dental caries......probably the most significant disease of mouth,,,,in this disease the enamel is degraded and some small holes on the tooth surface are visible, These holes are very dangerous as food particles and other edibles get jammed here and decay here causing bacterial and microbial growth. Our mouth in this situation becomes a carrier of sever infectious diseases of stomach and liver..with mouth and oral cancer
.
To fight this though sever surgical and clinical medicines are available but the basic to fight a disease is its vaccination,,,like polio or TB.....depending ob various pathogens several vaccinations are prepared and several are on the way...explore them below......
vidence of a specific bacterial cause of dental caries and of the function of the salivary glands as an effector site of the mucosal immune system has provided a scientific basis for the development of a vaccine against this highly prevalent and costly oral disease. Research efforts towards developing an effective and safe caries vaccine have been facilitated by progress in molecular biology, with the cloning and functional characterization of virulence factors from mutans streptococci, the principal causative agent of dental caries, and advancements in mucosal immunology, including the development of sophisticated antigen delivery systems and adjuvants that stimulate the induction of salivary immunoglobulin A antibody responses. Cell-surface fibrillar proteins, which mediate adherence to the salivary pellicle, and glucosyltransferase enzymes, which synthesize adhesive glucans and allow microbial accumulation, are virulence components of mutans streptococci, and primary candidates for a human caries vaccine. Infants, representing the primary target population for a caries vaccine, become mucosally immunocompetent and secrete salivary immunoglobulin A antibodies during the first weeks after birth, whereas mutans streptococci colonize the tooth surfaces at a discrete time period that extends around 26 months of life. Therefore, immunization when infants are about one year old may establish effective immunity against an ensuing colonization attempts by mutans streptococci. The present review critically evaluates recent progress in this field of dental research and attempts to stress the protective potential as well as limitations of caries immunization.,
Streptococcus mutans has been identified as the major etiological agent of human dental caries. The first step in the initiation of infection by this pathogenic bacterium is its attachment (i.e., through bacterial surface proteins such as glucosyltransferases, P1, glucan-binding proteins, and fimbriae) to a suitable receptor. It is hypothesized that a mucosal vaccine against a combination of S. mutans surface proteins would protect against dental caries by inducing specific salivary immunoglobulin A (IgA) antibodies which may reduce bacterial pathogenesis and adhesion to the tooth surface by affecting several adhesins simultaneously. Conventional Sprague-Dawley rats, infected with S. mutans at 18 to 20 days of age, were intranasally immunized with a mixture of S. mutans surface proteins, enriched for fimbriae and conjugated with cholera toxin B subunit (CTB) plus free cholera toxin (CT) at 13, 15, 22, 29, and 36 days of age (group A). Control rats were either not immunized (group B) or immunized with adjuvant alone (CTB and CT [group C]). At the termination of the study (when rats were 46 days of age), immunized animals (group A) had significantly (P < 0.05) higher salivary IgA and serum IgG antibody responses to the mixture of surface proteins and to whole bacterial cells than did the other two groups (B and C). No significant differences were found in the average numbers of recovered S. mutans cells among groups. However, statistically fewer smooth-surface enamel lesions (buccal and lingual) were detected in the immunized group than in the two other groups. Therefore, a mixture of S. mutans surface proteins, enriched with fimbria components, appears to be a promising immunogen candidate for a mucosal vaccine against dental carie.
Friday, July 9, 2010
Thursday, July 8, 2010
Relatives......Aids and Dentistry
wondered...but that's not fake...now a days every diseases which involves a surgical treatment is a relative of aids..AIDS is highly dangerous sexually transmitted disease[STD]..IT IS DANGEROUS TO BOTH THE DOCTOR AND TO THE PATIENT. The disease requires complete precaution to be prevented from further spreading,,as a dental clinic is very sophisticated,,it is advised to all practitioners to be very careful while doing oral surgical processes...a complete through case history of the patient involving the history of present illness and past illness is highly recommended...more relations of aids and dentistry are as follows......
There are approximately about 1,00,000 AIDS cases in India and 2 million people infected with HIV, according to the statistics from the WHO and the Indian government. According to experts, if the trend continues, India could have as many as 30 million people with HIV by the year 2010- about twice today’s worldwide count.
AIDS specialist Dr.Peeyush Tripathi had mentioned in his speech, "Many experts believe that India will soon have the unfortunate distinction of being the AIDS capital of the world."
AIDS, or Acquired Immunodeficiency Syndrome, is a highly lethal, progressively epidemic viral infection that destroys the immune system, increasing the individual’s susceptibility to infectious disease and cancer.
A sensitive immunodetection assay has been developed, which is used to identify antibodies in HIV infected patients and as a tool for studying and measuring the levels of CD4 T cells(lymphocytes that fight infection) present during the course of the disease. A normal CD4 cell count is usually above 600 cells/mm3. Severe immune suppression defined as a CD4 cell count below 200cells /mm3 is, as of Jan 1993, an AIDS diagnosis. For most HIV infected patients, there is a long clinical latency period, often extending to seven to eight years.
There are at least 10 genetic types or clades of the human immunodeficiency virus, each antigenically distinct, with different clades predominant in different parts of the world.
At a recent international conference on AIDS, a new triple drug therapy has been declared to be effective. It combines indinavir(it attacks the viral enzyme, HIV-protease, which the virus needs to replicate itself ) with AZT(or zidovudine, an inhibitor which attacks the virus through the enzyme called reverse transcriptase) and 3TC (or lamivudine, another HIV inhibitor), to reduce or eliminate HIV copies in the plasma of infected patients.
The expanding role of the dentist in the acquired immunodeficiency syndrome era can be classified into six issues.
The HIV virus must get into the blood stream to infect a person. In order for infection to occur, 3 things must happen.
3. Transmission should go directly from one person to the other very quickly. The virus does not survive more than a few minutes outside the body.
The non specific symptoms of AIDS, which can include fevers, fatigue, weight loss, severe diarrhea, do not begin until an average of 10 years after infection. Generally, any symptoms that last for more than 2 weeks and do not go away, or any symptoms that are very severe, need medical attention.
The ADA strongly affirms that Universal precautions are an effective and adequate means of preventing transmission of HIV virus from dental health care workers to patients and vice versa. Based on the experience of numerous general dentists over the last 10 to 15 years, patients infected with HIV can safely be treated in general dental settings.
However, establishment of dedicated clinics for HIV infected patients may be justified because clinical staff in such settings develop increased clinical experience and will be able to manage more complex patients with greater confidence.
To minimize complications after dental procedures, a thorough and appropriate medical assessment is necessary. The main concern for dentists treating HIV infected cases are;
-increased bleeding tendencies,
-post operative infections.
-drug interactions
-adverse reactions and
-prognosis for survival.
The mode of HIV transmission influence the provision of dental care. Hemophiliacs demand modifications of dental care, moreover, they have a high prevalence of hepatitis B, hepatitis C, and hepatitis delta virus infection.
Intravenous drug users(IVDUs) also have a high prevalence of hepatitis B and hepatitis C viral infections. IVDUs are highly susceptible to develop bouts of bacterial endocarditis. The use of appropriate analgesics is another concern while treating IVDUs.
Homosexual men show a propensity to develop certain types of oral lesions, such as necrotizing ulcerative periodontitis, oral hairy leukoplakia, and Kaposi’s sarcoma. Prevalence of hepatitis B virus infection is also high in this patient population.
Children with perinatally acquired HIV are considered to be at greater risk for caries than their siblings, more so with advancing disease.
During the course of HIV disease, patients take increasing number of medications. Dentists need to be aware of the medications that can cause neutropenia and anemia. These include zidovudine and trimethoprim- sulphamethoxazole (Septra, Bactrim). Zidovudine may also cause reduced salivary flow.
Many HIV infected patients are started on trimethoprim- sulphamethoxazole when their CD4 cell count drops below 200 cells/ mm3. More than 50%, however, develop severe adverse reactions and need to stop taking the medication. Patients also show increased adverse reactions toward other antibiotics, including amoxicillin-clavulanic acid, ciprofloxacin, dicloxacillin, erythromycin and clindamycin, when their CD4 cell count decreases.
During the course of HIV disease, all patients develop oral alterations, but none of these lesions are specific for HIV disease, and they can be present in other immune suppressed individuals. These lesions range from asymptomatic, subtle changes of the oral mucosa that are secondary to a decreased salivary flow or candidiasis to rapidly destructive lesions, such as necrotizing stomatitis, necrotizing ulcerative periodontitis, deep mycoses, and cancers.
The treatment of some of these oral lesions can be handled in a dental office on an outpatient basis. When treatment includes radiation, cancer chemotherapy, and long term intravenous medication for neoplasms, it is advantageous for the dentist to be a part of the treatment team instead of being the primary provider.
The treatment team may have a general internal medicine specialist who takes care of the patient’s non- infectious needs, and an infectious disease specialist to attend to all HIV related care. Community based organizations and social support networks are also involved with a multitude of services, including psychological counseling and drug rehabilitation.
Based on the current epidemiological evidences, Epstein and others have reported that infectious diseases, specially blood borne pathogens such as hepatitis B, hepatitis C and HIV are not transmitted from patient to patient via dental instruments.
Though it has been suggested that dental handpieces are capable of transmitting HIV in a dental setting, there has never been any reports that such a transmission has occurred.
Special attention should be paid to dentists who are more susceptible to diseases potentially transmitted in a dental setting, They include pregnant women, due to their immunologic changes and the developing foetus; dentists with the habit of excessive alcohol intake; those who had undergone splenectomy, radiotherapy, and long term corticosteroid therapy; also, dentists suffering from diseases that have an impact on the first and secondary defense against infections such as diabetes mellitus, chronic renal failure, leukemia or HIV.
There are approximately about 1,00,000 AIDS cases in India and 2 million people infected with HIV, according to the statistics from the WHO and the Indian government. According to experts, if the trend continues, India could have as many as 30 million people with HIV by the year 2010- about twice today’s worldwide count.
AIDS specialist Dr.Peeyush Tripathi had mentioned in his speech, "Many experts believe that India will soon have the unfortunate distinction of being the AIDS capital of the world."
AIDS, or Acquired Immunodeficiency Syndrome, is a highly lethal, progressively epidemic viral infection that destroys the immune system, increasing the individual’s susceptibility to infectious disease and cancer.
A sensitive immunodetection assay has been developed, which is used to identify antibodies in HIV infected patients and as a tool for studying and measuring the levels of CD4 T cells(lymphocytes that fight infection) present during the course of the disease. A normal CD4 cell count is usually above 600 cells/mm3. Severe immune suppression defined as a CD4 cell count below 200cells /mm3 is, as of Jan 1993, an AIDS diagnosis. For most HIV infected patients, there is a long clinical latency period, often extending to seven to eight years.
There are at least 10 genetic types or clades of the human immunodeficiency virus, each antigenically distinct, with different clades predominant in different parts of the world.
At a recent international conference on AIDS, a new triple drug therapy has been declared to be effective. It combines indinavir(it attacks the viral enzyme, HIV-protease, which the virus needs to replicate itself ) with AZT(or zidovudine, an inhibitor which attacks the virus through the enzyme called reverse transcriptase) and 3TC (or lamivudine, another HIV inhibitor), to reduce or eliminate HIV copies in the plasma of infected patients.
The expanding role of the dentist in the acquired immunodeficiency syndrome era can be classified into six issues.
- Provision of routine dental care .
- Oral lesions- screening, diagnosis, treatment, and recognition of their significance.
- Collaboration with other health care workers and social support systems.
- Education of other health care workers.
- Education in the community.
- Resource to HIV infected health care workers.
The HIV virus must get into the blood stream to infect a person. In order for infection to occur, 3 things must happen.
- One must be exposed to blood, pre-cum, semen, vaginal secretions, or breast milk.
3. Transmission should go directly from one person to the other very quickly. The virus does not survive more than a few minutes outside the body.
The non specific symptoms of AIDS, which can include fevers, fatigue, weight loss, severe diarrhea, do not begin until an average of 10 years after infection. Generally, any symptoms that last for more than 2 weeks and do not go away, or any symptoms that are very severe, need medical attention.
The ADA strongly affirms that Universal precautions are an effective and adequate means of preventing transmission of HIV virus from dental health care workers to patients and vice versa. Based on the experience of numerous general dentists over the last 10 to 15 years, patients infected with HIV can safely be treated in general dental settings.
However, establishment of dedicated clinics for HIV infected patients may be justified because clinical staff in such settings develop increased clinical experience and will be able to manage more complex patients with greater confidence.
To minimize complications after dental procedures, a thorough and appropriate medical assessment is necessary. The main concern for dentists treating HIV infected cases are;
-increased bleeding tendencies,
-post operative infections.
-drug interactions
-adverse reactions and
-prognosis for survival.
The mode of HIV transmission influence the provision of dental care. Hemophiliacs demand modifications of dental care, moreover, they have a high prevalence of hepatitis B, hepatitis C, and hepatitis delta virus infection.
Intravenous drug users(IVDUs) also have a high prevalence of hepatitis B and hepatitis C viral infections. IVDUs are highly susceptible to develop bouts of bacterial endocarditis. The use of appropriate analgesics is another concern while treating IVDUs.
Homosexual men show a propensity to develop certain types of oral lesions, such as necrotizing ulcerative periodontitis, oral hairy leukoplakia, and Kaposi’s sarcoma. Prevalence of hepatitis B virus infection is also high in this patient population.
Children with perinatally acquired HIV are considered to be at greater risk for caries than their siblings, more so with advancing disease.
During the course of HIV disease, patients take increasing number of medications. Dentists need to be aware of the medications that can cause neutropenia and anemia. These include zidovudine and trimethoprim- sulphamethoxazole (Septra, Bactrim). Zidovudine may also cause reduced salivary flow.
Many HIV infected patients are started on trimethoprim- sulphamethoxazole when their CD4 cell count drops below 200 cells/ mm3. More than 50%, however, develop severe adverse reactions and need to stop taking the medication. Patients also show increased adverse reactions toward other antibiotics, including amoxicillin-clavulanic acid, ciprofloxacin, dicloxacillin, erythromycin and clindamycin, when their CD4 cell count decreases.
During the course of HIV disease, all patients develop oral alterations, but none of these lesions are specific for HIV disease, and they can be present in other immune suppressed individuals. These lesions range from asymptomatic, subtle changes of the oral mucosa that are secondary to a decreased salivary flow or candidiasis to rapidly destructive lesions, such as necrotizing stomatitis, necrotizing ulcerative periodontitis, deep mycoses, and cancers.
The treatment of some of these oral lesions can be handled in a dental office on an outpatient basis. When treatment includes radiation, cancer chemotherapy, and long term intravenous medication for neoplasms, it is advantageous for the dentist to be a part of the treatment team instead of being the primary provider.
The treatment team may have a general internal medicine specialist who takes care of the patient’s non- infectious needs, and an infectious disease specialist to attend to all HIV related care. Community based organizations and social support networks are also involved with a multitude of services, including psychological counseling and drug rehabilitation.
Based on the current epidemiological evidences, Epstein and others have reported that infectious diseases, specially blood borne pathogens such as hepatitis B, hepatitis C and HIV are not transmitted from patient to patient via dental instruments.
Though it has been suggested that dental handpieces are capable of transmitting HIV in a dental setting, there has never been any reports that such a transmission has occurred.
Special attention should be paid to dentists who are more susceptible to diseases potentially transmitted in a dental setting, They include pregnant women, due to their immunologic changes and the developing foetus; dentists with the habit of excessive alcohol intake; those who had undergone splenectomy, radiotherapy, and long term corticosteroid therapy; also, dentists suffering from diseases that have an impact on the first and secondary defense against infections such as diabetes mellitus, chronic renal failure, leukemia or HIV.
Wednesday, July 7, 2010
WHITENING YOUR TEETH,,,,,CONCEPTS AND CONCEPTIONS
Everyone in this world want a shining pearl like teeth and a glittering smile .General scaling of tooth is very common these days and also there are a lot of products in the market which guarantee whitening and refreshing your mouth. discoloration of tooth is the major problem and concerning one.There are several whitening methods are available which are discussed below with there merits and demerits.
Why Teeth Get Dark
There are many causes of tooth discoloration. The most common include genetics, aging, consumption of staining substances (smoking, coffee, tea, and colas), tetracycline (antibiotic) staining, excessive fluoride, and old fillings. Whitening toothpaste can remove stain that is on the outside of the teeth. Dentists call this extrinsic staining. However, whitening toothpaste and professional dental cleanings will not change the color or intrinsic staining of the teeth. That is why tooth whitening (sometimes called tooth bleaching) is so popular
Here's How Tray Teeth Whitening Works
A whitening gel is placed in a tray that fits over your teeth. As the active ingredient in the gel, carbamide peroxide, is broken down, oxygen enters the enamel and bleaches the colored substances. The structure of the tooth is not changed; only the tooth is made lighter and whiter. Fillings, Crowns, and Bonding will not lighten.
The fit of the tray is critical to success of treatment. Impressions are made by your dentist. Accurate models of your teeth are obtained from which custom fitting whitening trays can be made.
How Safe is This?
Dentists have known for years that tray whitening or bleaching is a fast, safe and predictable way to whiten teeth 2-5 shades in a matter of days.
What is the difference between laser whitening and custom mouthpieces?.
Laser is done by a dentist who applies a 35% Hydrogen Peroxide solution on your teeth. Once this solution is on, a light is held a couple of inches away from your teeth to speed up the chemical reaction of the Hydrogen Peroxide. Many dentists advertise that this works better than tray type whitening. There is NO clinical data to indicate the laser whitening works any better than tray whitening. NONE! The problem with this procedure is that after a year of your normal eating habits (drinking coke, tea, coffee, etc.) your teeth become slightly discolored again and develops a new stain. With the laser whitening, you will have to go and pay $500 plus to have white teeth again. With the custom mouthpieces, you already have the custom mouthpieces that you can wear a year later for a night to take off the new stain at no cost.
How Does the Tray Whitening System Compare to Crest Whitestripes?
Crest White Stripes are a new plastic strip that is coated with Hydrogen Peroxide and placed across the front teeth. The strips do work...sort of. Tests by Crest show that teeth are lightened an average of 1 to 2 shades They tend to whiten only the front teeth while and the visible premolars are still dark.
How Long will Whitening Results Last? For most people, the treatment is long-lasting. Exposure to coffee, smoking, red wines, and some medicine products will gradually darken teeth again over time. After an initial treatment, most people do touch-ups one day about every 3-6 months.
How long will it take and How white will they get?
When wearing the trays Carbamide Peroxide is slowly broken down to Hydrogen Peroxide which whitens the teeth. The 16% gel whitens more slowly but causes less tooth sensitivity. The 22% gel whitens quickly but can cause temporary sensitivity to temperatures. Both the 16% and 22% gels need to be worn for about 10-14 days to achieve maximum whiteness.
Virtually everyone who whitens their teeth will see improvement.
The ultimate whiteness will be determined by the length of time the teeth are exposed to the whitening gel and the mineral composition of the teeth. Teeth whitening is kind of like a reverse suntan. Some people get great results in only one or two days while others need more treatment time.
The American Dental Association (ADA) has recently made public a review by the Cochrane Collaboration of 25 studies of home-use tooth whitening products. The 25 clinical studies looked at the effectiveness of home-use whiteners including:
Why Teeth Get Dark
There are many causes of tooth discoloration. The most common include genetics, aging, consumption of staining substances (smoking, coffee, tea, and colas), tetracycline (antibiotic) staining, excessive fluoride, and old fillings. Whitening toothpaste can remove stain that is on the outside of the teeth. Dentists call this extrinsic staining. However, whitening toothpaste and professional dental cleanings will not change the color or intrinsic staining of the teeth. That is why tooth whitening (sometimes called tooth bleaching) is so popular
Here's How Tray Teeth Whitening Works
A whitening gel is placed in a tray that fits over your teeth. As the active ingredient in the gel, carbamide peroxide, is broken down, oxygen enters the enamel and bleaches the colored substances. The structure of the tooth is not changed; only the tooth is made lighter and whiter. Fillings, Crowns, and Bonding will not lighten.
The fit of the tray is critical to success of treatment. Impressions are made by your dentist. Accurate models of your teeth are obtained from which custom fitting whitening trays can be made.
How Safe is This?
Dentists have known for years that tray whitening or bleaching is a fast, safe and predictable way to whiten teeth 2-5 shades in a matter of days.
What is the difference between laser whitening and custom mouthpieces?.
Laser is done by a dentist who applies a 35% Hydrogen Peroxide solution on your teeth. Once this solution is on, a light is held a couple of inches away from your teeth to speed up the chemical reaction of the Hydrogen Peroxide. Many dentists advertise that this works better than tray type whitening. There is NO clinical data to indicate the laser whitening works any better than tray whitening. NONE! The problem with this procedure is that after a year of your normal eating habits (drinking coke, tea, coffee, etc.) your teeth become slightly discolored again and develops a new stain. With the laser whitening, you will have to go and pay $500 plus to have white teeth again. With the custom mouthpieces, you already have the custom mouthpieces that you can wear a year later for a night to take off the new stain at no cost.
How Does the Tray Whitening System Compare to Crest Whitestripes?
Crest White Stripes are a new plastic strip that is coated with Hydrogen Peroxide and placed across the front teeth. The strips do work...sort of. Tests by Crest show that teeth are lightened an average of 1 to 2 shades They tend to whiten only the front teeth while and the visible premolars are still dark.
How Long will Whitening Results Last? For most people, the treatment is long-lasting. Exposure to coffee, smoking, red wines, and some medicine products will gradually darken teeth again over time. After an initial treatment, most people do touch-ups one day about every 3-6 months.
How long will it take and How white will they get?
When wearing the trays Carbamide Peroxide is slowly broken down to Hydrogen Peroxide which whitens the teeth. The 16% gel whitens more slowly but causes less tooth sensitivity. The 22% gel whitens quickly but can cause temporary sensitivity to temperatures. Both the 16% and 22% gels need to be worn for about 10-14 days to achieve maximum whiteness.
Virtually everyone who whitens their teeth will see improvement.
The ultimate whiteness will be determined by the length of time the teeth are exposed to the whitening gel and the mineral composition of the teeth. Teeth whitening is kind of like a reverse suntan. Some people get great results in only one or two days while others need more treatment time.
The American Dental Association (ADA) has recently made public a review by the Cochrane Collaboration of 25 studies of home-use tooth whitening products. The 25 clinical studies looked at the effectiveness of home-use whiteners including:
- Home whitener kits given out by dentists
- Over-the-counter whiteners
- They looked at all forms of tooth whiteners except whitening toothpastes:
- Films (which are painted on the teeth)
- Gels (applied in trays)
- Strips (applied to the teeth)
Tuesday, July 6, 2010
tooth fluorosis problem
fluorosis is a tooth coloring disorder mainly,in it the outer surface of tooth gets discolored...the enamel is matted and patchy and sometimes flaky...the major cause is the excess intake of fluorides and its salts through food and water in the body....it also affects many other parts of the body.in INDIA several regions are affected with flourosis
Dental fluorosis is a common disease in punjab(india).it is due to an unusually high dose of fluorides during odontogenesis causing a structural modification of hard dental tissues and thereby resulting in a hypomineralisation of these tissues.fluorotic enamel is a hypocalcified, porous,brittle and most unaesthetic tissue. Bleaching has been suggested by several authors in order to treat the unaesthetic aspect of dental fluorosis, but many results are however unsatisfactory. This is a novel method which is based on the structural characteristics of the fluorotic ename & organic and exogenous nature of fluorotic enamel stains which includes four different stages:- 1) Cleansing the enamel surface with pumice 2) Enamel etching with hydrochloric acid 3) application of sodium hypochlorite. 4) application of dental adhesives.
Introduction
A frequent question asked by most of patients residing in the fluorotic belt of punjab (india) is "will my tooth turn white?" Usually the answer is a "yes" with the explanation that the modern dental treatment procedures are such as to esthetically synchronise the facial harmony of tooth structure.the reason for this discoloration is a high fluoride concentration in water in certain areas of punjab. the normal colour of permanent teeth is greyish yellow, greyish white or yellowish white but the number of people with this colour are usually limited owing to over aggressive tooth brushing and abrasive cleansing materials, acidic food and drinks and last but not the least,ageing. The elderly people thus, have more yellowish teeth as compared to younger persons.these alterations in colour maybe physiologic or pathologic and endogenous or exogenous in nature. the modern era is an era of esthetics. People having teeth with normal colour also want to have whiter teeth to improve their smile. So one cannot ignore the wishes of such patients and hence bleaching, as we know, has emerged as the simplest, most common, least invasive and least expensive means available to dentists to lighten discoloration.
History
Many agents have been used in the past and a number of new methods have continued to be introduced. It was oxalic acid first by chappel in 1877 which was followed by various forms of chlorine, until hydrogen peroxide was first used by harlan in 1884. Many advances continued focussing basically on the ways to facilitate the absorption of bleaching agent. The recent developments of hi-tech computer imaging have enhanced patient understanding, expectation and ultimately satisfaction.
Mode of action
Bleaching works by oxidation in which the bleaching agent enters the enamel &/or dentin of the discolored tooth and reduces the molecules containing discoloration. The bleaching depth depends on the cause of the stains and where and how deep the stain has permeated the tooth structure plus how deep the bleaching agent can permeate to the source of discoloration and remain there long enough to release deep stains.
Etiology of tooth discoloration
Extrinsic discolorations are found on outer surface of teeth and are usually Of local origin e.g. Tobacco, paan, tea, coffee, silver nitrate stains, oral intake of iron suspensions, continuous use of mouth washes and gum paint. Intrinsic the stains are found within the enamel and dentin and are caused by The deposition of the substances within these structures e.g. Tetracycline, Fluorosis stains, amelogenesis imperfecta, dentinogenesis imperfecta, pulp necrosis etc.
Histopathology
fluorosed teeth are also called mottled teeth . Such teeth appear when child ingests excessive fluoride during enamel formation or calcification in areas where drinking water contains more than 1ppm of Fluoride. The higher concentration of fluoride is believed to cause a metabolic alteration in the ameloblasts which results in defective matrix & improper calcification. 1ppm of fluoride has no biological side effects on The vital organs of human body i.e. Kidney, heart & lungs. Fluoride up to 4ppm in drinking water occasionally produces skeletal fluorosis but above 8ppm coupled with malnutrition positively causes not only skeletal fluorosis but irreversible bone changes & deformity as well.
Histology
histological examination shows hypomineralised, porous sub-surface enamel below a well mineralised surface layer. The most affected teeth (in decreasing order) are premolars, 2ndmolars, followed by maxillary incisors, canines & 1st molars. Mandibular incisors are affected least.
Stages of fluorosis
the appearance of teeth depends upon the severity of the lesion which in turn depends upon the fluoride contents consumed by a particular individual through the water supply.
1) the constant use of water having fluoride to the extent of 1ppm causes mildest grade of mottling in 10% of the population.
2) as concentration of fluoride increases, the effect worsens, so much so that when the concentration reaches 6ppm,incidence of mottling is 100%.
3) very mild :- in this type there are very small white areas occasionally seen on the tooth surfaces, but do not involve more than 25% of tooth surfaces.
(4) mild :- in this type there is more extensive tooth involvement and involves 50% of tooth surfaces.
(5) moderate :- more surfaces are involved here and are subjected to attrition. They show marked wear with yellow or brown pigmentation.
(6) severe :- all enamel surfaces are involved, so much so that the tooth mor phology is affected.there is discrete or confluent pitting of enamel surfaces. Brown stains are widespread & the tooth often presents a corroded surface.
Optimum fluoride levels
In cold climate, recommended fluoride levels may be as high as 1.2 ppm whereas in extremely hot climate, a level of 0.7 ppm is recommended. In moderate climate, the optimum fluoride level is 1 ppm. High temperature causes increase in mottling because there is increased consumption of water containing fluoride. Distribution of mottling in various areas of teeth has no relation with periods of mineralisation of crown. Teeth are only affected provided the child lives in the area of fluorosis during the time of enamel mineralisation. Brown tooth stains respond to treatment but white stains are not effectively resolved. It has been observed that teeth in process of eruption receive maximum benefit from optimum amount of fluoride plus teeth exposed to f shortly after eruption were also protected although to a lesser degree.
Different f levels in punjab & other states of india
I) Punjab
II) Andhra Pradesh
III) Gujarat
IV) Tamil Nadu 1) Coimbatore 2) Dharampur 3) Madurai 4) Narkot 5) Salem 6) Trichi
all 1.5 --- 5ppm
V) Kerala 1) Allepey 2) Eranakulam 3) Quillon 4) Trichur
all 0 -- 1.5 ppm
V) Rajasthan
VI) Uttar Pradesh
Treatment options
Basically for all these stains or in particular fluorotic stains the treatment options available to us include :-
1) Veneering / laminates or placement of porcelain crowns
2) Micro / macroabrasion
3) Bleaching - a) vital tooth inoffice bleaching b) nightguard home bleaching c) our novel method of inoffice bleaching
1) Veneering or laminates or ceramic crowns
Advantages:
1) esthetically more acceptable
2) Long lasting
3) Durable
4) Simple
5) Can be given over endodontically treated tooth
6) more strength and resistance to forces
Disadvantages:
1) brittle
2) less shear strengh
3) causes loss of tooth structure
4) patient may not be willing
5) susceptible to fracture
6) due to tooth reduction, pulp & other tissues may face trauma
7) overcontouring may make it appear & feel unnatural
8) vitality tests cannot be done once crowns are properly fit
9) post cementation caries difficult to detect
10) lab.procedure needs precision for proper marginal seal
11) gingival irritation- may cause hyperaemia & bleeding
2) Micro/ Macro abrasion :-
This technique involves applying of 18% hcl to soften the enamel And then abrading it with a controlled abrasive technique With pumice to remove superficial stains / defects. Instead of pumice, even silicon carbide may be used with 11%hcl.
Advantages:
1) improved method for superficial stains
2) safer method
3) involves physical removal of tooth structure
Disadvantages:
1) can cause sensitivity
2) causes wearing of tooth structure
3) patients might not allow cutting of tooth structure
4) defect may persist after finishing of technique for which a restorative alternative is needed
3) Bleaching :-
This procedure has many methods and techniques involving various solutions in each technique.
Advantages:
1) easy
2) time saving
3) cheaper
4) patient acceptance better
5) can be carried out both in office & at home
Disadvantages:
1) requires patient cooperation(especially for home bleaching)
2) cannot be used where teeth have large pulps
3) cannot be used where teeth are too dark
4) cannot be used where the patient expectations are too high
5) cannot be used in impatient patients
6) causes cervical resorption
7) cannot be used in attritioned teeth which might cause sensitivity
8) cannot be used where teeth are bonded, laminated or have extensive restorations
9) not a perfect technique & merely changes colour to variable depths
10) lasts for only 1 - 3 years (short period)
A) Vital tooth inoffice power bleaching
This technique uses a combination of 37% phosphoric acid & 35%hydrogen peroxide.the oxidation reaction is generally promoted by a heated instument or with intensive light.in this method, one application is carried out weekly for 2 - 6 appointments with each treatment lasting 30 minutes. Use of phosphoric acid by this technique is optional.
Advantages:
1) caustic chemicals are totally under dentist's control.
2) soft tissue protection is better achieved by dentist.
3) bleaching of tooth is achieved more rapidly
Disadvantages:
1) slightly costly procedure.
2) unpredictable results.
3) uncertain duration of treatment
4) soft tissue damage possible for both dentist & patient.
5) rubber dam causes discomfort.
6) can cause post operative sensitivity.
B) Night guard home bleaching
This procedure involves making an impression of the teeth & pouring a cast of the same, trimming of the cast, application of a blockout resin & fabrication of a night guard tray by a vaccum former machine. After cooling, the tray is trimmed & a 10 - 15% gel of carbamide peroxide is recommended for the same. In this procedure the total treatment time is 2 - 6 weeks.
Advantages:
1) use of lower concentration.
2) ease of application.
3) minimal side effects.
4) lower cost (as compared to veneers)
5) lesser chair time.
6) much lesser labour intensive.
Disadvantages:
1) have to rely a lot on patient compliance for results.
2) longer treatment time.
3) unknown potential for soft tissue changes with excessive use.
4) treatment results are time & dose dependent.
5) peroxide solution may cause irritation of gingival papilla.
6) teeth become sensitive to temperature changes.
Another method using macken's solution has been described
1 part anaesthetic ether 0.2 ml - removes surface debris 5 parts hcl 38% 1ml --- etches 5 parts hydrogen peroxide 30% 1 ml --- bleaches
Our Approach For Inoffice Bleaching
Indications:
1) Fluorosis stains / systemic fluorosis
2) Tetracycline stains
Contra indications:
1) Hyperaemic gingiva
2) Persistant periodontal problem cases
3) Fractured incisors / anteriors
Clinical application
The various steps are
1) Cleansing
2) Isolating
3) Etching
4) Rinsing
5) Dehydration
6) Application of solution
7) Scrapping
8) Rinsing
9) Filling
The Steps in detail:
1) cleansing the tooth surface with a nylon tooth brush & a mixture of pumice and water to remove surface debris.
2) isolation is done by application of rubber dam.
3) then dry the tooth surface & do enamel etching with 35% hcl for 20 - 25 seconds.
4) copious rinsing is done to eliminate acid residues & the tooth is subjected to thorogh drying.
5) application of 95% ethyl alcohol to dehydrate the enamel surface.
6) now,the application of 30% hydrogen peroxide(h2o2) is done first for 1 minute followed by alternative application of 5.25% sodium hypochlorite (naohcl) is done for 5 minutes during which it can be re-applied to the tooth surface to keep it wet.
7) the removal of staining molecules can be accelerated by gently scrapping the tooth surface.
8) this is followed by thorough rinsing of tooth surface.
9) this procedure is repeated at the interval of three days for successive sittings till the results are satisfactory.
10) in the end, fill the microcavities caused in the tooth by this solution with a light cure dental adhesive.
Advantages:
1) HCl etches enamel,but does not penetrate.
2) Tooth structure is not damaged.
3) Very very few chances of post - operative sensitivity of tooth.
4) No heat / application is required.
5) Very economical as all the three solutions in quantity of 50 ml. Each cost rs. 250 - 300 (total ).
6) Very low quantity of solutions required at each sitting.
Disadvantages :
1) Fluorosed teeth require larger & repeated sessions to decolorise Them.
2) Some blanching of gingiva can occur which is reversible within Half an hour.
3) Transitory decrease in bond strengh occurs when composite is applied to bleached / etched enamel.however,after a week,no decrease is seen.
4) Unknown duration of treatment.
Discussion
The different hypothesis concerning the fluorotic stains removal are:
1) if a fluorotic tooth is put into a naohcl solution,it removes all the stains within a few hours.this confirms the organic & exogenous nature of fluorotic tooth stains which are due to elementary impregnation of a hypocalcified & porous tissue. said by :- triller m. Alterations des tissues by marie curie in 1984.
2) scanning electron microscope study (sem) study shows that Posteruptive calcified layer covers the fluorotic enamel surface ; hence the mineral layer removal is essential.
RESULT
In the end, i would like to conclude that this system of stains Removal seems to be clinically applicable & satisfactory with minimal abrasion of enamel surface.to make this technique Universally acceptable , lot of cases have to be treated with this technique.
Dental fluorosis is a common disease in punjab(india).it is due to an unusually high dose of fluorides during odontogenesis causing a structural modification of hard dental tissues and thereby resulting in a hypomineralisation of these tissues.fluorotic enamel is a hypocalcified, porous,brittle and most unaesthetic tissue. Bleaching has been suggested by several authors in order to treat the unaesthetic aspect of dental fluorosis, but many results are however unsatisfactory. This is a novel method which is based on the structural characteristics of the fluorotic ename & organic and exogenous nature of fluorotic enamel stains which includes four different stages:- 1) Cleansing the enamel surface with pumice 2) Enamel etching with hydrochloric acid 3) application of sodium hypochlorite. 4) application of dental adhesives.
Introduction
A frequent question asked by most of patients residing in the fluorotic belt of punjab (india) is "will my tooth turn white?" Usually the answer is a "yes" with the explanation that the modern dental treatment procedures are such as to esthetically synchronise the facial harmony of tooth structure.the reason for this discoloration is a high fluoride concentration in water in certain areas of punjab. the normal colour of permanent teeth is greyish yellow, greyish white or yellowish white but the number of people with this colour are usually limited owing to over aggressive tooth brushing and abrasive cleansing materials, acidic food and drinks and last but not the least,ageing. The elderly people thus, have more yellowish teeth as compared to younger persons.these alterations in colour maybe physiologic or pathologic and endogenous or exogenous in nature. the modern era is an era of esthetics. People having teeth with normal colour also want to have whiter teeth to improve their smile. So one cannot ignore the wishes of such patients and hence bleaching, as we know, has emerged as the simplest, most common, least invasive and least expensive means available to dentists to lighten discoloration.
History
Many agents have been used in the past and a number of new methods have continued to be introduced. It was oxalic acid first by chappel in 1877 which was followed by various forms of chlorine, until hydrogen peroxide was first used by harlan in 1884. Many advances continued focussing basically on the ways to facilitate the absorption of bleaching agent. The recent developments of hi-tech computer imaging have enhanced patient understanding, expectation and ultimately satisfaction.
Mode of action
Bleaching works by oxidation in which the bleaching agent enters the enamel &/or dentin of the discolored tooth and reduces the molecules containing discoloration. The bleaching depth depends on the cause of the stains and where and how deep the stain has permeated the tooth structure plus how deep the bleaching agent can permeate to the source of discoloration and remain there long enough to release deep stains.
Etiology of tooth discoloration
Extrinsic discolorations are found on outer surface of teeth and are usually Of local origin e.g. Tobacco, paan, tea, coffee, silver nitrate stains, oral intake of iron suspensions, continuous use of mouth washes and gum paint. Intrinsic the stains are found within the enamel and dentin and are caused by The deposition of the substances within these structures e.g. Tetracycline, Fluorosis stains, amelogenesis imperfecta, dentinogenesis imperfecta, pulp necrosis etc.
Histopathology
fluorosed teeth are also called mottled teeth . Such teeth appear when child ingests excessive fluoride during enamel formation or calcification in areas where drinking water contains more than 1ppm of Fluoride. The higher concentration of fluoride is believed to cause a metabolic alteration in the ameloblasts which results in defective matrix & improper calcification. 1ppm of fluoride has no biological side effects on The vital organs of human body i.e. Kidney, heart & lungs. Fluoride up to 4ppm in drinking water occasionally produces skeletal fluorosis but above 8ppm coupled with malnutrition positively causes not only skeletal fluorosis but irreversible bone changes & deformity as well.
Histology
histological examination shows hypomineralised, porous sub-surface enamel below a well mineralised surface layer. The most affected teeth (in decreasing order) are premolars, 2ndmolars, followed by maxillary incisors, canines & 1st molars. Mandibular incisors are affected least.
Stages of fluorosis
the appearance of teeth depends upon the severity of the lesion which in turn depends upon the fluoride contents consumed by a particular individual through the water supply.
1) the constant use of water having fluoride to the extent of 1ppm causes mildest grade of mottling in 10% of the population.
2) as concentration of fluoride increases, the effect worsens, so much so that when the concentration reaches 6ppm,incidence of mottling is 100%.
3) very mild :- in this type there are very small white areas occasionally seen on the tooth surfaces, but do not involve more than 25% of tooth surfaces.
(4) mild :- in this type there is more extensive tooth involvement and involves 50% of tooth surfaces.
(5) moderate :- more surfaces are involved here and are subjected to attrition. They show marked wear with yellow or brown pigmentation.
(6) severe :- all enamel surfaces are involved, so much so that the tooth mor phology is affected.there is discrete or confluent pitting of enamel surfaces. Brown stains are widespread & the tooth often presents a corroded surface.
Optimum fluoride levels
In cold climate, recommended fluoride levels may be as high as 1.2 ppm whereas in extremely hot climate, a level of 0.7 ppm is recommended. In moderate climate, the optimum fluoride level is 1 ppm. High temperature causes increase in mottling because there is increased consumption of water containing fluoride. Distribution of mottling in various areas of teeth has no relation with periods of mineralisation of crown. Teeth are only affected provided the child lives in the area of fluorosis during the time of enamel mineralisation. Brown tooth stains respond to treatment but white stains are not effectively resolved. It has been observed that teeth in process of eruption receive maximum benefit from optimum amount of fluoride plus teeth exposed to f shortly after eruption were also protected although to a lesser degree.
Different f levels in punjab & other states of india
I) Punjab
| 1) bhatinda - 4.5 ppm 2) mansa - 4.2 ppm 3) mukatsar - 3.3 ppm 4) faridkot - 3 ppm 5) ferozepur - 2.6 ppm 6) moga - 2 ppm 7) sangrur - 1.35 ppm 8) jalandhar - 0.55 ppm 9) amritsar - 0.45 ppm | 10) hoshiarpur - 0.44 ppm 11) nawanshahar - 0.4 ppm 12) fatehgarh sahib - 0.37 ppm 13) patiala - 0.35 ppm 14) ropar - 0.3 ppm 15) kapurthala - 0.25 ppm 16) ludhiana - 0.22 ppm 17) gurdaspur - 0.15 ppm |
| 1) nalgonda - 20.6ppm 2)prakasan - 12.0ppm 3)vishakhapatnam - 11.0ppm 4) anantpur - 10.1ppm 5)guntar - 10 ppm 6)medak - 9.8ppm 7)kunoor - 9.6ppm 8)nellore - 8 ppm 9)mehboobnagar - 6.4 ppm | 10)warrangal - 5.8 ppm 11) kareemnagar - 4.9 ppm 12) hyderabad - 4.8ppm 13) cuddapah - 4.6ppm 14) nizamabad - 3.0ppm 15) chittoor - 2.9 ppm 16) adkabab - 2.8 ppm 17) srikakalam - 2.8 ppm 18) Godavari - 1.6 ppm |
| 1) kutch - 1.2 -- 11 ppm 2) bhavnagar - 1.5 - 4ppm 3) jamnagar - 1.5 - 4ppm 4) rajkot - 2.5ppm 5) saurashtra - 1.5 - 2.5 ppm 6) rajpur - 0 - 2.5 ppm | 7) banakanta - 1.5 - 2ppm 8) godar - 1.6 - 1.7ppm 9) godhra - 0 - 1.6 ppm 10) surinderanagar - 0 - 1.5 ppm 11) surat - 0 - 1.3 ppm |
all 1.5 --- 5ppm
V) Kerala 1) Allepey 2) Eranakulam 3) Quillon 4) Trichur
all 0 -- 1.5 ppm
V) Rajasthan
| 1) Bharatpur - 28ppm 2) Tonk - 21ppm 3) Alwar - 20.6ppm 4) Sikar - 19.1ppm 5) Ajmer - 18.4ppm 6) Bhilwara - 16.5ppm 7) Swaimadhopur - 16.1ppm 8) Jhalawar - 16ppm 9) Churu - 16ppm 10) Jodhpur -16ppm 11) Sirohi - 15.8ppm 12) Jaipur - 15ppm 13) Nalpur - 14.2ppm | 14) kota - 14.2ppm 15) dungarpur - 12ppm 16) bikaner - 10.2ppm 17) barmer - 10ppm 18) pali -- 9.1ppm 19) ganganagar - 9ppm 20) jalour -- 8ppm 21) wagpur - 7.1ppm 22) chittorgarh - 6ppm 23) bundi - 5.8ppm 24) banswara - 4.3ppm 25) jhunjhunu - 2.2ppm |
| 1) Gorakhpur - 0.6-6.8ppm 2) Shahjahanpur - 4ppm 3) Lakhpur -0.1-4ppm 4) Rai bareilly - 0.6-3ppm 5) Banda - 0.6-3ppm 6) Agra - 0.2-3ppm 7) Kanpur - 0.2-3ppm 8) Varanasi - 0.2-3ppm 9) Unna - 0.1-3ppm 10) Aligarh - 0.4-2ppm 11) Allahabad - 0.2-2ppm 12) Itah -0.8-1.6ppm 13) Hamirpur - 0.6-1.6ppm 14) Azamgarh - 0.1-1.6ppm 15) Muradpur - 1.0-1.4ppm 16) Jamalpur - 1.0-1.2ppm 17) Lucknow - 0.8-1.2ppm 18) Meerut - 0.4-1.2ppm 19) Bulandshahar - 0.4-1.2ppm 20) Dijnor - 0.2-1.2ppm 21) Jhansi - 0.2-1.2ppm 22) Bareilly 0.1-0.9ppm 23) Balliya - 0.4-0.8ppm 24) Barabanki - 0.4-0.8ppm | 25) fatehgarh - 0.4-0.8ppm 26) mirzapur - 0.4-0.8ppm 27) gadhepur - 0.3-0.8ppm 28) gonda - 0.2-0.8ppm 29) basti - 0.2-0.8ppm 30) jalpum - 0.1-0.8ppm 31) dehradun - 0.1-0.8ppm 32) pratapgarh - 0.4-0.6ppm 33) manipuri - 0.4-0.6ppm 34) lahtpur - 0.1-0.6ppm 35) muzaffarnagar - 0.2-0.5ppm 36) rampur - 0.2-0.4ppm 37) pilibhit - 0.2-0.4ppm 38) bijnor - 0.1-0.4ppm 39) fatehabad - 0.1-0.4ppm 40) badari - 0.1-0.4 ppm 41) sitapur - 0.1-0.4ppm 42) saharanpur - 0.1-0.4ppm 43) mathura - 0.1-0.4ppm 44) faizabad - 0.2ppm 45) etawah - 0.1-0.2ppm 46) nainital - 0.1-0.2ppm 47) dahrich - 0.1-0.2ppm 48) sultanpur - 0.1ppm |
Basically for all these stains or in particular fluorotic stains the treatment options available to us include :-
1) Veneering / laminates or placement of porcelain crowns
2) Micro / macroabrasion
3) Bleaching - a) vital tooth inoffice bleaching b) nightguard home bleaching c) our novel method of inoffice bleaching
1) Veneering or laminates or ceramic crowns
Advantages:
1) esthetically more acceptable
2) Long lasting
3) Durable
4) Simple
5) Can be given over endodontically treated tooth
6) more strength and resistance to forces
Disadvantages:
1) brittle
2) less shear strengh
3) causes loss of tooth structure
4) patient may not be willing
5) susceptible to fracture
6) due to tooth reduction, pulp & other tissues may face trauma
7) overcontouring may make it appear & feel unnatural
8) vitality tests cannot be done once crowns are properly fit
9) post cementation caries difficult to detect
10) lab.procedure needs precision for proper marginal seal
11) gingival irritation- may cause hyperaemia & bleeding
2) Micro/ Macro abrasion :-
This technique involves applying of 18% hcl to soften the enamel And then abrading it with a controlled abrasive technique With pumice to remove superficial stains / defects. Instead of pumice, even silicon carbide may be used with 11%hcl.
Advantages:
1) improved method for superficial stains
2) safer method
3) involves physical removal of tooth structure
Disadvantages:
1) can cause sensitivity
2) causes wearing of tooth structure
3) patients might not allow cutting of tooth structure
4) defect may persist after finishing of technique for which a restorative alternative is needed
3) Bleaching :-
This procedure has many methods and techniques involving various solutions in each technique.
Advantages:
1) easy
2) time saving
3) cheaper
4) patient acceptance better
5) can be carried out both in office & at home
Disadvantages:
1) requires patient cooperation(especially for home bleaching)
2) cannot be used where teeth have large pulps
3) cannot be used where teeth are too dark
4) cannot be used where the patient expectations are too high
5) cannot be used in impatient patients
6) causes cervical resorption
7) cannot be used in attritioned teeth which might cause sensitivity
8) cannot be used where teeth are bonded, laminated or have extensive restorations
9) not a perfect technique & merely changes colour to variable depths
10) lasts for only 1 - 3 years (short period)
A) Vital tooth inoffice power bleaching
This technique uses a combination of 37% phosphoric acid & 35%hydrogen peroxide.the oxidation reaction is generally promoted by a heated instument or with intensive light.in this method, one application is carried out weekly for 2 - 6 appointments with each treatment lasting 30 minutes. Use of phosphoric acid by this technique is optional.
Advantages:
1) caustic chemicals are totally under dentist's control.
2) soft tissue protection is better achieved by dentist.
3) bleaching of tooth is achieved more rapidly
Disadvantages:
1) slightly costly procedure.
2) unpredictable results.
3) uncertain duration of treatment
4) soft tissue damage possible for both dentist & patient.
5) rubber dam causes discomfort.
6) can cause post operative sensitivity.
B) Night guard home bleaching
This procedure involves making an impression of the teeth & pouring a cast of the same, trimming of the cast, application of a blockout resin & fabrication of a night guard tray by a vaccum former machine. After cooling, the tray is trimmed & a 10 - 15% gel of carbamide peroxide is recommended for the same. In this procedure the total treatment time is 2 - 6 weeks.
Advantages:
1) use of lower concentration.
2) ease of application.
3) minimal side effects.
4) lower cost (as compared to veneers)
5) lesser chair time.
6) much lesser labour intensive.
Disadvantages:
1) have to rely a lot on patient compliance for results.
2) longer treatment time.
3) unknown potential for soft tissue changes with excessive use.
4) treatment results are time & dose dependent.
5) peroxide solution may cause irritation of gingival papilla.
6) teeth become sensitive to temperature changes.
Another method using macken's solution has been described
1 part anaesthetic ether 0.2 ml - removes surface debris 5 parts hcl 38% 1ml --- etches 5 parts hydrogen peroxide 30% 1 ml --- bleaches
Our Approach For Inoffice Bleaching
Indications:
1) Fluorosis stains / systemic fluorosis
2) Tetracycline stains
Contra indications:
1) Hyperaemic gingiva
2) Persistant periodontal problem cases
3) Fractured incisors / anteriors
Clinical application
The various steps are
1) Cleansing
2) Isolating
3) Etching
4) Rinsing
5) Dehydration
6) Application of solution
7) Scrapping
8) Rinsing
9) Filling
The Steps in detail:
1) cleansing the tooth surface with a nylon tooth brush & a mixture of pumice and water to remove surface debris.
2) isolation is done by application of rubber dam.
3) then dry the tooth surface & do enamel etching with 35% hcl for 20 - 25 seconds.
4) copious rinsing is done to eliminate acid residues & the tooth is subjected to thorogh drying.
5) application of 95% ethyl alcohol to dehydrate the enamel surface.
6) now,the application of 30% hydrogen peroxide(h2o2) is done first for 1 minute followed by alternative application of 5.25% sodium hypochlorite (naohcl) is done for 5 minutes during which it can be re-applied to the tooth surface to keep it wet.
7) the removal of staining molecules can be accelerated by gently scrapping the tooth surface.
8) this is followed by thorough rinsing of tooth surface.
9) this procedure is repeated at the interval of three days for successive sittings till the results are satisfactory.
10) in the end, fill the microcavities caused in the tooth by this solution with a light cure dental adhesive.
Advantages:
1) HCl etches enamel,but does not penetrate.
2) Tooth structure is not damaged.
3) Very very few chances of post - operative sensitivity of tooth.
4) No heat / application is required.
5) Very economical as all the three solutions in quantity of 50 ml. Each cost rs. 250 - 300 (total ).
6) Very low quantity of solutions required at each sitting.
Disadvantages :
1) Fluorosed teeth require larger & repeated sessions to decolorise Them.
2) Some blanching of gingiva can occur which is reversible within Half an hour.
3) Transitory decrease in bond strengh occurs when composite is applied to bleached / etched enamel.however,after a week,no decrease is seen.
4) Unknown duration of treatment.
Discussion
The different hypothesis concerning the fluorotic stains removal are:
1) if a fluorotic tooth is put into a naohcl solution,it removes all the stains within a few hours.this confirms the organic & exogenous nature of fluorotic tooth stains which are due to elementary impregnation of a hypocalcified & porous tissue. said by :- triller m. Alterations des tissues by marie curie in 1984.
2) scanning electron microscope study (sem) study shows that Posteruptive calcified layer covers the fluorotic enamel surface ; hence the mineral layer removal is essential.
RESULT
In the end, i would like to conclude that this system of stains Removal seems to be clinically applicable & satisfactory with minimal abrasion of enamel surface.to make this technique Universally acceptable , lot of cases have to be treated with this technique.
Monday, July 5, 2010
snoring,,,,,,,,,plzzzzzzzzzz dont....
uuuuuuhhhhhhhhhh.i hate when i listen snores of anybody ..especially when i am sleeping.it disturbs me a lot and as well as to you to.It is irritating noise...of throat and nose during inhalation while sleeping.....though it is very bad as its not safe for health and as usual irritating toooo..........but the matter of concern is that can it kill ...i say yes...actually a rescent study says it..........have alook.......
DELHI-- Dental surgeons said Saturday they have discovered why snoring can kill sometimes: It can actually cause damage to the arteries....THE MAJOR PURE BLOOD CARRIERS
Snoring is usually harmless, if annoying, unless a person has a particular disorder known as sleep apnea.
Sleep apnea is marked by irregular breathing and snorting. Sufferers often stop breathing completely for up to several seconds. It usually affects overweight, middle-aged men and has been linked with stroke and heart disease.
A team at the University KGMU at Lucknow School of Dentistry set out to see what the physical mechanism is.
Writing in the Journal of Oral and Maxillofacial Surgery, they said X-rays showed it is more complicated than seems immediately obvious.
"When persons with sleep apnea fall asleep, their tongue falls back into their throat, blocking their airway. As they struggle for breath, their blood pressure soars," Dr.,,Sandeep Vishvash an oral surgeon who worked on the study, said in a statement.
"We believe that this rise in blood pressure damages the inner walls of the carotid arteries lining the sides of the neck," he added.
"Cholesterol and calcium stick to the injury sites and amass into calcified plaques, which block blood flow to the brain. The result is often a massive stroke."and a sudden death..........
DELHI-- Dental surgeons said Saturday they have discovered why snoring can kill sometimes: It can actually cause damage to the arteries....THE MAJOR PURE BLOOD CARRIERS
Snoring is usually harmless, if annoying, unless a person has a particular disorder known as sleep apnea.
Sleep apnea is marked by irregular breathing and snorting. Sufferers often stop breathing completely for up to several seconds. It usually affects overweight, middle-aged men and has been linked with stroke and heart disease.
A team at the University KGMU at Lucknow School of Dentistry set out to see what the physical mechanism is.
Writing in the Journal of Oral and Maxillofacial Surgery, they said X-rays showed it is more complicated than seems immediately obvious.
"When persons with sleep apnea fall asleep, their tongue falls back into their throat, blocking their airway. As they struggle for breath, their blood pressure soars," Dr.,,Sandeep Vishvash an oral surgeon who worked on the study, said in a statement.
"We believe that this rise in blood pressure damages the inner walls of the carotid arteries lining the sides of the neck," he added.
"Cholesterol and calcium stick to the injury sites and amass into calcified plaques, which block blood flow to the brain. The result is often a massive stroke."and a sudden death..........
Sunday, July 4, 2010
root canal treatment and its prepration
one of the most common dental procedure is root canal treatment...it is of various types and its costs vary from procedure tp procedure..it is done in the roots of the tooth to seal the opened dentin..it helps in removing pain and sensitivity in the tooth.
The Elimination of microorganisms and their products from the root canal system and to shape it to receive an inert filling material.
The Elimination of microorganisms and their products from the root canal system and to shape it to receive an inert filling material.
Microorganisms are found to a variable degree up to the apical foramen in three modes:
1. as a suspension in the root canal2. colonizing the canal walls and3. colonizing the dentinal tubules.
It is impossible to completely sterilize the root canal system due to its complex structure. Luckily for us, removal of the bulk of the microorganisms and their products brings about periradicular healing due to an altered or less pathogenic residual flora.
The aim of canal preparation in vital teeth is to remove pulp tissue, which may become necrotic and infected.
A combined action of mechanical and chemical cleansing is effective in root canal preparation.
Working length determination
From the preoperative radiograph, estimate the average length of the tooth. Select a reproducible coronal reference point. It should not be part of a portion of tooth or restorative material that is likely to break off. Choose a file that is large enough to be visible on the radiograph (at least size 10).
Insert a file into the root canal, 1-2 mm short of the estimated length and take a parallel view radiograph. An average distance of 1 mm short of the radiographic apex is widely accepted as a reasonable estimate of the terminal portion of the canal. Remember, at times, this may be inaccurate by up to 3 mm.(see fig 1)
The important Relationship between apical foramen, root tip and apical constrication. A=Root apex B= Apical constriction
C= Root canal D=Cementum E=Dentin F=Apical foramen
In cases of narrow root tips, and when there is apical root resorption, working length should be shortened more than 1 mm. In the former, it is because perforation may occur when the root is prepared to a wider diameter(See Fig2) and in the latter, the canal exit may be ‘blunderbuss’ shaped that can allow extrusion of endodontic materials.
If the tip of the file is short of the radiographic apex by 1 mm, accept it as the working length. If the file is longer than the radiographic apex, measure the distance between the file tip and a point 1 mm short of the radiographic apex. Subtract this figure from the length of the diagnostic file to get the working length.
If the distance between the file tip and the radiographic apex is greater than 1 mm, subtract 1 mm from this distance and add it to the length of the diagnostic file to get the working length.
If you have reasonable number of endodontic cases, it is worth investing in an electronic apex locator. Many reliable brands are available in the market. I have been using J Morita’s Root ZX to my fullest satisfaction. Endoseries 5 had covered electronic apex locators.
Once you have determined the working length, it is of utmost importance to restrict instrumentation to this length. Avoid displacement of the stops.
The width of the taper to which the canal should be prepared should be based on personal preference and individual clinical experience. If they allow adequate cleaning and obturation, narrowly tapered preparations are more desirable, as they do not compromise root strength and avoid strip perforations.
Mechanical preparation refers to controlled removal of dentin by manipulating root canal instruments. Factors influencing the amount and pattern of dentin removal are,
-design and sharpness of the cutting edge
-the manner in which it is manipulated
-the force applied and
-the operator’s skill.
Operator’s skill is influenced by the ability to discriminate tactile feedback from the instrument and the ability to manipulate the instruments in a controlled way according to the mental image of a three dimensional shape of the root canal system.
You can either rotate the root canal instruments (clockwise and withdraw) or used in a push- pull filing motion to remove dentin. Or you can combine the two (ream and file) by 45-90 degree clockwise movements to engage the dentin and straight pull withdrawal to cut the engaged dentin. Due to uncontrolled dentin removal, errors in canal preparation viz., ledging, zipping and transportation of apical foramen may result. A reliable method to reduce uncontrolled forces is to use flexible files such as Flex-R, Flexo-file, Nickel-Titanium etc.,
Saturday, July 3, 2010
tooth pain control
pain killers or analgesics are very commonly taken drugs in every type of pain....but one should be very careful in taking those analgesics as they have many sideeffects on the body..they may even react in reverse manner
an Effective pain relief can be achieved with oral non-opioids and non-steroidal anti-inflammatory drugs. very important here,,,,These drugs are appropriate for many post-traumatic and post surgical pains, especially when patients go home on the day of the operation.
an Effective pain relief can be achieved with oral non-opioids and non-steroidal anti-inflammatory drugs. very important here,,,,These drugs are appropriate for many post-traumatic and post surgical pains, especially when patients go home on the day of the operation.
It is disheartening that in the selection of analgesics, tradition and ill informed prejudice sometimes hold sway over evidence and common sense. Analgesic efficiency is expressed as the Number Needed to Treat (NNT) i.e., the number of patients who need to receive the active drug to achieve at least 50% relief of pain in one patient compared with placebo, over a six-hour treatment period.
calculate NNT
1. first Calculate the percentage of people who have the desired outcome in the treatment group. E.g., 80/200 X 100 = 40% (80 got relief in 200 patients)2. then Calculate the percentage of people who have the desired outcome in the placebo or control group. E.g., 40/200 X 100 = 20%3. and Take (2) away from (1) to give the percentage of people helped by the treatment. e.g., 40- 20 =204. then Divide 100 by this percentage to give the NNT. E.g., 100/20 =5
The most effective drugs have a low NNT of about 2, meaning that for every two patients who receive the drug, one patient will get at least 50% relief because of the treatment (the other patient may obtain relief but it does not reach the 50% level).
the paracetamol 1gm, the NNT is nearly 5. Combinations of paracetamol 650mg with dextropropoxyphene 65mg (e.g., Poxy plus, Novamed) improves the NNT slightly. Ibuprofen is better at 3 and diclofenac (e.g., Oxalgin, Zydus Cadila ) at about 2.5.
These NNT comparisons are against placebo, the best NNT 2 means that while 50 of 100 patients will get at least 50% relief because of the treatment, another 20% will have a placebo response which then gives at least 50% relief, so that with diclofenac 70 out of 100 will have effective pain relief.
If the patients can swallow, it is best to prescribe drugs to be taken orally. Of the oral analgesics, Non Steroidal Anti Inflammatory Drugs (NSAID) perform best, and paracetamol alone or in combination are also effective.
Some of the NSAIDs are Ketoprofen, Aspirin, Naproxen, Indomethacin, Ketorolac, Piroxicam, Celecoxib, Meloxicam, Mefenemic acid, Rofecoxib, Diclofenac and Nimeluside.
Celecoxib (e.g., Zycel, Zydus Cadilla and Colcibra from Ranbaxy ), Rofecoxib (e.g., Toroxx 25 from Torrnet pharma and Rofact from Sun pharma), Meloxicam (e.g., Melogesic, Lupin) and Nimesulide (e.g., Nimbid, Astra-IDL) belong to a new family of NSAIDs. They are referred to as cyclooxygenase-2 (COX-2) inhibitors. Celecoxib has been approved for treatment of rheumatoid arthritis in USA, and rofecoxib is approved for treatment of acute pain.
Adverse effect data on NSAIDs from long term dosing, where gastric bleeding is the main worry, rates ibuprofen the safest. Gastrointestinal ulcers and bleeding are side effects of traditional NSAIDs that block COX-1 and COX-2. Both COX-1 and COX-2contribute to inflammatory response. In the gastrointestinal mucosa, COX-1 plays and important role. Prostaglandins such as prostaglandin E2 (PGE2) that are produced from COX-1 derived PGH2 protect gastrointestinal lining against ulceration.
Because traditional NSAIDs inhibit COX-1 and COX-2, they decrease gastrointestinal synthesis of prostaglandin (predisposing patients to GI ulceration) and production of platelet thromboxane A2 (predisposing patients to bleeding).
Though clinical data on GI toxicity of celecoxib and rofecoxib are limited, they are encouraging and show approximately 1% absolute risk reduction for symptomatic ulcers. Post marketing surveillance should help clarify the actual risk for serious ulcer complications with these new COX-2 inhibitors and reveal other non-gastrointestinal toxic reactions that result from their use.
Friday, July 2, 2010
use of mouthwashes
mouthwashes are chemical products which help to clean our oral environment...in the market their are several companies producing several types of mouth washes...you need to just choose thr best product according to ur need.....here i help you in choosing a good mouth wash.... simple breath fresheners to products that can really influence oral health, a variety of mouth washes are available in the market.depending on their basic chemical constituent..they are as follows.....
Fluoride containing mouth rinses help to prevent dental decay. They may be recommended for:
b. Following sub gingival scaling and root planning when the gingivae may be sore for a few daysm use of a mouth wash is recommended for about 3 days.
Substantivity is the ability of drugs to adsorb onto and bind to soft and hard tissues. The substantivity of Chlorhexidine was first described in the 1970s. Due to this property, Chlorhexidine can maintain effective concentration for prolonged periods of time.
Different brands of Chlorhexidine are available in the market, e.g., Rexidin (Warren), Clohex (Group) and A.M.-P.M (Elder).
Side effects
Lastly, alcohol containing mouth washes have been shown to reduce the hardness of composite and hybrid resin restorations.
Fluoride containing mouth rinses help to prevent dental decay. They may be recommended for:
- Children having orthodontic treatment
- Children with high caries risk A.M.-P.M. Junior (Elder) mouth wash contains 0.03% Triclosan and 0.05% Sodium Fluoride.
- Patients suffering from dry mouth and
- Patients who have undergone radiation therapy.
Antiplaque or anti microbial mouth wash is used to inhibit bacterial plaque formation and prevent or resolve chronic gingivitis. They can affect only supra gingival plaque. So they have no role in the treatment of existing periodontal disease, since they cannot either reach the sub gingival environment or penetrate thick layers of established plaque. In these situations, they are used after supra and sub gingival scaling has been done, rendering the tooth surfaces clean, in order to maintain this situation for a short period when the soreness of the gingiva may prevent effective mechanical plaque control.
Indications for Antiplaque mouth washes
- To replace mechanical tooth brushing when this is not possible in the following situations.
- In cases of acute oral mucosal and gingival infections
- After periodontal or oral surgery and during the healing period
- After cosmetic jaw surgery or intermaxillary fixation used to treat jaw fractures.
- For mentally and physically handicapped patients.
- As an adjunct to normal mechanical brushing in situations where this may be compromised by discomfort or inadequacies.
a. After scaling when there is cervical hypersensitivity due to exposed root surfaces, prescribe mouth washes for about 4 weeks. Measures to treat hypersensitivity should also be instituted simultaneously.
b. Following sub gingival scaling and root planning when the gingivae may be sore for a few daysm use of a mouth wash is recommended for about 3 days.
Types of Antiplaque mouth washes
- Mouth washes containing essential oils. Listerine (Parke Davis), one of the oldest mouth washes available, is an essential oil/phenolic mouth wash. It has been shown to have moderate plaque inhibitory effect and some anti-gingivitis effect. Its lack of profound plaque inhibitory effect is because it has poor oral retention.
- Oxygenating agents like Hydrogen peroxide, buffered Sodium peroxyborate and Peroxy carbonate in mouth washes have a beneficial effect on acute ulcerative gingivitis, probably by inhibiting anaerobic bacteria
- Bisguanide antiseptics, like Chlorhexidine, Alexidine and Octenidine possess antiplaque activity.
Bisguanide antiseptics are able to kill a wide range of microorganisms by damaging the cell wall.
Chlorhexidine molecule gets adsorbed onto the oral surfaces and gets released at bactericidal level over prolonged periods. Due to this process, Chlorhexidine has antiplaque properties unsurpassed by other agents.
The antibacterial action of Chlorhexidine is due to and increase in cellular membrane permeability followed by coagulation of the cytoplasmic macromolecules. It is effective in vitro against both Gram +ve and Gram –ve bacteria including aerobes and anaerobes and yeast and fungi.
Substantivity is the ability of drugs to adsorb onto and bind to soft and hard tissues. The substantivity of Chlorhexidine was first described in the 1970s. Due to this property, Chlorhexidine can maintain effective concentration for prolonged periods of time.
Different brands of Chlorhexidine are available in the market, e.g., Rexidin (Warren), Clohex (Group) and A.M.-P.M (Elder).
Side effects
- It has an unpleasant taste
- It alters taste sensation
- Produces brown stains on teeth, which is very difficult to remove. This can also affect the mucous membranes and tongue and may be related to the precipitation of chromogenic dietary factors onto the teeth and mucous membranes, Due to this reason, it is important to advise patients using Chlorhexidine mouth wash to avoid the intake of tea, coffee and red wine during the duration of its use. Remember to severely restrict its use in patients with visible anterior composite and glass ionomer restorations since they also get stained.
- Chlorhexidine encourages supra gingival calculus formation.
- Mucosal erosion and parotid swelling are other much rarer side effects.
Since Chlorhexidine is poorly absorbed by the GI tract, it displays very low toxicity.
- Triclosan, a trichlora-2’-hydroxy diphenyl ether, is a non-ionic antiseptic. It has a moderate antiseptic effect when used as a mouth wash in combination with zinc.
It has been shown to reduce histamine induced dermal inflammation and reduce the severity and healing period of aphthous ulcers.colgate has given us a good mouth wash
Colgate Total Plax mouth wsh has Triclosan and Sodium fluoride as its components. Triclosan has little or no substantivity, but is oral retention can be increased by its combination with copolymers of methoxy ethylene and maleic acid.
- Povidone iodine appears to have no significant plaque inhibitory activity when used as 1% mouth wash and the absorption of significant levels of iodine through the oral mucosal may make this compound for prolonged use in the oral cavity. It could cause problem of iodine sensitivity in sensitized individuals.
Piodin (Glaxo Wellcome), Povidine Gargle (Stadmed) are povidone iodine mouth washes available in the market.
The alcohol content of mouth washes
Most mouth washes contain pharmaceutical grade alcohol, as a preservative and as a semi- active ingredient. Significant amounts of alcohol contained in many mouth washes can lead to certain disadvantages. Care should be taken that they are not accidentally swallowed, especially by children, to avoid toxicity. Small children should not be advised mouth washes, because they are not able to spit out properly. More over, most children have good gingival health.
Because of known links between alcohol consumption plus tobacco smoking and oral and oral and pharyngeal cancer, it has been suggested that the frequent use of alcohol containing mouth washes might increase the incidence of this form of cancer.
Thursday, July 1, 2010
important tips for teeth
as being a dentist i am giving you very important ,easy and necessary tooth tips ....please follow them and keep your teeth fit......1. Brush regularly and as soon after eating as possible - even after snacking. Brushing keeps small food particles from becoming giant feasts for unwanted bacteria. If possible, brush a full two minutes. Divide the teeth into quadrants and spend at least 30 seconds on each quadrant. Use the sulcus technique, angling the bristles and gently inserting and cleaning underneath the gum line while you brush. If you are not sure how to do this, ask your hygienist.
2. Select a good dentifrice and stick with it. You don’t need much and when the mouth fills with foam, many people will spit it out and consider themselves finished brushing. There are many, many toothpastes and powders on the market all touting claims from being the best whitener to being the most natural. Try a powder with a good mixture of baking soda and flavoring - you’ll never go back to pastes! Fluoride? You won’t need it if you keep to a strict hygiene routine. Hydrogen peroxide? Good old baking soda is proven to be a better anti-microbial without the risk. You will be surprised how clean your teeth feel after using a baking soda-based powder. Just can’t deal with the powder? Keep your eye on a new paste called TheraSol being developed. This may be one of the most effective toothpastes to hit the market, but may only be available through dental offices.
3. Brush your tongue or use a tongue scraper. Why do a great job on your teeth only to have them come in immediate contact with the microbes living on the surface of your tongue? As an added benefit, your breath will be MUCH better!
4. Floss at least once a day. Flossing further cleans and removes calculus where your toothbrush cannot reach.
5. Learn how to irrigate the teeth and gums and do it daily. Oral Irrigation serves several purposes; it helps to remove food particles trapped below the gum line, using the right antimicrobial fluid in your irrigator can help remove the ‘biofilm’ which harbors bacteria dangerous to your oral health and irrigating massages the gums resulting in increased circulation. Short on time? New irrigators can now be attached right to your faucet or shower outlet allowing you to clean your teeth while you do the rest of your body. ShowerPik and QuickPik II are two such appliances new on the market.
6. Irrigate deep pockets with a cannula tip and good antimicrobial solution. This measure is one of the best things an individual can do, on his or her own, to assist in stopping decay where pockets have formed between the tooth and gum. Before you buy an oral irrigator, make sure you select an irrigator such as the Via Jet, which can accommodate the tiny cannula tips. Not all do. When irrigating a deep pocket, the cannula tip is small enough to deliver the antimicrobial solution deep, where the regular irrigator tip cannot reach. Ask your dentist for help in this. If you have the right dentist, he’ll be supportive and informative in your personal hygiene efforts.
7. See your dental professionals regularly, but choose them wisely. There are good offices and bad ones and you need to seek a good hygienist as well as a D.D.S. Make sure your hygienist is allowed a good 45 minutes to an hour - enough time to properly work on your teeth. Listen to your hygienist when she tells you about a problem area and don’t be afraid to ask questions. Be on time for your appointments. Talk to your dentist about ‘periodontal anti-infective therapy’ involving home irrigation and antimicrobial solutions. This is cutting edge science and a little effort on your part might keep you away from the ‘specialist.’ Don’t be afraid to ask questions. If your professional won’t take the time to answer you in a way you can understand or gets offended by your questions, it may be time to move on.
8. White teeth do not necessarily mean healthy teeth. While your biggest concern right now may be your smile, make sure that smile will be there, in good shape, years from now. Tooth whitening is tremendously popular today and many companies are catering to the market. While tooth whiteners remove staining, to some degree, they do not necessarily do the cleaning job required by your other efforts.
9. Nutrition is half the battle. A demineralization and remineralization process is taking place constantly as the teeth are being bathed in healthy saliva (See article on ‘demineralization’ at www.mizar5.com/demin.htm ). The body is equipped to care for itself as long as conditions are right, and as everything else in the body requires good nutrition, the teeth and gums are no exception. Staying away from sugar is fine, but don’t forget carbohydrates; cakes, breads, chips… Vitamin C has long been known as important for healthy gums and a good colloidal mineral supplement will provide the calcium and phosphorus your teeth need. Your strong autoimmune system is one of your best defenses against poor oral health and GOOD food is your best source of essential vitamins & minerals.
10. Finally, allow the time, use the time, and be on time. These are YOUR teeth. How you care for them will determine how they will care for you down the road. Your attention to your good oral health could even save your life.
2. Select a good dentifrice and stick with it. You don’t need much and when the mouth fills with foam, many people will spit it out and consider themselves finished brushing. There are many, many toothpastes and powders on the market all touting claims from being the best whitener to being the most natural. Try a powder with a good mixture of baking soda and flavoring - you’ll never go back to pastes! Fluoride? You won’t need it if you keep to a strict hygiene routine. Hydrogen peroxide? Good old baking soda is proven to be a better anti-microbial without the risk. You will be surprised how clean your teeth feel after using a baking soda-based powder. Just can’t deal with the powder? Keep your eye on a new paste called TheraSol being developed. This may be one of the most effective toothpastes to hit the market, but may only be available through dental offices.
3. Brush your tongue or use a tongue scraper. Why do a great job on your teeth only to have them come in immediate contact with the microbes living on the surface of your tongue? As an added benefit, your breath will be MUCH better!
4. Floss at least once a day. Flossing further cleans and removes calculus where your toothbrush cannot reach.
5. Learn how to irrigate the teeth and gums and do it daily. Oral Irrigation serves several purposes; it helps to remove food particles trapped below the gum line, using the right antimicrobial fluid in your irrigator can help remove the ‘biofilm’ which harbors bacteria dangerous to your oral health and irrigating massages the gums resulting in increased circulation. Short on time? New irrigators can now be attached right to your faucet or shower outlet allowing you to clean your teeth while you do the rest of your body. ShowerPik and QuickPik II are two such appliances new on the market.
6. Irrigate deep pockets with a cannula tip and good antimicrobial solution. This measure is one of the best things an individual can do, on his or her own, to assist in stopping decay where pockets have formed between the tooth and gum. Before you buy an oral irrigator, make sure you select an irrigator such as the Via Jet, which can accommodate the tiny cannula tips. Not all do. When irrigating a deep pocket, the cannula tip is small enough to deliver the antimicrobial solution deep, where the regular irrigator tip cannot reach. Ask your dentist for help in this. If you have the right dentist, he’ll be supportive and informative in your personal hygiene efforts.
7. See your dental professionals regularly, but choose them wisely. There are good offices and bad ones and you need to seek a good hygienist as well as a D.D.S. Make sure your hygienist is allowed a good 45 minutes to an hour - enough time to properly work on your teeth. Listen to your hygienist when she tells you about a problem area and don’t be afraid to ask questions. Be on time for your appointments. Talk to your dentist about ‘periodontal anti-infective therapy’ involving home irrigation and antimicrobial solutions. This is cutting edge science and a little effort on your part might keep you away from the ‘specialist.’ Don’t be afraid to ask questions. If your professional won’t take the time to answer you in a way you can understand or gets offended by your questions, it may be time to move on.
8. White teeth do not necessarily mean healthy teeth. While your biggest concern right now may be your smile, make sure that smile will be there, in good shape, years from now. Tooth whitening is tremendously popular today and many companies are catering to the market. While tooth whiteners remove staining, to some degree, they do not necessarily do the cleaning job required by your other efforts.
9. Nutrition is half the battle. A demineralization and remineralization process is taking place constantly as the teeth are being bathed in healthy saliva (See article on ‘demineralization’ at www.mizar5.com/demin.htm ). The body is equipped to care for itself as long as conditions are right, and as everything else in the body requires good nutrition, the teeth and gums are no exception. Staying away from sugar is fine, but don’t forget carbohydrates; cakes, breads, chips… Vitamin C has long been known as important for healthy gums and a good colloidal mineral supplement will provide the calcium and phosphorus your teeth need. Your strong autoimmune system is one of your best defenses against poor oral health and GOOD food is your best source of essential vitamins & minerals.
10. Finally, allow the time, use the time, and be on time. These are YOUR teeth. How you care for them will determine how they will care for you down the road. Your attention to your good oral health could even save your life.
the importance of dental history
we are made to take dental and medical details of patients on apaper ...its a very important document as it is the only hard copy of the patients past and present medical and dental history.....the ADA has recommended this very strictly ..to keep this dental history private and safe...the legal issuses related to it are as follows....
dental chart is a legal document. It is the first line of defense in a malpractice suit. When a patient decides to file a lawsuit against a dentist, the dental chart becomes the single most important piece of information relative to the suit. A poorly written, inadequate narrative can be the most damaging evidence against a clinician.
The ADA questioned several of the major malpractice carriers about various record-keeping errors that they had observed in malpractice proceedings. The number one record-keeping error they identified was failure to have a treatment plan. The number two record-keeping error was failure to update the medical history. The medical history should be updated at every patient visit by the clinician. At least once per year, the patient should be asked to verify that his or her current medical history is correct by signing the form (or tablet in paperless offices). Most risk management experts recommend having the patient fill out a completely new history about every three years.
There have been numerous malpractice cases where patients were prescribed drugs by dental professionals that were clearly contraindicated by the patient’s medical history. This brand of inattentiveness can lead to serious consequences for both the patient and clinician.
You might be interested to know that one of the top reasons clinicians lose malpractice cases is when the clinician finds out he or she is being sued for malpractice, somebody alters the chart. Why do clinicians alter the chart? The main reason is because the clinician failed to record thorough chart notes at the time of treatment, and the clinician tries to make it appear thorough after the fact.
Recently I spoke with an attorney who shared with me that he lost the biggest case of his entire career because the doctor altered the chart after he found out he was being sued. The doctor tried to insert additional comments and make them appear as contemporaneous to the original entry. An expert with the court determined that two different pens had been used and was able to state that the original entry had been altered. Of course, this revelation destroyed the doctor’s credibility and ultimately caused him to lose the case.
When people write incomplete chart notes, the usual excuse is lack of time. It becomes a habit to whiz through the day without being concerned with recording details of patient visits in the practice. More often, the problem is not lack of time but rather lack of due diligence. People get sloppy with record-keeping. The fact is that in a court of law or before a state dental board, incomplete records could prove to be the most damaging factor to the clinician. Remember that in the eyes of the law or a state dental board, if something is not recorded in the chart, it never happened. Clinicians have a legal and ethical responsibility to record complete and accurate information. Dental professionals are without excuse for poor, inadequate records.
Thorough documentation includes the complete and accurate recording of all collected data, treatment planned and provided, recommendations, and other information relevant to patient care and treatment. All entries should record information objectively and comply with HIPAA regulations.
Some charting tips include:
Unfortunately, it may take a lawsuit or board complaint to arouse some people from their sloppy record-keeping slumber. For sure, that would be an unpleasant wake-up call!
dental chart is a legal document. It is the first line of defense in a malpractice suit. When a patient decides to file a lawsuit against a dentist, the dental chart becomes the single most important piece of information relative to the suit. A poorly written, inadequate narrative can be the most damaging evidence against a clinician.
The ADA questioned several of the major malpractice carriers about various record-keeping errors that they had observed in malpractice proceedings. The number one record-keeping error they identified was failure to have a treatment plan. The number two record-keeping error was failure to update the medical history. The medical history should be updated at every patient visit by the clinician. At least once per year, the patient should be asked to verify that his or her current medical history is correct by signing the form (or tablet in paperless offices). Most risk management experts recommend having the patient fill out a completely new history about every three years.
There have been numerous malpractice cases where patients were prescribed drugs by dental professionals that were clearly contraindicated by the patient’s medical history. This brand of inattentiveness can lead to serious consequences for both the patient and clinician.
You might be interested to know that one of the top reasons clinicians lose malpractice cases is when the clinician finds out he or she is being sued for malpractice, somebody alters the chart. Why do clinicians alter the chart? The main reason is because the clinician failed to record thorough chart notes at the time of treatment, and the clinician tries to make it appear thorough after the fact.
Recently I spoke with an attorney who shared with me that he lost the biggest case of his entire career because the doctor altered the chart after he found out he was being sued. The doctor tried to insert additional comments and make them appear as contemporaneous to the original entry. An expert with the court determined that two different pens had been used and was able to state that the original entry had been altered. Of course, this revelation destroyed the doctor’s credibility and ultimately caused him to lose the case.
When people write incomplete chart notes, the usual excuse is lack of time. It becomes a habit to whiz through the day without being concerned with recording details of patient visits in the practice. More often, the problem is not lack of time but rather lack of due diligence. People get sloppy with record-keeping. The fact is that in a court of law or before a state dental board, incomplete records could prove to be the most damaging factor to the clinician. Remember that in the eyes of the law or a state dental board, if something is not recorded in the chart, it never happened. Clinicians have a legal and ethical responsibility to record complete and accurate information. Dental professionals are without excuse for poor, inadequate records.
Thorough documentation includes the complete and accurate recording of all collected data, treatment planned and provided, recommendations, and other information relevant to patient care and treatment. All entries should record information objectively and comply with HIPAA regulations.
Some charting tips include:
- NEVER alter or add to original chart notes. If you need to amend an entry, make a new entry as an addendum to the original entry.
- For paper charts, do not skip lines between entries. Do not leave white space. Do not write in margins or below the last line, and always use permanent ink. Handwritten notes must be legible.
- Record events of the visit in the order they happen.
- Record all materials used, especially anesthetics (kind and how much).
- Be consistent with abbreviations. Some risk management experts advise against using the abbreviation “WNL” because it is ambiguous.
- Stick to the facts, and do not use unclear verbiage, such as “Patient seemed angry.” Note instead, “Patient said, ‘I’m sick and tired of this sore tooth.’ ”
- Do not ever record disparaging entries in a chart that you would not want a jury to see, such as “PITA patient.”
- Date
- Reason for the visit
- Thorough review of health and dental history
- Patient’s chief complaint in his/her own words
- Symptoms (symptomatic or asymptomatic)
- Clinician’s visual findings
- Diagnostic records
- Doctor’s examination
- Doctor’s diagnosis
- Doctor’s recommended treatment
- Discussion with patient and his/her choice of treatment
- Treatment rendered
- Items given to patient
- Next scheduled visit
- Signature
Unfortunately, it may take a lawsuit or board complaint to arouse some people from their sloppy record-keeping slumber. For sure, that would be an unpleasant wake-up call!
hey mom......dont kiss me....
a mothers kiss is the heavenly thing for every body of every age,,,,its so soothing and relaxing....but no one can imagine that a mom kiss can spread diseases too....dental caries is one of those diseases which uis psread by moms kiss......plzzzz have a review here......
When pooja Sharma took her daughter in for her first dental checkup a few years ago, she got a surprise. Not only did her 24-month-old have two cavities in her baby teeth, the pediatric dentist suggested she might have “caught” them from her mom...it makes her surprised
“The dentist handed me this piece of paper that talked about saliva transfer,” said ppja, a 22year-old teacher from delhi. “It said not to share cups or utensils or food and said, ‘No kissing your kid on the lips.’ I was shocked; I’d been taking a bite of food and then giving her a bite since she started eating. I told the dentist I’d never heard of this and he said these were new findings.”
As it turns out, studies about the transmission of cavity-causing bacteria from mom to baby have been published for 30 years. The primary culprit is Streptococcus mutans, a bacteria that can pass from person to person through the transfer of saliva, such as sharing utensils, blowing on food, and yes, even kissing that sweet little bundle of joy on the mouth.
According to a 2008 study in Pediatric Dentistry, “strong evidence demonstrated that mothers are a primary source of MS [mutans streptococci] colonization of their children; a few investigations showed other potential sources … notably fathers.”
“There have been many, many studies,” said Dr. Jane Soxman, a pediatric dentist from Allison Park, Pa. “It’s well-documented. You can’t blame it all on kissing a child on the lips — that’s one of several different factors that would have to be working together. But the main thing to know is that tooth decay is a bacterial infection and you can spread it from one person to another during the window of infectivity, which is during infancy and especially during the time of tooth eruption. That’s when the teeth are most vulnerable. It’s as if you had a bad cold and were kissing your child, you would spread the cold virus.”
Only parents (or caregivers) with active tooth decay can spread the Streptococcus mutans bacteria through the transfer of saliva. And philips stressed that the transmission of bacteria-laden saliva is just one piece of the puzzle. Tooth decay is caused by a combination of factors, including the transfer of infectious saliva, genetics, oral hygiene, and feeding practices, such as letting your baby constantly suck on a sippy cup full of juice or milk or other sugar-laden liquid. (Bacteria uses the sugar to produce acid, which breaks down enamel.) Baby teeth are particularly vulnerable to decay.
“When teeth first come into the mouth, when they first erupt, the enamel is very soft,” said philips. “They’re brand new virgin surfaces and are very susceptible.”..............sooo
dont kiss me mom....atleast not on lips,,,,,,plzzzzzzzzzzzzzzzzzzzz
Subscribe to:
Posts (Atom)