DENTAL IMPLANTS

A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants may be an option for people who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

TYPES OF DENTAL IMPLANTS

• Endosteal (in the bone): This is the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth. This type of implant is generally used as an alternative for patients with bridges or removable dentures.
• Subperiosteal (on the bone): These are placed on top of the jaw with the metal framework's posts protruding through the gum to hold the prosthesis. These types of implants are used for patients who are unable to wear conventional dentures and who have minimal bone height.

Before dental implant

After dental implant

ARE YOU A CANDIDATE FOR DENTAL IMPLANTS?

The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own. Your dentist and periodontist will work together to make your dreams come true.

WHAT IS A DENTAL IMPLANT PROCEDURE LIKE?

This procedure is a team effort between you, your dentist and your periodontist. Your periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs.

• Replacing a single tooth  If you are missing a single tooth, one implant and a crown can replace it.
• Replacing several teeth  If you are missing several teeth, implant-supported bridges can replace them.
• Replacing all of your teeth   If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them.
• Sinus augmentation  A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.
• Ridge modification   Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

WHAT CAN I EXPECT AFTER RECEIVING A DENTAL IMPLANT?

As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply!

After treatment, your periodontist will work closely with you and your dentist to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.

Symptoms of Bone Spicules after a Tooth Extraction

Bone spicules often occur after having your wisdom teeth removed, but can occur with the extraction of any of your teeth. More often than not, they work themselves out and are fine within a few weeks or sometimes months, but on occasion they may become infected or cause you a great deal of pain. The symptoms are fairly easy to identify in most cases.

When you have had your wisdom teeth removed, you may find that within a few days or even weeks, there are bony bumps that you can feel with your tongue. These are bone spicules. For the most part, they are simply a little bit annoying, but can be very tender and painful if they become infected. Another possible symptom is that the bone fragment actually does stick out of the gums. When this happens, it can lead to a great deal of pain. It can irritate the inside of your mouth, making it very uncomfortable to eat, talk, or even to live life normally.

Also make sure to watch for signs of infection. If there is any swelling at the site, you will need to see your dentist or oral surgeon. If you have a lot of pain that will not go away, you will need to seek attention for the problem. It is very important to get these things looked at as soon as they start to cause problems, as infections could lead to much more serious problems.

If you feel either of these symptoms and you have had a tooth or some teeth recently extracted, it is important to see your dentist or oral surgeon immediately. While many of these problems do take care of themselves, there are those that do not, and it is better to be safe than sorry. On occasion, your oral surgeon may be able to file down or remove the bone spicules so that you can go on with your life more easily and with less pain.

It is important to see your dentist or oral surgeon if there are any complications at all with any tooth extraction, and bone spicules are just one of many complications that can occur. The best thing that you can do is to work closely with your oral surgeon or dentist both before and after any kind of tooth extraction so that you can minimize. It can also alleviate any worries that you may have because your doctor can let you know any possible side effects.

Scaling and Root Planing

What Is It?

Scaling and root planing is the most common and conservative form of treatment for periodontal (gum) disease.

Scaling is the removal of calculus (commonly called tartar) and plaque that attach to the tooth surfaces. The process especially targets the area below the gum line, along the root.

Plaque is a sticky substance, full of bacteria, that forms on teeth. When plaque hardens over time, it is called calculus.

Plaque is more likely to stick to rough surfaces. For this reason, the root surface is made smooth in a process called root planing. Root planing removes any remaining calculus and smooths irregular areas of the root surface.
                                       

What It's Used For

Bacteria cause periodontal disease. Plaque and calculus provide an irregular surface that allows these bacteria to attach easily. Scaling and root planing are done to remove the plaque and calculus. For early stages of the disease, this treatment may be all that is needed to get the condition under control. This is especially effective with gingivitis. With more advanced gum disease, scaling and root planing may be the first step before surgery.

Preparation

For some patients, scaling and root planing can cause discomfort. A local anesthetic may be used to numb the portion of your mouth that is being worked on.

How It's Done

Scaling and root planing are done with a combination of ultrasonic scalers and hand instruments. Ultrasonic instruments are electric or air-powered. They have two components:

1. A relatively dull metal tip that vibrates at a very high frequency and "knocks" plaque and calculus off the tooth.
2. A water irrigation system that cools the tip and helps to flush out debris from around the teeth

Hand instruments are not powered. They have cutting edges that your dentist or hygienist uses to chip away plaque and calculus.
These instruments come in various shapes and sizes. Different instruments are used for different teeth, and even for different surfaces of the same tooth.
Typically, ultrasonic instruments are used first to remove large deposits of plaque and calculus from the crowns and roots of the teeth. Hand instruments called scalers and curettes are then used to remove any remaining material and make sure that the tooth surface is clean and smooth. When working under the gum line, your dentist or hygienist cannot see the plaque or calculus. He or she will rely on the sense of touch to feel for roughness on the root surface.
Sometimes, scaling and root planing can be completed in one visit. This usually is possible if you have gingivitis, the earliest stage of gum disease. However, if you have periodontitis, multiple visits are usually needed. The periodontist typically will do one-quarter of your mouth (a quadrant) at each visit.

Follow-Up

For two to three days after the treatment, you may have some soreness and be sensitive to hot and cold temperatures. Over-the-counter pain relievers can help.

You may be asked to use an antiseptic mouth rinse after scaling and root planing. This is especially likely if your gums are very sore. However, you should continue brushing and flossing as usual. You can expect some minor bleeding in the first days after scaling and root planing. This usually stops within a week.

Risks

Treating periodontitis decreases gum inflammation. It also eliminates periodontal pockets, which can trap plaque. Therefore, if treatment is successful, the swelling will be gone and your gums will shrink or recede.

The extent of shrinkage depends on the initial depth of the pocket and the severity of periodontitis. The more severe the disease, the more your gums will recede after successful therapy. As a result, some part of the root is exposed. This makes the tooth look longer. It also will be more sensitive to heat and cold. To prevent root cavities, your dentist may prescribe a fluoride-containing gel. It's also important to control plaque.

Pulp Polyp

The pulp polyp, also known as chronic hyperplastic pulpitis or proliferative pulpitis, is an uncommon and specific type of inflammatory hyperplasia that is associated with a nonvital tooth.

Pulpal diseases are broadly divided into reversible and irreversible pulpitis and are based on the ability of the inflamed dental pulp to return to a healthy state once the noxious stimulus has been removed. In the case of the pulp polyp, the disease process is irreversible. In contrast to most cases of irreversible pulpitis, the pulp polyp is usually an incidental finding that occasionally mimics reactive and neoplastic diseases of the gingiva and adjacent periodontium.

Medical Care

• Treatment of a pulp polyp in a permanent tooth includes either root canal therapy or extraction of the tooth.
• The more conservative pulpotomy treatment has been successful in selected cases when only the coronal pulp is affected.
• In immature teeth with incomplete root development, placement of an apical barrier and strengthening of the thin root with composite resin may be indicated prior to root canal treatment.
• Pulp revascularization of an immature permanent tooth is another new treatment approach that results in the formation of vital pulpal tissue.
• The tooth requires a full-coverage crown following endodontic therapy.
• Prior to extensive restorative treatment, the risks and benefits of this treatment, including the long-term prognosis of the affected tooth in a young child, needs to be thoroughly explained.

Surgical Care

• The affected tooth is extracted when primary teeth are involved or when minimal tooth structure in permanent teeth is available for restoration or the alveolar bone support is unfavorable.
• A surgical crown lengthening procedure may be needed to prepare a tooth for a full-coverage crown.
• Healing is uneventful in most cases.

Medication Summary

Systemic medications are not recommended for the management of this lesion. Antibiotics are not prescribed for the treatment of the pulp polyp, despite a bacterial component. However, an antibiotic paste mixture is used within the canals of the infected tooth when the revascularization process is performed for the treatment of the nonvital tooth.

Further Outpatient Care

• Periodic dental examinations are recommended to monitor the success of the root canal therapy or to intercept problems associated with the premature loss of a tooth.
• Orthodontic treatment may be needed to restore the occlusion.
• If a tooth is extracted, either a dental implant or fixed dental prosthesis (bridge) is a treatment option to restore function and aesthetics.

Complications

• Space discrepancy from crown destruction or premature loss of a tooth may result in a crowded malocclusion, supereruption of an opposing tooth, or the impaction of a succedaneous tooth.
• Without definitive treatment, some of these long-standing, nonvital teeth may progress to symptomatic disease, including periapical inflammatory disease and (rarely) cellulitis and osteomyelitis of the jaws.

Prognosis

• The prognosis is excellent. No risk for recurrence exists once definitive treatment has been rendered.

Patient Education

• Reinforce the importance of routine oral health care to prevent the development of deep carious lesions that may cause inflammatory pulpal disease and more serious sequelae.

Dental Abrasion

                              

It may seem logical that the harder you brush your teeth, the cleaner they will be. But applying too much pressure can actually weaken the outer layers of the tooth structure. This condition, called dental abrasion, can occur when any foreign object causes friction against your teeth and gradually wears away the enamel on the surface.

If you've noticed the signs of dental abrasion, small v-shaped notches near the gums, it may be time to review your oral hygiene regimen with your dentist or dental hygienist. Don't worry, you won't need to retire your toothbrush altogether.

Your dentist or dental hygienist can suggest proper techniques to restore and protect a healthy smile.

Cause and Effect

Strenuous brushing is the most common culprit, but any object that repeatedly rubs against your teeth can wear them down. Using toothpicks improperly can contribute to dental abrasion, as well chewing on fingernails, pencils or other objects.

In some cases, ill-fitting retainers or partial dentures can also be to blame. Believe it or not, the type of toothpaste you use may even be a factor as some formulas are more abrasive than others.

While protecting the appearance of your teeth may be the most obvious reason to prevent and treat dental abrasion, weakened enamel can also contribute to more serious dental problems over time. Many patients experience increased tooth sensitivity to heat and cold. In addition, without its protective outer layer, a tooth may be more susceptible to infection. In advanced cases, when dental abrasion is left un diagnosed and/or untreated, a tooth may need a tooth filling or tooth extraction.

Dental Abrasion Treatment: What You Should (and Should Not) Do

While there are multiple ways to treat dental abrasion, it's always better to prevent dental issues before they start. You can start your dental treatment by following a few simple guidelines:

- Always use a soft-bristled toothbrush.
- Ask your dentist for tips on how to brush properly, and avoid brushing too hard.
- Refrain from chewing on toothpicks and pencils or biting your nails.
- Make sure removable dental appliances fit properly and have them checked on a regular basis.
- Don't forget to schedule regular dental visits to give your dentist a chance to detect any problems early on.

If any portion of your tooth surface has begun to wear away, your dentist may be able to correct the problem with fluoride treatment. Depending on your needs, he or she may also use dental bonding or dental fillings to replace the lost tooth structure. Also be sure to ask your dentist about air abrasion, which is the newest method of cleaning out tooth decay -- while also relieving dental anxiety.

The most important step you can take in abrasion treatment and prevention is to see a dental professional on a regular basis and ask questions about your hygiene regimen.

Pericoronitis

Why are Wisdom Teeth/3rd Molars most often Extracted often by Dentists

Wisdom Tooth or the 3rd Molar is the most commonly Extracted tooth due to pathological reasons by Dentists. Wisdom Teeth or 3rd molar teeth are being considered as vestigial parts of the human body as with evolution over decades it is seen that in some people 3rd molars are completely absent not even tooth buds are seen, and in others the jaw size decreasing constantly is the main reason for the lack of space for the 3rd molars to erupt into Occlusion and leading to Impaction.

There are various Steps in local examination to diagnose Impaction and the type of Surgery required to remove it. For example Wharf's Assesment of Impacted 3rd molar. After Reading this post you will understand Why a dentist prefers removal of 3rd molar and asks you to get it extracted.

Reasons for 3rd Molar Extraction:

Here are some reasons why 3rd Molar is the most commonly impacted tooth in the Oral cavity and also why Dentists persist of getting it removed every time you visit a dentist.

Most commonly impacted tooth:

We all know that 3rd molars are the most commonly impacted teeth in the oral cavity after them come the Canines, but because of Impaction the Other teeth in the oral cavity are affected mostly 2nd Molar which is adjacent and due to the position of the 3rd molar it is most commonly affected. If there is Mesial Impaction of 3rd molar there is a trench formed between the crowns of 3rd and 3nd molar which will lead to food accumulation and if there is horizontal impaction the crown of 3rd molar will impinge on the root of 2nd molar leading to resorption of the Root. Hence for this main reason 3rd molar is the most extracted tooth in Oral Cavity.

Lack of Space in the dental arch:

Due to constant evolutionary changes to living beings the change in living conditions and the lack of requirement of that extra tooth to chew and to get good appearance the Jaw Size of Humans is decreasing and this is leading to loss of Space in Jaw for the 3rd molar to erupt which takes place after the growth stage is finished in Boys/Girls.

Lack of Space preventing eruption of 3rd molar

Lack of Space due to decrease in Jaw size is the Major reason for Impaction of 3rd molar which in turn leads to Extraction of the impacted 3rd molar.

Unwanted Location of the tooth:

Due to lack of Space and the tooth having no place to go the tooth is seen to get stuck in various unwanted locations which are classified as Mesial, Distal, Horizontal, Vertical Impaction and this is the cause of various conditions like, Caries, Cysts, Pericoronitis etc and the only solution is removal of this harmful tooth. Sometimes the Root of Impacted 3rd molar most commonly impinges on the Inferior or Dental Alveolar Nerve canal, so relation of third molar to Dental/Inferior alveolar canal is important in diagnosing and deciding the treatment plan.

Difficult to clean and prevent caries:

Due to the location of 3rd molar in the far end of the Oral cavity and at many times because of its odd locations makes it very difficult to clean and remove Food and Debris from accumulating which will lead to Caries to the Impacted tooth and along with it the adjacent 2nd Molar as well. In Mesial impaction because of the trench formation between 3rd and 2nd molar Caries is seen in both 3rd molar and the distal aspect of 2nd molar, so to protect the 2nd Molar removal of 3rd molar is compulsory.

Common reason for Pericoronitis:

Pericoronitis is the most common complain in 3rd molar impactions and the most common reason why people come to know that they have impacted tooth and visit the Dentist. Pericoronitis is nothing but inflammation of the Soft tissue covering the crown of the Impacted 3rd molar because it constantly gets impinged between the 3rd and 2nd molar crowns. 

Fillings - Dental

Your dentist may use several methods to determine if you have tooth decay, including

• Observation — Some discolored spots on your teeth may indicate decay, but not all of them. Your dentist may use an explorer, a metal instrument with a sharp tip, to probe for possible decay. Healthy tooth enamel is hard and will resist pressure by the explorer. Decayed enamel is softer. The instrument will stick in it slightly. Explorers must be used with caution. Pressing too hard with an explorer can damage a healthy tooth.
• Cavity-detecting dye — This can be rinsed over your tooth. It will stick to decayed areas and rinse cleanly from healthy ones.
• X-rays — X-rays can help your dentist see decay that doesn't show on the surface. However, X-rays are often not accurate in detecting smaller cavities on occlusal (top) surfaces. Current fillings or other restorations also may block the view of decay.
• Laser fluorescence cavity detection aids — These small wands measure changes caused by caries (tooth decay). They are especially useful for pit and fissure areas.

Tooth Sensitvity

Tooth sensitivity is a common name for dentin hypersensitivity or root sensitivity. If hot, cold, sweet or very acidic foods and drinks, or breathing in cold air, makes your teeth or a tooth sensitive or painful then you have sensitive teeth.

Is Tooth Sensitivity Common?
Tooth sensitivity is very common and it has been estimated that approximately half the population experiences tooth sensitivity. Tooth sensitivity can come and go over time.

Why does Tooth Sensitivity (Dentin Hypersensitivity) Happen?
Tooth sensitivity is usually caused by dentin on root areas exposed due to receded gums or periodontal disease. Receded gums are very common and up to four fifths of people have gum recession by the time they are 65.

When the root of a tooth becomes exposed it does not have a layer of enamel like the crowns of your teeth. Instead the roots have a very soft covering called cementum, which once lost leaves the dentin of the root exposed. Overzealous brushing or using a very abrasive toothpaste can also cause abrasion of the tooth's enamel surface and expose dentin. A very acidic diet – for example a diet with a lot of citrus food, pickles or sodapop — can cause tooth erosion and dissolve the tooth surface, exposing the dentin. Bulimia and GERD can also result in dental erosion and sensitivity due to acid in the mouth.

Keys to Controlling Bad Breath

If you're serious about learning what's causing your bad breath, consider scheduling an appointment with your dental professional. Given your full medical and dental history along with an oral examination, your dentist should be able to identify the culprit. The causes of bad breath are numerous and include certain foods, alcohol or cigarettes, poor oral hygiene, periodontal disease, diabetes, dry mouth, sinus or throat infections, lung infections or abscesses, kidney/liver failure, gastrointestinal issues and severe dieting.

Treatment of Bad Breath
It is important to conduct thorough oral hygiene at home twice daily utilizing tooth brushing with a fluoride antibacterial toothpaste and flossing to remove food debris and plaque on teeth, bridgework and implants, and brushing the tongue to remove odor-causing bacteria. A published study reported that tongue and tooth brushing in combination with dental flossing significantly decreased bleeding of the gum tissue over a two week period of time as well as reduced bad breath¹. Another clinical study conducted by the University of Buffalo dental researchers confirmed that brushing twice a day with an antibacterial toothpaste and using a tooth brush with a tongue cleaner can eliminate bad breath ².

Bad Breath

Bad breath, also known as halitosis, is breath that has an unpleasant odor. This odor can strike periodically or be persistent, depending on the cause. In many people, the millions of bacteria that live in the mouth (particularly on the back of the tongue) are the primary causes of bad breath. The mouth's warm, moist conditions make an ideal environment for these bacteria to grow. Most bad breath is caused by something in the mouth.

Some types of bad breath, such as "morning mouth," are considered to be fairly normal, and they usually are not health concerns. The "morning mouth" type of bad breath occurs because the saliva that regularly washes away decaying food and odors during the daytime diminishes at night while you sleep. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor.