Competitive Swimmers May be at Higher Risk for Tooth Decay

Competitive swimmers are incredibly
underestimated athletes. Society
portrays male professional basketball
and football players as some of the
“toughest” athletes. But what about the
grueling training regime competitive
swimmers must endure every day? Not
to mention, the constant smell of
chlorine, dry-skin and often
permanent goggle rings around the
eyes (not the most attractive qualities).
Competitive swimmers also have a
bond unlike any other athlete. Every
ASDA meeting I attend, I meet
somebody new who understands the
saying “Chlorine: It’s what’s for
breakfast.” A recent study has
revealed that particular “breakfast” is
harmful to your teeth. The study
monitored 100 competitive swimmers
in India, finding that 90% of these
athletes showed some form of enamel
erosion. The level of erosion and
sensitivity was found to be directly
proportional to the amount of time
spent in the pool.
Chlorine is one contributing factor to
enamel erosion. The pH level of the
pool is also at fault. The lower the pH,
the more likely your eyes will burn
and your pearly whites will erode.
The chemical levels of public pools is
often beyond our control. If you or one
of your patients is training for a
triathlon or you work with children
who spend a lot of time in the pool, be
sure to reinforce oral hygiene
instructions and regular dental check-
ups.



~Katie Sowa, Houston ’15, editor-in-
chief, ASDAblog


Courtesy: American Students Dental Association

Is Root Canal Treatment Painful?

Most patients having a root canal do not find it to be a painful procedure . Most Dentists have a great deal of experience in getting teeth anesthetized.
If I am starting a root canal and my initial
attempt(s) at achieving anesthesia are
incomplete, there are a number of additional injection options available , including intraligamental,intrapulpal and intraosseous anesthesia.
Assuming that my initial block or infiltration anesthetic was not entirely effective, I find that intraligamental injections are my favorite
technique to make a root canal pt comfortable.
Intraligamental injections usually are best
achieved when a dentist uses a special
intraligamental syringe that delivers a few drops of anesthesia under pressure at the four corners of a tooth. When properly administered, this type
of anesthesia will make a patient comfortable
during their root canal . The only draw back is that occasionally teeth given an intraligamental
injection become slightly tender for a day or two when a patient applys chewing pressure.


Courtesy:Ask Dr. Spindel

DENTAL STEM CELL RESEARCH

Dental professionals are very excited
because scientists have found that our
teeth contain valuable stem cells that, if
properly stored, could potentially hold the
cure to a number of diseases, like
Parkinson’s, diabetes, and cancer, and with the future potential to help heal spinal cord injuries, as well.
Stem cell research has been immersed in
controversy over the years for many
reasons, with the main issues including the following:
• Embryonic stem cells carry technical
and ethical challenges.
• Bone marrow stem cells are very painful
to collect.
• Cord blood stem cells can only be
harvested at birth.

However, with the discovery of stem cells in teeth, an accessible and readily available source of stem cells has been identified.
What’s more, dental stem cells are very
convenient to collect, while possessing
similar benefits for the development of new restorative medical therapies.
Extracting teeth poses a much lower risk
than harvesting stem cells via more
invasive surgical procedures, and patients also experience far fewer complications.
Dentists can now be at the forefront of
regenerative medicine, and also serve as a valuable ally to the medical and research communities.
Dental stem cell research, collection, and
storage are gaining strong momentum in
the dental industry. For example, the
American Academy of Pediatric Dentistry
(AAPD) Council on Clinical Affairs published a policy on stem cells that contained this statement:

The American Academy of Pediatric
Dentistry recognizes the emerging field of
regenerative medicine and encourages
dentists to follow future evidence-based
literature in order to educate parents about the collection, storage, viability, and use of dental stem cells with respect to
autologous regenerative therapies.
A child’s tooth under the pillow may be
worth a buck, but that same tooth, properly collected and stored, will be far more valuable in the future.

Courtesy: The Dental Geek

Tooth Impaction and Wisdom Teeth

An IMPACTED TOOTH is one that fails to erupt into the dental arch within the specific time. Because impacted teeth do not erupt, they are retained throughout the individual's lifetime unless extracted or exposed surgically. Teeth may become impacted because of adjacent teeth, dense overlying bone, excessive soft tissue or a genetic abnormality. Most often, the cause of impaction is inadequate arch length and space in which to erupt. That is the total length of the alveolar arch is smaller than the tooth arch (the combined mesiodistal width of each tooth). The third molars are frequently impacted because they are the last teeth to erupt in the oral cavity. Mandibular third molars are more commonly impacted than their maxillary counterparts. As a general rule, all impacted teeth must be removed unless otherwise contraindicated.

Horizontal Impaction of 3rd Molar.

CLASSIFICATION

Classifications enable the oral surgeon to determine the difficulty in removal of the impacted tooth. The primary factor determining the difficulty is accessibility, which is determined by adjacent teeth or other structures that impair access or delivery pathway. The majority of classification schemes are based on analysis on a radiograph. The most frequently considered factors are discussed below.

Angulation of teeth

Most commonly used classification system with respect to treatment planning. Depending on the angulation the tooth might be classified as:

1. Mesioangular

2. Horizontal

3. Vertical

4. Distoangular

5. Palatal

6. Buccal

7. Lingual

Teeth start to pass through the gums (emerge) during infancy, and again when the primary (baby) teeth are replaced by the permanent teeth.
If a tooth fails to emerge, or emerges only partially, it is considered to be impacted. The most common teeth to become impacted are the wisdom teeth (the third set of molars). They are the last teeth to emerge, usually between the ages of 17 and 21.
An impacted tooth remains stuck in gum tissue or bone for various reasons. It may be that the area is just overcrowded and there's no room for the teeth to emerge. For example, the jaw may be too small to fit the wisdom teeth. Teeth may also become twisted, tilted, or displaced as they try to emerge, resulting in impacted teeth.

Impacted wisdom teeth are very common. They are often painless and cause no apparent trouble. However, some professionals believe an impacted tooth pushes on the next tooth, which pushes the next tooth, eventually causing a misalignment of the bite. A partially emerged tooth can trap food, plaque, and other debris in the soft tissue around it, leading to inflammation and tenderness of the gums and unpleasant mouth odor. This is called pericoronitis.

Symptoms

Bad breath

Difficulty opening the mouth (occasionally)

Pain or tenderness of the gums (gingiva) or jaw bone

Prolonged headache or jaw ache

Redness and swelling of the gums around the impacted tooth

Swollen lymph nodes of the neck (occasionally)

Unpleasant taste when biting down on or near the area

Visible gap where a tooth did not emerge.

 

Tests and Examination

Your dentist will look for swollen tissue over the area where a tooth has not emerged, or has only partially emerged. The impacted tooth may be pressing on nearby teeth. The gums around the area may show signs of infection such as redness, drainage, and tenderness. As gums swell over impacted wisdom teeth and then drain and tighten, it may feel like the tooth came in and then went back down again.

Dental x-rays confirm the presence of one or more teeth that have not emerged.

Treatment

No treatment may be needed if the impacted tooth is not causing any problems.
Over-the-counter pain relievers may help if the impacted tooth causes discomfort. Warm salt water (one-half teaspoon of salt in one cup of water) or over-the-counter mouthwashes may be soothing to the gums.

Removal of the tooth (extraction) is the usual treatment for an impacted tooth. This is usually done in the dentist's office, but difficult cases may require an oral surgeon. Antibiotics may be prescribed before the extraction if the tooth is infected.

Prognosis

Impacted teeth may cause no problems for some people and may never require treatment. Treatment is usually successful when it does cause symptoms.
It is often preferable to have wisdom teeth removed before age 30 due to the flexibility of bone, which will allow an easier removal and better healing. As a person ages, the bone becomes more rigid and complications can develop.

Complications

Complications of an impacted tooth include:
Abscess of the tooth or gums
Chronic discomfort in the mouth
Infection
Malocclusion of the teeth
Plaque trapped between teeth and gums

WISDOM TEETH

Horizontal Impaction Of Mandibular Left 3rd Molar

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

When wisdom teeth are misaligned, they may position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. 

Wisdom teeth may not need to be removed if they are:

— Healthy

— Grown in completely (fully erupted)

— Positioned correctly and biting properly with their opposite teeth

— Able to be cleaned as part of daily hygiene practices.

Many times, however, wisdom teeth — the third molars in the very back of your mouth — don't have room to grow properly and can cause problems. Erupting wisdom teeth can grow at
various angles in the jaw, sometimes even horizontally.
Sometimes wisdom teeth only partially emerge through the gums. Other times, they remain completely hidden. Wisdom teeth that aren't able to emerge normally become impacted, or trapped,
within your jaw.
If the wisdom teeth emerge partially through the gums, a passage way is created, which can cause problems. And because this area is hard to see
and clean, it can become a magnet for bacteria that cause gum disease and oral infection.
Some dentists recommend removing wisdom teeth if they don't fully emerge or if they grow near the nerve of the lower jaw. Many dentists believe it's
better to remove wisdom teeth before the roots are fully formed, when someone is younger and more likely to recover faster from surgery. This is why some young adults have their wisdom teeth pulled
before the teeth cause problems and become more firmly rooted in the jaw.

According to the American Dental Association, wisdom teeth removal may be necessary if you experience changes in the area of those teeth, such as:

— Pain

— Repeated infection of soft tissue behind the lower last tooth

— Cysts (fluid-filled sacs)

— Tumors

— Damage to nearby teeth

— Gum disease

— Extensive tooth decay.

      The decision to remove wisdom teeth isn't always clear. Talk to your dentist or an oral surgeon about the position and health of your wisdom teeth and what is best for the situation.

Treatment 

The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.

Surgical Removal of Impacted tooth

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Tooth Extraction During Pregnancy

Hormonal changes occur during pregnancy due to which the gums become sensitive in case of pregnant females. Gums swell up and will become inflamed in case of pregnancy and will bleed. Periodontal problems occur in this period due to plaque which is present around the teeth. Gum problems very often occur around the wisdom tooth and gums become more aggravated in case of pregnant females. Neglecting ordinary oral care because of press of other duties may increase the incidence of dental caries in pregnant females.

Pregnancy is not a disease but special considerations should be made when tooth extraction is required during pregnancy. The most important thing is to avoid any damage to the baby. Elective procedures should be deferred in the first and the third trimester. If the tooth is infected and is non-restorable, then it should be removed. Infection may cause harm to the baby. Baby should not be exposed to any harmful factors.  

Dentists or oral surgeons usually avoid tooth extraction during pregnancy. If a mother is in constant pain during pregnancy, then she would be stressing her body which would be not good for the child. So tooth extraction should be done in case of pregnancy.

Tooth extraction is no longer painful these days. The procedure is done under anesthesia. Lesser amount of anesthesia should be given to the patient.  Obstetricians and gynecologists also allow tooth extraction during pregnancy if the patient has pain.

If tooth extraction has to be done in pregnancy, then it has to be done in the middle trimester period. Patients in first or the last trimester should have their tooth extraction postponed if possible. Tooth extraction can also be done in latter part of first trimester and first month of last trimester. Extensive surgical procedures should be avoided in the first and the last trimester. They should be deferred until after the child has been delivered.

Trimesters of pregnancy

There are 3 trimesters of pregnancy- first trimester, second trimester and third trimester.

1. In the first trimester, organogenesis of foetus takes place that is the formation of organs of the baby takes place. Liver, kidneys, heart etc. are formed in first trimester of pregnancy. Foetus is highly susceptible to developmental malformations if the mother passes through stress and strain in first trimester. If tooth extraction has to be done in the first trimester, then it should be done in the latter part of first trimester.
2. During the second trimester of pregnancy, the baby is just growing. It is considered as safe period in pregnancy and all the dental procedures can be performed in second trimester. Second trimester is the best time of tooth extraction in pregnancy. While doing the tooth extraction, if the patient falls into syncope, then patient is turned on to the left side to relieve the pressure. Patient should not be kept in supine or reclined position. This is to avoid pressure on inferior vena cava by the foetus which can even lead to hypotension (Decrease in blood pressure).
3. In the third trimester, it is problem for the lady to sit in the dental chair in the same position for hours. Large quantities of steroids are released into the blood. Uterine contraction is stimulated by oxytocin hormone which causes change of premature labour. Blood volume increases and patient can’t be comfortable on the chair. If patient is in severe pain and tooth extraction has to be done in third trimester, then it should be done in the first month of last trimester.

Obstetricians and gynecologists allow for full dental care during the last trimester of pregnancy and the most elective dental care during the second trimester.

Wisdom Tooth Extraction during pregnancy

Wisdom teeth might need extraction when the lady is pregnant. Most of the obstetricians and gynecologists believe that wisdom tooth extraction can be done during pregnancy. Wisdom tooth should be removed with minimum of trauma during pregnancy. Antibiotics and pain pills may be prescribed by the dentist to reduce the infection and pain which can further stress both mother and baby. Wisdom tooth Extraction should be done in the second trimester which is the safe period of pregnancy.

Medications during pregnancy

Pain killers used during pregnancy

• Acetaminophen can be prescribed to the patient for pain relief. It is considered safe throughout pregnancy.
• Ibuprofen is considered safe till 32 weeks of pregnancy. If pain is very severe, then narcotics can be given like codeine for short duration of time after consulting patient’s obstetrician.

Antibiotics are required to treat or prevent infection. Antibiotics used during pregnancy

• Penicillin (Category B for safety in pregnancy) and cephalosporin’s can be given to the patient unless the patient is allergic to it.
• Erythromycin is also safe during pregnancy provided patient’s stomach can tolerate it.
• Tetracycline should not be given to the patient. Tetracycline given during pregnancy in second or third trimester or in neonates may lead to tetracycline pigmentation in teeth of baby.

Time of tetracycline treatment                                                                                       Teeth affected

4 months intrauterine life (foetus) to 3 months post-partum                                                 Deciduous incisors

(period after the birth of baby)

5 months intrauterine life to 9 months post-partum                                                             Deciduous canines

Tetracycline causes internal pigmentation due to chelate formation of tetracycline with calcium.

Use of anesthesia during pregnancy

Lidocaine is commonly used local anesthetic agent used during tooth extraction. (Category B for safety in pregnancy). It does cross placenta after it is given. Anesthesia which is administered should be as less in amount as possible but it should be enough to make patient comfortable. If pain is experienced by the patient, then she will be administered more local anesthesia. Local anesthesia is usually used without epinephrine. Epinephrine is a vasoconstrictor and it increases the duration of anesthesia. If the dentist feels that the patient requires anesthesia with epinephrine, then patient’s obstetrician can be consulted. If a patient is comfortable, then the stress on the patient and baby is also reduced. Anesthesia will also be more effective if the patient is more comfortable.  

Inhalation or intravenous anesthesia is avoided during pregnancy as it increases the risk of miscarriage in the first trimester.  

X-rays during pregnancy

During tooth extraction procedure, it may be necessary to take a radiograph. While taking x-ray in pregnant woman, to cover the upper part of body, lead apron shield can be used. Diagnostic x-rays don’t have radiation dose too much which can cause any side effect to the developing foetus or embryo.

Pregnant women should-

1. Tell the dentist that she is pregnant. The treatment plan and the medications which are to be given to the patient may be altered in case of pregnancy.
2. To avoid dental problems, she should maintain a good oral hygiene and should get dental cleaning done during the course of pregnancy to avoid deposits in the teeth.
3. She should not miss her dental appointments. Pregnant woman needs to get dental cleaning done regularly because of sensitivity and bleeding of gums.

It is always better to visit the dentist or the oral surgeon to know whether tooth extraction should be performed or not. Dentist can take care of pregnant woman and the baby.

courtesy: SSDC

Anti Microbial Agents

ANTIMICROBIAL DRUGS

   

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