About Dentures

Dr. Tanvee Singh, Smile Care, Bandra 2

Dentures are replacement teeth for teeth that are missing, as a result of falling out or having to be pulled. Dentures are commonly worn mostly by older individuals. They are usually constructed out of metal and acrylic resin, a material very similar to plastic. Dentures are not permanent inside of the mouth, and therefore are removable.

Types :

There are two different types of dentures: partial dentures and complete (also referred to as "immediate") dentures. Partial dentures take the place of a few missing teeth, whereas complete dentures, unsurprisingly, replace every tooth in the mouth. They are both removable and made out of acrylic resin and metal.

Significance :

Dentures are worn by individuals who have lost some or all of their teeth, usually from tooth decay periodontal disease or injury. The reason for dentures is to benefit a person's appearance, because teeth help support facial muscles. Without the help of dentures supporting these muscles, the face would sag and make a person appear older than their years. Dentures also make eating (especially chewing) and speaking much easier.

Caring for dentures :

1. Dentures need to be taken care of just like natural teeth do. They should be brushed with your denture toothpaste twice daily to remove lingering food particles, as well as plaque build up.
2. Remove the denture and rinse your mouth with a mouth wash once daily to keep infections at bay.
3. Visit your dentist when you develop sores or experience sudden difficulty in speaking or eating.
4. Make sure you get your denture reevaluated at every 6 months interval by your dentist.

Prevention/Solution :

There are several ways to avoid getting periodontal disease or tooth decay, which are both things that lead to having to get dentures, whether they are complete or partial. Floss your teeth daily, limit your intake of sugary soft drinks, brush your teeth at least twice a day with a toothpaste containing fluoride, and visit the dentist every 6 months for a routine cleaning and checkup appointment.

Considerations :

There are some disadvantages to having dentures. They definitely take a while to get used to, which is not surprising as you would have a whole new set of teeth in your mouth. People with dentures often have speech issues when they are getting used to them. Sores and other mouth irritations also can occur with dentures (these are usually caused by not removing your dentures enough or not cleaning them properly).

Facts :

A new denture will not last forever, and if old dentures are much over 7 years, the mouth and face will have changed in ways which will make it more difficult to build satisfactory new ones. What happens over the course of a number of years, is that the dentures slowly disappear under the lip, and upper and lower dentures began to fit together differently bringing lower jaw forward, and in some cases making it possible to bite only on the front denture teeth. If lose dentures are worn long enough, body will tend slowly to build more and more soft flabby gum tissue to fill the spaces between the denture base and the underlying bone.

1. Lower dentures can be very hard to wear. Many people with upper and lower dentures often wear only the upper on a routine basis, since uppers are retained with at least degree of suction. Fortunately, now there is a way to stabilize the lower denture by fabricating Implant supported or Implant retained dentures.
2. 2.Many people stop going to their dentist after dentures are fitted. Some people believe that complete dentures mean the end to oral problems and those original dentures should last forever. Regular check-ups are still the best insurance that your mouth is healthy.

Bleeding Gums And Their Care

Dr. Kripa Shetty, Smile Care, Bandra 1.

Bleeding gums is a serious problem. It indicates the beginning of the destructive process involving the supporting tissue around the tooth or some serious underlying systemic problems.

Causes :

Plaque accumulation on teeth is the primary cause for poor gums. This plaque if not removed through regular brushing and dental appointments, will harden into what is known as tartar. Ultimately, this will lead to inflamed gums, a condition called gingivitis, increased bleeding and finally a more advanced form of gum and jawbone disease known as periodontitis.

Other causes of bleeding gums include :

• Brushing too hard
• Improper flossing
• Infection, which can be either tooth or gum-related
• Scurvy (Vitamin C deficiency)
• Vitamin K deficiency
• Hormonal changes during pregnancy
• Leukaemia (Blood Cancer)
• Ill-fitting dentures
• Use of blood thinners

Home Care :

• Visit the dentist at least once every 6 months for plaque removal. Follow your dentist's home care instructions.
• Brush teeth gently with a soft-bristle toothbrush after every meal. The dentist may recommend rinsing with salt water or hydrogen peroxide and water. Avoid using commercial, alcohol-containing mouthwashes, which aggravate the problem.
• Floss teeth twice a day to keep plaque from building up.
• Eliminate between-meal snacks and reduce carbohydrate intake to help prevent plaque build-up on teeth.
• Use an oral irrigation device on the low setting to massage the gums.
• Maintain a balanced, healthy diet.

Additional tips :

• Avoid the use of tobacco, which aggravates bleeding gums.
• Have poorly fitting dentures adjusted and relined by your dentist if they are causing sore spots in gums.
• Avoid aspirin unless your physician has recommended that you take it.
• Control gum bleeding by applying pressure directly on the gums with a gauze pad soaked in ice water.
• If you have been diagnosed with a vitamin deficiency, take recommended vitamin supplements.
• If side effects of medication are irritating, ask your doctor to adjust or substitute another medication. Never change your medication without consulting your doctor.

You should see your dentist if :

• Your gums continue to bleed even after treatment
• The bleeding is severe or chronic
• Other unexplained symptoms are associated with the bleeding.

Care For Retainers

Dr. Tanvee Singh, Smile Care, Bandra 2

Retainer wear is one of the most important parts of your orthodontic treatment. Initially, retainers should be worn ALL OF THE TIME (removable) except when brushing, eating, playing certain musical instruments, or participating in physical activities.

Please follow these instructions for removable retainers :

1. Retainers need to be cleaned just like your teeth.
   1. Use your toothbrush and toothpaste to scrub them, or a fingernail brush with soap and water.
   2. If they develop a bad taste, you may soak them in mouth wash, but only for a short period of time. Some mouth washes can cause the plastic material in the retainer to deteriorate.
   3. Use an "over the counter" denture cleaner to clean your retainers on a periodic basis as needed.
2. ALWAYS keep retainers in the case provided. Retainer loss and breakage is usually a result of not being in the case. Take extra care not to wrap your retainers in napkins at mealtime since they could be thrown away too easily this way.
3. Retainers are made of a plastic substance and can warp if hot water is used on them. Take care to leave them out of the heat. (In other words, putting your case on the dashboard of a car in the summer is bad news.)
4. Pets will eat retainers. Don't leave them lying around.
5. The small lower retainer could be lost in the sink drain, so keep the drain covered when brushing the retainer.
6. When participating in sporting events or physical exercise, you should remove your retainer and place it in your retainer box for safe keeping

Fixed Retainer

A fixed retainer or splint is a retainer that is cemented in place on the backside of the teeth.

Please follow these instructions for fixed retainers

1. It is very important that you brush and floss thoroughly paying special attention to the fixed retainer.
2. Use interdental brushes to clean in between teeth.
3. Avoid eating sticky food and biting from front teeth.
4. If your fixed retainer becomes detached from any of the teeth, please call the office immediately.

Consequences Of Missing Teeth

Dr. Rachana Bhama, Smile Care, Bandra1

As soon as a tooth is lost the bone will degenerate and the teeth on either side will shift or tip into the empty space. If there is a tooth directly above or below the space it will over erupt, as there will not be anything to prevent it from coming out of the gum tissue. The majority of bone degeneration will occur within the first six months but will slowly continue for years. The movement of the adjacent teeth will not occur immediately; rather it will become noticeable after three to five years. How fast it occurs will depend on the density of bone in the area, your bite and how well your teeth occlude or interlock with each other.

If you have missing teeth and you do not replace them, these movements will occur. These movements may create gum problems and /or decay and could lead to the loss of other teeth. As you lose more teeth, you will be forced to chew in other areas, and this often leads to tooth fracture from overloading, excessive wear and or TMJ (jaw joint) problems. Eventually more extensive and expensive dentistry may be required in the future.

There are several reasons that you want to replace a missing tooth or teeth. A tooth has many functions some being to chew, to speak, to keep the facial muscles and tissue in a proper position, to smile, and to keep the other teeth from shifting. Once a tooth is lost this whole balance is disrupted and it leads to many various problems.

For certain teeth, such as your wisdom teeth, it is unlikely that you will need to replace them. As adults we have three molar teeth and we do most (about 80%) of our chewing from the first molar to the first premolar/canine area. About 20% is done in the second molar area, and very little is done in the wisdom teeth area. Therefore, we seldom miss or need our wisdom teeth if they are absent or removed. The second molar does at times need replacing, depending on each individual's situation.

In children, baby teeth maintain space for the developing permanent teeth. If baby teeth are lost early, crowding problems may be unnecessarily created and may require orthodontic treatment to correct. Baby teeth are generally not replaced with another tooth; however, an appliance (space maintainer) is often placed until the permanent tooth erupts.

Dental Recontouring - Is It Right For You ?

Dr. Rachana Chindhade, Smile Care, Nashik

Dental recontouring maybe the right choice for people who want to correct minor imperfections and overall dental health by removing minor crevices or overlaps in which plaque or tarter can accumulate.

Recontouring is the most conservative cosmetic treatment. It is quick, and painless procedure whose results can be seen immediately.

Who should consider Recontouring ?

Recontouring is an effective method to correct minor imperfections such as :

• Fixing small chips.
• Smoothing out bulges or pits in tooth’s enamel.
• Adjusting slight irregular tooth shapes caused by too many or uneven teeth.
• Adjusting the length of pointed canines.

What does Recontouring involve ?

Initial Examination :

The dentist may first take an X-ray of your teeth to determine the size and location of the tooth’s pulp (the centre of the tooth that contains nerves and blood vessels). If the tooth’s enamel is too thin or if the pulp lies too close to the tooth surface re-contouring may not be possible.

Procedure :

The dentist will use sanding disks or diamond burs to remove minute portions of your tooth enamel. Sometimes, strips of sandpaper will be used to shape and smooth out im- perfections. When the teeth are already shaped properly, the dentist will polish your teeth. Tooth recontouring will not affect the living pulp of the tooth so anaesthetic is not re-quired. Most people need one or more visits in order to finish the treatment.

What are the risks involved in Tooth Recontouring ?

Tooth recontouring does not pose any major risks although if the tooth enamel is relatively thin, your teeth may become more sensitive to hot and cold temperatures after the procedure.

What are the follow-up procedures for Recontouring ?

Tooth recontouring does not use any artificial materials to shape the teeth. This means that your teeth will not require any special care after the procedure.

Dress Up Your Smile With Dental Jewelery And Teeth Whitening

Dr. Anjali Dilbaghi, Smile Care, Bandra 1.

Imagine the perfectly groomed you with hair so lustrous, immaculately done nails and impeccable make up, outfit to suit the occasion, shoes like the Cinderella story, complementing accessories to complete the picture! One would imagine what more could be added to this perfect picture to impart that extra dazzle! Well what about your smile? You are never completely dressed without a smile!!

A stunning bright smile adorned with a diamond would never fail to catch the eye.

At Smile Care we could effortlessly add a radiant gem to your smile in a single 20 minute visit. If you have dull or yellow teeth you could also enhance your smile with a simple 30 minute office teeth whitening. Unbelievable but true!

Decorating ones smile with an American diamond has become a trend among youngsters and party goers. A lot of brides too opt for the diamond to add grace to the occasion. This is a painless procedure and is completed in 20 minutes with a single visit to the dentist. It does not create any hindrance to everyday activity and the diamond can be removed by the dentist when required.

Teeth whitening is a procedure carried out by the dentist to brighten the color of ones teeth. This can be done in the dental office or at home (under the guidance of the dentist). It takes about 30 minutes to complete the procedure in a dental office and shows results instantly. The results may last upto 1½ years depending heavily on a person’s food habits.

Teeth whitening is adopted also as a treatment modality in case of stained, discolored teeth. Microscopic intrinsic stains and discolorations are present deep within the teeth which give them an overall dull or yellowish appearance. The whitening agent is a peroxide based formula which reacts with the stains in the teeth oxidizing and completely removing them. The gums and lips are protected by special barriers to avoid contact with the whitening agent.

So, in today’s era, where our appearance is vital to our success, dressing up ones smile plays a crucial role to add that extra sparkle!

Dry Mouth or Xerostomia

Dr. Dimple Bharadwaj, Smile Care, Bandra 1

Causes of Dry mouth

Iatrogenic

1. Drugs
2. Irradiation
3. Graft versus host disease

Disease

1. Dehydration
2. Psychogenic
3. Salivary gland diseases
4. Sjogrens syndrome

Points for patients : Managing dry mouth

• Drink enough water, and sip on water and other non sugary fluids throughout the day.
• Replace missing saliva with salivary substitute’s eg artificial saliva, Alcohol- free mouth rinses or moisturizing gels. Proven effective product is GC Dry Mouth Gel.
• Stimulate drugs with sugar free chewing gums or sugar free sweets.
• Always take water or non alcoholic drinks with meals and avoid dry or hard crunchy food and sticky food.
• Moisten food with gravies, sauces, yoghurt. Pineapple has an enzyme that helps clean the mouth.
• Avoid anything that may worsen dryness such as drugs, alcohol, smoking, caffeine
• Keep mouth clean using a fluoride tooth paste and by flossing
• Avoid hot dry environments- if possible consider a humidifier for the bedroom

Flossing : Key To Fight Gum Disease

Dr. Rachana Bhama, Smile Care, Bandra1

Flossing is an essential part of the tooth-cleaning process because it breaks up and removes plaque from between teeth and at the gumline, where periodontal disease often begins. Most cavities and periodontal disease begin between the teeth. While brushing is important, the bristles of your brush simply can't reach between the teeth. Did you know that without flossing, 40% of the surfaces of your teeth are NEVER clean? To keep your gums and teeth healthy, you must floss at least once a day.

Benefits of flossing :

• Decreased risk of gum disease
• Better breath
• Removes plaque in between teeth
• Polishes tooth surfaces

How to Floss :

1. Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger. If the floss is hard to get between your teeth, try using dental tape, which is thinner.
2. Holding the floss between your thumbs and forefingers, guide it between two teeth by gently rubbing it back and forth.
3. When the floss reaches the gum line, curve it around one of the teeth and gently slide it back and forth in the crevice between the tooth and the gum.
4. Holding the floss tightly against the side of the tooth, rub gently up and down.
5. Repeat for each tooth, including the backside of your last teeth, changing to a different part of the floss as you go along.

5 Excuses for Not Flossing :

1. My Gums Bleed - This is a sign you REALLY need to start flossing because you have an infection in your gums.
2. I get my teeth professional cleaned twice a year, so I don't have to brush or floss - Plaque can turn to hard calculus in less than 2 days. Daily cleaning is needed to keep your teeth clean.
3. No time to floss ? - Floss your upper teeth in the morning, lower teeth in the evening.
4. My teeth are too tight for the floss - Try a polymer floss that is ADA approved or use the flosser.
5. I'm afraid of damaging my gums when I floss - The technique is important. Remember to slide the floss between the gum and teeth with light pressure.

Remember :

• Don't be discouraged with your first attempts at flossing; you will improve with time and practice!
• Your gums may bleed and be sore the first few days that you floss however they will heal and stop bleeding in a couple of days once the bacteria are removed.
• Flossing disturbs bacteria and stops it before it can create plaque and cause gum and bone disease.  Floss once a day for a healthier set of teeth and gums

Gum Disease Treatment

Dr. Tejaswini Malasane, Smile Care, Nasik

Gum disease or periodontal disease is the infection of the gums and bone that supports teeth. Initial stage of gum disease is called gingivitis and if gingivitis is left untreated it progresses to a condition that is known as periodontitis which can have serious implications such as loss of your teeth.

Treatment for the gum disease :

• Gingivitis is the initial stage of gum disease and is characterized by swollen bleeding gums.
• The best remedy for gingivitis is very careful attention to brushing and flossing. Your dentist might want to do a careful and complete cleaning of the teeth, but the rest is up to you.
• Brush at least twice a day. Floss daily. Your dentist may give you special instructions about the proper way to brush and floss.
• Regular dental visits will help you to ensure that the disease is curbed/caught as soon as it appears.

Once periodontitis has set in, brushing and flossing should remain top priority. However, specific treatments will be needed.

Mild periodontitis :

• The first step by the dentist is scaling and root planing, a deep cleaning technique. Scaling removes plaque and calculus (tartar) from under the gum line. Root planing smoothes any bumps or rough areas on the tooth roots. Plaque tends to build up on rough surfaces.
• Antibiotics may be prescribed by the dentist along with scaling and root planing. Antibiotics can be swallowed as a pill or applied in gel, powder or chip form to the affected area of the mouth.
• Sometimes these treatments are not successful and the dentist may recommend a periodontal surgery.

Moderate periodontitis :

• Moderate periodontitis is a treatable condition. It can be treated by scaling and root planning.
• Dentist may prescribe some specific antibiotics. You may have to try a different antibiotic or several courses of antibiotics.
• If antibiotic treatment fails, the next step is usually periodontal surgery. These procedures can reshape the gums or encourage new growth of the bone that you have lost.
• Your teeth may become loose. So the dentist may have to splint these loose teeth to other strong teeth in the same arch to stabilize them.

Advanced periodontitis :

• Advanced periodontitis will require surgical treatment. In this type of surgeries the flap of gum is raised and the disease-causing bacteria are removed. Then the tooth roots are smoothed and then, bone grafts or tissue-stimulating proteins are placed where the bone has been destroyed. This helps to encourage the body's natural ability to regrow the lost bone and tissue. The gums are stitched back in place. This helps the gum tissue to reattach to healthy bone.
• Loose teeth may be splinted to stabilize them.
• Extremely loose and/or painful teeth may need to be extracted.
• People with periodontis should diligently follow their dentist’s advice.

Oral Rehabilitation And Implants

Dr. Kavita Mahesh, Smile Care, Bandra 1.

While all changes to the face have a functional impact, even a minor change within the chewing system needs to be based entirely on function. Aesthetics cannot be achieved without function. In fact, any aesthetically pleasing smile makeover, evolved within a framework of function and interaction. Beauty is harmony and it also applies to your teeth and jaws.

We have a large group of specialized muscles that contract in certain situations and pull the overlying soft tissues into a smile. Teeth become exposed. The amount of tooth exposed during a smile varies from patient to patient. A young person displays more tooth surface than an older person. This is caused by two things: the progressive sagging of the upper lip and the attrition (shortening) of the upper incisors.

These signs of aging are the main reasons why many middle-aged individuals decide to 'lift' their smile by lengthening their front teeth with veneers. They often receive six to ten upper porcelain veneers. However, any dimensional change of the front teeth has to consider stomatognathic function. Another concern is loss of teeth which leads to jaw bone loss and collapse of facial support. Tooth replacement be it an anterior or a posterior tooth is important to restore oral and facial function.

The best tooth replacement options available today are with dental implants. These are tooth shaped titanium inserts which can receive caps once they integrate with the jaw bone to restore the original look, comfort and feel like our natural teeth. Dental implants can be utilized to restore one or even all teeth in our jaws based on patients restorative and esthetic needs. When you receive a new smile, it is not just 'painted' into your face. It is integrated in complete functional harmony with the surrounding structures of the skull.

A full-mouth oral reconstruction is a challenging treatment modality. The entire dentition is rehabilitated during a full-mouth reconstruction. The restorative dentist needs to thoroughly understand every aspect of the dentition, its relationship to the jaw joints, and the functional interactions of the masticatory muscles. A full-mouth reconstruction approaches the oral cavity truly holistically. It leads to a complete rehabilitation of the mouth.

Who are the patients needing a full-mouth reconstruction?

Patients requiring extensive restorative care frequently exhibit significant loss of tooth structure.

Severe wear mainly caused by - Parafunctional habits like grinding or clenching teeth / chewing pan or tobacco / Erosion, due to acidity, dry mouth.

Tooth loss - Extracted or missing teeth in the mouth can lead to excessive stress and wear of remaining teeth.

At Smile Care®, our team of doctors initiate the full mouth therapy with a thorough diagnosis of the cause of tooth wear with elimination of cause as a priority. The next step is to develop a treatment plan to restore patients chewing ability along with esthetics after discussing various treatment options with the patient.

Preventive Dentistry For Kids

Dr. Poorva Gharpure, Smile Care, Nasik.

New technologies have given us a better insight into different approaches in dentistry. Regular dental checkup is the first step towards prevention of dental decay. Preventive measures suggest interception done best at earliest or initial stages. Parents are encouraged to be active in making decisions along with dentists for their child’s dental therapy.

Based on caries risk assessment of a child, protection from cavities can be achieved through :

1. Topical and systemic fluorides
2. Remineralization toothpastes/chewing gums
3. Dental sealants

Topical and systemic fluorides :

Topical fluorides: Professionally applied fluorides are used in a gel or varnish form, main constituent being acidulated phosphate fluoride or stannous fluoride. Biannual application of such topical fluorides has proven to be effective especially in kids having high risk of caries and for newly erupted permanent molars. Fluoride gels or foams are applied in soft application trays for a period of 4 minutes as against fluoride varnishes that are painted onto teeth and left on. Other topical fluoride means are fluoride mouth rinses and dentifrices, to be used under professional guidance.

Systemic fluorides: Fluorides that are delivered through ingestion account for systemic fluorides. Different food sources or dietary supplements like tablets or lozenges can increase fluoride levels in blood. Fluoridated water supply also provides for systemic intake.

Remineralization toothpastes/chewing gums :

Incipient chalky lesions and undetectable subsurface lesions suggestive of decay can be reversed through application of remineralization pastes or consumption of chewing gums containing amorphous calcium phosphate-casein phosphopeptide complexes or calcium sodium phosphphosilicate which are clinically proven to aid in remineralization of dental enamel.

Dental sealants :

Anatomical variations in the form of deep occlusal pits and fissures in molars and rarely premolars render teeth susceptible to dental decay. Newly erupted permanent first molars are more susceptible to decay since they are one of the first teeth to erupt in the oral cavity. Sealants are plastic like flowable resin materials which when applied over preconditioned teeth and subjected to light of specific spectrum, harden over the surfaces applied. Food deposition and accumulation reduces considerably in these areas, thereby minimizing possibility of decay.

Preventive orthodontics :

Preventive orthodontics focuses on maintaining integrity of normal developing dentition. Problems regarding discrepancy of occlusion in forms of premature shedding or over retained milk teeth, thumb sucking or tongue thrusting habits, crowding, spacing and other tooth size-jaw size abnormalities can be identified and evaluated for the need of treatment at an early stage when the permanent teeth start erupting, by the age of 7 years. Sometimes, a wait and watch approach in mixed dentition stage is useful to assess whether discrepancy is self correcting. Dental appliances like habit breaking, space maintainers or others which aid in guided jaw growth, help in correction of minor problems which may complicate at a later stage.

Before determining the treatment modalities for the child, it is necessary to evaluate the age, previous exposure to fluorides, water fluoridation levels, dental eruption pattern and decay rate of the child. Caries risk assessment by a dental professional, effective communication & co-operation with parent will allow the child to receive proper dental care to maintain healthy teeth in the long run.

Replacement Of Natural Teeth With Implants

Dr. Abhijit Vajramushti, Smile Care, Kolhapur

Until a few decades back when natural tooth was lost, it was replaced by a removable partial Denture, or a fixed prosthesis, Each of these treatment options had their own disadvantages, With the advancement of technology and research, dentistry today has a better option for the replacement of a natural tooth - with dental implants. Dental implant is an artificial substitute to replace the root portion of teeth and put into the bone and gums of mouth. Replacement teeth are then fixed on to these new roots. Dental implants allow people who are with missing teeth to be able to smile, speak and chew well and comfortably.

Types of Implants :

There are three types of implants :

1. Endosseous Implant : These implants are usually shaped like a screw or cylinder. They are placed within the jaw bone.
2. Subperiosteal Implants : These Implants consist of mental frame work that attaches on top of the jaw bone but underneath the gum tissue.
3. Transosteal Implant : These implants are either a metal pin or a U - shaped frame that passes through the jaw bone and the gum tissue, in to the mouth.

Implants are made from metals and alloys such as Titanium, Titanium-Aluminium-V alloy, Chromium-cobalt-mobedium alloy, ceramics.

Advantage of Implant over traditional prosthesis.

The goal of modern dentistry is to return patientas to oral health in a predictable fashion. The partial and complete edentulous patient may be unable to recover normal function, esthetics, comfort, or speech with a traditional removable prosthesis.

The patient’s function when wearing a denture may be reduced to 60% compared with that formerly experienced with natural dentition, however, an implant prosthesis may return the function to near normal limits. The esthetics of the edentulous patient also is affected because of bone atrophy continued resorption leads to irreversible facial changes. An implant stimulates the bone and maintains its dimension in a manner similar to healthy natural teeth. As a result, the facial features are not compromised by lack of support. In addition, implant supported restorations are positioned in relation to esthetics, function and speech, not in neutral zones of soft tissue support. The soft tissues of the edentulous patient are tender form the effects of thinning mucosa decreased salivary flow, and unstable or unretentive prosthesis.

The implant retained restoration does not require soft tissue support and improves oral comfort. Speech and function are compromised with prostheses form the supporting structures during use. The tongue and peri-oral musculature may be compromised to limit the movement of the mandibular prosthesis. The implant prosthesis is stable and retentive without the efforts of the musculature

Root Canal Therapy

Dr. Kripa Shetty, Smile Care, Bandra 1

A tooth is basically made up of two parts: the crown and the root.

The crown is what you see when you smile or open your mouth. It's the part that sits above your gumline. An outer enamel layer and the dentin inside protect the tooth's underlying structures and prevent bacteria from entering the tooth.

The root is below the gumline. It makes up about 2/3rds of the tooth's total length. The root canals house the pulp and extend to the underlying bone. The pulp helps nourish the tooth and is made up of tiny blood vessels and nerves. The blood vessels carry nutrients to the tooth, and the nerves give feeling to the tooth. The pulp tissue enters and exits through openings at the root tips.

Unhealthy Tooth Bacteria can invade your tooth through a loose filling, a cavity, or a crack. In the initial stages the cavity can be cleaned and a tooth colored filling done to restore it. However, once the pulp becomes infected by the bacterial attack, a root canal treatment is necessary to restore it. If left untreated, the inflammation and infection will spread down the root canal, often causing sensitivity to hot or cold foods, throbbing, aching, or pain when you chew. This may lead to the bone getting infected as the bacteria escape through the root openings. The bone breaks down, and your ligament surrounding the root may swell and loosen the tooth.

ROOT CANAL TREATMENT

The goal of root canal therapy is to restore the health of your damaged tooth. During treatment, the pulp is removed from your root canals through a small opening in the crown. Then the canals are cleaned and disinfected. The adjoining diagram shows an instrument being used to clean the canal.

Treatment may take one or more visits. The tooth is first numbed. An opening is made in your tooth and any existing fillings or decay is removed. Then your dentist removes unhealthy pulp with tiny, flexible files. Using delicate, up-and-down motions, your dentist gently cleans and smooths your canals to disinfect them and prepares them for filling.

The canals are then sealed with an inert material that occupies the space vacated by the removal of the pulp.

After the inside of your tooth has been treated, the outside will be restored to protect your tooth's underlying structures and to bring the tooth back into function. Your dentist will usually cover the tooth with a ceramic or metal crown.

After root canal therapy your tooth should function and feel like your other teeth. Take care of your treated tooth the same way you would your other teeth. Brush after every meal, and floss before going to bed. Also, have regular dental checkups, cleanings, and any other dental work you may need so that your teeth last as long as you do!

Solution For Discolored Teeth

Dr. Poonam Agarwal, Smile Care, Vashi.

Do you ever wish that your teeth were whiter ???

Very often, the distinction between a good smile and a great smile is the whiteness of the teeth. This leads to some people worry needlessly about the overall color of their teeth. For e.g. A person with light complexion may believe that his/her teeth are too dark when actually they are normal in color. A Sun tan, darker makeup or a darker lipstick will usually make teeth appear much whiter by increasing the contrast between the teeth and the surrounding facial features. But, many people have definite aesthetic problems which require treatment. The treatment for discolored teeth is based on treating the causes for discoloration.

Causes for discoloration of Teeth :

• Extrinsic {on the surface}causes : These include discoloration caused by Tea, coffee, wine, cola or other drinks or foods, tobacco smoking, bacteria producing colored pigments, salivary protein layer covering the tooth surface, tooth decay or a broken down filling.
• Intrinsic {changes in the tooth material} causes : These include discoloration caused by excessive exposure to fluoride during early childhood, Use of tetracycline antibiotics during the second half of pregnancy causing stained teeth in the child, Use of tetracycline antibiotics at the age of or before 8 years , Trauma affecting a tooth at childhood. The loss of blood supply and nerve supply can by itself cause discoloration of the tooth.
• Age-related discoloration : This is a combination of extrinsic and intrinsic factors. Dentin naturally yellows over time. The enamel that covers the teeth gets thinner with age, which allows the dentin to show through. Foods and smoking also can stain teeth as people get older. Finally, chipping or other injuries also can discolor a tooth, especially when the pulp {nerve} has been damaged.

Treatment for Discolored Teeth :

• Many extrinsic stains can be removed by regular professional cleanings and home care. Good home care includes brushing, flossing and rinsing after meals.
• If a broken down filling or a cavity is the cause, filling the defect will improve the discoloration.
• Discoloration resistant to cleaning or intrinsic stains can be corrected or greatly improved through conservative procedures such as Bleaching, Micro abrasion or Veneering.
• Bleaching will not lighten some stains. In this case, your dentist may recommend covering the discolored areas. This also may be useful when the tooth is chipped or badly damaged. A tooth can be covered with a color-matched composite bonding material or veneers {thin ceramic shells that cover the outer surfaces of the teeth}
• If your tooth has darkened after a root canal, bleaching the enamel won't help. Your dentist can apply a bleaching material to the inside of the tooth, or you may consider a crown or veneer.
• Stains caused by tetracycline medications usually require more than one form of treatment depending upon the type of stains.
• Age related stains can be treated using the combination of above mentioned treatments.

Sports Dentistry

Dr. Poorva Gharpure, Smile Care, Nashik

In the recent times, preventive dentistry has emerged as the main focus of dentistry. Awareness among sportsmen and various international sport organizations has recognized the need of dentistry in sports. Prevention of such injuries can be achieved through proper patient education, diagnosis, treatment of existing dental problems & designing custom made mouthguards.

Types of orofacial injuries commonly observed in athletes include injuries to the dentition, namely, fractured or knocked out teeth, loosened teeth or teeth forced out of position. Injuries resulting in dislocation or fracture of jaws may be incurred due to direct impact on jaws.

Contact sports like football, boxing, martial arts, hockey and non contact sports like basketball, baseball, bicycle riding, soccer, wrestling, racquetball, surfing and skateboarding should be supplemented with protective appliances like mouthguards.

Preventive solutions for orofacial injuries can be enlisted as :

1. Regular check up for any undiagnosed problem that might cause an unexpected problem during athletic event.
2. Completion of any ongoing dental treatment.
3. Use of mouthguard under professional dental guidance.

Mouthguards :

Mouthguards are readymade or custom made devices fabricated in a way to provide maximum coverage over all teeth. Usually they are adapted over maxillary teeth unless indicated on mandibular teeth. Material used for mouthguard must have shock absorbing properties. According to various international organizations for sports dentistry, material of choice for custom made mouthguards is ethylene vinyl acetate.

Types of athletic mouthguards :

1. Stock : Has no individual fitting and is least desirable; available at local sports stores.
2. Boil & bite : individual fitting attempted by boiling material and adapting to individual teeth and is less desirable; available at local sports stores. Uneven distribution of material does not allow proper fit and protection.
3. Custom made : The most preferred type. Fabricated under proper guidance of a dentist, they are either made in dental clinic or sent by the dentist to the dental lab for custom fabrication with proper guidelines. The advantage of a custom made mouthguard is its fit, adapatability to individual speech requirements, customized occlusion and no interference in breathing.

Custom made mouthguards : They are designed according to the sport played, age of athlete and history of any previous trauma. Eg: Boxing and martial arts need mouthguards to be made keeping in mind maximum exchange of oxygen and adequate airway maintenance in unexpected events like nasal obstruction due to blow on nose. Custom made mouthguards are further classified according to the method of fabrication as :

1. vaccum custom made by vaccum machines
2. pressure laminated custom made by pressure machines.

Features of mouthguard :

1. shock absorbing concussive forces to lower jaw.
2. protection against neck injury.
3. distributing force of blow all over surrounding teeth and gums.
4. adequate material thickness, maximum occlusal coverage.

A snugly fit customized mouthguard when in place causes forward and downward movement of movement of the jaw, opening the space between the glenoid fossa and condylar head. Any impact to the lower jaw reduces the possibility of direct impact of head of condyle to the glenoid fossa, thereby decreasing impact and forces to the entire temporal region.

Maintenance for mouthguards :

1. Store in hard, perforated case.
2. Replace when signs of wearing out are evident.
3. Keep clean using toothbrush and water.
4. Never keep in warm place or in hot water.

As a helmet will not hamper the ability to drive a bike, likewise athletes should understand that oral protection by way of properly fitted mouthguards will not hamper their ability to perform. “Prevention is better than cure”, says an old adage. This holds true for orofacial injuries in sport events. Damage due to lack of proper measures may lead to a range of minor to major events having a long lasting impact on patient’s oral as well as general health. We at Smile Care share the responsibility of limiting orofacial injuries for those sportspersons/athletes, maximizing their potentials to excel as professionals.

Teeth And Gum Care

Dr. Tanvee Singh, Smile Care, Bandra 2.

Teeth are meant to last a lifetime. By taking good care of your teeth and gums, you can protect them for many years. No matter how old you are, you need to take care of your teeth and mouth. You will not just feel better about smiling, talking, and laughing but also eat better.

Cavities, bad breath, bleeding gums and dental caries are almost household names due to poor oral hygiene practiced by most people. But there are ways to improve a person's dental condition, which can be followed by anyone in a relatively easy manner. Teeth and gum care involves four activities, which are brushing, flossing, eating the right kind of food and paying regular visits to the dentist.

Brushing is the simplest way of ensuring proper oral hygiene, and should be done at least twice a day. If possible, the frequency of brushing can also be increased to every time a meal is had, however small it may be. Brushing teeth helps remove plaque, which is a thin coating of calcium compounds on the teeth. Plaque by itself does not harm the teeth in any way, but it is the bacteria residing within the plaque that pose threat towards teeth. These bacteria cause cavities by producing acids by reacting with food items. Brushing removes plaque and keeps the enamel clean.

Flossing is another important activity for ensuring proper dental hygiene. Flossing helps remove food and plaque that accumulates between teeth where toothbrushes cannot reach. This plaque, if allowed to remain there will harden into tartar, which can only be removed by a dentist using special equipment. Flossing should be done gently to avoid damage to the gums and instructions printed on the pack should be strictly followed.

Sugar and starch intake should be lowered to ensure good dental health. Starchy food like potato chips and sugary food like candies stick to the teeth and assist the bacteria in producing acids. Most of the problems can be avoided, however, if a person brushes the teeth after having food of these kinds.

Regular visits to the dentist can help a person keep the teeth in top shape. These visits ensure that the dentist can spot any problem with the patient's teeth at the onset of it. This can cure many ailments before they develop into serious problems.

Lastly, there is no substitute for maintaining proper oral hygiene. Healthy teeth and gums are every person's dream and it is attainable easily too. All that it takes is a little more effort and sensibility.

The effect of Diabetes on teeth and soft tissues of the mouth

Oral health problems can be more serious when you have diabetes. Excessive tooth decay; gum disease; infection and delayed healing; salivary gland dysfunction; fungal infections; taste impairment; could be related to the fact that you have been diagnosed positive for diabetes.

Teeth Whitening : What Works and When to Say No

Dr. Rachana Bhama, Smile Care, Bandra 1

Teeth whitening has become the most popular cosmetic procedure in the world for people who want to look younger, more confident and attractive. However, it's important to understand that this popular practice has its own limitations.

Whitening works if done for :

• General staining caused by exposure to colouring foods and drinks
• Mild tetracycline staining
• Mild fluorosis (mottling)
• Age related yellowing and greying.

When to say no to Whitening :

• Below16 years of age.
• Pregnant or Lactating women.
• Sensitive teeth or gums, including sensitivity associated to gingival recessions or defective fillings.
• Suffering from Gingivitis, Periodontitis, or Advanced Cavities.
• Anterior Restorations.
• Severe Tetracycline Staining.
• Severe Flurosis.
• Plastic or Peroxide Allergy.
• Professional In-Office Whitening.
• Dentist-administered in-office bleaching is the quickest and easiest method of teeth whitening.

What is In-Office Bleaching all about ?

Today, there are two primary types of in-office bleaching - light-activated bleaching and non-light activated. Light-activated procedures shade improvement in 60 minutes with the use of a laser or LED-powered light.

Non-Light Activated bleaching systems eliminate the light and use advanced bleaching gels with a variety of procedures. Non-light activating whitening can occur in a single office visit, or can be also used in combination with home whitening, for tougher stains.

Advantages : There are various advantages to in-office treatment as opposed to other forms of teeth whitening. Dentist-administered whitening procedures permit higher concentrations of bleach and can assure proper bleach contact with teeth - improving the chances of maximum whitening. In Deep Bleaching especially, a new mouth tray technology actually seals the bleaching agent to the teeth overnight, creating the highest bleach/teeth contact in any available method.

Results : The results of in-office whitening can last up to several years. Usually it lasts for about 3-4 years, although Deep Bleaching has been known to last 5+ years. Some people have reported the loss of one shade in about 6 months. However, maintaining the color is easy by using recommended toothpastes and mouthwashes.

In-Office treatments are painless for most, but may cause transient sensitivity post whitening. It would last for 2 – 3 days. This can be taken care off by using a desensitizing toothpaste or mouthwash as prescribed by the dentist.

Home Whitening :

Home Tray Whitening is tooth whitening in a kit that can be used at home. A plaster model of your teeth is made and then custom-fitted tray is created to fit each arch of your mouth. When you are home, you fill the trays with a peroxide bleaching gel and place them over your teeth. The concentration of peroxide will determine how long you wear the trays and how quickly you achieve results. Some people use the trays for 30 to 90 minutes a day over a two-week period, while others wear the trays overnight for 1 to 2 weeks. During this period, dentists check for any sensitivity to the gel.

The results obtained from such kits usually last for years. If the teeth start staining again, re-touch bleach will help restore teeth to a whiter shade.

Whitening Toothpastes :

Over-the-counter teeth whitening toothpastes are the most popular whitening products. The success of any teeth whitening technology lies primarily in the amount of time the teeth are in contact with a bleaching agent - and the concentration of the bleaching agent being used. Since toothpastes contain a very low concentration of bleach and remain on the teeth for mere minutes - or even seconds - they deliver only a small degree of visible change under ideal circumstances.

The companies that manufacture these whitening pastes do not make false claims, and consequently, promise only modest whitening results.

How do whitening toothpastes work ?

Almost all the whitening toothpastes work on the same principle. They use hydrogen peroxide or other whitening agents in very small quantities to gently remove surface stains caused by tea, coffee, wine, etc.

Whitening strips or paint-on applications :

Whitening strips or paint-on applications and are widely available at stores nationwide.

How do they work ?

Typically involve the use of a low-concentration bleaching gel. Most people with simple surface stains will experience a multi-shade change, primarily on their front teeth. While the technology of at-home, over-the-counter whitening is designed for ease-of-use; most people will find it very difficult to follow the directions exactly, particularly with regard to reaching and whitening the back teeth.

Tongue Piercing

By Dr. Manali Thakker, Smile Care, Bandra 1

There is a history of ritual tongue piercing in ancient cultures to honour the gods. Permanent or long term piercing of the tongue is part of the resurgence of body piercing in contemporary society. The tongue is often pierced with straight barbell style jewelry. Due to the frequent movement of the tongue, jewelry size and comfort is especially important. Barbells that are too thin are prone to migration, causing discomfort and irritation. Tongue piercings can often be easily stretched to accommodate larger jewelry. Often the initial piercing is done at 2 mm, stretching a few months later to 2.4 or 3 mm. It is possible to stretch further to diameters beyond 10 mm. The beads at the end of the barbell can be made of many decorative materials, including plastic, but the environment of the mouth can cause cracking and discoloration in the jewelry over time. "No-see-um beads", flat beads matching the color of the tongue, are sometimes worn to conceal this piercing, often in places of employment.

Placement :

The placement is marked and a clamp applied. The traditional placement for a tongue piercing is along the midline of the tongue, in the center of the mouth. It is often approximately 0.75 inches (1.9 cm) or so back from the tip of the tongue. Initial jewelry is usually longer than will ultimately be required, to allow for swelling, which is common following the piercing. Piercers often recommend drinking cold beverages and chewing on ice to help reduce the swelling.

Healing :

Because of the tongue's exceptional healing ability, piercings can close very fast. Even completely healed holes can close up in a matter of hours, and larger-gauged holes can close in just a few days. The length of time for the hole to heal varies greatly from person to person; some people with larger-gauged holes (greater than 4ga) can still fit jewelry (albeit smaller) in their piercing after months or even years. It is generally recommended to avoid piercing in bodies under development or in people not capable of taking care of a recent piercing. Teens from the age of 16 onwards usually don't report problems.

Complications :

The most common long-term complications of intra-oral ornament are :

• Poor oral hygiene may lead to serious infections which may even spread to the rest of the body. Infection can cause the tongue to swell, blocking or restricting the airway.
• Bacteria under the tongue often spread quickly and can lead, in extreme cases, to the potentially fatal toxic shock syndrome or blood poisoning.
• If piercing equipment is not sterilised, there is also the risk of infections like HIV and hepatitis being passed on.
• Accidentally biting a tongue stud can cause teeth to crack or damage to fillings and other dental work.
• Studs can come loose and can be swallowed or inhaled, leading to breathing problems.
• Saliva production is increased.
• There may be injury or shrinkage of gums.
• There is difficulty in chewing or swallowing.
• Prolonged blood loss immediately after procedure.
• Possibility of disease transmission, such as hepatitis.
• There is also the possibility of a person developing an allergic reaction to a stud if it is not made from gold, titanium or surgical steel.
• Other potential dangers include deep cyst formation, scarring, damage to veins and nerves and neuromas - overgrowths of nerve tissue.

Care to be taken :

• Do not rinse mouth with any type of mouthwash. This can cause irritation and discoloration to the piercing. Never clean the piercing with hydrogen peroxide or rubbing alcohol as this can cause serious injury. Salt water is also an effective rinse. Always rinse tongue after it has been touched or after eating something.
• After getting pierced the tongue will swell up to about twice its normal size and lymph will come out from the wound. Do not worry, this is normal. Swelling will start reducing in three to four days and go away completely in seven to eight. The tongue should be fully healed within 6-8 weeks. During those weeks do not play with or touch the tongue.
• Avoid eating hot or spicy foods during the healing process, as this may cause discomfort and hinder the healing process. One should only eat small, soft amounts of food like mashed bananas, mashed potatoes, cereal, cold soup, applesauce or rice.
• Do not drink alcohol or coffee.
• Do not smoke.

Tooth Colored Fillings Vs Silver Amalgam Fillings

Dr. Kripa Shetty, Smile Care, Bandra 1

The most common choices for filling small cavities were silver amalgams (a mixture of silver-tin alloy, copper and mercury that sets up hard and silver colored). Presently composite resin (a mixture of acrylic plastics, quartz fillers and colorants) is predominantly used as filling material of choice.

Silver fillings are more economical, their appearance may be less attractive than a more natural-looking composite filling. Over time, like most metals, silver fillings will eventually corrode and even leak causing decay to reoccur underneath the fillings. There is also a slow expansion that amalgam undergoes and the part of the tooth next to the filling may fracture over time, necessitating a much larger filling, a crown or even extraction of the tooth if the fracture is vertically down the root below the bone. Also, for some patients the feeling of metal in the mouth may be displeasing.

Composite fillings are primarily a resin which has been "filled" with other inorganic materials. This compound makes a composite filling more resistant to wear, color adjustable, and easier to polish. The advantages of choosing a composite filling include a more natural appearance, frequently a strengthening of the filled tooth, and a bonding of the filling to the tooth creating a better seal. This bonding also means that the filling can often be made smaller than a comparable silver filling since silver requires certain size criteria be met to resist breaking or falling out while composites need minimal tooth reduction. Their ability to be molded into requisite shapes and the available range of tooth like shades makes them a versatile and popular material in filling, veneering and provisionalization of teeth.

The disadvantages are that there is a need for more stringent moisture control and it is more technique-sensitive procedure. Composites can discolor over time acquiring a yellowish tinge which can be corrected by polishing. The choice of which restorative material to use in your mouth depends on balancing the factors of appearance, longevity, strength of the tooth involved, and cost. You have to decide with your dentist’s guidance as to the size of the filling and your goals/expectations for the filling.