BACKGROUND

The civilization of India is one of the oldest civilizations in the World, spanning more than 4000 years and witnessing the rise and fall of several Empires, and projecting a unique assimilation of various cultures and heritage. The Country has always been portrayed as a land of spiritual integrity with professors of Philosophy, who have engineered the magnanimity of its nationalism. One of the oldest scriptures in the World, the four-volume Vedas that many regard as the repository of national thoughts, which have anticipated some of the modern scientific discoveries, has been created in the orb of this myth oriented Country. This strong affinity with religion and mythology has been reflected time and again through various art forms and performing arts, which are symbolical of the composite culture of India. Unity in diversity is another facet of the Country’s inherent nationalism, which had been fused by the feeling of national fervour incited by various foreign invasions that ever made its way to the Indian shores. Religious tolerance and cultural amalgamation have given shape to a uniquely secular Nation, which has created an impressive status of itself in the global arena.

GEOGRAPHY

PEOPLE

GOVERNMENT

ECONOMY

HISTORY

BACKGROUND

The civilization of India is one of the oldest civilizations in the World, spanning more than 4000 years and witnessing the rise and fall of several Empires, and projecting a unique assimilation of various cultures and heritage. The Country has always been portrayed as a land of spiritual integrity with professors of Philosophy, who have engineered the magnanimity of its nationalism. One of the oldest scriptures in the World, the four-volume Vedas that many regard as the repository of national thoughts, which have anticipated some of the modern scientific discoveries, has been created in the orb of this myth oriented Country. This strong affinity with religion and mythology has been reflected time and again through various art forms and performing arts, which are symbolical of the composite culture of India. Unity in diversity is another facet of the Country’s inherent nationalism, which had been fused by the feeling of national fervour incited by various foreign invasions that ever made its way to the Indian shores. Religious tolerance and cultural amalgamation have given shape to a uniquely secular Nation, which has created an impressive status of itself in the global arena.

GEOGRAPHY

PEOPLE

GOVERNMENT

ECONOMY

HISTORY

The American Heart Association published its first guidelines in 1955. Since then the guidelines have been modified several times. Each revision has tried to make the antibiotic regime simpler to increase patient compliance. The revisions also attempt to consider the fact that many bacteria present can eventually become resistant to the antibiotic therapy.

The guidelines for antibiotic prophylaxis was updated in 1990 and most recently in 1997. Before we review the most recent guidelines, as they relate to dentistry, please remember this. The original decision to use antibiotics to prevent infection was based on the assumption that if antibiotics are effective in treating an infection, they should be able to prevent them. Any studies to support this premise were done strictly in the laboratory and the primary mechanism for the prevention of endocarditis is not known.

The AHA guidelines are followed by most practitioners, but it is not unusual to find certain changes in dosages or medications made by particular doctors.

Antibiotic prophylaxis is RECOMMENDED for the following:

High-risk category

Prosthetic cardiac valves,including bioprosthetic and homograft valves
Previous bacterial endocarditis
Complex cyanotic congenital heart disease (e.g., single ventricle states, transposition of the great arteries, tetralogy of Fallot)
Surgically constructed systemic pulmonary shunts or conduits

Moderate-risk category

Most other congenital cardiac malformations (other than above and below)
Acquired valvar dysfunction (e.g., rheumatic heart disease)
Hypertrophic cardiomyopathy
Mitral valve prolapse with valvar regurgitation and/or thickened leaflets

Antibiotic prophylaxis is NOT RECOMMENDED for the following:

Negligible-risk category (no greater risk than the general population)

Isolated secundum atrial septal defect
Surgical repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosus
Previous coronary artery bypass graft surgery
Mitral valve prolapse without valvar regurgitation
Physiologic, functional, or innocent heart murmurs
Previous Kawasaki disease without valvar dysfunction
Previous rheumatic fever without valvar dysfunction
Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators

FOR HIGH & MODERATE RISK PATIENTS
Antibiotic prophylaxis is recommended for the following dental procedures:

Dental extractions
Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance
Dental implant placement and reimplantation of avulsed teeth
Endodontic (root canal) instrumentation or surgery only beyond the apex
Subgingival placement of antibiotic fibers or strips
Initial placement of orthodontic bands but not brackets
Intraligamentary local anesthetic injections
Prophylactic cleaning of teeth or implants where bleeding is anticipated

FOR HIGH & MODERATE RISK PATIENTS
Antibiotic prophylaxis is not recommended for the following dental procedures

Restorative dentistry (operative and prosthodontic) with or without retraction cord
Local anesthetic injections (nonintraligamentary)
Intracanal endodontic treatment; post placement and buildup
Placement of rubber dams, postoperative suture removal, taking of oral impressions, and fluoride treatments
Placement of removable prosthodontic or orthodontic appliances and orthodontic appliance adjustment
Taking of oral radiographs
Shedding of primary teeth

RELATED NEWS ITEMS

Treating Gum Disease with Antibiotics – Oct 18, 1999 (Ivanhoe)
Misuse, Overuse and Underuse of Antibiotics – Jul 12, 2000 (ABC News)

Learn what to do in the event of injury to your mouth. It could save you a lot of pain and distress. Dental emergencies can be managed with a little prevention and preparation. Ask your dentist or staff about their emergency procedures. Exercise common sense and caution by using safety equipment. And always keep your dentist’s phone number where everyone in the family can access it quickly. The key to minimizing a dental injury is to see your dentist as soon as possible.

A dental emergency can easily be described as any abnormal oral condition that causes pain or concern. Most often, it takes the form of an injury to the teeth, gums or jaw. In addition to injuries, an abscess, toothache or infection can cause pain, swelling or fever. In case of emergency, there may be something you can do depending on the circumstances.The following are some of the types of dental emergencies and what you can do before you can reach us.

Broken Filling

In most cases, treatment can be delayed until a convenient time is available. Rough edges can be smoothed off with an emery board and the hole can be filled with warm wax or sugarless gum.

Loose cap

When a cap (crown) becomes loose or falls off, it can be placed back over the tooth until re-cementation can be done. For a little more security, place a small piece of sugarless gum in the crown for retention. The cap should not be left off the tooth for more than several days or it may not be possible to put it back on. You should go to your dentist as soon as possible to get it recemented because it is very easy to get decay under a loose cap.

Broken tooth

Bring all fragments, for we may be able to bond them back for you. If soft tissue (lips, cheek, tongue) are lacerated, check if the fragments are embedded in the wound. Even if the fragments are lost, see us as soon as possible because the fractured tooth may become sensitive and the infected nerve may cause pain.

Knocked-out Tooth

If a permanent tooth is completely dislodged from the mouth, immediate care is required. If possible, place the tooth back in the bleeding socket, or under your tongue (to keep it moist), or even in a glass of cold saline or milk (not water). You can rinse it with saline or milk (not water), but do not touch or scrub the root;otherwise this may damage the cells on the root surface, which are vital to the success of reimplantation of the tooth. Contact us at once. Remember, the sooner the tooth is put back into its socket, the better the prognosis.

Related News Item
Save a Knocked-Out Tooth – Jul 14, 2003 (Ivanhoe Newswire)

Bleeding

Only severe bleeding is a real emergency. This may be the result of a recent surgical procedure (e.g. extraction) or trauma. Apply pressure to the bleeding area with a teabag or gauze pad and get help as soon as possible.

Swelling

If your mouth, lips or face swells due to a dental problem, this generally indicates an infection. You should be seen by your dentist as soon as possible. Swelling that affects your eye or throat, or a fever also requires immediate attention. Begin rinsing with a solution of water and salt, and you may apply a cold pack to the outside of your face.

Toothache

A toothache usually indicates that something is wrong. Pain may come from the tooth itself, the gums or the jaw muscles or joints. Take aspirin, crocin of ibuprofen, if you can use them. Do not put heat or any of these pain relievers directly on the tooth – take them as directed on the label. If the patient is a child, call us as soon as possible for an emergency appointment.

Suspicion of Jaw Fracture

Do not move the jaw. Secure the jaw in place by tying a bandage or towel around the jaw and over the top of the head. Go immediately to a hospital emergency room, or call your dentist.

Dry mouth is the condition of not having enough saliva to keep your mouth wet. It is known as xerostomia

Saliva is necessary to help protect the teeth in these important ways:

• Saliva constantly flushes the mouth to clear food debris that may act as a food supply for the bacteria in plaque.

• It reduces the pH (acidity) of the waste products produced by plaque which helps to limit tooth decay by these acid attacks.

• Saliva is the source of systemic fluorides and minerals needed for the remineralization of damaged dental enamel.

• It helps digest food

• It prevents infection by controlling bacteria and fungi in the mouth

• It makes it possible for you to chew and swallow

Saliva does not flow evenly through the mouth. There are saliva “highways”, such as the tongue side of the lower molars, where the flow is greater and faster. There are saliva “byways” such as the check side of the upper incisors where to flow is less and slower. The result is that plaque will be more cavity causing on the byways than the highways of the mouth.

Saliva covers the teeth and gums with a protein film. Stimulated saliva offers more buffering protection than non-stimulated saliva. This is why can often help prevent caries.

Without enough saliva you can develop tooth day or other infections in your mouth and you would limit your nutritional intake if you could not chew or swallow certain foods.

Dry mouth can:

• Cause difficulties in tasting, chewing, swallowing, and speaking

• Increase your chance of developing dental decay and other infections in the mouth

• Be a sign of certain diseases and conditions

• Be caused by certain medications or medical treatments

Symptoms include:

• A sticky, dry feeling in the mouth

• Trouble chewing, swallowing, tasting, or speaking

• A burning feeling in the mouth

• A dry feeling in the throat

• Cracked lips

• A dry, tough tongue

• Mouth sores

• An infection in the mouth

• Decay, when there is not an adequate supply of saliva, the rate of tooth decay increases rapidly

Most often, chronic dry mouth is caused by:

• Side effect of drug therapy. More than 400 medicines can cause the salivary glands to make less saliva. Medications used to treat hypertension, anxiety, depression or psychosis cause the most difficulty. Antihistamines, antispasmodics, cancer-chemotherapy drugs, decongestants, and muscle relaxants often cause dry mouth.

• Health conditions such as extensive radiation therapy to the face and neck can cause severe dry mouth.

• Many disease effect saliva flow: Sjogren’s syndrome*, bacterial and viral infections, poorly controlled diabetes, salivary-gland stones, tumors, Alzheimer’s disease, diabetes, anxiety, HIV/AIDS, depression, Bell’s palsy, and Parkinson’s disease. Alzheimer’s and stroke can not feel the wetness in their mouth.

• Chemotherapy drugs that are used to treat cancer can make saliva thicker causing the mouth to feel dry.

• Nerve damage from an injury to the head or neck that tell salivary glands not to make saliva.

• Attachment loss from periodontal disease or who have had root caries are especially vulnerable to the adverse effects of xerostomia.

Dry mouth is not a normal part of aging. So if you think you have dry mouth, see your dentist or physician.

RECOMMENDATIONS FOR WHAT TO DO FOR DRY MOUTH

Here are some suggestions to help relieve the dryness; preserve soft tissue and help prevent the tooth decay that results from dry mouth:

• Take frequent sips of water throughout the day.

• Chronic dryness will make your mouth more easily irritated, so experiment to find the level of seasoning you can tolerate.

• Us a water spray bottle to wet your mouth. Keep it near the places you work, sit and sleep.

• Chew sugarless gum to stimulate salivary flow. Chew gum that contain xylitol, a sweetening agent that reduces cavity-causing bacteria.

• A warm salt water or baking soda rinse can improve oral comfort when your mouth is sore.

• Suck on sugarless hard candy to stimulate saliva flow; citrus, cinnamon or mint-flavored candies are good choices.

• Chew fibrous foods, like carrots and celery between meals.

• Use an electric toothbrush.

• Drink frequently while you eat. This makes chewing and swallowing easier and improves taste.

• Use an anti-bacterial mouthwash which does not contain alcohol or sugar.

• Use bland, non-spicy sauces (no masalas) and gravies on foods to add more moisture to the foods you eat. Be aware that spicy or salty foods may cause pain in a dry mouth

• Moisten foods with butter.

• Limit caffeine-containing beverages because they increase dryness after drinking them.

• Carry a toothbrush with you to brush often to decrease your risk toward cavities.

• Do not use toothpastes that contain sodium lauryl sulphate which is a foaming agent because it can irritate gum tissue.

• Limit sweet, sticky, sugary foods and high acid food they increase your risk towards cavities.

• Always brush immediately after eating. If you can not brush, swish and swallow water as soon as possible.

• Dentures make people with dry mouth more susceptible to infection from yeast organisms, which adhere to the plastic. Soak your denture overnight in one part chlorine beach to ten parts water to prevent infection.

• Do not use mouth washes with alcohol or phenol in them, alcohol dries out and damages gum tissue.

• Use fluoridated mouth rinses and gels.

• After brushing your teeth and right before you go to bed, brush or apply this toothpaste with a cotton tip to gums and teeth for one minute, Then swish for one minute to force the gel to cover all your teeth and gum tissue. Make sure you spit out all the fluoride. Do NOT swallow or rinse your mouth after you do this. Go to bed with the fluoride residue on these surfaces. Do this again in the morning and do not eat or drink anything for 30 minutes after this routine.

• Apply fluoride gel into a mouthguard and wear for five to ten minutes before bed and in the morning. Again, do NOT swallow any of the fluoride.

• Avoid irritants, such as tobacco and alcohol-including high-alcohol-content mouthwashes – and products containing cinnamon, peppermint, or wintergreen – they dry out the mouth.

• Breath through your nose (breathing through your mouth evaporates moisture).

• Use a room vaporizer to cut down on mouth dryness especially at night.

• If your salivary glands are not working right ask your doctor to give you a medicine called pilocarpine that helps your salivary glands to work better.

• If you dry mouth is caused by medicine, ask your doctor to change your medicine or adjust the dosage.

• Keep you recare appointments at least four times a year to keep your mouth healthy by having your teeth professionally cleaned, receive fluoride treatments and early detection of cavities.

RELATED NEWS ITEMS

Ethyol Reduces Radiation-Induced Dry Mouth – Jun 25, 1999 (Doc’s Guide)
Dry Mouth Syndrome Affects Dental Health – Jun 11, 2001 (E-Dental)
Dry Mouth From Diabetes Can Cause Cavities – Oct 02, 2001 (Intelihealth)
Elderly Bothered By Dry Mouth And Burning Mouth – Jan 02, 2002 (Intelihealth)

When a person has had all of their teeth removed we must make complete dentures for the person to wear. Dentures are an acceptable solution, but no match for our real teeth! Hence we always try to save natural teeth. When the teeth are removed we are left with a ridge of bone on the upper and lower parts of our mouth,that we can use to put false teeth on.The lower denture always takes a little more work for most patients to get used to for two reasons:lack of height of bone and prescence of the tongue. The tongue increases in size in an edentulous mouth and it resists any new encumberence to its unchallenged domain. In the upper ridge however there are no such interferences .

Upper CD	Lower CD	Upper & Lower CDs

Advantages long term experience over the years relative low cost predictable results tolerated well by most people restores missing teeth and lost ridge or gums function and appearance is restored aesthetically good where lip and cheek support is inadequate can be fabricated fairly quickly Disadvantages cause pressure that results in underlying bone resorption and soreness removability- not fixed like natural teeth bulk instability because it is removable and underlying progressive bone resorption looseness as it can only sit atop the gums- especially lowers only low chewing or biting forces can be produced speech problems due to a large appliance in your mouth and it may move taste problems longevity- the need to reline to fit or wearing out covering the roof of the mouth which can result in gagging problems risk of breakage REMOVABLE PARTIAL DENTURES An important step in maintaining a healthy smile is to replace missing teeth. When teeth are missing, the remaining ones can change position, drifting into the surrounding space. Teeth that are out of position can damage tissues in the mouth. In addition, it may be difficult to clean thoroughly between crooked teeth. As a result, you run the risk of tooth decay and periodontal (gum) disease, which can lead to the loss of additional teeth. In situations where only some teeth are missing we can also use a Removable Partial Denture. A removable partial denture fills in the space created by missing teeth and fills out your smile.It is usually used when the space without teeth is too large for a bridge,or there are no teeth on either side of the gap or for economic reasons.The partial denture locks into place with its metal clasps.A denture helps you to properly chew food, a difficult task when you are missing teeth. In addition, a denture may improve speech and prevent a sagging face by providing support for lips and cheeks. There are two types of these:ones made fully of plastic(acrylic) or ones having a metal framework for rigidity and the teeth are the same kind used in full dentures.The latter ones are called CAST partial dentures and are much better and expensive. These particular partials replace some upper teeth. The metal you see will fit across part of the palate. Parts of a CPD A Cast PD CPD on model Rem partial denture FAQ ABOUT REMOVABLE PARTIAL DENTURES How do you wear a removable partial denture? Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and they are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. How long will it take to get used to wearing a denture? For the first few weeks, your new partial denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Follow all instructions. Your denture should fit into place with relative ease. Never force the partial denture into position by biting down. This could bend or break the clasps. How long should I wear the denture? We will give you specific instruction about how long the denture should be worn and when it should be removed. Initially, you may be asked to wear your partial denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Then we need to adjust the denture to fit more comfortably. After making adjustments,we will normally recommend that you take the denture out of your mouth before going to bed and replace it in the morning. Will it be difficult to eat with a partial denture? Replacing missing teeth should make eating a more pleasant experience. Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid foods that are extremely sticky or hard. You may want to avoid chewing gum while you adjust to the denture. Will the denture change how I speak? It can be difficult to speak clearly when you are missing teeth. Consequently, wearing a partial denture may help.If you find it difficult to pronounce certain words with your new denture, practice reading out loud. Repeat the words that give you trouble. With time, you will become accustomed to speaking properly with your denture. How do I take care of my denture? Handling a denture requires care.Brush the denture each day to remove food deposits and plaque. Brushing your denture helps prevent the appliance from becoming permanently stained. Rinse the denture under water after meals to remove loose food debris. Brush regularly after each meal, or at least before bed. Brush with water, soap, or a mildly abrasive toothpaste, or denture paste. Scouring powders or other abrasive cleaners should not be used because they scratch the denture. Scratches make the denture more susceptible to collecting debris, plaque and stain. You can use a denture brush or a regular soft toothbrush to clean the denture, but use a separate brush for cleaning any natural teeth you have. It’s best to use a brush that is designed for cleaning dentures. A denture brush has bristles that are arranged to fit the shape of the denture.A regular, soft-bristled toothbrush is also acceptable.Avoid using a brush with hard bristles, which can damage the denture.Clean your dentures by thoroughly rinsing off loose food particles. Moisten the brush and apply the denture cleaner. Brush all denture surfaces gently to avoid damaging the plastic or bending the attachments.Make sure you reach all areas of the denture.When brushing the appliance do not hold it firmly or with pressure as this can break the denture. Clean the denture over a sink half filled with water and place a towel in the sink to act as a cushion in case the denture should drop. Do not soak or rinse the denture in hot water, this can distort the shape and fit of the denture. Never scrape the denture with sharp instruments in an attempt to remove hard deposits. Instead, take it to a dental professional for them to remove the deposits. We can recommend a denture cleaner. Some people use hand soap or mild dishwashing liquid to clean their dentures, which are both acceptable. Other types of household cleaners and many toothpastes are too abrasive and should not be used for cleaning dentures. The denture can be soaked in a solvent (such as Efferdent, Polident) or a detergent with a chemical action that removes or loosens light stains and deposits. Rinse the denture with water afterwards. Chemical immersions can be done daily or several times a week. Ultrasonic cleaning is done during a dental appointment to remove heavy stain and calculus (tartar). The most effective way to keep your dentures clean is by daily brushing, in combination with soaking the dentures in a chemical solution. Your gums are important too: Not only do your dentures need maintenance, but care also needs to be given to the tissues under your denture. The gums should be cleaned daily with a soft toothbrush or a washcloth. This removes the plaque and debris on the gums. It also massages and stimulates circulation of tissues. Massage your gums by placing the thumb and index finger over the ridge and use a “press-and-release” stroke. Will my denture need adjusting? Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture.Dentures that do not fit properly should be adjusted. Loose dentures can cause various problems, including sores or infections.If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose,you need to see us immediately. In many cases, necessary adjustments or repairs can be made. INSTRUCTIONS FOR PATIENTS WITH DENTURES You’ve just received your new dentures. whether you’re a seasoned veteran or a new denture wearer, we’re sure there are many questions which may need to be answered. We hope that the following information will prove to be helpful during the next few weeks of your denture adjustment period. * Learning to wear a new denture can take time. Don’t become discouraged if you find some difficulty in the beginning. YOU’RE NOT ALONE! Please do not listen to friends who tell you how easy it was for them to get used to their dentures and how they can eat everything and anything. They are either bragging, have greater bone and gum support or their memories may be poor.Your dentist will help you through any difficulties you may face or any situations that may arise during your adjustment period. * A lower denture usually takes more time to adjust to than an upper denture. The tongue may feel restricted and will tend to play, sometimes even subconsciously, with the new prosthesis. It will soon adapt to the restrictions and to the new feeling that a denture presents. * It is natural to experience fullness of the mouth with new dentures. Expect to have excessive flow of saliva. At first you will have a feeling of looseness, especially the lower denture. You will adjust to it. * Try to eat only soft foods for the first couple of days. Then, as you progress to more solid foods try to eat slowly and deliberately, attempting to place even amounts of food on both sides at the same time during the chewing cycle. By placing food on both sides of the mouth at the same time, you balance the biting forces on the new denture and will help to make it more stable. The longer you take to eat your meal, the faster you will learn to master your new prosthesis. * Try to take small bites at first. Cut all your food into small portions. If, and when, your gum tissues are strong enough to try foods which are bitten off (bread, corn on the cob, etc. ), try to press the food against the back teeth on the upper in order to stabilize the denture. * It is perfectly normal to experience some discomfort associated with sore spots during the adjustment period. Nature did not intend for us to wear hard plastic against soft gum tissue. It takes a while for the gum tissues to firm up and to accommodate to the hard plastic denture. * If sore spots should develop (and in some cases they do not), please be sure to wear the denture for at least 24 hours prior to your adjustment visit! If your dentist can’t see the sore spot visually, it is sometimes impossible for him to make the necessary adjustments. * Reading aloud during the first couple of days will go a long way in reducing any minor speech problems which may result from wearing a new denture. If speech problems continue to persist, please let your dentist know. * An unclean denture is neither healthy, attractive or comfortable. Clean you new denture every morning and night with either a denture toothbrush and denture toothpaste ( if necessary, any toothpaste can be used ) or with one of the commercially available denture cleaners or soak them overnight in baking soda and water. Please be sure to check with your dentist to make sure that the commercial cleaner will not interfere with the type of denture liner you may have in your prosthesis. Permanent soft liners and temporary soft liners react poorly to most commercial cleaners. * We prefer that you leave out both of your dentures at night. This allows your gum tissues to breathe and also relieves them of the constant pressures of mastication. When left out of the mouth, all dentures should be left in water to prevent warpage. * Using excessive amounts of denture adhesive to retain ill-fitting dentures invites serious problems and more involved correction at a later date. * Gum tissues are in a constant state of change but dentures are not. Therefore, periodic relining of your dentures may be necessary. If you find your denture getting looser and mastication more difficult, this may be a sign that a reline may be needed. It is very important for your dentist to see you regularly to evaluate the state of your oral tissues and to determine if additional treatment is required. Dentures typically need to be relined or remade every 3-5 years. * NEVER try to adjust your dentures yourself ! Home remedies, although simple, will only lead to trouble. If any problems arise or if you have any additional questions, your dentist is available to help. RELATED NEWS ITEMS Regenerated teeth may eat up denture market – Jul 16, 2000 (HealthCentral) Dirty Dentures: Microwave Treatment Kills Bacteria – Jun 10, 2003 (Simplesteps) Unique Breakthrough Gets Denture-Wearers Smiling – Mar 10, 2006 (E-Dental) Dentures Aren’t Stopping People From Eating Their Vegetables – Aug 26, 2008 (SimpleSteps)

Cavity in a molar	Cavity	Cavity abscess

Factors that MUST be present to produce caries

How are cavities prevented?

The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body’s natural defense against cavities, saliva alone is not sufficient to combat tooth decay. The best way to prevent caries is to brush and floss regularly. To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottled and canned beverages.If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants-thin, plastic coatings that provide an extra barrier against food and debris.

Who is at risk for cavities?

Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities.Children and senior citizens are the two groups at highest risk for cavities.

Decay that is unique to adults:
- Root cavities – As you age, your gums can recede, leaving parts of your tooth root exposed. Since there is no enamel covering your tooth roots, these exposed areas easily decay. Most people over 60 have root cavities as a result of gum disease.
- Repeated decay around existing fillings – Decay can form around existing fillings and crowns. This is because these areas are not as smooth as a natural tooth surface and can decay easier.
Cavities from dry mouth – dry mouth is present due to a decrease in saliva.

What areas are likely to decay?

Surfaces
Teeth next to each other because this area is hard to clean
Pits
Fissures in the “chewing” (occlusal) surface of teeth
Gum line

What can I do to help protect my teeth?

The best way to combat cavities is to follow three simple steps: Cut down on sweets and between-meal snacks. Remember, it’s these sugary and starchy treats that put your teeth at extra risk. Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits-the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush.. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child’s developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children. See your dentist at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.

What can your dentist do to help you avoid cavities:

Sealants…are for all ages! They are a plastic “coat” placed on the surface of a tooth to “seal” out decay. You must see your dentist twice a year to check the sealants to make sure they have not chipped or “leaked”.

Provide you with oral hygiene instructions: tooth brushing and flossing and dental diet suggestions.

Have x-rays taken to check for tooth decay in and between teeth to stop them while they are small in order to save your tooth structure.

Remove decay and fill any cavities that exist because they are a good source of bacterial infection!

Smooth edges and repair gaps in existing fillings that could be areas for bacteria to grow.

RELATED NEWS ITEMS

Dentists run out of cavities to fill – Jan 05, 2000 (Detroit News)
Light beam identifies cavities – Oct 17, 2000 (HealthCentral)
Reverse Tooth Decay – Feb 01, 2001 (Ivanhoe)
Children miss school from dental problems – Feb 08, 2001 (E-Dental)
Tea fights cavities, reduces plaque – May 22, 2001 (E-Dental)
If Mom Chews Gum, Children Have Healthier Mouths – Jun 26, 2001 (InteliHealth)
Advance In Vaccine For Tooth Decay – Jul 10, 2001 (InteliHealth)
Dry Mouth From Diabetes Can Cause Cavities – Oct 02, 2001 (InteliHealth)
No Link Found Between Soft Drink Consumption And Cavities – Oct 08, 2001 (Science Daily)
Tooth Decay In Baby Teeth Affects Permanent Teeth, Too – Mar 25, 2002 (InteliHealth)
‘Good’ Bacteria Seen as Potential Cavity Fighters – Jun 28, 2002 (Yahoo)
Genetically engineered bacteria fight tooth decay – Jul 27, 2002 (DentalReach)
New Sugar Free Medicines Don’t Erode Teeth – Sep 25, 2002 (DentalReach)
Five Billion People Worldwide Suffer From Tooth Decay – Feb 24, 2004 (SimpleSteps)
Researchers’ Test Can Predict Cavities – Feb 17, 2005 (USC)
Raisins fight oral bacteria – Jun 12, 2005 (Dental Bazaar)
Cranberry juice curbs cavities, new research shows – Nov 23, 2005 (Fox News)
64% children suffer from dental caries: survey – Dec 19, 2005 (Dental-News)
Syrupy Medicines Increase the Risk of Tooth Decay – Jan 10, 2006 (MedIndia)
Popular Drinks Eat Away at Tooth Enamel – Mar 09, 2006 (SimpleSteps)
Kids With Cavities Overweight, Not Underweight – Mar 23, 2006 (Medical News Today)
Roast veggies as bad for teeth as fizzy drinks – May 04, 2006 (Daily Mail)
Sports Drink Can Be Tough on Teeth – May 16, 2006 (InteliHealth)
Gummy vitamins, rotten teeth? – Sep 24, 2007 (USA Today)
Cavity-causing Bacteria May Be Made To Self-destruct – Jan 07, 2008 (Science Daily)
Tooth Erosion Caused By Popular Energy Drinks – Mar 13, 2008 (Medical News Today)
Tooth erosion grinds away at the young – Apr 07, 2008 (USA Today)
Fruit smoothie boom could trigger tooth decay epidemic – May 19, 2008 (Daily Mail)
Why Do Women Get More Cavities Than Men? – Oct 15, 2008 (Medical News Today)

A crown is a restoration that covers, or “caps,” a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth. Prosthetic crowns are made of metal, porcelain fused to metal substrates, or new all-white restorative materials. Crowns are necessary when a tooth is generally broken down and fillings won’t solve the problem. If a tooth is cracked, a crown holds the tooth together to seal the cracks so the damage doesn’t get worse. Crowns are also used to support a large filling when there isn’t enough of the tooth remaining, attach a bridge, protect weak teeth from fracturing, restore fractured teeth,cover badly shaped or discolored teeth or protect a root-canal filled tooth with compromised strength.

How is a crown placed?

The tooth is numbed and prepared for the crown by removing any decay or weakened areas. The remaining tooth structure is then reshaped to meet proper crown preparation design. If necessary, a restorative material, usually a composite resin, is added to the remaining tooth structure to ensure that the prosthetic crown will have a good foundation. This procedure is called a “build-up.” After the tooth is prepared, an impression of teeth and gums is made and sent to the lab for the crown fabrication. On the next visit, the dentist cements the permanent crown onto the tooth.During the second appointment,the new crown is placed on the tooth. Adjustments may be required to exact the perfect fit, so that the crown will feel comfortable in the mouth and will conform to the bite. When the crown fits seamlessly and contacts the neighboring teeth correctly, the crown is cemented on the tooth.

Will it look natural?

Yes. The dentist’s main goal is to create crowns that look like natural teeth. That is why dentists take an impression. To achieve a certain look, a number of factors are considered, such as the color, bite, shape, and length of your natural teeth. Any one of these factors alone can affect your appearance.If you have a certain cosmetic look in mind for your crown, discuss it with your dentist at your initial visit. When the procedure is complete, your teeth will not only be stronger, but they may be more attractive.

What is the difference between a cap and a crown?

There is no difference between a cap and a crown.

How long do crowns last?

Crowns should last approximately 5-8 years. However, with good oral hygiene and supervision most crowns will last for a much longer period of time. Some damaging habits like grinding your teeth, chewing ice, or fingernail biting may cause this period of time to decrease significantly.

How should I take care of my crowns?

To prevent damaging or fracturing the crowns, avoid chewing hard foods, ice or other hard objects. You also want to avoid teeth grinding. Besides visiting your dentist and brushing twice a day, cleaning between your teeth is vital with crowns. Floss or interdental cleaners (specially shaped brushes and sticks) are important tools to remove plaque from the crown area where the gum meets the tooth. Plaque in that area can cause dental decay and gum disease.Regularly scheduled examinations and hygiene appointments must be adhered to, or the same bacterial assault which causes decay and makes dental care necessary may cause the restorations to fail.

A typical molar crown	A ceramic crown	A gold crown
Before crowns	After Crowns
Gaps before crowns	Closed with crowns

DENTAL BRIDGES

The “bridge” prior to placement			The “bridge” in the mouth
A typical bridge			A Ceramic bridge

BRIDGES – FREQUENTLY ASKED QUESTIONS

What is a bridge?

A bridge is a dental appliance that replaces one or more natural missing teeth,thereby “bridging” the space between two teeth.Bridges are cemented into place on the “abutment” teeth–the surrounding teeth on either side of the space or span. Unlike removable partial dentures,bridges cannot be taken out of the mouth by the patient.

A bridge is a device that typically consists of three units-a pontic (a false tooth) fused between two crowns that are cemented onto the abutment teeth.

Who should get a bridge?

A person with missing teeth and committed to maintaining good oral hygiene practices,is a good candidate for a bridge. A bridge is the most natural choice to fill the space in the mouth left by missing teeth. If left unfilled, this space can cause the surrounding teeth to drift out of position and can cause teeth and gums to become more susceptible to tooth decay and gum disease that can cause further tooth loss. Bridges not only correct an altered bite, improve the chewing ability and speech, but they also safeguard the appearance by preventing the collapse of facial features that can cause premature wrinkles and age lines.

What type of bridges are there?

Besides traditional bridges, another popular design is the resin bonded or “Maryland” bridge, primarily used for the front teeth. This is usually the most economical choice when the abutment teeth are healthy and don’t contain large fillings. The pontic is fused to metal bands that can be bonded to the abutment teeth with a resin cement and hidden from view, reducing the amount of preparation on the adjacent teeth.

A cantilever bridge may be used if there are teeth on only one side of the span. This involves anchoring the pontic to one side over one or more natural, adjacent teeth. If there are no adjacent teeth to act as anchors,an implant is recommended–a metal post that is surgically embedded into the bone and capped with a crown as an abutment. In some cases where the span is large, a removable partial denture is recommended or even an implant-supported prosthesis.

What is the procedure of its fabrication?

For a traditional fixed bridge, the first appointment consists of the dentist reducing the adjacent abutment teeth that will act as anchors. Impressions are made, from which a metal framework, including the pontic, is created. By the second appointment, the final bridge is fitted over the teeth. The total treatment time is usually around one week, depending on the type of bridge. However, because it is often difficult to match the natural shade of your teeth, the treatment time may be longer.

How do I care for a bridge?

With a bridge, it is more important than ever to brush, floss and see the dentist regularly. If buildup of food debris and plaque -the sticky film of bacteria formed from ffood acids-is not controlled, the teeth and gums can become infected, requiring further treatment and resulting in possible loss of the bridge.We recommend using floss threaders that help remove bacteria from hard to reach spaces between the bridge and adjacent teeth and gums. Crowns on the bridge cover most of the exposed portion of your tooth and decay does not affect a bridge since it is made of metal and /or porcelain. However, where the natural tooth meets the crown of the bridge can become decayed. If optimal oral hygiene care is maintained,a bridge can last for many years.

Suggestions and precautions

Adjustment period: It is ok for the bridge to feel a little out of place for a few days after cementing. This is because the teeth around this area are adjusting to new forces both in between the teeth and upon biting.

Preventive Procedures: To provide optimum longevity for your restorations and to prevent future decay and supporting-tissue breakdown, please use the following home care tips:

Brush after eating and before bedtime around the bridge with a soft toothbrush, especially where the crown or bridge meets the gum line (margin). At this margin area harmful bacteria can be harbored to cause decay and gum disease. An electric toothbrush is highly recommended over manual to help you keep this area clean

Floss at least once to twice a day. Use the proxy brush, floss threader or automatic flosser to remove plaque under and around these areas to maintain good oral hygiene. On a bridge you must clean “under” as well as around the bridge. If you do not control the buildup of food debris and plaque your teeth and gums can become infected.

Water Pik™ can be used with an antibacterial, alcohol free mouthwash at the gum line and under the bridge to keep this area healthy

Fluoride rinse is to be used before bed. Swish the fluoride rinse vigorously in your mouth for at least one minute. Do not swallow any of the rinse and do not eat or drink anything for 30 minutes.

Use a proxybrush (interdental brush) to clean around the area after each meal

Chewing: Do not chew hard foods on the restorations for 24 hours from the time they were cemented — to attain optimum strength, the cement must mature for approximately 24 hours Also avoid eating or chewing on hard objects, food or ice

Limit snacks, if high in sugar brush this area or swish with water

Sensitivity: Do not worry about mild sensitivity to hot or cold foods. This sensitivity will disappear gradually over a few weeks. Infrequently, sensitivity last longer than six weeks.

Recare: Inadequate return for examination is the most significant reason for prostheses failure. Visit us at regular six-month examination periods. Often problems that are developing around the restorations can be found at an early stage where they can be corrected easily and will be more affordable. Waiting for a longer time may require re-doing the entire restoration.

Problems: Call us immediately if any one of these conditions occurs: If the tooth is the first tooth to hit when you bite down after a couple of days, contact us for an adjustment; a feeling of movement or looseness in the restoration; sensitivity to sweet foods; a peculiar taste from the restoration site; breakage of a piece of material from the restoration or sensitivity to pressure. ]]> http://www.drkhosla.com/?feed=rss2&p=62 1