Dental Acute Necrotizing Ulcerative Gingivitis

Acute Necrotizing Ulcerative Gingivitis (ANUG) is an oral infection that is characterized by necrosis of gingiva. Ulcers of oral mucosa also occur in patients with severe nutritional deficiencies.

Clinical manifestations of ANUG:

• Sudden pain, tenderness, profuse salivation, a peculiar metallic taste and spontaneous bleeding from the gingival tissues.

• Patient commonly experiences loss of sense of taste.

• Ulcers develop most commonly on the interdental papillae and the marginal gingivae.

Treatment:

At the initial visit the gingivae should be debrided with both irrigation and periodontal curettage. The extent of debridement depends on the soreness of the gingivae. Antibiotics are usually not necessary for routine cases of ANUG. These cases can be successfully treated by debridement, irrigation and curettage.

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Diabetes and Dental Hygiene

What are the dental problems Diabetic patient experiences ?

• Decrease in salivary flow.

• Burning mouth or tongue.

• Dry mouth also may develop, causing an increased incidence of decay.

• Gum recession has been found to occur more frequently and more extensively in moderate-and poorly-controlled diabetic patients because plaque responds differently, creating more harmful proteins in the gums.

• Diabetics tend to lose collagen, a protein that supports gums, skin, tendon cartilage, and bone, in their gum tissue thus hastening periodontal destruction.

• The diabetics had more plaque on their teeth and experienced more bleeding of their gums when being examined.

The first signs are red, sore, and bleeding gums. This can lead to periodontitis, which is an infection in the gums and the bone that holds the teeth in place. Pockets form between the teeth, which fill with germs and pus. If not treated and the infection gets worse, your gums may pull away from your teeth, making the teeth look very long, and your teeth will loosen.

What is the best time to receive dental care?

• If your blood sugar is not under control, talk with both your dentist and physician about receiving elective dental care.

• Dental procedures should be as short and as stress free as possible.

• Make morning appointments because blood glucose levels tend to be under better control at this time of day.

• If you have a scheduled appointment, eat and take your medications as directed.

• Test your blood sugar level and take your blood pressure and bring these results with you to our office.

• Be prepared to update your health/dental history at each visit so we can provide you with the best possible care for your condition.

• See your doctor before scheduling treatment for periodontal disease. Have your doctor send your dentist records on your overall medical condition BEFORE treatment starts.

• Postpone non-emergency dental procedures if your blood sugar is not in good control. However, abscesses should be treated right away.

• See your dentist on a regular basis, every 3 to 4 months, for exams and cleanings. Keep him informed of your health status and if you have any problems controlling your blood sugar.

• Know that healing time will take longer due to your diabetic condition.

• Follow your individualized meal plan and learn more about meal planning and diabetes for better blood sugar control.

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is root canal safe for children

A " baby root canal " is a very safe and effective way for your child to keep her tooth until it will naturally come out at age 6-7. What concerns me is not the procedure, but that the fact that your 3 year old daughter needs it to begin with. If it is due to trauma (fractured tooth), so be it. However, if it is due to decay... you should re-evaluate your home care habits with the child. Talk to your dentist and make sure that there are no other problems in her mouth and that you are following the proper health care regimen for her. Baby teeth need to be brushed and cleaned everyday, just like adult teeth.

Dental : Root Canal Treatment (RCT)

Root canal treatment is a method to clean roots by gaining access from the tooth with the help of Dental instruments and specific equipments. When the carious lesion reaches pulp (where all blood vessels are present), then the only option left is RCT. Sometimes carious lesion even extend from root to apex (where root ends), then extraction is advisable as RCT will have poor prognosis in this case.

Time taken or sittings involved during RCT depends upon the extent of infection in tooth.

Steps involved in RCT are as follows:

Gaining Access to Root canals: Access from the surface of the tooth(crown) is gained with the help of Drilling instrument . Normally there are 3 canals in molars, 2 canals in premolars and 1 canal in Incisors and canine. Number of root canals can vary in tooth from person to person, it is never fixed.

Cleaning and Shaping of Root canals: Once the access is gained, then with the help of instrument known as files as shown in figure, Canals are cleaned. To avoid friction and proper cleaning disinfectant solution known as sodium hypochlorite is used. It removes all the debris and infection from the canals and makes them sterile. It usually takes 2 sittings, but if infection is less than it can be completed in 1 sitting also. After the thorough cleaning, temporary filling is placed in tooth and patient is asked to come after 2 days.

Filling of Root canals: Once the canals are cleaned, and then canals are properly dried with the help of paper points and filled. Canals are filled tightly with Gutta percha points (GP points). After filling of root canals, Permanent filling is placed in tooth; normally permanent filling does not last long. Always Crown is mandatory after RCT as tooth becomes weak from inside. To avoid further fracture of tooth, crown is mandatory.

Some frequently asked questions regarding RCT:

Is RCT Painful ?

No, RCT is not painful. Before starting the procedure dentist always anaesthetize the tooth to make it convenient for patient and as well as for Doctor.

Is RCT Safe ?

Yes, RCT is safe. When carious lesion reaches deep inside the tooth then RCT is only option to save the toth.

How many sittings are normally involved in RCT ?

If tooth is not infected then RCT can even be completed in single sitting. But, if infection is more then it normally takes 3 sittings and even more depends on the extent of infection.

Can Pregnant Women Undergo RCT ?

No, It is not at all recommended. RCT should be postponed until the birth of baby.

Is Crown Mandatory after RCT ?

Yes, Crown is mandatory after RCT to make tooth stronger and last longer. Without crown tooth can fracture anytime and after fracture, Extraction is the only option.

Does Pain Exists After RCT ?

If through cleaning and infection is removed during procedure then pain vanishes. But, if cleaning and filling of root canal is not done properly by the Dentist then surely patient will complain of pain again and again.

How Many X-Rays Are Involved In RCT ?

Normally one X-Ray before starting the procedure and one at the end of the procedure. It depends upon the Dentist, as he is a better judge of the condition involved during the procedure.

Do All Carious Tooth Need RCT ?

No, only the tooth in which carious lesion extends deep inside the pulp need RCT. Otherwise, fillings can be done to save the tooth.

Why Root Canal Treated Tooth Is Known As Dead Tooth ?

In Root canal procedure, Pulp(where blood supply of tooth is present) is removed and canals are cleaned properly. Main indication of RCT is when carious lesion reaches pulp and infects that area, then to relieve patient from pain it is removed. Tooth will no doubt remain in its position only the difference comes is it becomes non - sensitive, for this reason it is known as dead tooth.

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Dental Dentures

What are Dentures?

Dentures are the artificial prosthesis which is the substitute of missing teeth. Dentures take support of surrounding soft tissues and teeth to stabilize in oral cavity.

How many types of dentures are there?

There are two types of dentures:

• Partial dentures

• Complete dentures

What are partial Dentures?

When some teeth are present and few are missing then Partial denture is fabricated.

How many types of partial dentures are present?

Partial dentures are of two types:

• Removable partial denture(RPD)

• Fixed Partial Denture(FPD)

What are the advantages of Removable partial denture?

1. Removable partial denture can be easily removed by patient and can easily be cleaned.

2. It is less expensive

3. Removable partial dentures are fully tooth supported and helps in normal chewing.

What are the disadvantages of Removable partial denture?

1. Since removable partial denture are fully tooth supported, sometimes cause injury to tooth supported gums.

2. If patient does not maintain proper oral hygiene, RPD can be harmful for other remaining natural teeth.

3. Due to removing RPD again and again it sometimes becomes loose.

What are the advantages of fixed partial denture?

1. These dentures are attached to natural teeth, roots or implants and cannot be removed by patient.

2. FPD has high retention as compared to removable partial denture.

3. Patient feels FPD like his natural teeth. Hence less compliance factor.

What are the disadvantages of FPD?

1. It is expensive procedure.

2. More time consuming and regular checkups are advisable.

3. If patient’s supportive teeth are not strong enough to bear forces offered by FPD, then it has poor prognosis.

4. If RCT of supportive teeth fails and patient come back with pain in supporting tooth then whole FPD has to be removed and placed again.

5. If FPD is not fixed properly or some space is left while fitting then food lodgment continues and results in bad smell from mouth.

What are the steps to be taken care of after placing partial denture in mouth?

• Patient should maintain proper oral hygiene.

• Regular flossing is advisable.

• Patient should not bite hard from artificial teeth.

• Regular follow up checkups are recommended.

• Always put RPD in water after removing from mouth.

• Do not wash RPD with bleaching agent or detergent. Special cleansing agents are available to wash RPD.

What is complete denture?

When all the teeth are missing (edentulous) then complete denture is fabricated. Below are images of maxillary complete denture and mandibular complete denture. They vary in shape according to the shape of oral cavity.

How many teeth are present in complete denture?

Normally 28 teeth are present in Complete Denture, but sometimes we have to miss second premolar in case of small jaw size.

How much time is required to fabricate complete denture?

At least 1 week time is optimum for complete denture

Why dentist ask to carry old photo while adjusting teeth in Denture?

After having a look of old photograph Dentist gets an idea of the shape and setting of teeth. To minimize the patient compliance and to have a natural look old photograph is mandatory.

Can patient start immediately eating with complete denture?

First patient should start with liquids and then with soft food and then finally with normal daily routine food items. Surrounding soft tissues and tongue takes time to adjust with new thing in mouth. May be for few days patient find some speech problem as well. Once you oral cavity get use to denture then everything gets fine.

Can patient brush complete denture?

Yes, patient should daily brush the teeth of denture in a same way like his natural teeth. After every meal cleaning is mandatory. Special cleaning tablets are available which are used to remove satins from the denture.

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Dental Plaque and Gingivitis

What is plaque?

Plaque is a sticky white colored layer which forms on the tooth surface. This layer is rich in bacteria which gets stick on teeth and slowly starts eroding the upper layer of teeth (Enamel).

When it get form on our teeth?

When you eat any sweets or drink any soft drinks with sugar, the bacteria release acids that attack your tooth enamel. Plaque formation starts after every food intake.

Should we brush after every meal?

Yes, brushing is advisable after every meal to get rid of plaque.

Does Plaque gives rise to caries?

Yes, continuous attack of bacteria makes the tooth surface look yellow and slowly it turns to black which is an initiation of caries. Some caries are superficial which does not progress if proper brushing is done.

Is brushing the only solution to remove plaque?

Apart from brushing following are the other methods:

• Regular flossing

• Mouthwash rinses

Does plaque formation also lead to bad breath?

Yes, plaque formation leads to bad breath.

What are the consequences of plaque formation?

What is gingivitis?

Inflammation of gum tissue is known as Gingivitis.

What are the causes of Gingivitis?

Major causes of gingivitis are:

• Plaque deposition on teeth: It is one of the major causes of gum bleeding and inflammation, if proper brushing and flossing is done then plaque does not proceed to Gingivitis.

• Pregnancy: In pregnancy most common condition is gingivitis also known as pregnancy gingivitis. Due to hormonal changes and frequent vomiting, nausea gums swell and becomes red. Dental checkup during pregnancy is advisable, though treatment can be delayed till child birth.

• Diabetes: In diabetic patients Gum bleeding is very common as their immune system becomes weak and not capable to fight against bacteria causing disease.

How can you prevent Gingivitis?

Steps to prevent Gingivitis are:

• Regular flossing

• Brushing twice a day

• Mouthwash rinses twice a day

• Regular dental checkups and cleaning of teethe.

What is the treatment of Gingivitis?

Gingivitis can be treated by

• Deep Scaling beneath the gums is done to clean underlying calculus and plaque.

• Curettage: Curettage is the process in which soft tissue lining is removed to eliminate diseased tissue as shown in the video.

Dental Health Care for Children

Dental or oral health care of children starts from the day when baby is born. Few simple steps which can contribute to healthy teeth are:

1. Always wipe off gums after feeding the baby.
2. Try to avoid bottle feeding as far s possible.
3. Never allow baby to sleep with milk bottle in his mouth.
4. Once your child starts going to play school, teach him how to brush. Brushing regularly with fluoride toothpaste avoid caries.
5. Teach him good oral habits. For example, rinsing after every meal and brushing twice a day.
6. Avoid thumb sucking habit. Teeth start protruding outside if this continues for a long time.
7. Avoid sweets and sugary snacks in between the meal, this can lead to cavities.
8. Young children tend to swallow toothpaste, so take proper care and do not allow them to swallow as toothpaste contains fluoride.
9. Regular dental checkups are useful to have a proper record of baby’s teeth.
10. During teething always take care of dental hygiene. Tethers or gum soothers used should be properly washed and clean.