and provide professional dental hygiene treatments.
Does my child need dental sealants?
Sealants cover the pits and fissures in teeth that are difficult to brush and therefore susceptible to decay. We recommend sealants as a safe, simple way to help your child avoid cavities, especially for molars, which are hardest to reach.
My child plays sports. How can I protect his teeth?
Even children’s sports involve contact, and we recommend mouthguards for children active in sports. If your little one plays baseball, soccer, or other sports, ask us about having a custom-fitted mouthguard made to protect the teeth, lips, cheeks, and gums.
What should I do if my child sucks his thumb?
The large majority of children suck their thumbs or fingers as infants, and most grow out of it by the age of four, without causing any permanent damage to their teeth. If your child continues sucking after permanent teeth erupt, or if your child sucks aggressively, let us know and we can check to see if any problems may arise from the habit.
When should my child have dental X-rays taken?
We recommend taking X-rays around the age of two or three. The first set consists of simple pictures of the front upper and lower teeth, which familiarizes your child with the process. Once the baby teeth in back are touching one another, then regular X-rays are recommended. Permanent teeth start coming in around age six, and X-rays help us make sure your child’s teeth and jaw are healthy and properly aligned.

Sunday, 8 December 2019

Denture Treatment

Why do I Need a Partial Denture Treatment?
Denture treatments are used to replace missing teeth.  Dentures can be removed from your mouth or put back in. It might take some time to get used to having dentures in your mouth, and they won’t ever feel exactly like your natural teeth, but with today’s advancements they are more comfortable and natural looking than ever before.
Two Types of Dentures
The two types of dentures are full or partial. These two terms refer specifically to the size of the dentures you are having fitted. A partial is used to replace fewer teeth but full dentures are used if all of the teeth are being replaced.
How Dentures Work
If you are fitted with full dentures, a special acrylic base that is the color of your gums will be fitted over your gums. They are shaped like a horseshoe with a base to cover the top of your mouth. we will take an impression of your mouth and gums and specially make dentures to fit your mouth comfortably. There are three basic fittings for dentures that the dentist will choose from.
  • Conventional Full Dentures are put in the mouth once the teeth have been removed and all the tissue has healed. Each person heals at a different rate, and this can be a lengthy process.
  • Immediate Full Dentures are put in immediately after the teeth have been extracted. The dentist will have already taken impressions in earlier visits. The advantage to this procedure is that you are not without your teeth for an extended amount of time.
  • Partial Dentures are built on a metal structure that will attach directly to your teeth. For some, crowns need to be placed directly on the remaining natural teeth which can serve as anchors.
Getting Used to Dentures
It can take some time to get used to dentures since they can feel uncomfortable at first. They can feel awkward for a few weeks and even for a few months for some people. It might even take some practice to learn how to eat with them in. It’s not uncommon for them to feel a little loose or bulky while you are getting used to them. You might feel like your tongue doesn’t have enough room and you may make extra amounts of saliva for a while. You will get used to them as time goes by and they will not be as uncomfortable.
When to See a Dentist about Dentures
Once you get dentures, you may have some difficulty speaking or with some pronunciations. You may need to practice saying words out loud in order to master their pronunciation. In no time, you will be able to speak properly with dentures. Some people experience a “clicking” sound when they are talking. If this happens, have the dentist examine them. Sometimes dentures can slip a little when you are laughing or coughing. They can be repositioned by biting down and then swallowing. If they continue to cause speaking problems speak to the dentist to see if an adjustment can be made.