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Orthodontics

What is orthodontics?

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention, and treatment of dental and facial irregularities.

Who is an orthodontist?

An orthodontist is a specialist who has completed an advanced education program following dental school, to learn the special skills required to manage tooth movement and guide facial development.

What are some possible benefits of orthodontics?

• A more attractive smile • Reduced appearance-consciousness during critical development years • Better function of the teeth • Possible increase in self-confidence • Increased ability to clean the teeth • Improved force distribution and wear patterns of the teeth • Better long term health of teeth and gums • Guide permanent teeth into more favorable positions • Reduce the risk of injury to protruded front teeth • Aid in optimizing other dental treatment.

How does orthodontic treatment work?

Braces use steady gentle pressure to gradually move teeth into their proper positions. The brackets that are placed on your teeth and the arch wire that connects them are the main components. When the arch wire is placed into the brackets, it tries to return to its original shape. As it does so, it applies pressure to move your teeth to their new, more ideal positions.

How long does orthodontic treatment take?

Treatment times vary on a case-by-case basis, but the average time is from one to two years. Actual treatment time can be affected by rate of growth and severity of the correction necessary. Treatment length is also dependent upon patient compliance. Maintaining good oral hygiene and keeping regular appointments are important in keeping treatment time on schedule.

Endodontics

Who is an Endodontist?

An Endodontist specializes in root canal treatment. Dental decay that is neglected often spreads deep inside the tooth and reaches the pulp tissue in the core of the tooth. They specialize in removing infected and inflamed pulp and filling the area left after its removal.

Why does a tooth require root canal treatment (R.C.T.)?

Basically, tooth is made of three layers, outer strong and hard enamel, intermediate tough dentin and inner soft pulp that contains the nerve ending, blood vessels and others cells which maintain the vitality of the tooth. When dental decay is allowed to progress, it results in a deep cavity that may reach the pulp thereby exposing the pulp to the exterior. Exposure of the pulp may also occur due to erosion or trauma like fracture of the tooth. Whenever the pulp is exposed to the exterior, it develops inflammation and infection. A tooth that has its pulp exposed by decay, trauma, etc has two treatment options - extraction of the tooth or retains the tooth by undertaking a root canal treatment.

Can a tooth with an abscess or infection that has spread beyond the root be saved by R.C.T.?

Once the pulp gets infected and adequate treatment is not carried out there is a chance that the infection may spread to the underlying bone. In such cases the infection forms an abscess in the bone that is nothing but collection of pus. Such an abscessed tooth can be saved by antibiotic therapy followed by root canal treatment. However, these patients required to follow up regularly by X rays and clinical check up until complete healing takes place.

How many visits does it take to complete root canal treatment?

Depending on the involved tooth and infection status it may take multiple visits or can be completed in a single sitting.

Oral Surgery

Who is an oral surgeon?

An oral surgeon is a dental specialist who specializes in surgery of the oral and facial region. An oral surgeon extracts teeth, performs surgeries involving the jawbones, etc.

Why are teeth extracted?

Teeth may need to be removed for a variety of reasons like: i. Very large cavity/ caries that cannot be restored with cements. ii. Periodontal diseases or in simple words diseases of the gums. iii. Fractured or broken teeth iv. Teeth that are traumatized leading to infection and inflammation of the pulp. v. Teeth that fail to erupt or are unable to erupt into the mouth and are deep inside the bone. They are called impacted teeth and may have to be removed. vi. Teeth that are abnormal in development i.e., structure, shape, size, etc. vii. Teeth that are involved in cysts or tumors. viii. Ectopic teeth that have erupted in a wrong place. ix. Sometimes the orthodontist may remove some teeth to correct crooked teeth.

Why is the wisdom tooth removed so often?

The wisdom teeth are the third molars, which are the last teeth in the dental arch. The teeth usually erupt between 18 and 25 years of age. In many individuals, the wisdom teeth remain in the bone, as they may not have adequate space in the dental arch to emerge out. This condition is called impaction. In addition the third molar may erupt in abnormal inclination thus affecting the health of the adjacent teeth. So the wisdom teeth need to be removed often.

Prosthodontics

What are dentures?

Dentures are artificial substitutes used to replace all or some of the lost teeth and adjoining tissues to maintain function, health and esthetics of the tissues. So in simple words dentures help replace lost teeth.

What are the different types of dentures?

Dentures are broadly classified as partial and complete dentures. Complete dentures replace all the teeth while partial dentures replace a few teeth. Partial dentures can be again classified as removable partial dentures and fixed partial dentures. Removable partial dentures replace a few teeth and are designed to be removed and replaced by the patient. The fixed partial dentures also replace a few teeth but cannot be removed by the patient.

What is a crown?

A crown is a restoration that covers the entire tooth like a cap. It can be made of porcelain or acrylic. Crowns are used to restore teeth that are discolored, have multiple decays or are fractured.

What is a bridge?

A bridge is a prosthetic appliance that replaces missing teeth by permanently getting attached to the adjacent remaining teeth.

Periodontics

Who is a Periodontist?

A Periodontist is a specialist trained in the care of (periodontal tissues) gums and other tissues that support the teeth. Periodontists have years of extra schooling and experience that allow them to use special techniques to treat advanced periodontal diseases.

What are the common signs of gum diseases?

Common signs are bleeding, red and swollen gums. Irrespective of the person's complexion, the gums should never be red, or be swollen. Persistent bad breath, receding gums, increasing spaces between the teeth, one or more teeth becoming loose, and vague aching, itching or discomfort around the gums are some of the other common signs.

What is gingiva (gum) and its function?

The gingiva (gum) is the protective type of skin that is closely adapted to the necks of the teeth and covers the bone holding the roots of the teeth. There is a shallow ditch like space that separates the margin of the normal gingiva from the tooth surface. This space is 2mm in depth and is called gingival sulcus. It is one of the places that a dentist will carefully examine to detect the presence of gum disease.

What causes Gum Disease?

Gum disease, is an infection of the gums caused by bacteria. These bacteria produce toxins that irritate the gingiva, and also directly infiltrate into the gingiva causing them to become inflamed and bleed easily. If the irritation persists, the gingiva separate from the teeth and form pockets. Plaque then forms within these pockets and eventually destroys the gingiva and the underlying bone. The teeth may then become loose and fall out or need to be removed.

Do all gum disease require surgical procedure?

Several non-surgical techniques are available for treating periodontal conditions, and the technique chosen will depend on the extent of damage that the disease has caused to the periodontium. The Periodontist will evaluate the condition of the periodontium and removal all the plaque and tartar deposits. In addition to this he will also use various antiseptics and antibiotics that are specifically meant for treating periodontal disease. If this treatment also fails to completely resolve the disease, he will have to resort to periodontal surgery.

What is a graft and can it replace tissues lost due to periodontal disease?

If the gum disease is diagnosed at a stage when there is not much loss of periodontal tissues, the lost tissues can be grafted. Grafts can be of soft tissues or hard tissues. The former is always taken from another site in the mouth of the patient being treated. Hard tissue grafts can be purchased from tissue banks.

Restorative Dentistry

What are cavities or dental decay?

Decay or dental caries is a disease in which the tooth is destroyed by softening as a result of growth of microorganisms on and around the teeth in presence of food particles.

How do cavities form on the tooth?

The microorganisms that exist in mouth along with the food remains form a sticky thin and translucent layer on the tooth called dental plaque. The plaque in initial stages can easily be removed by brushing and flossing. If it is not removed, the plaque gets attached firmly to the teeth and the bacteria multiply and in the process release mild acids that destroy the tooth structure. The enamel gets destroyed layer by layer and the bacteria gradually penetrate deeper into the tooth. The affected part of the tooth gets weakened and breaks during chewing and results in a cavity. The process is slow and continues until proper treatment is executed.

Can a badly decayed tooth be saved?

If sufficient sound tooth structure remains, then the tooth can be saved by covering the whole tooth with a metal crown / cap. A dentist specialized in crown and bridge prostheses will be the best person to treat such teeth.

Can a filled or restored tooth get decayed?

Yes, even a cavity filled with a permanent filling can develop dental caries below the filling. Hence, better care by brushing, flossing the restored tooth along with routine checkup will enhance the long-term success.

Does an abscessed tooth need to be removed?

Dental abscess is the extension of infection from the tooth to the underlying bone. Once, active infection is controlled by antibiotics, the tooth is treated by special procedure called root canal filling. This helps the tooth to be retained in position and function normally.

Can any dentist do all types of fillings?

Any dentist can do routine fillings. Badly decayed teeth and root canal treatment are better handled by a dentist specialized in restorative dentistry and endodontics.

What is a temporary filling?

If the dental decay is close to the pulp a medicated layer of filling is placed over the affected area and a temporary filling is done. Once the pulp heals the temporary restoration is removed and a permanent filling is done.

What is a permanent filling?

While temporary fillings are meant to last a few months only the permanent fillings last longer. Well made permanent fillings can last decades if not a life time.

Can you fill a cavity with a material that is the same color as the tooth?

Filling materials are available that are similar in color to tooth color. These are thus very esthetic in appearance and match the color of the teeth. These filling materials are called composites.

Tooth Loss

What are the causes of Tooth loss?

There are various reasons for tooth loss like Normal childhood tooth loss, Tooth decay, Loose tooth, Tooth injury, Mouth trauma, Gum disease, Periodontal disease.

How does complete tooth loss affect a person?

Loss of all natural teeth can contribute to a person's psychological, social, and physical impairment. Even when missing teeth are replaced with well-constructed dentures, there may be limitations in speech, chewing ability, taste perception, and quality of life.

At what age will a child get the adult teeth after the baby teeth are lost?

The first permanent 'adult' molars (back teeth) will appear at about 6 years of age, behind the baby teeth and before the first teeth start to fall out at about 6 to 7. The permanent ‘adult’ teeth will then replace the ‘baby’ teeth. It is usually the lower front teeth that are lost first, followed by the upper front teeth shortly after. All permanent teeth should be in place by the age of 13, except the wisdom teeth.

How can one replace a lost tooth?

The type of replacement depends on the number of teeth lost, the location of the lost teeth, and the health of the remaining teeth, gums, and the bone around the teeth's roots. Teeth can be replaced with appliances that are fixed or cemented to existing teeth (bridges), implants, or removable appliances (partial or full dentures).

How can Tooth loss be prevented?

Tooth loss can be prevented through education, early diagnosis, and regular dental care. Children and adults must recognize the signs and symptoms of oral and systemic diseases and know the oral and general health care practices necessary to prevent them.

Teeth Whitening

How Does Tooth Whitening Work?

There are many ways to whiten the teeth right from whitening toothpastes to other products that can remove many surface stains, to light-activated whitening techniques. All whitening techniques mainly work in two ways either the bleaching procedures or the non-bleaching procedures.

What is bleaching and non-bleaching procedures?

Bleaching procedure is the one which uses bleaches that contain an active ingredient, most often carbamide peroxide or hydrogen peroxide in concentrations of 10-22%, which helps remove both deep and surface stains.A non-bleaching procedure works by physical and/or chemical action to help remove surface stains. All toothpastes rely on mild abrasion to remove surface stains between dental visits. Whitening toothpastes have special chemical or polishing agents that provide additional stain removal.

Why should I whiten my teeth?

Tooth whitening is preferred in order to avoid the embarrassment of yellow teeth due to natural aging process or due to stains caused by over-consumption of tea, coffee and cola. Whitening the teeth not only gives a younger look but also boosts the confidence level and hence self esteem.

How safe is tooth whitening?

Over a decade of research has proven bleaching and other whitening methods to be both safe and effective. Several products in the market today have shown no adverse effects on teeth or gums in substantial clinical and laboratory testing. In the past, the higher bleach concentrations used in-office treatment resulted in more sensitivity. Today, however, bleaching gels are well buffered, making sensitivity less of an issue. Sensitivity may occur in people after whitening procedures, particularly when they eat hot or cold foods, but usually disappears after 48 hours and stops completely when treatment is stopped.

Who should avoid teeth whitening?

Whitening procedures should not be done while a woman is pregnant because the effect of the whitening materials on the development of the fetus is not known. Since the procedure is cosmetic and option, it should be postponed until after delivery.

Crowded teeth/ Crooked teeth

What will happen when one has crowded or crooked teeth?

Toothache is a condition related to the irritation in the nerve root of the tooth. Each tooth has a soft spongy dental pulp, the inflammation of which causes pain in the tooth. Toothache usually takes place due to dental decay or dental cavities. Toothache is a very common problem and can happen to anybody at any point of time.

What are the common causes for toothache?

Common Causes of Tooth Ache: Tooth decay, Swelling of the pulp, Consumption of soft drinks, Consumption of refined carbohydrates and sugar, Faulty diet , Tooth infection, Crack in the tooth.

How can toothache be prevented?

The best way to prevent toothache is to keep your teeth and gums healthy. Try to avoid cavities by reducing your intake of sugary foods and drinks - have them as an occasional treat and at mealtimes only. Brush the teeth twice daily by using a toothpaste containing fluoride really helps. Cleaning between the teeth using dental floss, woodsticks, or an inter-dental brush according to your dentist's advice will help prevent toothache.

What should one do in the case of a toothache?

• Avoid hot, cold or sweet stimuli. This will help prevent pain from pulpitis. • Take a pain killer under the dentist’s guidance. • If the pain is caused by exposed root surfaces, toothpaste for sensitive teeth, either used normally or rubbed onto the exposed root, may be helpful. • A saltwater mouthwash can also prevent infection if you have mouth ulcers. • Visit the dentist as soon as possible.

Toothache

What is toothache?

Toothache is a condition related to the irritation in the nerve root of the tooth. Each tooth has a soft spongy dental pulp, the inflammation of which causes pain in the tooth. Toothache usually takes place due to dental decay or dental cavities. Toothache is a very common problem and can happen to anybody at any point of time.

What are the common causes for toothache?

Common Causes of Tooth Ache: Tooth decay, Swelling of the pulp, Consumption of soft drinks, Consumption of refined carbohydrates and sugar, Faulty diet , Tooth infection, Crack in the tooth.

How can toothache be prevented?

The best way to prevent toothache is to keep your teeth and gums healthy. Try to avoid cavities by reducing your intake of sugary foods and drinks - have them as an occasional treat and at mealtimes only. Brush the teeth twice daily by using a toothpaste containing fluoride really helps. Cleaning between the teeth using dental floss, woodsticks, or an inter-dental brush according to your dentist's advice will help prevent toothache.

What should one do in the case of a toothache?

• Avoid hot, cold or sweet stimuli. This will help prevent pain from pulpitis. • Take a pain killer under the dentist’s guidance. • If the pain is caused by exposed root surfaces, toothpaste for sensitive teeth, either used normally or rubbed onto the exposed root, may be helpful. • A saltwater mouthwash can also prevent infection if you have mouth ulcers. • Visit the dentist as soon as possible.

Bleeding Gums

Is bleeding of the gum a serious problem?

Yes, bleeding gums is a serious problem. It is either indicating the beginning of the destructive process involving the supporting tissue around the tooth or some serious underlying systemic problems, which could be fatal.

Why do gums bleed?

Bleeding from the gums is mainly due to inadequate plaque removal from the teeth at the gum line. This will lead to a condition called gingivitis, or inflamed gums. If plaque is not removed through regular brushing and dental appointments, it will harden into what is known as tartar. Ultimately, this will lead to increased bleeding and a more advanced form of gum and jawbone disease known as periodontitis.

How can bleeding gums be treated?

If long standing inflammation is the cause of bleeding then removal of the source of bacteria will result in improvement of the situation. Proper maintenance of the teeth by the patient is a must. For vitamin deficiency, proper diet or vitamin supplements are recommended. Sore and bleeding gums can be aggravated by citrus fruits and juices, rough or spicy food, alcohol, and tobacco. Gum bleeding can be controlled by applying pressure with a gauze pad soaked in ice water directly to the bleeding gums. Brush teeth gently (with a soft-bristle toothbrush) after every meal. The dentist may recommend rinsing with salt water or hydrogen peroxide and water.

Missing Teeth

What is the dental implant?

Dental implants are titanium metal' screws' that are placed into prepared sites in the jawbone where they become solidly integrated with the bone. The implant can then be used to support crowns, bridges or dentures, eliminating the need for conventional dental plates or multi-unit bridges.

Are they long lasting and safe?

Dental implants are now a well- established technique with the success rates of over 90% over a ten year period. The bio-compatible metal used in the implant, titanium is well proven for strength and safety in hip replacements and other surgical techniques.

Why replace missing teeth?

Lost teeth often need to be replaced as soon as possible otherwise the bite may be disrupted, causing problems including possible over eruption, bone resorbtion and further tooth loss. Left unchecked, this can result in a collapsed facial profile.

What are the ways of replacing the missing teeth?

There are three ways of replacing the missing teeth and they are: 1. Fixed Bridge 2. Dental Implant 3. Removable appliance

What is Crown and Bridge treatment?

Crown and Bridge treatment is a long-term method of replacing missing teeth. A crown is placed on an individual tooth, (somewhat like a thimble over our finger) where there is no longer sufficient tooth structure left to place a filling. A bridge spans a space where one or more teeth have been lost in the dental arch. The teeth on either end of the span are crowned.

Broken Fractured Teeth

What are the different kinds of fractures?

Fractures could range from minor to severe. There are different treatments for different fractures: • Minor Fracture • Chips • Cusp fracture • Serious fractures • Cracked tooth • Split tooth • Vertical tooth fractures • Decay-induced fracture The dentist will suggest the treatment based on the type of fracture

Why do Dental fractures occur?

Teeth are remarkably strong, but they can chip, fracture or break. Dental fractures are commonly seen with other oral injuries. The typical cause is severe force to the teeth sufficient to disrupt the enamel and/or dentin of a tooth. Teeth usually break as a result of trauma from biting down on something hard or from a blow to the face. Cavities that have weakened the tooth also can cause chipping or fractures. Early recognition and management can improve tooth survival and functionality.

What can be done for fractured teeth and broken teeth?

Fractured teeth: There is no way to treat fractured teeth at home, one needs to see a dentist whenever a tooth is sensitive to changes in temperature or if it hurts while eating. Pain that is constant is a serious warning sign because it may mean that a fracture has damaged the nerve and live tissues inside the tooth. Broken Teeth: One will have to consult a dentist who will need to determine if the break was caused by decay and if the nerve is in danger. Adults with a damaged nerve usually will require root canal treatment, but in children, there's a possibility the nerve can be saved if the dentist is able to treat the problem immediately.

Discolored Tooth

What causes tooth discoloration?

Teeth become discolored for different reasons: • Frequent consumption of coffee, tea, or colas. • Some antibiotics may darken developing teeth in children. • Aging - The dentin underneath the enamel of a tooth gradually darkens with age. • Use of tobacco products. • Accidents - If a tooth has been traumatized, sometimes the nerve will gradually “die”, and the tooth becomes dark. • Sometimes after root canal treatment also a tooth will generally darken.

What can be done about tooth discoloration?

The three most common remedies for tooth discoloration are: • Bleaching • Veneers • Caps (Crowns)

What does one do if there is discoloration due to nerve damage?

If the dentist says that nerve damage caused the discoloration, one has to have a vitality test done. This test will show if the nerve has died. If so, one needs to undergo root canal treatment followed by internal bleaching of the tooth or teeth. There are much more conservative treatments than capping the teeth. Bonded veneers can be done without sacrificing the tooth structure needed for capping.

Space between teeth

What causes the space between teeth?

The cause of spacing may be heredity or some personal habit like tongue thrusting, thumb sucking, abnormal swallowing, etc. Another cause in adults is advanced gum disease, leading to loss of supporting bone and the teeth spreading out. The cause of the spacing can determine the technique used for correction.

Can the space between the teeth be set right?

Yes! There are several techniques available to close gaps. The method chosen will depend upon the cause of the space, the condition of the adjacent teeth and the amount of time available to correct the defect.

What are the ways by which the gap between the teeth be closed?

Basically there are four treatments to rectify the space between the teeth: • Orthodontics • Veneers • Bonding • Crowning

Cavity/ Holes

What are the symptoms of a cavity?

The common symptoms of having a cavity is a toothache - particularly after sweet or hot or cold foods or drinks - or you may have visible pits or holes in the teeth.

What is dental cavity?

Dental cavities are holes that damage the structure of teeth. Dental cavities are also simply known as cavities, tooth decay or caries. Having a cavity is one of the most common of all disorders, second only to the common cold. It usually occurs in children and young adults but can affect any person. It is the most important cause of tooth loss in younger people.

How to prevent cavities?

• Brush daily with a fluoride tooth paste. • Floss daily. • Check with your dentist about the use of supplemental fluoride. • Check with your dentist about the use of dental sealants. (A plastic protective coating applied to the chewing surfaces of back teeth to protect them from decay). • Eat nutritious and balanced meals and limit snacking. • Visit your dentist every 6 months.

Can babies also get cavities?

Yes! If babies and toddlers have teeth they can get cavities. Infact baby bottle tooth decay can be a big problem. This occurs when babies are put to sleep with a bottle filled with milk, formula; fruit drink or sugar water and allowed to feed continuously. The liquid baths the teeth and in a very short time a cavity starts. To prevent baby bottle tooth decay parents should only give their children bottles filled with water at nap time or bed time.

Bad Odour

How can I prevent bad breath?

To keep a fresh breath one must get rid of gum disease, and keep the mouth clean and fresh. Brushing the teeth and gums and cleaning the tongue twice a day with a fluoride toothpaste can help getting rid of bad breath.

What causes bad odour or bad breath?

There are various reasons for the bad breath. Persistent bad breath is usually caused by the smelly gases released by the bacteria that coat the teeth and gums. However, strong foods like garlic and onions can also add to the problem. Smoking is also one of the main causes of bad breath, along with certain illnesses such as nasal and stomach conditions. Food particles that get deposited between the teeth and on the tongue will rot and can sometimes cause an unpleasant smell. Dry mouth can also cause bad breath Other medical conditions that cause bad breath include infections in the throat, nose or lungs; sinusitis; bronchitis; diabetes; or liver or kidney problems.

How can a Dentist help in curing bad breath?

A routine checkup with a dentist helps in keeping the mouth clean and fresh. Regular check-ups will allow the dentist to watch out for any areas where plaque is caught between the teeth. The dentist or hygienist will be able to clean all those areas that are difficult to reach. They will also be able to show you the best way to clean the teeth and gums.

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