Sodium Hypochlorite Accident

Oct 16, 2018
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Sodium Hypochlorite IncidentSodium Hypochlorite Incident

Sodium hypochlorite goes in the periapex during irrigation when – Short roots open apex, Over instrumented apex straight roots.

USE OF FRONT VENTED NEEDLES

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Error in length determination.

How to identify or differentiate sodium hypochlorite accident from pulpal or periapical pain?

Sudden pain immediately after irrigation in an otherwise painless tooth.

Sudden oozing of blood from an otherwise cleaned canal swelling immediately after irrigation.

Colour changes in outer skin related to the tooth PRECAUTIONS:

ALWAYS USE A SIDE VENTED NEEDLE for irrigation

Keep the length of the irrigating needle 2mm short of working length inside the canal (correct length determination using apex locator important)

Do not push the irrigant with pressure (the needle should be loose in the canal, not locked) dispense the irrigant very slowly.

Focus on the irrigation.

How to manage a patient with sodium hypochlorite accident.

Reassure the patient and tell them the truth, “It is just medicine gone beyond your tooth. You will be fine soon.”

Immediately irrigate with abundant saline continuously.

Local anesthetic solution with adrenaline can be used as a first irrigant, if blood oozing from the canal.

If swelling present, give open dressing, recall after 12 hours, re-irrigate and give closed dressing advice corticosteroid at least for 3 days. (control inflammation)

Advise painkillers, if pain is terrible Tramadol may be prescribed.

Mild antibiotics are prescribed (sodium hypochlorite if goes, in large quantities, periapically may cause tissue necrosis making it susceptible to infection)

Advise ice pack application for a day; recall and reassure.

It may take 4 days to 3 weeks for complete recovery depending on severity. Prevention is always better than cure.

My patient immediately post sodium hypochlorite accident with upper left molar.

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DISCLAIMER : “Views expressed above are the author’s own.”

Are right angles, actually right?

Oct 6, 2018
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Are right angles, actually right?

One of my close friend Dr Mehta is an expert in the field. Keeping patient satisfaction being his only motto, he has established a very good practice in a short time. Dentistry is a laborious field which requires highly accurate preparations and a lot of hard work to establish a good practice. This includes sitting for a longer duration of time in a single position and working to achieve that highly skilful preparation which dentistry demands. Patients are highly satisfied with Dr Mehta’s treatment and friendly disposition, but Dr Mehta, in turn, is suffering from occupational problems, like back pain.

Unlike other fields, the problem encountered by a dentist is maintaining an ergonomic posture without compromising accessibility which is very difficult at times. The results being that majority of dentists suffer from lower back pain at one or the other time during their practice. Sitting for long durations of time alone has a detrimental effect on spine when compared to standing, but in a field like ours which demands sitting for longer periods throughout the day, what is the best way to sit?

Since the beginning of professional dentistry in eighteenth century, a lot of things have changed including instrumentations, concepts, techniques of working etc., one that however has remained same since the beginning of sit down dentistry is the posture of a dentist attending to patients. Most of us sit straight with all the major joint at right angle. T, this posture was considered to be proper until now, but their cent research suggests that it can cause detrimental effects on joints, discs and ligaments.

Problem:

Practising with all the major joints at right angle (Figure 1) for a longer period of time along with other contributing factors can lead to Cumulative Trauma Disorder (CTD).

CTD is defined as work-related pain or injury to the musculoskeletal system resulting from microtrauma which accumulates at rates faster than the body can repair.

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Signs and symptoms:

  • Decrease strength and range of motion
  • Pain, stiffness, swelling or inflammation
  • Numbness or tingling in hands or feet
  • Shooting or stabbing pain in arms or legs

Solution:

Our posture should be such that it provides optimal working conditions along with physical comfort so that we as the dentist can perform the whole procedure accurately. For a posture to be balanced it does not necessarily require to be rigid.

To be classified under safe working posture there should be:

  • 0-20 degrees of neck flexion
  • Hip angle of 105 to 125 degrees
  • The seat of the operating stool should be slightly tilted forward to about 5-15 degrees.

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Advantages:

  • Chairs with a tilting seat leading to hip angle of 105 degrees rather than 90 degrees helps maintain a low back curve, decreases disc pressure, enables closer positioning of patient and may help reduce low back pain.
  • It also minimizes strain on other spinal discs, muscles and ligaments while working.
  • An ergonomic posture will help reduce stress and eliminate many potential occupational associated injuries due overuse of certain muscles and bad posture.

Conclusion:

In order to render appropriate patient care, it is also necessary for a dentist to be mindful of their own health and well-being, by working in a comfortable posture guided by natural laws of human body anatomy.

To all my dental artists out there!!! Keep giving the world all your positive energies and pretty smiles but don’t get too busy to forget to take care of your own self.

Regards

Dr. Zainab Rangwala

References:

  1. Hedman T, Fernie G. mechanical response of lumbar spine to seated postural loads. Spine 1997;22(21):2571-4.
  2. Bethany Valachi (PT, MS, CEAS). Practice Dentistry Pain-Free.

PHOTOS: POSTUREDONTICS LLC.

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DISCLAIMER : “Views expressed above are the author’s own.”

You choose: Private or group practice?

Jun 21, 2018
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You choose: Private or group practice?You choose: Private or group practice?

You choose: Private or group practice?

The practice of dentistry is chosen based on an individual’s personality and goals. The dentistry practice in a group has the wide variety of conceptual configuration, different dentists and specialists. Whether you decide to practice in group or as an individual, there will be challenges, just that the types of challenges may differ. Dental practices consist of three basic types one is private solo practice, solo practice with facility sharing and group practice. The challenges faced by each practice has its own pros and cons depending on various factors.

Private practice

A private practice is a healthcare professional service usually by a medical physician or dentist, setting up practice by a practitioner who is independent of external policy control.

Private practice in dentistry

Advantages

  • They can provide and render services as required by the demand.
  • They have an option to increase or decrease the treatment modality fees.
  • They can locate their private practice where they decide.
  • Being own boss allows them flexibility to choose the number of hours they work.

Disadvantages

  • The overhead costs for staff, assistants, utilities and maintenance of equipment can’t be shared.
  • In the event of being unable to practice, they may not have a fallback plan for another source of income.

Note in a selection of place

  • Mindful decision because the place cannot be changed frequently.
  • Awareness of the number of dentists practicing in the vicinity.
  • Assessing the surrounding dental colleges in order to get support if required.
  • Assessment of demographics in the locality and surrounding areas.

Note in a selection of location

  • Choosing a busy area like a marketplace, heart of the city, streets which are on the main road may make it more popular and increase the chance of walkins.
  • A location near railway station and bus stand may make the clinic more accessible.
  • Areas of commercial trends especially office hours to support office goers.
  • Residential areas are also an option to cater to the elderly, retired individuals, housewives and children.
  • An important element to be considered which will resonate is to be safe for the doctors and patients.

Note in the selection of building

The clinic must preferably be on the ground floor, if it is in the higher floor, lifts, parking must be there for individuals to reach the clinic. There should also be security, good ventilation with proper electrical, sewage and drainage systems.

Ideas for setting up a dental clinic

First and foremost aspect is financial assistance, aware of the rate of interest and repayment terms and schedules, always buy dental products and equipment from best manufacturers. Always associate with good service network individuals, know the schemes, discounts, combo and promotional offers. Assess and know the guarantee and warranty for equipment and product.

Ideas for designing a dental clinic

Budget, manpower and space constraints, avoid dark colours with soft lighting environment which may soothe the body and mind. It is always better to take the support and service of the architect, interior designer and personal indemnity insurance with all statutory licenses and take initiative for the option of insurance coverage.

Management of dental clinic:

  • In the initial stage beginning and managing both are important.
  • Solo and group practice.
  • On-call specialists and cleaner.
  • Dental assistant, full-time receptionist.

Aspects and role of receptionist

The receptionist should be confident with pleasing personality and good looks. They must be trained to handle, manage patient appointments, maintain correct record keeping, scheduling the appointments. They must have the knowledge of computer skills like sending and receiving emails, collection of payments, maintain book of accounts, do payments to agencies on time and also stock maintenance.

 Aspects and role of Dental assistant

The role of dental assistant is to keep all the instruments ready for dental work. They must have adequate knowledge of handling equipment and instruments. They must be aware of dispensing materials and assist minor procedures like alginate mixing, developing of X-rays. The dental assistant service enhances productivity, reduces the stress of dentist and maintain sterilization protocols.

The responsibility of opening up a clinic 30 minutes prior to the first appointment and detail explanation must be given about investigations and diagnosis. It is better to inform the patient about the treatment cost and mode of payments. Association of the best laboratory technician and noting to take care of the time proper management and disposal of waste.

Strategies for marketing:

Educate patrons about the importance and value of dental health by creating more awareness with educational leaflets and posters.

There are two types of marketing:

External marketing

The initiative is taken to remain focused in the outward environment and activities are done in order to attract more patients such as free dental check-up campaign in schools and individuals working in private companies. Awareness about dental health is also done through lectures in social organisation, clubs, senior citizen groups and writing articles in magazines and newspapers. Free dental check-up programmes have been organised in a clinic and offered discount concessional treatments for specific target group.

 Internal Marketing

The action taken for marketing is within the dental setup which affects the current patients like making and creating brochures/informative booklets, videotapes of advanced trend treatment modalities such as implants, procedures of smile designing, teeth whitening, full aesthetic ceramic crown, surgical procedures, advanced RCT treatment procedures.

The successful programme must result in improved oral health habits among individuals who undergo and henceforth create a way for attracting many new patients. The overall effort is to make patient aware of the procedures and also can be helpful for individuals or others whom he or she can refer. The dental health emphasis is given mainly to comprehensive treatment. The effective way of marketing is when an existing patient is fully satisfied with the quality of treatment procedures undergone and recommends that to his family members, friends and acquaintances about that dentist. It is always best to treat each and every patient with commitment and dedication, and also being a practitioner better to enhance the dentistry skills by updating the advancing trends of the field.

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DISCLAIMER : “Views expressed above are the author’s own.”

Bleeding on punching in the nose … Thoughts on bleeding on probing

Jun 15, 2018
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Bleeding on punching in the nose ... Thoughts on bleeding on probingBleeding on punching in the nose ... Thoughts on bleeding on probing

Bleeding on probing is also known as bleeding gums or gingival bleeding. It is a term used by dentists and dental hygienists when referring to bleeding that is induced by gentle manipulation of tissues at the depth of the gingival sulcus. Bleeding on probing, abbreviated as ‘BOP’ is an objective, easily assessed and widely used criterion to diagnose gingival inflammation.

The two earliest signs of gingival inflammation are:

  • Increased gingival crevicular fluid production rate
  • Bleeding from gingival sulcus on gentle probing

Bleeding on probing appears as a change in colour or other visual signs of

inflammation. Gingival bleeding on probing indicates an inflammatory lesion

both in epithelium lining of the sulcus and in the connective tissue. The blood

comes from lamina propria after ulceration of the lining.

Peer-reviewed dental literature thoroughly establishes that bleeding on probingis a poor positive predictor of periodontal disease, but conversely, lack ofbleeding is a strong negative predictor. The clinical interpretation of thisresearch is that BOP presence may not indicate periodontal disease, the

continued absence of BOP is a strong predictor (approximately 98%) of

continued periodontal health.

Local Factors Associated With Bleedingon Probing

There are many possible causes of gingival bleeding. The main cause of gingival bleeding is the formation and accumulation of plaque around the teeth due to improper brushing and flossing of teeth. The hardened or calcified form of plaque and calculus provides an ideal surface for further plaqueformation. Contributing factors to plaque retention may lead to gingivitis and ultimately lead to gingival bleeding on probing. The contributing factors include caries, malpositioned teeth, mouth breathing, partial dentures, lack of attached gingiva and fixed orthodontic treatment.

Chronicand Recurrent Bleeding

Most common cause of gingival bleeding is gingival inflammation. Bleeding is chronic and provoked by mechanical trauma. Bleeding may occur from tooth brushing, toothpicks and food impaction. It may also occurby biting into solid food such as apples. Traumatic injuries such as laceration of gingiva by toothbrush bristles during aggressive tooth brushing or by sharp pieces of hard food can cause gingival bleeding even in the absence of gingival disease. Gingival burn from hot food and chemical increase the chances of gingival bleeding. Spontaneous bleeding or bleeding on slight provocation can occur in Acute Necrotizing Ulcerative Gingivitis (ANUG).

Histological evaluation has revealed that in early stages of gingivitis, cytokines are responsible for connective tissue breakdown. Matrix metalloproteinase also plays a vital role in tissue breakdown. Histopathologic alterations that result in abnormal gingival bleeding include dilatation & engorgement of the capillaries, & thinning or ulceration of the sulcular epithelium. After the vessels are damaged & ruptured interrelated mechanisms induce hemostasis. Vessel wall contract, blood flow diminishes, blood platelets adhere to the edges of tissue and a fibrous clot is formed, which contracts & results in approximation of edges of the injured area. Bleeding recurs when the area is irritated. In case of moderate or advanced periodontitis, the presence of bleeding on probing is a sign of active tissue destruction. 

Systemic Factors

Hemorrhagic disorders in which abnormal gingival bleeding is encountered include:

  • Vitamin C deficiency (scurvy): Interdental & marginal gingiva is bright red with swollen, smooth and shiny surface. In fully developed scurvy, gingiva becomes boggy, ulcerated and bleeds spontaneously.
  • Platelet disorders (thrombocytopenic purpura): There is an abnormal reduction in number of circulating blood platelets so patient develops focal haemorrhage into tissue & organs, including skin & mucous membrane.
  • Vitamin K deficiency: It is involved in prothrombin synthesis. It also regulates the level of factor VII, IX & X (proconvertin, christmas factor & stuart-prower factor, respectively). Hence, its deficiency leads to gingival bleeding.
  • Other coagulation defects:
    1. Haemophilia:It is characterized by prolonged coagulation time & haemorrhagic tendencies. Gingival haemorrhage in such cases may be massive & prolonged.
    2. Leukaemia:There is progressive overproduction of white blood cells which usually appear in circulating blood in an immature form. Oral manifestations are gingivitis, gingival hyperplasia, haemorrhage & ulceration of the mucosa.
    3. Christmas disease:It is also known as Haemophilia B, in which there is deficient level of coagulant factor IX (Christmas factor).
  • The effect of hormonal replacement therapy, oral contraceptives, pregnancy & the menstrual cycle are also reported to affect the gingival bleeding.
  • Diabetes:Marked inflammation noted in diabetic patients affects both epithelium & connective tissue which leads to destruction of reticulin fibers. The low immunity also makes them susceptible to opportunistic infections like candidiasis.
  • Medications: Anticonvulsants, antihypertensives & immunosuppressants are well known to cause gingival enlargement and increases the susceptibility of gingival bleeding.

Diagnosis

In order to determine the periodontal health of a patient, the sulcular depths of gingiva needs to be recorded followed by observation of any bleeding on probing. This is often accomplished with the use of a periodontal probe. A periodontal probe is a calibrated probe used to measure the depth and determine the configuration of a periodontal pocket. The insertion of probe to the bottom of the pocket elicits bleeding if the gingiva is inflamed & the pocket epithelium is atrophic or ulcerated. The probe is carefully introduced to the bottom of the pocket for bleeding test & gently moved laterally along the pocket wall. Sometimes bleeding appears immediately after removal of the probe; other times it may be delayed for few seconds. Therefore, recheck for bleeding on probing after 30 to 60 seconds.

An examination to rule out the systemic factors contributing to gingival bleeding helps to formulate the appropriate patient management protocol. Additional corresponding diagnosis tests to certain disease may be required. This includes oral glucose tolerance test for diabetes mellitus, blood studies, human gonadotrophin levels for pregnancy, radiologic imaging for teeth and jaw bones.

Alternatively, a dental floss may also be used to assess the gingival bleeding index. It is used as an initial evaluation of patient’s periodontal health especially to measure gingivitis. The number of bleeding sites is used to calculate the gingival bleeding score.

Many bleeding indices have been devised; some assess bleeding as simply present or absent, whereas others use grading in an attempt to assess severity of bleeding. The choice of which index to use depends on whether the purpose is an epidemiological survey, a clinical study, diagnosis and treatment. Bleeding may be elicited manually with toothpicks, dental floss and a periodontal probe. A controlled-force probe may be expensive and can cause less trauma and false-positive bleeding from healthy tissues.

There is evidence that smokers have less or delayed gingival bleeding when compared with non-smokers. Therefore smoking needs to be controlled to avoid gingival bleeding. Measurement of gingival bleeding tendency should be an integral part of a comprehensive oral examination. In clinical practice, the use of graded bleeding index is more likely to identify sites that are at risk of further destructive activity. Hence, bleeding indices are good tools for monitoring individual patients both for initial therapy and maintenance.

Bleeding point index

It is used for the evaluation of gingival inflammation. Retract the cheek & place the periodontal probe 1mm into the sulcus or pocket at the distal aspect of posterior tooth in the quadrant for recording the index. Carry the probe lightly across the length of sulcus to the mesial interproximal area on the facial aspect. Wait for 30 seconds & record the presence of bleeding on the distal, facial & mesial surface. Repeat the same for palatal surface. Percentage of the number of bleeding surfaces is calculated by dividing the number of surfaces that bled by the total number of tooth surfaces (4 per tooth) and multiplied by 100. A score of 10% or fewer bleeding points are considered good but 0 is ideal.

Sulcus Bleeding Index (SBI)

Developed by Muhlemann HR and Sen S in 1971. It is a modification of Papillary-Marginal Index of Muhlemann and Mazor ZS.

Scoring Criteria:

  • Score 0: Healthy looking papillary and marginal gingiva
  • Score 1: Healthy looking gingiva, bleeding on probing
  • Score 2: Bleeding on probing, change in colour, no edema
  • Score 3: Bleeding on probing, change in colour, slight edema
  • Score 4: Bleeding on probing, change in colour, obvious edema
  • Score 5: Spontaneous bleeding, change in colour, marked edema

Four gingival units are scored systematically for each tooth include labial, lingual marginal gingival (M units) and mesial, distal papillary gingival (P units). Scores for these units are added and divided by four to determine the sulcus bleeding index.

Gingival Bleeding Index (GBI)

In 1947, Carter and Barnes introduced Gingival Bleeding Index, which records the presence or absence of gingival inflammation. The mouth is divided into six segments and flossed in the following order: upper right, upper anterior, upper left, lower left, lower anterior and lower right. However, 30 seconds is allowed for re-inspection of each segment. Bleeding is recorded as present or absent. For each patient, a gingival bleeding score is obtained by noting the total units of bleeding. Gingival bleeding index by Ainamo & Bay (1975) is performed through gentle probing of gingival crevice’s orifice.

Papillary Bleeding Index

This index was introduced by Saxer and Muehlemann in 1975. A periodontal probe is inserted into the gingival sulcus at the base of the papilla on mesial aspect and then moved coronally to the papilla tip. This is repeated on the distal aspect of the papilla. The intensity of any bleeding is recorded as:

  • Score 0: No bleeding
  • Score 1: A single discreet bleeding point
  • Score 2: Several isolated bleeding points or a single line of blood appears
  • Score 3: The interdental triangle fills with blood shortly after probing
  • Score 4: Profuse bleeding occurs after probing, blood flows immediately into the marginal sulcus

Eastman Interdental Bleeding Index (EIB)

Caton & Polson developed this index in 1985. A wooden interdental cleaner is inserted between the teeth from the facial aspect, depressing the interdental tissues 1 to 2 mm. This is repeated four times and the presence or absence of bleeding within 15 seconds is recorded. Path of insertion should be parallel to occlusal surface. Insertion and removal of interdental cleaner are done four times and then moved on to next interproximal area.

Score = Number of bleeding areas/Total number of areas x 100

Treatment

  • Mechanical plaque removal
  • Corresponding treatments for diagnosed diseases must be given priority
  • Dentists may prescribe soft-bristle toothbrush for brushing
  • Flossing twice a day can prevent building up of plaque interdentally
  • Tobacco should be avoided as it may aggravate bleeding gums
  • Balanced healthy diet must be consumed

If there is persistent continuation of inflammation and bleeding, a prescription of antiplaque rinse would be useful.

Conclusion

BOP indicates the progression of attachment loss. If periodontal treatment is successful, bleeding on probing will cease. BOP is extremely important because it’s a wake-up call that gives the patient an opportunity to avoid a chronic and incurable disease. We have to heed signs and turn the patient around at this point for better health.

 References

  1. Charles R. Craig, Robert E. Stitzel (2004) In Modern Pharmacology with clinical applications (Edition 6). Lippincott Williams & Wilkins. p. 506.
  2. Carranza’s Clinical Periodontology, 9th edition, 2002. page 447
  3. Hayes EB, Gubler DJ. Pediatr Infect Dis J 1992; 11: 311- 317.
  4. Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol 1990 Nov; 17 (10):714-21.
  5. Newbrun E. Indices to measure gingival bleeding. J Periodontol 1996 Jun; 67 (6):555-61.

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DISCLAIMER : “Views expressed above are the author’s own.”

Are dentists contributing to an antibiotic overuse?

May 29, 2018
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Are dentists contributing to an antibiotic overuse?Are dentists contributing to an antibiotic overuse?

Before early 20th century, folk or traditional medicine was widely practiced all over the world to treat infections. The advent of antibiotic Penicillin in 1928 by Scottish Bacteriologist Sir Alexander Fleming revolutionized medical practice. He noticed inhibitory action of a stray mold on a plate culture of staphylococcus bacteria in his laboratory at St. Mary’s Hospital, London. The mold was a strain of Penicillium, P.notatum which gave its name to the famous drug Penicillin. The term antibiotic derives from Greek anti which means “against”+ biōtikos, “fit for life, lively”, which comes from biōsis, “way of life”, and that from bios, “life”. Antibiotics are a class of antimicrobial drugs used to treat and prevent bacterial infections.

Majority of the orofacial infections encountered in dental practice are of odontogenic origin. Most of the odontogenic infections are caused by aerobic and anaerobic bacteria. Viridans streptococci are the most frequently isolated bacteria among the aerobes, whereas Peptostreptococcus, Bacteroides and Prevotella are the most common bacterial species among anaerobes. Therefore, the use of antibiotics in dentistry for therapeutic as well as the prophylactic purpose is quite common. Amoxicillin which belongs to the Penicillin family is the first drug of choice to treat dental infections and to prevent other medical complications. But with 34% of Prevotella species resistant to amoxicillin, alternatives such as amoxicillin/clavulanate, clindamycin and metronidazole are also considered in dentistry.

Patients allergic to penicillin are treated with clindamycin which is the second drug followed by azithromycin and metronidazole. Azithromycin has enhanced pharmacokinetics in encountering the anaerobes involved in endodontic infections. Metronidazole is a synthetic antimicrobial agent, which is bactericidal and most effective against anaerobes. Ciprofloxacin is one of the common drugs used for endodontic infections due to its effective action against oral anaerobes, gram-positive aerobic organisms (Staphylococcus aureusEnterobacter species and Pseudomonas). The first generation cephalosporins like cefadroxil, cephradine provide a broad spectrum antibiotic when gram-positive organisms are suspected to be the causative factor of the infection. Cephalosporin is advisable for delayed-type allergic reactions to penicillin and when erythromycin cannot be used. It is indicated in endodontic practice as they exhibit good bone penetration. Tetracyclines are bacteriostatic antibiotics that may be used alone or in combination with surgical intervention in periodontal conditions.

As per The ICU Book, “The first rule of antibiotics is trying not to use them, and the second rule is trying not to use too many of them.” Antibiotic prescribing may be associated with unfavourable side effects ranging from gastrointestinal disturbances to fatal anaphylactic shock and development of resistance. Antibiotics should be prescribed at correct frequency, dose and duration so that minimal inhibitory concentration is exceeded, in order to prevent the side effects and selection of resistant bacteria. The ideal duration of antibiotic treatment is the shortest cycle capable of preventing both clinical and microbiological relapse. Repeated antibiotic prescriptions and prolonged courses of antibiotics destroy the commensal flora of oral cavity. In addition, longer durations up to 21 days may result in the selection of resistant strains and a reduction in the ability of the oral flora to resist the colonization by harmful microorganisms that are not normal residents, leading to superimposed infections by multi-resistant bacteria and yeasts. The alteration in GIT microflora also adversely affects gastrointestinal health.

Over the period of year’s misuse of antibiotics has led to Antibiotic Resistance (AR or ABR). Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic. It is a specific type of drug resistance. Antibiotic resistance evolves naturally via natural selection through random mutation, but it could also be engineered by applying an evolutionary stress on a population. In simple terms, there is emergence of bacterial strains that become resistant and continue to multiply even in the presence of therapeutic levels of antibiotic that it normally should have been susceptible to. Hence, they no longer respond to treatment with the most common antibiotics. The inappropriate use and overuse of antibiotics like penicillin and erythromycin have been associated with emerging antibiotic resistance since 1950s. We have entered an era where some bacterial species are resistant to the full range of antibiotics available with the methicillin-resistant Staphylococcus aureus. It is the most widely known example of extensive resistance.

Common forms of antibiotic misuse include excessive use of prophylactic antibiotics in travellers and failure to prescribe correct dosage of antibiotics on the basis of the patient’s weight and medical history. Other forms of misuse include failure to take entire prescribed course of the antibiotic, incorrect dosage and administration or failure to rest for sufficient recovery. Many antibiotics are frequently prescribed to treat symptoms or diseases that do not even respond to antibiotics or that are likely to resolve without treatment. Also, incorrect or suboptimal antibiotics are prescribed for certain bacterial infections.

Self-prescription of antibiotics is another example of misuse. A large chunk of the Indian population prefers going to a pharmacist rather than a doctor in order to self-prescribe antibiotics. These pharmacists inappropriately prescribe antibiotics even for viral infections such as common cold. The appropriate guidelines for prescribing antibiotics are not followed in most of the cases. The compulsory 3 to 7 day course for acute infections isn’t even mentioned to the patient. This leads to missed antibiotic dosages which contribute significantly to antibiotic resistance.

I personally witnessed an incident at a pharmacy right beside a hospital where a gentleman asked the pharmacist to prescribe a tablet for relieving cough & cold. The pharmacist politely asked him to take an appointment with the doctor in the hospital.The gentleman replied that he didn’t have time to consult a doctor. It made me wonder what made him to do so. Did he think that he would save time as well as few bucks which he would have had to spend as consultation? Also isn’t it obvious that he wouldn’t mind referring to a pharmacist again for a toothache, just to save money?

Is it a smart move? What about antibiotic misuse? Who is then responsible for the burden of Antimicrobial Resistance (AMR)? Are people even aware that it as an urgent threat to mankind? The increasing ineffectiveness of antimicrobial drugs to treat common and life-threatening infections would take a serious toll on healthcare. In developed countries, stringent rules and regulations do not allow patients to self-administer antibiotics without a doctor’s prescription. Is it high time that even we need to incorporate such rules in order to avoid indiscriminate use of antibiotics?

I’m sure as practising dentists; majority of you must have come across a lot of patients who just ask for tablets to relieve pain and infection. They have no interest whatsoever to get the tooth treated. To some extent, patient counselling does help to make them understand that pulp extirpation or tooth extraction is the treatment for the offending tooth. However, there is a group of treatment-averse patients who turn a deaf ear to our insistence.

In another scenario, lot of people must have experienced unscheduled emergency pain cases and walked into the clinic on a busy day leaving us with just 5-10 min to spare between other scheduled patients. The protocol would be to accurately diagnose the condition and do the needful accordingly. In spite of being aware that dental pain is primarily an inflammatory condition and usually best treated by clinical intervention supported with effective analgesia. But lack of time makes it more convenient for us to prescribe antibiotics and analgesics as we do not want a call from the patient late at night disturbing our peace and sleep.

Often, it happens that patients refer to the best dentist with acute pain symptoms. The dentists prescribe them with antibiotic and analgesic, the patients do not make subsequent appointments further for treatment of the offending tooth. After a week, when their pain shoots up. Severe pain again force them to refer to another dentist who again prescribes them with same routine antibiotics and analgesics. By chance, if the patient again fails to get treated and repeats this with third dentist, the susceptibility to opportunistic infections increase plus it leads to antibiotic resistance.

Can we afford to imagine a world without effective antibiotics? It is not just the responsibility of the medical practitioners but dental practitioners too to curb the menace of antibiotic abuse. Minimizing inappropriate antibiotic prescribing plays a key role in limiting the development of antibiotic-resistant bacteria. Since dentists prescribe approximately 7 to 10% of all primary care antibiotics, dental prescribing may contribute to antibiotic misuse. The National Center for Disease Control and Prevention estimate that approximately one-third of all outpatient antibiotic prescriptions are unnecessary. Antibiotics should be prescribed when there is severe infection spreading in the mouth. Unfortunately, lot of dentists routinely prescribe oral antibiotics in acute dental conditions. They are under the impression that over-antibiotics give better and unpleasant complications to patients.

Good knowledge of antibiotics is the need of the hour in prescribing for dental conditions. Recommendations to improve antibiotic prescribing practices are given below in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. Antibiotics should be prescribed only if it is clinically beneficial to the patient. Here are a few conditions commonly encountered in clinical practice that do not require an antibiotic prescription:

  1. Pulpitis: Inflammation is confined. Hence, it is not a true infection. Extirpation of inflamed pulp is the ideal treatment.
  2. Apical periodontitis: Infectious process has just reached adjacent periodontal tissues without any signs of systemic infection such as fever or facial swelling. Since there is pulpal necrosis involved there is no circulation. Effectiveness of antibiotic in such a situation is questionable as it is unlikely that the antibiotic would reach the bacteria in the necrotic pulp in therapeutic concentrations.
  3. Dentinal Hypersensitivity: Differentiate between pulpitis and dental hypersensitivity. Eliminate the cause such as sealing off open dentinal tubules by fillings or desensitizing toothpastes.
  4. Apthous ulcers: They are self-limiting. Symptomatic therapy such as hydration and topical analgesics is sufficient.
  5. Traumatic ulcers: Ulcers due to traumatic injuries, hot food items, chemical burns etc. heal within 10-14 days. Ulcers due to sharp cusps, ill-fitting dentures; sharp denture edges, Orthodontic wires etc. resolve after the trauma-inducing factor is removed. Provide symptomatic relief using topical analgesics.
  6. Viral infections like HSV-1 infections (Primary Herpetic Gingivostomatitis, Herpes labialis): Self- limiting, symptomatic therapy for associated fever and ulcers. Topical and oral antivirals, hydration, oral hygiene maintenance.
  7. Chronic Gingivitis: Resolves after removal of local irritant i.e. plaque via mechanical therapy.
  8. Chronic periodontal conditions: Resolves after removal of local irritant i.e. plaque & Calculus via mechanical therapy.
  9. Dry socket: Gentle irrigation and zinc oxide eugenol packs. NSAIDS for pain relief.
  10. Post-endodontic flare ups: Controlled prospective clinical trials have demonstrated that antibiotics are not beneficial in treating symptoms after root canal treatments.

Listed below are a few common conditions requiring antibiotics:

  1. Acute periapical abscess
  2. Infected periapical cyst
  3. Periodontal abscess
  4. Facial cellulitis which may or may not be associated with dysphagia
  5. Pericoronitis
  6. Acute Necrotizing ulcerative gingivitis: For cases of acute necrotizing ulcerative gingivitis requiring systemic antibiotic therapy in which penicillin is precluded, tetracyclines are most beneficial.
  7. Acute periodontal conditions where drainage and debridement is not possible and infection is spreading systemically
  8. Medically compromised patients, diabetics, organ transplant patients, HIV, Neutropenia, Chronic steroid usage, sickle cell anemia
  9. Oral infections accompanied by elevated body temperature, evidence of systemic spread like lymphadenopathy
  10. Bacterial sialadenitis
  11. Prophylactic antibiotics for Bacterial endocarditis
  12. Permanent Tooth avulsion

There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of antibiotics in dentistry. The concerned authorities in India need to start campaigns to create awareness among the dentists as well as general public regarding antibiotic misuse. Multifactorial interventions aimed at both dentists and patients can reduce inappropriate prescription of antibiotics. Knowledge about antibiotic selection, dosage duration of antibiotic therapy is a must. We as dentists must reinforce the phrase “Antibiotics don’t cure toothache” among patients. Therefore, antibiotics should never be considered as an alternative to dental intervention, but rather as an adjunct.

References:

  1. britannica.com
  2. Peng LF. Dental Infections in Emergency Medicine Medication. Medscape- Drugs & Diseases; 2018 Jan.
  3. Cope A, Francis N, Wood F, Mann MK, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database of Systematic Reviews 2014; 6.
  4. Marino PL (2007). Antimicrobial therapy. The ICU book. Hagerstown, MD: Lippincott Williams & Wilkins. p. 817.
  5. Larson E. Community factors in the development of antibiotic resistance. Annual Review of Public Health. 2007; 28 (1): 435–47.
  6. Hawkey PM. The growing burden of antimicrobial resistance. The Journal of Antimicrobial Chemotherapy. 2008; 62(1): i1–9.
  7. Bahl R, Sandhu S, Singh K, Sahai N, Gupta M. Odontogenic infections: Microbiology and management. Contemporary Clinical Dentistry. 2014; 5(3):307-311.
  8. dentalcare.com
  9. Ramu C, Padmanabhan T. Indications of antibiotic prophylaxis in dental practice- Review. Asian Pacific Journal of Tropical Biomedicine. 2012; 2(9):749-754.
  10. Dar-Odeh NS, Abu-Hammad OA, Al-Omiri MK, Khraisat AS, Shehabi AA. Antibiotic prescribing practices by dentists: a review. Therapeutics and Clinical Risk Management. 2010; 6:301-306.
  11. FC Peedikayil. Antibiotics: Use and misuse in pediatric dentistry. Journal of Indian Society of Pedodontics and Preventive Dentistry. October-December 2011; 29(4):282-287.

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DISCLAIMER : “Views expressed above are the author’s own.”

Middle mesial canals.

May 23, 2018
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Middle mesial canalsMiddle mesial canals

Dr. Shivani Bhatt

“For everyone that asketh …..recieveth

He that seeketh….. findeth

To him that knocketh…. It shall be opened”

The Bible

 

 

The above is one of the many articles that illustrate the importance of detection, cleaning, shaping and filling of middle mesial canals.

I would like to share one of my failed cases because of missed middle mesial canal.

Case treated by me comes with pain again after 2 years

Chief  complaint:

  • Severe pain associated with root canal treated 46 in a 28 year old male patient

On examination:

  • 46 with metal crown
  • No swelling
  • Very tender on percussion

Radiograph shows:

Diagnosis:

Treatment plan:

Treatment

  • Removal of crown
  • Rubber dam isolation
  • Pre endo built up in composite
  • Removal of gp points by R-Endo by micromega
  • Search for middle mesial canal(mm)
  • Where and how to search for middle mesial canals;
  • Mm is present in the isthumus between the mesiobuccal and mesiolingual canals more towards the mesiolingual.
  • Troughing of the isthmus between mb and ml with
  • Scaler tip
  • Endo guide bur
  • Dg 16 probe
  • Magnification
  • Irrigation to remove the dentinal shavings

At times the mm meets one of the two canals or both the canals at a point near or above the apex.

Prepare only till that point to avoid weakening of tooth structure.

Preparation of all canals with TF

Apical diameter: mesials-30 distal-35

Irrigation: 5% warm sodium hypochlorite MDA

Calcium hydroxide dressing for 10 days

Obturation: lateral condensation

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DISCLAIMER : “Views expressed above are the author’s own.”

Managing dental trauma in the emergency

May 11, 2018
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Managing dental trauma in the emergencyManaging dental trauma in the emergency

The trauma to the facial aspect is displaced, fractured or lost teeth that can have impacted significantly on psychological, functional and aesthetic effects on a tooth. The role of dentists must collaborate to create the awareness about treatments and prevention of traumatic injuries to an oral and maxillofacial region.

Dental trauma:

It is the simple or complex branch of dentistry that encompasses, assessment, aetiology, management, epidemiology, prevention, may be interdisciplinary and multidisciplinary management which embraces sequelae of posttraumatic such as resorption of root and its treatment.

Classification of dental trauma:

Ellis Classification 1:

Class 1: Fracture of enamel involving little or no dentin.

Class 2: Fracture of enamel and dentin but no pulp

Class 3: Fracture of enamel, dentin and pulp.

Class 4: Tooth becomes non-vital with or without loss of crown.

Class 5: Traumatically avulsed tooth

Class 6: Fracture of a tooth with or without crown fracture.

Class 7: Displacement of a tooth without fracture of crown or root

Class 8: Fracture of crown en masse and its replacement.

Class 9: Fracture of deciduous teeth

Causes of Dental Trauma:

At 2 or 3 years of age, The incidence of traumatic injuries to the primary teeth is seen during motor coordination is developing whereas traumatic injuries to permanent tooth occur later i.e secondary followed by violence, sports, road accidents, accidental falls, collisions etc:

Management of Dental trauma:

Examination of a patient:

  1. Clean the oral cavity with saline or water
  2. Take note of medical and dental history
  3. Questionnaire:
  4. How/when/where did the injury happen or occur?
  5. Did the patient experience a period of unconsciousness?
  6. Is there any bite disturbances?
  7. Is there any teeth reaction to heat and or cold exposure?

Clinical examination:

  1. Examine the Lips, face and muscles of the oral cavity for lesions of soft tissue
  2. Palpate the signs of fractures and skeletal aspect of the facial region
  3. Inspect the region of dental trauma for abnormal responses to percussion, the mobility of tooth abnormality in tooth position
  4. Pulp testing
  5. Radiographic examination:
  6. Occlusal
  7. Periapical
  8. Panoramic
  9. Photographic documentation: Take a pre and post treatment photograph in order to assess the outcome of treatment, and also for the medicolegal purpose

Traumatic injuries of teeth:

  1. Concussion
  2. Luxation
  3. Fracture

Concussion:

  1. No mobility and displacement of the tooth
  2. Injury and inflamed PDL
  3. Tender tooth

Visual sign: Displacement of tooth

Percussion test: Tender on tapping or touch

Mobility test: No marked increased mobility.

Pulp sensibility test:

  1. Positive Result
  2. Important in assessing the risk of complication in healing
  3. Lessor lack of response to the test indicates an increased risk of pulp necrosis laterally.

Radiographic Findings: Nil

Radiographs:

  1. Occlusal
  2. Periapical

Instructions are given:

  1. One week soft diet
  2. Brush teeth using soft bristles
  3. To prevent plaque accumulation advised rinsing 0.1 % chlorohexidine mouthwash.

Luxation:

Displaced tooth in labial, lingual or labial direction, Periodontal ligament partial or

total separation, Supporting alveolus fractures may occur. It is similar to extrusion injuries.

Visual sign: Displaced usually in labial, palatal or lingual direction.

Percussion test: Metallic sound is usually heard.

Mobility Test: Immobile tooth

Pulp Sensibility Test: Except for teeth with minor displacement gives a lack of response.This test is important in assessing the healing complication risk. In initial examination indicates positive result to a reduced risk of pulp necrosis in the later stage.

Radiographic Findings: Widened periapical ligament is seen on occlusal exposure.

Radiograph: periapical, occlusal

Treatment:

  1. Before repositioning, rinse the exposed part of root surface with saline.
  2. Apply local anaesthesia and reposition the tooth with digital pressure or forceps in order to disengage it from the socket of bone.
  3. Gently reposition it into original position, stabilise the tooth for 4 weeks using a flexible splint, due to associated fracture nearly 4 weeks is indicated.

Instruction is given:

  1. 1 week for soft food
  2. Use soft bristles for brushing the teeth
  3. In order to prevent plaque accumulation rinse with 0.1% chlorohexidine mouthwash.

Enamel fracture:

It is confined to enamel with loss of tooth fracture

Visual Sign: Loss of enamel seen

Percussion Test: Non-tender, in case of tenderness, evaluate tooth for a possible root fracture injury or for a Luxation.

Mobility Test: Mobility is normal

Radiographic Findings: Loss of enamel is visible

Radiograph: Periapical and occlusal.

Treatment: Restoration of a tooth with composite resin depending on the extent and also the location of the fracture. In case of a tooth, fragment treatment is bonding to the tooth is the treatment of choice.

Enamel- Dentin fracture:

Enamel and dentin fracture without involving pulp.

Visual Sign: Loss of enamel and dentin

Percussion test: Non-tender, In case of tenderness evaluate tooth for apossible root fracture injury or luxation.

Mobility Test:  Mobility normal

Radiographic findings: Visible enamel and dentin loss.

Radiograph: Occlusal and periapical.

Treatment: Treatment is done covering exposed dentin with glass ionomer or a permanent restoration using a and composite resin and bonding agent.

Enamel – Dentin – Pulp fracture:

Enamel and dentin loss of tooth and pulp exposure is seen

Visual sign: Loss of enamel, dentin and exposed pulp tissue.

Percussion test: Non-tender

Mobility test: Mobility normal

Radiographic findings: Tooth substance loss is visible

Radiograph: occlusal, periapical

Treatment: To preserve pulp vitality for young patients with open apex by pulp capping or partial pulpotomy in order to secure development of the tooth. This treatment is also the treatment of choice for closed apices patients.

Calcium hydroxide compounds and MTA are used for such procedure. In older patients with closed apices and luxation injury with displacement, The treatment of choice is RCT.

Crown, root fracture without pulp involvement:

It involves enamel, dentin, cementum with loss of tooth structure but not exposing pulp.

Visual Sign: Fracture of crown extending below gingival margin.

Percussion Test: Tender is seen.

Mobility Test: Fragment of the coronal part is mobile.

Radiographic findings: Apical extension of fracture not visible usually.

Radiograph: Occlusal and periapical.

Treatment :

  1. Removal of the fragment.
  2. Gingivectomy and removal of crown sometimes osteotomy.
  3. Extrusion of fragment apically orthodontically.
  4. Surgical extrusion
  5. Decoration
  6. Extraction in severe cases.

Crown-root fracture with pulp involvement:

Enamel, dentin, cementum with loss of tooth structure and pulp exposure.

Visual Sign: Fracture of crown extending below the gingival margin

Percussion test: Tender on the tooth is seen on percussion.

Mobility test: Mobility of coronal fragment.

Radiographic findings: Fracture of apical extension usually not visible.

Radiograph: Occlusal and periapical.

Treatment :

  1. Fragment removal and gingivectomy.
  2. Fragment orthodontic extrusion
  3. Surgical extrusion
  4. Extraction with severe cases.

Root fracture:

Fracture associated with the root of tooth involving cementum, dentin and pulp.

Visual Sign: Coronal part of tooth mobility is seen, in some cases displaced sometimes crown discolouration transiently gingival sulcus bleeding.

Percussion test: Tender tooth

Mobility test: Coronal segment of the tooth mobility is seen.

Radiographic finding: Line of root fracture visible. In a horizontal or diagonal plane fracture involves root of the tooth.

Treatment:

  1. Before repositioning rinse exposed root surface with saline.In case of displacement reposition the coronal segment of the tooths soon as possible.
  2. Recheck it radiographically the correct position of the placed tooth.
  3. Stabilise the tooth with a flexible splint for 4 weeks.
  4. Stabilisation is beneficial for a longer period of time up to 4 months if the root fracture is near the cervical area of the tooth
  5. To determine pulpal status monitor healing for at least 1 year.
  6. In case of the fracture seen RCT of the coronal segment and also for the pulp necrosis indicated.

In determining the success of tooth replantation the paramount is extra-oral time 2. The common injuries are enamel and dentin fractures 3. Timely care is important because these are the situations of an inappropriate or inefficient case of emergency.

References:

  1. Sasikala Pagadala1*, Deepti Chaitanya Tadikonda2 Pagadala S, Tadikonda DC. An overview of the classification of dental trauma IAIM, 2015; 2(9):157-164
  2. Ritu NamdevAyushi JindalSmriti BhargavaLokesh BakshiReena Verma, and Disha Beniwal. Awareness of emergency management of dental trauma Contemp Clin Dent. 2014 Oct-Dec; 5(4): 507–513
  3. Jackson NG1Waterhouse PJMaguire A. Management of dental trauma in primary care: a postal survey of general dental practitioners. Br Dent J. 2005 Mar 12;198(5):293-7;

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DISCLAIMER : “Views expressed above are the author’s own.”

Pregnancy, oral health and you | TIPS for to be moms

Apr 11, 2018
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Pregnancy, oral health and you | TIPS for to be momsPregnancy, oral health and you | TIPS for to be moms

 

Pregnancy, oral health and you.

Good oral care plays a vital role in our daily lives; it helps to keep our gums healthy and our teeth free from cavities. Our intake of food primarily is from our mouth and any nutritional deficiency is immediately seen in the oral cavity. Maintaining oral hygiene is important, as ratio of oral diseases is not constrained to a particular age group, it equally affects both men and women. From a health perspective, there are many differences between genders based on physiological characteristics. Oral health is no different and is affected by hormonal fluctuation during pregnancy, menstruation and menopause. Some of the common oral diseases occuring during pregnancy are gingivitis,periodontitis, bad breath, pregnancy tumours, dental caries, TMJ disorder, bruxism, dry mouth, etc.

  • Gingivitis: Inflammation of gums is known as pregnancy gingivitis. During pregnancy nearly 65 to 75% of women are prone to gum conditions like infection or bleeding due to increased imbalance in hormones. This starts in the second month and can continue through the nine months of pregnancy. The gums become tender, swollen, red and bleeds when brushed as well as flossed. Also due to hormonal changes blood flow in the gum tissue is increased and is more sensitive to the bacteria of plaque, if it is left untreated this progresses to periodontists so rather than ignoring, seeking dental help and undergoing required treatment would be of great help.
  • Periodontitis: It is the inflammation of the gums surrounding structures of teeth which progressively destroy ligaments, connective tissue, bone, etc. The cause of periodontitis during pregnancy is untreated gingivitis, the elevated prostaglandins, C reactive protein and spread of bacteria. The receptors of estrogen and progesterone found in the tissues of periodontium, increased levels affects the tissue response, to the vessels of gingiva, fibroblast and extracellular matrix. The symptoms of periodontitis are swollen gums, tenderness, bleeding gums, interproximal wide spaces between the teeth, gums pull away the teeth, receding gums, weakens and loosens the tooth. According to recent study of periodontology, the adverse effects of periodontitis is Premature Low Birth Weight babies. (PLBW). The treatment of periodontitis is scaling and root planing prevents the adverse outcome caused during pregnancy.
  • Bad breath: Also known as halitosis, is a condition of foul breath. Food particles when contacts with bacteria produces sulphur compound and hence causes bad breath. Brushing regularly twice a day with fluoridated toothpaste is a good practise of oral hygiene and would relieve from bad breath.
  • Pregnancy tumour: Is a condition of hyperplasia with inflammatory lesion seen in oral cavity. It prevails among 10 to 20 percent of women and known with other names as pregnancy epilude/granuloma pregnancy/pyogenic granuloma/lobular capillary haemangioma. It occurs after the first trimester of pregnancy caused by hormonal changes. It is asymptomatic, with well-defined, single or multiple raised nodules, size may vary from 0.5 to 2.5 cms. The symptoms are difficulty in swallowing and chewing, the may ulcerate and bleed. The recommended treatment is surgical lesion of the tumour, also advanced laser surgery .
  • Dental caries: Tooth decays during pregnancy is due to saliva with high cariogenic bacteria, improper oral hygiene, vomiting and nutritional deficiencies. Consult your dentist and undergo suggested treatment procedures would help reduce the risks caused by tooth decay.
  • TMJ disorder:TMJ refers to temporomandibular joint, The TMJ disorder is jaw pain. Swelling in TMJ is due to stress during pregnancy. The pressure around the temporomandibular joint results in swelling of face progressively lead to headache, uncomfortable movements and also discomfort while opening the jaw. If the pain persists for prolonged period of time, it’s better to consult a dentist.
  • Bruxism: Is also known as teeth grinding. It occurs due to hormonal changes, physical and physiological stress, emotional worries during pregnancy and results in jaw pain, headache, teeth pain, insomnia, etc. Overall effects results the mother to be stress and tension with emotional pressure leads to affect the foetus growth. Certain medications like Ibuprofen (NSAIDs) non-steroidal anti-inflammatory drug and also muscle relaxants recommended by dental practitioner may help to get relief from teeth grinding.
  • Dry mouth: Known as xerostomia, it occurs due to decreased saliva flow, dehydration, gestational diabetes, metabolic changes, prescribed drugs and its effects. The symptoms of dry mouth is metallic and bitter taste in mouth, dental caries, cracked lips, gingivitis, bad breath, difficulty in chewing and swallowing, burning sensation in the mouth, mouth sores, etc. It is advised to chew xylitol chewinggum and intake of sialogogues helps to increase salivary flow to a certain extent. In case of severity consult a dental practitioner at the earliest.

Tips for to be moms (Stages of pregnancy)

1.      Before pregnancy

    1. Consult a dentist for regular check up in order to know about the status of your oral health.
    2. If any treatment is suggested, it is best advice to undergo and follow the regimen prescribed as per the dentist.

2.      During first trimester

    1. Inform the dentist that you are pregnant.
    2. Frequently rinse your mouth out if suffering from morning sickness.
    3. In order to avoid morning sickness use bland toothpaste.
    4. Use small and soft bristles toothbrush in order to avoid vomiting.
    5. Never brush immediately after vomiting.

3.      During second trimester

    1. Avoid of sugary snacks.
    2. It is good to have healthy diet with Vitamin C, B12 and Calcium supplements to build your teeth strong and healthy.
    3. If any pregnancy tumour is seen, consult a dentist immediately.

4.      During Third Trimester

    1. Avoid undergoing dental procedures.
    2. Regularly brush and floss your teeth twice in a day.
    3. Schedule a dental appointment after the baby is born.

5.      Postpartum nursing

    1. Consult your dentist soon after your delivery.
    2. X- ray and local anaesthetics are safe during breastfeeding.
    3. It is safe to postpone major dental procedure until this time.

Dental science is modernised and clear in its understanding that oral hygiene plays a vital role prior to as well as during pregnancy. During pregnancy, it is always good to follow awareness of knowledge gained about dental regimens. Although an effort of understanding is finally to keep and maintain good oral health status by hoping moms for growing foetus.

Also, checkout oral hygiene tips for children: Click here

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DISCLAIMER : “Views expressed above are the author’s own.”

Dental hygiene for the pregnant woman

Mar 13, 2018
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Dental hygiene for the pregnant womanDental hygiene for the pregnant woman
Food

The development of the teeth of the embryo begins towards the 5th and 6th weeks of intrauterine life, so it is sometimes even before the confirmation of your pregnancy! From the beginning, a special importance to food is required. Sticky and sugary foods should be avoided and if they are consumed, immediate brushing is indicated.

The sugars and the absence of brushing cause the lowering of the pH of the saliva below the critical threshold where the production of acid triggers the demineralization process of tooth enamel, the first stage of tooth decay. The more the consumption of sugars is frequent, the more the involvement of the enamel will progress towards the less calcified parts of the inside of the tooth (dentin and pulp).

Vitamins and minerals

Pregnancy requires a sufficient amount of vitamins (A, B, C, D, etc.) as well as minerals (phosphorus, iron, calcium, etc.). The calcium in your teeth is stable and the baby can not change that structure. However, if your calcium intake is insufficient (eg dairy products), the embryo will draw calcium from your bones.

Dental treatments during pregnancy

During the first trimester, a consultation with your dental hygienist is recommended. By knowing your condition, she will evaluate your oral condition and advise you appropriately. The hygienist will completely clean your teeth, removing all deposits responsible for dental caries and gum disease (bio-film or plaque, tartar, stains).

Even if dental X-rays are safe, they will not be taken until after your pregnancy, except in emergency situations (eg, abscess, fracture, etc.). If this is the case, the lead apron covering the abdomen will still be used. When curative treatments are required, they can usually be planned during the second trimester of pregnancy and the products used (eg, anesthetic) have no adverse effect on the fetus. Some treatments will however have to be postponed after pregnancy (ex: bleaching).

Pregnancy gingivitis (or pregnancy)

Hormonal changes during pregnancy can cause a reaction in the gums and the presence of bio-film (dental plaque) can aggravate this situation. Swelling, redness, tenderness and spontaneous bleeding are possible. It is important to maintain good daily oral hygiene by brushing, using a soft bristle brush and fluoride toothpaste, and using dental floss. With good care, the condition of your gums will recover after delivery.

Premature birth and low birth weight babies

Many studies show that toxins present in periodontal disease (tooth support: gums and bones) cause the risk of premature birth and low birth weight babies. These children have lower resistance to infections and more often have birth or developmental abnormalities.

nausea

Brushing with a soft-bristled brush and rinsing the mouth with water or a fluoride mouthwash helps to reduce the stomach acid deposited on the teeth and mucous membranes, as well as in the mouth. saliva.

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DISCLAIMER : “Views expressed above are the author’s own.”

Dental hygiene for children

Dental hygiene for childrenDental hygiene for children
The eruption of teeth

The last teeth of milk finish their eruption between 20 months and 33 months and these will remain in the mouth until the age of 11 or 12 years. Primary teeth play an important role in permanent dentition as they prepare and maintain the location of the teeth until the eruption occurs between 6 years and 13 years.

brushing

Brushing should be done at least twice a day, using a soft bristle brush and fluoride toothpaste (the size of a pea toothpaste is sufficient). If the child has a susceptibility to tooth decay, brushing should also be followed by every meal and every sweet or sticky snack.

You are a model

The young child observes and seeks to imitate. Encourage him to hold the brush and brush himself. However, you must always complete the brushing because the child does not acquire the dexterity required until the age of 6 years and sometimes even 8 years! Children under 6 must always be accompanied by an adult when brushing their teeth to ensure that every surface is cleaned, to make sure the child does not swallow toothpaste and rinses properly his mouth.

Some children have spaced teeth and others have tighter teeth. No toothbrush can clean properly when two teeth are in contact. The decay can develop there, only the dental floss will make it possible to complete these places. To do this, at least once a day, your child will need your help until he has the required skill. The sooner you start flossing, the better your dexterity and the sooner you’ll be inclined to include that excellent habit in your daily routine.

Visit to the dental hygienist

Your child should continue to visit the dental hygienist every six or twelve months, depending on the frequency established to ensure optimal follow-up, according to his needs. It is always good to prepare the child well before the visit: history books and role plays will help you. Prefer an appointment in the morning because the child is at this time well rested. The visits will mainly consist of a polishing of the teeth, a fluoride application and personalized advice from the dental hygienist.

Sealing of pits and fissures (sealent)

The troughs and furrows of the chewing surface of the permanent teeth easily trap food debris and bacteria from the bio-film (dental plaque), thus promoting the development of decay. As soon as the first permanent molars have erupted (around the age of six) and according to the morphology that they will present, sealing may be advisable. This resin will fill the hollows and furrows and, combined with good hygiene, prevent the development of cavities.

Food

The choice of snacks is important for your child’s dental health. Fresh fruits and vegetables and some cheeses are great snacks for his dental health. 100% pure fruit juices are preferable to fruit drinks or cocktails, which are very high in sugar and low in vitamins. However, a large amount of juice promotes an acidic environment, conducive to cavities. Nothing better than water to appease big thirsts. Finally, make sure your child consumes enough dairy products.

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DISCLAIMER : “Views expressed above are the author’s own.”