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..........

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.

Microorganisms are found to a variable degree up to the apical foramen in three modes:

1. as a suspension in the root canal

2. colonizing the canal walls and

3. 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.,

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.