Dental Health is ignored by Malaysians
Posted by: drkam on: November 23, 2009
Comment:
drkam
It is shocking to learn from this Bernama report which stated that only six percent of Malaysians (total population of 28 million) are utilising dental services available in our country. Given rising living standards, one would have expected adults would be conscious of good oral hygiene and dental care. Children are setting the good example, given that free dental care is provided by clinics on wheels that come to our schools regularly.
The Ministry of Health Dentistry Division Director Datuk Dr. Norain Abu Taib attributes the low turnout of adults at dental clinics, both government and private clinic, to their not being able to “understand the importance of dental health”. Blogs like mine have been spreading the message that apart of considerations of personality of having a good set of teeth, oral hygiene habits must be inculcated early in our young Malaysians preferably at school. Obviously, Datuk Dr. Norain and her team are doing their best in this regard. But more needs to be done to ensure that a higher percentage of Malaysians see their dentists regularly.
Parents too have a critical role to play and should be example of good practitioners of oral hypiene, encouraging their children to see their dentist at least once every 6 months. Adults too can be encouraged to take preventive measures to ensure that they can enjoy having good teeth throughout their lifetimes. It pays off if they undertake preventive measures like proper brushing and flossing of their teeth and going off to see their dentists at the slightest sign that they have cavities or swollen gums.
Early attention saves lots of cost and inconvenience. The visit to dentist should be liken to a visit to a beautician, hair stylist or a masseur. But then, all attempts to look good would come to naught if one carries a poor set of the teeth. A good set of teeth enhances one’s personality and does wonders to one’s self confidence. Furthermore, one must not compromise on one’s health, including dental health–drKam.
KUALA LUMPUR, Nov 15 (Bernama) — Only six per cent of Malaysia’s 28 million population are utilising dental services and half of them are schoolchildren, Health Ministry Dentistry Division director Datuk Dr Norain Abu Talib said on Sunday. She said the small percentage was mainly due to the fact that most of the people in the country would only seek dental treatment if they were having dental problems. “They will only go to the dental clinic when they have toothache. That will be too late because by then you have to extract the tooth.” She said this after opening the 20th Convention and Science Exhibition of the Malaysian Private Dental Practitioners Association here. She said although the country was facing a shortage of dentists, it was not the main reason why most Malaysians did not seek dental treatment. “The main reason is that most of the people are not aware of the importance of dental health,” she said.
Nevertheless, Dr Norain said the ministry had targeted to have a ratio of one dentist for every 4,000 patients by 2020 to ensourage more people to visit the dental clinics. “Although we aim to achieve that target by 2020, with 11 institutions of higher learning offering dentistry, we are confident that the target can be achieved by 2018,” she said, adding that the current ratio was one dentist for every 7,800 patients. — BERNAMA
Remove Your Amalgam Fillings Safely
Posted by: drkam on: November 16, 2009
November 16, 2009
Introduction
Many of us have these amalgam fillings. Too many people feel that they have amalgam toxicity. A lot of times, people need to have these fillings removed because it is chipping or is just wearing down from many years of use. Many years ago, getting an amalgam filling was no big deal but today, people wonder whether mercury based fillings are safe.
Mercury is a highly toxic metal associated with damage to the kidneys and central nervous system. Mercury vapor is emitted from volcanoes, coal-burning power stations, and municipal incinerators and returns to the earth through rain contaminated with metallic mercury. Metallic mercury is methylated to methyl mercury in oceans and lakes and enters the food chain via fish and other seafood. Long-lived predator fish such as shark, swordfish, tilefish, king mackerel, and pike and bass in fresh water are the main sources of methyl mercury. Dental amalgams are an important source of mercury vapour and the vaccine preservative thimerosal is a significant source of ethyl mercury.
Today we have a choice: Avoid using amalgam
Go to a Prudent Dentist
If you are like many of us and need to get an amalgam filling replaced, the best advice is to go to a dentist who takes extra precautions in the removal. If a dentist is just going to go in and take it out as if he was just filling it, then run and run fast. Go to a dentist who believes that it is dangerous to remove these fillings. When a filling is being removed, mercury is leaked out ,and you are breathing it in. During the removal, a patient can be exposed to mercury vapor. Sometimes, the patient can even swallow some.
The increase in mercury in a person’s body can cause many different problems. Illness, memory problems, and chronic fatigue are a few of the possible problems. If a few extra precautions are taken on the dentists part, it does not have to amount to all of those problems. It is not recommended to have amalgams removed while pregnant or breastfeeding unless there is no other option. The mercury vapor would be passed on to the fetus or in the breastmilk. There have been studies that link mercury to autism. It is best to just wait until after you give birth or stop breastfeeding, for your baby’s sake.
Safe Removal of Amalgam Fillings
Dentists all over the world remove millions of amalgam fillings every day, with no regard for the possible mercury exposure that can result from grinding them out. Much of the time, a new amalgam filling goes back in place of the old one. The dental establishment claims that amalgam is a stable material, that emits little or no mercury, but then turns around and blames the mercury-free dentists for “unnecessarily exposing patients to excess mercury” when removing amalgams electively. Well, which is it? Stable, or mercury emitting.
However, please bear in mind that the material presented here is intended strictly as a set of suggestions. A licensed practitioner must make up his or her own mind concerning specific treatment options.
Cut and Chunk, Keep it cool
Most of these suggestions are simple and obvious, common sense physical means of reducing exposure. If you remove an old amalgam by slicing across it and dislodging big chunks, you will aerosolize less of the contents than if you grind it all away. If you keep it under a constant water spray while cutting, you will keep the temperature down, and reduce the vapor pressure within the mercury.
Suction!
Your best tool for removing mercury vapor and amalgam particulates from the operating field is your high volume evacuation (HVE). Keep it going next to the patient’s tooth until you are finished with the removal and clean-up process. But check to see where in your office it discharges! If the vacuum pump discharges into an open trap or through its own base, you could be pumping mercury vapor into your utility room or lab. A highly effective HVE adjunct is the “Clean-Up” suction tip, which has an enclosure at the end that surrounds the tooth you’re working on. It dramatically reduces the spatter of particles, directing them efficiently into the suction tube.
Rubber dam or no rubber dam?
Some dentists hate rubber dams, while others can’t live without them. Reduced exposure amalgam removal can be done either way. A rubber dam will help contain the majority of the debris of amalgam grinding, among its many other benefits.
Berglund and Molin8 demonstrated, as a follow-up to Molin’s 1990 study, that the use of a rubber dam eliminated the spike in plasma mercury one day after amalgam removal, as well as the spike in urine mercury ten days afterward: evidence of its protective benefit. Of course both amalgam removal groups, dam or no dam, showed 50-75% reduction in mercury levels a year later.
But you must know that mercury vapor will diffuse right through the dam, and some of the particulates will often sneak past it. So:
- Always use a saliva ejector behind the dam to evacuate air that may contain mercury vapor.
- Rinse the dam well as you go, because amalgam particles left on it will emit mercury from your garbage can. (If you wipe your dirty mirror on a gauze square or the patient’s bib, that gray smear also emits quite a lot of mercury vapor!)
- As soon as the amalgams are out, remove the dam and thoroughly rinse the patient’s mouth before placing the new restorations. It can take as much as sixty seconds of rinsing to fully remove the mercury vapor. Search for gray particles. If there are particles on the back of the tongue, have the patient sit up and gargle them out.
If you don’t use a rubber dam, you must be vigilant with the HVE, and take frequent breaks to thoroughly rinse the field. Either way, the “Clean-Up” suction tip reduces the dispersion of particulates in the area.
Cover the Skin
Covering the patient’s face with a barrier will prevent spattered amalgam particles from landing on the skin, or the eyes. The barrier can be as simple as a moist paper towel, or as elaborate as a surgical drape.
Rubber gloves
Mercury vapor will diffuse through latex and vinyl gloves, just as it does through latex and vinyl rubber dams. Nitrile material is a more effective diffusion barrier, and while there are no nitrile rubber dams available, nitrile rubber gloves appear to better protect the dentist’s hands from a concentration of mercury vapor.
Controlling the Breathing Space
However efficient your HVE technique is, the air surrounding the operative field will fill up with a mercury vapor and amalgam particulate aerosol. Keeping the breathing space of the patient and dental staff free of contamination is the next priority.
Supplemental Air
Provide the patient with piped–in air, so they do not have to breathe the air directly over the mouth during amalgam removal. A positive pressure respiration device such as a nitrous oxide nose hood, or a similar ventilation device, is probably the best way to provide clean air. A nasal cannula that admits ambient air won’t help.
Respirators for the Staff
The typical paper hygienic masks that are in everyday use are of no benefit whatsoever for removing either amalgam particulates or mercury vapor from the air we breathe. The best protection for the dental staff, from an industrial hygiene point of view, would be a positive pressure respirator. This kind of system is certainly available from safety equipment suppliers. Much simpler to set up would be a Bureau of Mines certified, “half–mask” respirator with mercury rated filter cartridges. However, the cartridges need to be fitted with a “P-100” rated particulate filter, which will remove particles as small as 0.3 microns.
Conclusion
Amalgam filling should be carefully removed. It is prudent for you to visit a dentist who takes special effort and use proper procedure to have them removed. Although studies have yet to make definite conclusions about the effects of amalgam on our health, we now have knowledge about the toxicity of mercury and its effects on the kidneys and central nervous system. You may be well advised to see a good dentist who will be able to advise you on what can be done with your amalgam fillings. Be sure to ask your dentist how he would deal with the removal of those fillings. As this article tries to show, special removal procedures are required before amalgam fillings can be safely removed.
Form of Mercury in Older Dental Fillings Unlikely to be Toxic
Posted by: drkam on: November 11, 2009
Safety of Mercury-containing fillings
Introduction
University of Saskatchewan research team found that surface forms of mercury in older “silver” fillings (also known as amalgams) may be less toxic than previously thought. But due to the significant mercury loss over time, human exposure to mercury lost from fillings is “still of concern” and that further research is needed to determine when, how and in what form mercury is lost from fillings. Despite the fact that their finding is far from conclusive, we still should have our old fillings checked during our routine visits (at least once every 6 months) to our dentist.
Dental Amalgam ( Mercury) Fillings may be less toxic than previously thought.
by Graham George, B.Sc., D.Phil., et.al
Amid the on-going controversy over the safety of mercury-containing dental fillings, a University of Saskatchewan research team has shed new light on how the chemical forms of mercury at the surface of fillings change over time.
Their work, just published in the American Chemical Society journal Chemical Research in Toxicology, shows that the surface forms of mercury in older “silver” fillings (also known as amalgams) may be less toxic than previously thought.
“The dental amalgam on the surface of an old tooth filling may have lost as much as 95 per cent of its mercury but what’s left is in a form that is unlikely to be toxic in the body,” said U of S Canada Research Chair Graham George who led the study.
But the team cautions that due to the significant mercury loss over time, human exposure to mercury lost from fillings is “still of concern” and that further research is needed to determine when, how and in what form mercury is lost from fillings.
Mercury-based fillings have been used by dentists to repair teeth for well over a century. But in recent decades, their use has become controversial due to concerns about exposure to potentially toxic mercury.
“Mercury can potentially exist in several different chemical forms, each with a different toxicity,” said George. “Prior to our work, little was known about how the chemical forms of mercury in dental amalgam might change over time.”
The team used a special X-ray technique at the Stanford Sychrotron Radiation Lightsource to probe the amount and chemical nature of mercury at the surface of both freshly prepared metal fillings and aged fillings (about 20 years old) obtained from the U of S dental clinic’s tooth bank.
While the fresh fillings contained metallic mercury, which can be toxic, aged fillings contained a form of mercury called beta-mercuric sulfide or metacinnabar which is unlikely to be toxic in the body. For this reason, grinding or polishing during dental cleaning is unlikely to cause any toxic effects.
But of potential greater concern is the nature of the surface mercury lost from fillings. This may be due to evaporation (with subsequent inhalation and leaching of mercury into saliva), exposure to some kinds of dental hygiene products such as those containing peroxides, exposure to certain sulphur-containing foods (such as onion and garlic or coffee), or other factors.
“Possibly this missing mercury is in the less toxic form of mercury (metacinnabar) abraded from the surface of the filling. Or alternatively, it may be mercury lost prior to formation of the metacinnabar through various types of exposures,” said George.
In North America, the traditional view is that the advantages of mercury-containing amalgam outweigh any possible health risks, and for this reason, mercury-containing dental amalgams are still widely used.
Other members of the team include Satya Singh, Jay Hoover, and Canada Research Chair Ingrid Pickering. This project was supported by a grant from the Canadian Institutes of Health Research.
Conclusion
Because of its durability, dental amalgam (mercury based) are still widely used in North America and other developed countries. With new types of tooth colored fillings, most dentists are gradually phasing out its use. In the case of Dr Kamsiah, she has never used dental amalgam for fillings in her private practice (since 1997). This is a matter of her personal choice to ensure that her patients are not exposed to unnecessary health risks.
Single tooth replacement options
Posted by: drkam on: November 10, 2009
by Dr Kamsiah binti Gulam Haider
Introduction
When children loose a tooth, there is celebration and joy. When adults loose a tooth, there is usually concern and dismay. Children replace their own tooth by growing one anew. Adults require assistance from their family dentist. The first job of the dentist is to assist their patient with the decision of how to replace that tooth.
There are many options available to replace teeth. When a front tooth is lost in an accident, such as when playing a sport or in a car, time can be a major concern. Dentists can replace a tooth very quickly by fabricating a single tooth denture . This kind of denture is much like an orthodontic retainer with one or two teeth; it may have a couple of wire clips that hold it onto other teeth. Dentures are easy to wear and care for, and they repair the patient’s appearance. Most people are not happy with their ability to chew with the denture in place, so they remove it when eating. Some have trouble talking with the denture at first, but speech improves with practice. This is the least expensive way to replace a tooth. Some patients will live with a denture for years before replacing it with a more permanent false tooth or another denture.
There are three basic ways to fix a missing tooth or teeth.
- A fixed bridge
- A removable appliance
- A dental implant
A fixed bridge
Having a bridge is like having three crowns. The teeth on either side of the missing tooth are prepared for crowns, an impression is made, and the case is sent to a dental laboratory. The laboratory then makes the crowns and fastens a false tooth between the two crowns – this is a bridge.The advantages of a bridge are that it is fixed, stable, and feels like your own teeth. In most cases it can be made to look just like you never had a tooth missing. The disadvantage is that you have to treat two teeth besides the one that was extracted – these teeth may otherwise be perfectly sound with nothing wrong.
A Maryland bridge is the least expensive type, but has some esthetic and mechanicalproblems.Usually used as an interim treatment during implant treatment in 2 stage implant procedure.
Using the ovate pontic technique with a dental bridge can create the illusion that the false tooth is growing out of the gum.
A Removable Appliance.
Something removable can be used to replace a missing tooth. This can be anything from a budget “denture” (a piece of plastic with a false tooth attached) or a Cobalt Chromium, to a more sturdy metal and acrylic removable partial denture.
The advantages of the removable partial denture appliance are that it is a more economical way to replace missing teeth than a fixed bridge. Also, you can replace multiple teeth with one appliance. If the span of missing teeth is three or more, or if there are not solid teeth on both sides of the missing teeth, a fixed bridge may not work.
The disadvantages are that it may not be as esthetic as a bridge. Clasps will be required to retain the removable partial, and it may not be possible or practical to entirely conceal those (though that problem can be avoided often with a “precision attachment” partial). Also, there may be some discomfort with wearing removable hardware in your mouth, and it is not as stable as a bridge.
A dental implant
A dental implant is an artificial “root” that is implanted in your jaw after a tooth extraction, and then a tooth is placed on it. Biologically, it is like placing an entirely new artificial tooth in your mouth.The advantages of an implant are: No teeth on either side have to be prepared for crowns, so there is no grinding on “good teeth” – you just fix the missing tooth. Implants can also span the space of multiple missing teeth. There is no limit to the span they can cover, as long as the patient’s health is good and there is healthy and adequate bone to support the implant. An implant also is fixed and feels just like your own teeth. Read our more thorough discussion of implants, plus see before-and-after photographs, on our cosmetic dental implant page.
The disadvantages of implants are that they can cost more and be more and time-consuming, and the cost may not be covered by dental insurance. You will likely have to deal with two dentists – the dentist who does the surgery to place the implant, and the dentist who puts the false tooth on top of the implant. There is also a delay in getting the false tooth or teeth – a healing interval of several months may be required before the artificial root can have a tooth placed on it. There is also surgery involved with its attendant discomfort and healing period.
However, if you are missing multiple teeth or all your teeth, there is a strong advantage to dental implants in that they will preserve the jawbone. Sometimes dentists don’t explain the negative long-term consequences of missing teeth, which are that your jaw gradually shrinks until you can’t wear any removable appliance. To read more about this, please see our page about facial collapse. So if you want to still be able to eat when you’re 80, you may want to consider investing in dental implants to replace those missing teeth.
Conclusion
Removable partial dentures have metal clasps that clip onto teeth to hold the device in the mouth. Patients need to take these in and out for cleaning after eating. Tooth supported bridges rely on the adjacent teeth for support. The teeth next to the missing tooth space are ground down and the bridge is cemented onto them. This bridge does not come in and out and relies on the integrity of the adjacent teeth for support.
The final method of tooth replacement is the dental implant, which is a replacement for the root of a tooth. The implant is placed where the root of the missing tooth used to be. The replacement root is then used to attach a replacement tooth.
There is significant loss of adjacent teeth (ranging from 12%-19%) if the missing tooth is not replaced.Tooth supported bridges improve the survival rate, with abutment tooth loss from 7%-10% at 6.7 and 8.6 years. Removable partial dentures increase abutment tooth failure rate ranging from 17% to 30% at 4.2 to 7 years. There is no significant difference in the statistics of the various studies.When an individual loses a tooth there are important decisions to be made.
Patients who do not replace missing teeth may experience shifting of teeth, spaces opening between teeth (resulting in food impaction), collapse of the bite, alterations in their chewing ability, TMJ pain, and trauma to the remaining teeth. People sometimes don’t replace teeth that are “in the back” of the mouth because no one sees them. The back teeth are needed to support the bite and grind up food. We can all swallow food that is not chewed thoroughly, but this compromises the nutrition we extract from our diet.
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Dental care for those above 6 year old
Posted by: drkam on: November 4, 2009
Dental care for those above 6 year old
Dental Treatments
Filling
If you suffer from dental caries, you have to see a dentist for filling to prevent the caries from getting worse.
Why do we need filling？
*To stop pain caused by decayed tooth.
*To restore the shape and functions of the tooth, such as chewing, articulating, aesthetics, and etc.
*To keep the carious deciduous teeth to prevent alignment problem in permanent teeth due to early loss of deciduous teeth.
*Overview of filling process
-Remove the decayed tooth structure.
-Place the filling material into the cavity.
-Trim off and polish the filling material.
-How many filling materials do you know?
Composite resin fillings
Colour: similar to natural tooth colour
Glass Ionomer Cement
Colour: similar to natural tooth colour
Compomer
Colour: similar to natural tooth colour
Stainless steel crown
Colour: Silver. It has different sizes, and it is often used on deciduous molars.
Feeling uncomfortable after filling?
- It takes a few days to adapt to the newly filled tooth. If situation hasn’t gradually improved, or has even slowly got worse, you need to see the dentist for a detailed examination.
Temporary Denture
If a child loses his/her permanent tooth due to an accident, his/her dentist needs to fabricate a temporary denture for him/her.
Purpose
To improve aesthetics by filling the gap left by the missing tooth. To wait until the child’s jawbones are fully developed (around 18 years old) to insert a permanent denture/bridge/implant.
Material
Plastic and stainless steel wires.
Procedure
Impressions of the teeth are taken, and the occlusion is recorded
The temporary denture is fabricated in the dental laboratory
The temporary denture is fitted
Points to note
After fitting a temporary denture, extra attention should be paid to the oral hygiene in order to prevent dental caries and periodontal disease.
Thoroughly clean the denture and teeth every morning and before bed at night.
When the temporary denture is not worn, it must be soaked in plain water.
If severe discomfort is felt when wearing the temporary denture, you must bring your child to the dentist immediately.
Pulp Treatment (Root Canal Treatment)
What is pulp treatment?
Pulp treatment is necessary if the pulp of a tooth is infected or became necrotic because of trauma or dental caries. The treatment involves partial or complete removal of the pulp and application of filling material to fill up the area.
Knowing more about pulp treatment
Pulp treatment requires a few visits to complete. Remember to revisit on schedule!
If the filling material has fallen off during the treatment period, you must ask the dentist to refill the material in order to avoid infection caused by bacteria in the saliva.
Local anaesthesia may be required during the treatment. Remember not to bite your lips or tongue before the anaesthesia has worn off.
Leong’s Premolar
What is Leong’s Premolar?
Some permanent premolars have a projected portion of the tooth structure which is fragile; this kind of premolar is called ‘Leong’s Premolar’. If the projected portion fractures, the pulp inside the tooth may become necrotic from bacterial infection, or even results in abscess.
If I have a Leong’s Premolar, what should I do?
To avoid the projected portion to fracture, the dentist will use the preventive treatments below according to individual need:
Method 1: Strengthen the projected portion
Method 2: Remove the projected portion and apply filling to the cavity
If you think you have a Leong’s Premolar, you should ask your parents to take you to a dental clinic for a detailed check-up and receive appropriate treatment as soon as possible!
Orthodontic Treatment
What is orthodontic treatment?
Orthodontic treatment is a series of processes to move poorly aligned teeth to a desirable position.
Orthodontic treatment can：
Improve aesthetics
Improve the occlusion and chewing function.
Types of orthodontic appliances
Fixed orthodontic appliance
Procedure
Placement of orthodontic brackets.
The orthodontic wire and orthodontic brackets are connected by elastics and stainless steel wires (ligatures).
Regular dental revisits are needed according to the instructions of the orthodontist.
After the teeth have moved to favourable positions, a retainer is used to hold and stabilize the teeth in these positions.
How long does a fixed orthodontic treatment take?
The overall duration lasts for about one and a half to three years. The actual time needed depends on the complexity of treatment.
Removable orthodontic appliance
It is suitable for simple orthodontic treatments.
Procedure
Impressions of the teeth are taken.
The removable orthodontic appliance is fabricated in the dental laboratory.
The appliance is fitted in the mouth. It is also activated.
Regular dental visits to check the tooth movements and adjust the appliance.
How long does a removable orthodontic treatment take?
The overall duration lasts for about 6 to 12 months. The actual time needed depends on the complexity of treatment.
Points to note on orthodontic treatments
When you are wearing an orthodontic appliance, extra attention towards oral hygiene is needed to prevent dental caries and periodontal disease.
When you are wearing a removable orthodontic appliance, the appliance and teeth must be thoroughly cleaned every morning and evening before wearing it again. Leave the appliance in a cup of water when it is not worn.
If severe discomfort is felt when you are wearing an orthodontic appliance, consult your orthodontist immediately.
Consult the dentist to see whether or not it is necessary for you to undergo orthodontic treatment. Allow him to check your oral situation and explain the treatment to you in detail.
Extraction
Why do we need to extract a tooth？
Caries is found on a tooth where we cannot or do not need to repair it.
For the needs of orthodontic treatment.
Procedure
Apply local anaesthesia to let the teeth and oral tissues to get numb.
Use dental tools to take the tooth out.
Tightly bite on a piece of gauze or cotton roll to help stop bleeding.
Points to note after extraction
For the next 24 hours, you should :
Not rinse your mouth vigorously
Not disturb the wound with your tongue or fingers
Not use alcoholic beverages
Not do heavy exercise
Not smoke
Take pain control medication as recommended
Generally speaking, the wound will gradually heal in 3 to 4 days after the extraction. If discomfort persists even after 4 or 5 days, you should ask your parents to bring you to the dentist for a detailed check-up.
Fissure sealant
Under what circumstances are fissure sealants needed?
Fissure sealant is a composite sealant; it requires a dental professional to apply it for us.
If there are deep fissures on a tooth, dental plaque can easily accumulate in these areas where toothbrush bristles cannot access to and clean these areas.
In order to prevent these teeth from dental caries, we need to apply fissure sealants to seal these fissures.
Procedures for applying fissure sealants
First use diluted acid to etch the surface of the tooth so that the sealant can adhere onto the tooth.
Use water to wash away the acid, blow-dry the tooth, and then apply the fissure sealant onto the fissure.
Use curing light (a dental light source) to harden the fissure sealant in the fissure.
Scaling and Polishing
Why do we need scaling and polishing?
Scaling removes the accumulated dental plaque, calculus, and stain from the surfaces of our teeth, which can prevent periodontal disease.
Treatment procedure
Use dental instruments or ultrasonic scaling machine to remove calculus.
Polish the surfaces of teeth to remove stain and keep the surfaces smooth.
Points to note after scaling
There may be slight discomfort and minor gingival bleeding in the first few days after scaling. Please do not worry. You only need to thoroughly clean your teeth daily, and the discomfort and gingival bleeding will gradually disappear. The gum will become healthy as well.
Prophylaxis is designed to preserve health and prevent the spread of disease. The purpose of polishing tooth surfaces is to make these surfaces smooth which makes it more difficult for plaque and debris to accumulate on your teeth to cause decay or gum disease
Dental polishing or prophy, is rarely done at the first appointment due to restrictions applied by patients dental plans and is only done after completing the clinical exam if there is no presence of gum disease.
It is professionally defined as a procedure that includes scaling and polishing procedures to remove coronal plaque, calculus and stains deposits that are coronal only (which rarely exist) and is a scaling and polishing procedure for patients in a healthy oral state.
Professional polishing removes plaque, tartar, and stain from the teeth. It is a cosmetic procedure that removes surface stains on the crown part of the tooth or above the gumline so they will look and feel cleaner. However, this procedure is not a procedure that cleans infected, diseased gum tissue and root surfaces. This is only a superficial cleaning and will not eliminate disease or get it under control. 
This cleaning may be done by your dentist, dental hygienist, and/or a licensed professional who performs this polishing in the dental office along with education in the proper care of your teeth and gums.
It’s main purpose is to improve the appearance of your teeth by making them look cleaner and brighter.
A Patients Right to Choose
Posted by: drkam on: November 1, 2009
As consumers we all like to have options. In fact, I remember a psychology course in college where we examined a vending machine study. The study, among other things, determined that they would sell more Snickers bars when there were Snickers bars and some other option, than when there was nothing but Snickers bars.
The same hold true for any purchase we decide to make. Often, increasing case acceptance is simply a matter of allowing that patient to feel like they have choices. Especially when it comes to payment plans. Sometimes the anxiety of letting go of that money, or making that commitment today is just too much to stomach. Thoughts of a leaky roof, a broken down car, or the possibility of a losing a job leave a patient wondering if this treatment can wait…because, what if something bad does happen.
Payment plans are nothing new, but patients will frequently reject them because they know what it likely entails:
· Applying for a new credit card
· Having an “introductory/promo rate” with retroactive interest
· Another open line of credit on their credit report (even after it is paid off)
· One more credit card to stick in your wallet
In order to overcome some of these aversions, many practices choose to offer in-house financing. It certainly helps increase case acceptance when the patient knows you’ll offer 90 or 180 days to pay their bill, but how quickly time passes and they soon forget the wonderful treatment they received. Unfortunately, you simply can’t go repo the tooth…not that it would help you pay your bills but might serve as motivation for them to pay theirs. I’m only kidding–it would be quite spiteful indeed.
Accounts receivable balances, however, can become a serious issue for the health of your practice. They can become a small cancer that quickly grows undetected until it is a serious problem. They can be difficult to reduce and hard to manage and the time and money involved in properly managing them can have you feeling more like a collections agency than a dental practice.
Again, I am not recommending the elimination of either, but rather pointing out that by giving your patients options (in addition to the 2 mentioned here), they will say “yes” more often than if they feel they only have the Snickers bar to choose from. Just a simple way to help patients feel comfortable and more in control of their treatment plan. Don’t fall into the trap of thinking that Care Credit and in-house financing are your only options. Dentists like having options other than Snickers too, right?
Tooth Sensitivity
Posted by: drkam on: October 25, 2009
Introduction
Tooth sensitivity is tooth discomfort in one or more teeth, triggered by hot, cold, sweet or sour foods and drinks, or even by breathing cold air. The pain can be sharp, sudden, and shoot deep into the nerve endings of your teeth. For millions of people, sensitive teeth can make life miserable. The pain and discomfort make even favorite hot or cold foods impossible to enjoy. All is not lost. In many cases, sensitive teeth can be successfully treated bringing long sought after relief.
What Causes Tooth Sensitivity?
Tooth sensitivity occurs when the underlying layer of your teeth – the dentin – becomes exposed as a result of receding gum tissue (the protective blanket that covers the tooth roots). The roots, which are not covered by hard enamel, contain thousands of tiny tubules leading to the tooth’s never center (the pulp). These dentinal tubules (or channels) allow the stimuli – for example, the hot, cold, or sweet food – to reach the nerve in your tooth, which results in the pain you feel.
There are many factors that can lead to tooth sensitivity, including.
-
Brushing too hard. Over time, brushing too hard or using a hard-bristled toothbrush can wear down enamel and cause the dentin to be exposed. It can also cause recession of the gums (the gum tissue pulls away from the teeth).
- Recession of the gums. As gums move away from a tooth due to conditions such as periodontal disease, the root surface becomes exposed.
- Gum disease (gingivitis). Inflamed and sore gum tissue may cause sensitivity due to the loss of supporting ligaments, which exposes the root surface that leads directly to the nerve of the tooth.
- Cracked teeth. Chipped or broken teeth may fill with bacteria from plaque and enter the pulp causing inflammation.
- Teeth grinding. grinding or clenching your teeth may wear down the enamel and expose underlying dentin.
- Tooth whitening products or toothpaste with baking soda and peroxide. These products are major contributors to teeth sensitivity.
- Your age. Tooth sensitivity is highest between the ages of 25 and 30.
- Plaque build-up. The presence of plaque on the root surfaces can cause sensitivity.
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Mouthwash use. Long-term use of some mouthwashes. Some over-the-counter mouthwashes contain acids that can worsen tooth sensitivity if you have exposed dentin (the middle layer of the tooth). The acids further damage the dentin layer of the tooth. If you have dentin sensitivity, ask your dentist about the use of a neutral fluoride solution.
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Acidic foods. Regular consumption of foods with a high acid content, such as citrus fruits, tomatoes, pickles and tea, can cause enamel erosion.
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Recent routine dental procedures. Sensitivity can occur following teeth cleaning, root planing, crown placement, and tooth restoration. Sensitivity caused by dental procedures is temporary, usually disappearing in 4 to 6 weeks.
What Can I Do to Reduce Tooth Sensitivity?
- Maintain good oral hygiene. Continue to follow proper brushing and flossing techniques to thoroughly clean all parts of your teeth and mouth.
- Use a soft bristled toothbrush. This will result in less toothbrush abrasion to the tooth surface and less irritation to your gums. Brush gently and carefully around the gum line so you do not remove more gum tissue.
- Use desensitizing toothpaste. There are several brands of toothpaste available for sensitive teeth. With regular use you should notice a decrease in sensitivity. You may need to try several different brands to find the product that works best for you. Another tip. spread a thin layer of the toothpaste on the exposed tooth roots with your finger or a Q-tip before you go to bed. Do not use a tartar control toothpaste; rather, use a fluoridated toothpaste.
- Watch what you eat. Frequent consumption of highly acid foods can gradually dissolve tooth enamel and lead to dentin exposure. They may also aggravate the sensitivity and start the pain reaction.
- Use fluoridated dental products. Daily use of a fluoridated mouth rinse can decrease sensitivity. Ask your dentist about available products for home use.
- Avoid teeth grinding. If you grind or clench your teeth, use a mouth guard at night.
- See your dentist at regular intervals. Get professional tooth cleaning, oral hygiene instructions, and fluoride treatments every 6 months (or sooner depending on your condition).
If you still have discomfort, talk to your dentist. There may be some dental procedures that may help reduce sensitivity, including the use of:
- White fillings (bonding) to cover exposed root surfaces
- Fluoride varnishes applied to the exposed root surface
- Dentin sealers applied to the exposed root surface
Conclusion
If you cannot get relief by brushing gently and using sensitivity tooth, your dentist has several options for relief. Your dentist can use “oxalate” compounds that, when applied on the root of the affected tooth, will reduce if not eliminate the sensitivity. Many dentists prescribe high flouride content mouthwashes which help to reduce tooth sensitivity. They may also apply “bonding agents” to close the pores of the tooth root. Always consult your dentist regularly so that you can be proactive in the care and maintenance of your teeth. Protect your smile and feel good about yourself.
Fluorosis can damage your child’s smile
Posted by: drkam on: October 20, 2009
Introduction
drkam
Too much flouride during the early stages of tooth development can cause fluorosis (discolourisation). Children between the ages of 1 and 4 are most susceptible to this problem. Flourosis is not a disease, but it is a cosmetic nuisance, which can be prevented in the young . But if it is allowed to go unattended, flourosis can result in darkened teeth in adults. Fortunately, the damage caused to the physical appearance of the teeth can be corrected by a dentist. Crowns and veeners are usually to cover-up darkened teeth.
As it is always the case, prevention is the best option. By taking your child to the dentist regularly, early signs of flourosis can be detected and early remedial action can be taken. The article is intended to create awareness of fluorosis with some practical steps that you as parents can take to help your kids, especially those between the ages of 1 to 4 when their ‘milk’ teeth are being replaced permanent teeth.
Fluorosis
Fluorosis is a dental problem which happens when a child ingests too much fluoride during the early stages of tooth development. It usually affects children between the ages of one and four years old. It is at this stage when permanent teeth begin to form underneath the ‘milk’ teeth. Children over the age of eight are at almost no risk of developing fluorosis.
Symptoms of Fluorosis
If your child has an excess of fluoride in their diet while their permanent teeth are developing, this can bring about the noticeable signs of fluorosis. The main characteristic of fluorosis is the stains which form on the teeth when yellow and brown spots begin to appear on the enamel of the tooth. The colour changes can range from minor tinges to extensive changes in the enamel’s surface. Stains and discoloured spots can also appear as streaks and in the more severe cases, black and gray spots or pits can develop.
Once your child’s teeth are fully develop, fluorisis no longer poses any risk, this is usually around the age of eight at the latest. Although fluorosis is not a disease in itself, it can be a very noticeable cosmetic condition. In minor cases of fluorosis the discolourations can be so tiny that only your dentist will notice them. The marks that flourorsis leaves on your teeth will be permanent, and as time passes they have a tendency to darken.
Diagnosing Fluorosis
It’s easy for your dentist to spot the signs of fluorosis during one of your regular checkups. You may be asked some questions about your child’s diet such as if they’re using fluoride supplements, a fluoride toothpaste or drinking an excess of fluoridated water. It’s common to be asked about several other medical conditions which could potentially have a similar effect, so that they can be ruled out.
Your dentist will give your child a thorough oral examination and may take some X-ray photographs to scan for any other defects in the teeth. It’s important not to assume your child has fluorosis if they develop stains on their teeth. There’s a range of conditions, some more serious, which can produce symptoms similar in appearance to fluorosis, so make sure you have any discolouration examined by your dentist.
Treating Fluorosis
Fortunately, in most cases, fluorosis is so minor that it doesn’t warrant any treatment. Similarly, the discolouration associated with fluorosis can often occur only on the back of your teeth, where they can’t be spotted. In more severe cases, the front teeth may have to be treated through teeth whitening or another cosmetic treatment. In the most extensive cases of fluorosis, the teeth which have become discoloured can be covered with dental restorations like veneers or crowns.
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Step 1
Look for signs of dental fluorosis. Although mild cases may produce no visible signs on your child’s teeth, moderate to severe fluorosis causes white lines, streaks or spots, as well as pitting of the teeth, misshapen enamel and brown, black or gray spots.
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Step 2
Visit your dentist for a diagnosis. Your dentist will take x-rays and examine your child’s teeth and gums to rule out other dental conditions and defects that may look like fluorosis. Your dentist will need to know your child’s exposure to fluoride, including toothpaste containing fluoride, fluoridated water consumption and fluoride supplements. If your dentist diagnoses your child with fluorosis, he may suggest cosmetic treatments, depending on the severity.
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Step 3
Get teeth-whitening treatments. Although many cases of dental fluorosis are mild enough to not require treatment, tooth whiterning may be an option, to remove stains on the enamel of the front teeth.
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Step 4
Consider tooth restorations for severe cases of fluorosis. Your dentist may recommend bonding, crowns or veneers, if whitening is not enough to correct the affects of fluorosis.
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Step 5
Heed prevention measures. Be aware of your child’s fluoride intake, especially while he is under the age of 6. Make sure your child uses only a pea-sized amount of toothpaste and spits instead of swallowing after brushing his teeth. Have your dentist or local health department check your water for fluoride levels before allowing your child to take fluoride supplements.
What to Consider with Fluorosis
Preventing Fluorosis
You should make sure to only use a pea-sized amount of toothpaste if your child is under the age of six. It’s also important to make them spit after brushing rather than swallowing. As such, you should avoid toothpastes which might encourage swallowing like flavoured toothpastes and to make sure products which contain fluoride aren’t anywhere your children can get at them. There’s a number of soft and fruit drinks which contain fluoride and many brands of bottled water also contains added fluoride. It’s important to make sure your child doesn’t consume a lot of these beverages in order to avoid fluorosis.
Cosmetic Dentistry
Conclusion.
The treatments discussed above have appeared in earlier postings on this blog. In this posting, however, the focus is on fluorosis which can affect children between the ages of 1 and 4 because there is too much fluoride in their diet. Parents and guardians have special responsibility to ensure that kids under their care develop healthy teeth and gums. Special attention must be given to those between the ages of 1 and 4 who are most susceptible to flourosis.
Flourosis is preventable and can be detected early if you make it a point to take your kids to see your dentist regularly. It not just to prevent flourosis, but also to monitor the development of their teeth. Advice of your dentist should be taken seriously. There is also the added benefit of regular dental visits and that is, your child will be able to overcome the fear of dentist syndrome, which is very common in adults.—drKam.
It takes discipline to maintain a great smile
Posted by: drkam on: October 14, 2009
It takes discipline to maintain a great smile.
Introduction
drkam
It takes a lot of effort if you wish to have a good set of teeth. It calls for discipline on your part as you need to observe oral hygiene habits consistently. A good set of clean teeth with healthy gums enhances your personality by boosting your confidence. Therefore, getting a brilliant smile can only come after following good oral hygiene techniques.
People have today become much more conscious of appearance and wellness than ever before. They are living longer, thanks to advances in medical and dental science and in their quest for youthfulness, they invest time, effort and money in dental care in particular, healthy foods, and are doing regular exercises.
Dental Care is essential
Getting a brilliant smile can only come from making sure that you brush your teeth regularly and properly to prevent the build up of tartar and tooth decay and bleeding gums. Obviously one of the steps towards this is making sure that you visit your dentist regularly for check ups, but there are also ways you should look after your teeth in-between visits to ensure good oral health.
Eating a good healthy diet without too many snacks or sugary refined foods also helps. Use dental products which contain Fluoride. Your dentist may also advise you to rinse with a mouthwash containing fluoride and show you the appropriate way of brushing of your teeth and the use of floss. It is important to brush your teeth at least twice each day and after every meal is the ideal. You should also floss at least twice each day to make sure food is not trapped between teeth.
Plaque develops on your teeth every day and taking these measures you can prevent plaque and decay.
Avoid Smoking
Smoking bad for your health and can lead to oral cancer, periodontitis, and tooth decay. It will also stain your teeth. For help on how to stop this unhealthy habit, please contact your dental surgeon.
Conclusion
It pays to have a good set of clean and healthy set of teeth. Observe the above tips and you will earn the distinction of having a brilliant smile as bonus. All it takes is discipline on your part. That smile can do wonders to your personality, confidence and poise. You should give yourself a chance that you richly deserve to have your dental flaws rectified . See your dentist regularly.
Wisdom Teeth: Err on the side of caution
Posted by: drkam on: October 9, 2009
drkam
October 9, 2009
Introduction
No one escapes the agony and pain caused by wisdom teeth. It is not unusual for us to treat this problem as part of our maturing process, hence the word “wisdom” to teeth which pop up in our adult phase. But it is always important that we see our dentist regularly so that problems with wisdom teeth can be dealt with at the first sign of the problem. There are risks associated with the removal impacted wisdom teeth by surgery. This article discusses in reasonable detail how wisdom teeth can cause complications.
Something that is considered elementary or routine for young patients can be serious, especially for 25 year olds and above, especially those who have deeply impacted wisdom teeth. It pays to err on the side of caution, making sure that you see your dentist when you detect early signs of pain due to your wisdom teeth.
What are the risks of an operation to remove impacted wisdom teeth?
All operations have risks, and your oral surgeon should talk to you about things that could go wrong. Anaesthetics can have side effects. These are more likely with a general anaesthetic. You may have an allergic reaction to the anaesthetic, or get breathing or heart problems. These problems are serious. If you have any allergies, you must tell your doctor.
It’s hard to say exactly how often problems happen with surgery to remove wisdom teeth. About 1 in 20 people get problems during or after an operation to take out their wisdom teeth. These problems aren’t always serious or permanent. You may get more serious problems if you’re over 25 and have deeply impacted teeth.
1. Sinus Complications
The upper wisdom teeth roots are very close to the maxillary sinus and some people even have roots that go into the sinus. An opening into the sinus after the removal of wisdom teeth occurs once in a while. If this occurs it is likely that bacteria can prevent healing and get into the sinus. This infection does not respond well to antibiotics and often requires additional surgery to drain the sinus. A material called gelfoam is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. If this does occur patients are often given antibiotics, decongestants, should avoid certain activities, and should see an Ear, Nose, and Throat (ENT) Doctor.
It is also possible that a fragment of the tooth can end up in the maxillary sinus. Irrigation with saline may allow the tooth fragment to be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times a procedure called a caldwell luc must be performed.
2. Numbness/ Nerve Damage
Nerves in your mouth may be damaged during surgery to remove your lower wisdom teeth. Your lower lip, chin or tongue may feel tingly or numb. This happens to between 1 and 8 out of 100 people. For 1 in 100 people, the numbness is permanent, where as others regain feeling after 3 months. The lingual nerve may be permanently damaged in up to 1 in 100 people which is the nerve that helps you sense pain and temperature in your mouth. Dentists and surgeons often use an instrument called a lingual nerve retractor to move the nerve out of the way. But this can actually increase the risk of damage. The inferior alveolar nerve can also be damaged. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch and the sense of touch to the right or left half of the chin and lower lip.
3. Dry Socket (Alveolar Osteitis)
Between 1 in 10 and 1 in 100 people get a throbbing pain after their operation, which is when a blood clot does not form properly in the socket. In some cases, this happens because the patient has disregarded the instructions given by the surgeon. Smoking, spitting or drinking with a straw in disregard to the surgeon’s instructions can cause this, along with other activities that change the pressure inside of the mouth, such as playing a musical instrument. The extraction site will become irritated and pain is due to the bone lining the tooth socket becoming inflamed. The symptoms are made worse when food debris trap in the tooth socket. Dry sockets can heal in a couple of weeks without treatment. Dry socket is not an infection and is inflammation within the bony lining of an empty tooth socket. A dry socket presents as a sharp and sudden increase in pain which usually starts around 2 to 5 days after wisdom teeth removal.
dry-socket, no blood clot
4. Jaw Fracture
In very rare cases, the removal of a wisdom tooth will weaken the jaw bone. This is due to the obligatory removal of bone to obtain access to the impacted tooth. It is very rare of the jaw to fracture after the removal of a wisdom tooth due to weakening and chewing normal foods.
5. Infection
Infection following the surgical removal of wisdom teeth happens to about 1 or 2 out of 100 people. Signs of infection include fever above 100 degrees, abnormal swelling, pain or a salty or prolonged bad taste, with or without evidence of discharge from the surgical site.
6. Injury to Teeth
Damage to fillings and adjacent teeth, to bridgework or to surrounding bone can occur during the removal of impacted wisdom teeth. Even the best surgeon will occasionally have this type of complication. This is rare and happens to less than 1 in 100 people.
7. Root Fragments
This happens to about 5 in 100 people. You might need to have the fragment removed if it causes problems. Usually the fragment is close to a nerve or adjacent sinus. Removal of the root tip could jeopardize adjacent structures. The oral surgeon uses his clinical expertise to determine the benefit to risk ratio of removing a root tip. The fragments can be monitored using x-rays.
8. TMJ pain
TMJ dysfunction following the removal of wisdom teeth is unusual and usually temporary. If treatment is required, it is usually conservative in nature and includes anti-inflammatory medicines, physical therapy and in some cases short term bite splint therapy.
9. Bleeding
Everyone bleeds after surgery, but it should stop by the time you go home. Less than 1 in 100 people have bleeding that is difficult to stop. Small amounts of blood within the first 48 hours after extraction is normal.
10. Air Embolism/ Subcutaneous Emphysema
A gas related embolus can be caused by inadvertent injection of a mixture of air and water under pressure which then passes into the mandible (jaw) to the veins and then to the large vessels leading to the heart. Large amounts of air can cause serious problems including cardiac arrest and death, by traveling to the large veins leading to the heart, and mechanically blocking the flow of blood through the heart. Microbubbles, not detectable by conventional imaging techniques may provoke an inflammatory response and cause tissue damage. Doppler ultrasound may aid in detection and Hyperbaric Oxygen Therapy for treatment.
11. Chronic Headache
Your head can pound 24/7 and cause you severe pain every day.
12. Trigeminal Nerve Damage
Trigeminal neuralgia can develop if there is injury to the trigeminal nerve. This causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw. Trigeminal neuralgia is considered by many to be among the most painful of conditions and once was labeled the suicide disease because of the significant numbers of people taking their own lives before effective treatments were discovered.
13. Hematoma
A hematoma is a pooling blood in tissues that can happen when a needle moves through blood vessels.
14. Anaphylaxis
A loss of vascular tone indicated by a precipitous fall in blood pressure caused by contact with an allergen (due to anesthesia or another chemical given) can result in bilateral facial manifestations with possible cardiorespiratory symptoms.
15. Angiodema
A massive escape of fluid into the tissue from blood vessels causing large edematous swellings usually appears in the maxilla as a reddened area with well circumscribed rings and a buring sensation.
16. Vertigo/Dizziness
I have found no literature to support this; however, multiple patients have described strange feelings inside the head along with dizziness and vertigo. One such patient complained of these symptoms continuing to persist 12 years after the extractions.
17. Myoclonus
There is some literature suggesting perhiperal nerve damage causes myoclonus and body pounding symptoms/ palpitations.
18. Brain Damage
Anesthetics have been linked both mechanistically and phenomenologically to brain damage in non humans. No human studies have verified this. A few people have noticed cognitive impairment after recieving anesthesia.
19. Death
We can’t exclude the possibility of death during surgical removal of teeth. Multiple people have died as a direct result of having their wisdom teeth removed. Learn about death occuring after wisdom teeth removal.
For some people this third set of molars can grow inside without complication, especially those that NOT been giving any problems such as acute chronic pain or swelling, because a lot of other surgical removal of wisdom teeth is necessary . Your dentist will advise you if it is necessary to remove your wisdom teeth.
Conclusion
As in all matters related to our personal health and well being, it is absolutely essential that we take action at the first sign of a problem brewing with your wisdom. It is best to consult your dentist early so that a proper routine can be established to monitor and manage the problem with your wisdom teeth. With modern X-ray technology and imaging, you can be informed in advance of the severity of your problem. Usually it is easier if you are young and active to deal with it. Your dentist will recommend what steps you need to take. Usually a surgical procedure is required to remove your troubling wisdom teeth. But there are risks associated with surgery which we need to bear in mind.
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