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.

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 =20

4. 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.

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:

1. Children having orthodontic treatment
2. Children with high caries risk A.M.-P.M. Junior (Elder) mouth wash contains 0.03% Triclosan and 0.05% Sodium Fluoride.
3. Patients suffering from dry mouth and
4.  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

 

1. To replace mechanical tooth brushing when this is not possible in the following situations.
1. In cases of acute oral mucosal and gingival infections
2. After periodontal or oral surgery and during the healing period
3. After cosmetic jaw surgery or intermaxillary fixation used to treat jaw fractures.
4. For mentally and physically handicapped patients.
2. 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

 
 

1. 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.
2. 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
3. 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

1. It has an unpleasant taste
2. It alters taste sensation
3. 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.
4. Chlorhexidine encourages supra gingival calculus formation.
5. 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.

 

4. 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.

5. 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.

 

Lastly, alcohol containing mouth washes have been shown to reduce the hardness of composite and hybrid resin restorations.

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.

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:

1. 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.
2. 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.
3. Record events of the visit in the order they happen.
4. Record all materials used, especially anesthetics (kind and how much).
5. Be consistent with abbreviations. Some risk management experts advise against using the abbreviation “WNL” because it is ambiguous.
6. 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.’ ”
7. Do not ever record disparaging entries in a chart that you would not want a jury to see, such as “PITA patient.”

According to Marcia Freeman (www.marciafreeman.com), chart entries should include the following:

• 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

You need to sound the warning trumpet to everyone in the practice regarding the possible consequences of inadequate record-keeping, which includes updating medical histories. Those consequences include loss of a malpractice suit, suspension or revocation of license, even jail time. I suggest you conduct a staff meeting and go over the record-keeping protocol from a defensive standpoint. Let everyone know you have the best interests of patients and clinicians at the forefront of the discussion.
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