Gingivitis

To make matters simple, Gingivitis is nothing but the inflammation of the gums. It is a form of periodontal disease.
What causes Gingivitis ?
Gingivitis is caused by the plaque form on your teeth which when hardens get deposited at the base of tooth. Plaque is a sticky material made of bacteria, mucus and food debris. The plaque turns into a hard material known as tartar that becomes trapped at the base of your teeth and the bacteria and harmful toxins can further irritate and inflame the gums causing the same.

Vigorous brushing and flossing of teeth also can lead to the formation of Gingivitis.

Apart from this there are other elements that can cause Gingivitis are as follows:

• General illness

• Poor dental hygiene

• Pregnancy (hormonal changes increase the sensitivity of the gums)

• Uncontrolled diabetes

• Rough edges of fillings and ill-fitting or unclean mouth appliances (such as braces, dentures, bridges, and crowns) can irritate the gums and increase the risk of gingivitis.

• Medications such as phenytoin and birth control pills, and heavy metals such as lead and bismuth are also associated with gingivitis.

• It usually develops during puberty or early adulthood due to hormonal changes and may persist or recur frequently, depending on the health of your teeth and gums

Why treating Gingivitis ?

Gingivitis involves inflammation and infection that gradually destroys tooth tissues that hold the tooth in place. It also impacts the gums, periodontal ligaments and tooth socket and finally results in loss of tooth.

Signs and symptoms

The general symptoms of Gingivitis are as follows:

• Bleeding gums (blood on toothbrush even with gentle brushing of the teeth)

• Bright red or red-purple appearance to gums

• Gums that are tender when touched, but otherwise painless

• Mouth sores

• Swollen gums

• Shiny appearance to gums


During test and examination, dentists will look for soft, swollen, red-purple gums. All the tartar and plaque can be found at the base of the tooth. The gums are usually painless and mildly softer.

Duration of treatment

Generally the treatment duration varies from 1 week to 2 weeks depending upon the criticality of your disease and other factors.


Treatment procedure

The treatment is done with the objective of reducing the inflammation. Professional dentists, after cleaning the teeth advise the patients how to brush and floss properly in order to keep your teeth healthy. Professional tooth cleaning in addition to brushing and flossing may be recommended twice per year or more frequently for severe cases. Antibacterial mouth rinses or other aids may be recommended in addition to frequent, careful, tooth brushing and flossing. Repair of misaligned teeth or replacement of dental and orthodontic appliances may be recommended.

Post treatment complications

Following are the few complications that may arise after carrying out the entire treatment:

• Recurrence of gingivitis

• Periodontitis

• Infection or abscess of the gingiva or the jaw bones

• Trench mouth

You need to approach your dentist under the following circumstances post treatment:

• If symptoms of gingivitis are present, especially if you have not had a routine cleaning and examination in the last 6 months.

• If the medication advised by the dentist Is not curing the problem of Gingivitis.

Preventive measures

A few preventive measures are as follows:

• Prevention is better than cure. A sound oral hygiene is the best treatment and cure for Gingivitis

• The teeth should be brushed at least twice daily and flossed gently at least once per day. For people who are prone to gingivitis, brushing and flossing may be recommended after every meal and at bedtime.

• Special appliances or tools like special toothpicks, toothbrushes, water irrigation, or other devices may be advisable to the patients

• Usage of anti-plaque or anti-tartar toothpastes or mouth rinses are recommended

• Regular professional tooth cleaning is important to remove plaque that may develop even with careful brushing and flossing. Many dentists recommend having the teeth professionally cleaned at least every 6 months.

For more updated information and process information see: dentists in Pune

Root Canal Treatment

What is Root Canal Treatment?

root canal treatment is a process of drilling out of the soft tissue (pulp) of the tooth, including the tooth's root canals.  Root canal treatment is considered to be the last attempt to save the severely compromised tooth from being extracted.  If the root canal treatment is carried out properly including removing all germs from the infected area it can last for many years and even sometimes till death.

Why Root Canal Treatment?

If the below mentioned five methods of checking heavily indicate the need for a root canal then you can be about 99% sure it's necessary. Root canal is advisable only after through analysis of the below mentioned steps:

1. Careful visual exam of the teeth (looking for color change).

2. Checking for temperature sensitivity (hot/cold).

3. Observing any additional sensitivity to pressure; either from biting, tapping or pushing on the suspect tooth.

4. Carefully X-Raying the area(s) in question. Many teeth that are categorised "showed need" under X-Ray for root canal treatment subsequently healed without it.

5. The tooth should be checked with an electronic nerve tester:  A simple device that measures the nerve's ability to react to a mild electrical stimulus.

If your dentist is recommending root canal without performing all these then it would be best for you to discuss this with the dentist..

If any one or two of the indicators are not conclusive it's generally best to wait for a while.  In many cases the situation will "settle down'' and resolve itself.

Signs & Symptoms

Some of the general symptoms and early signs of root canal are as follows:

• Pain when chewing
• Fever
• Sensitivity of the teeth to hot or cold
• Bitter taste in the mouth
• Foul smell to the breath
• Swollen neck glands
• General discomfort, uneasiness, or ill feeling
• Redness and swelling of the gums
• Swollen area of the upper or lower jaw
• An open, draining sore on the side of the gum

If the root of the tooth dies as a result of infection, the toothache may stop. However, this doesn't mean the infection has healed; the infection remains active and continues to spread and destroy tissue. Therefore, if you experience any of the above listed symptoms, it is important to see a dentist even if the pain subsides.

Duration

There are several factors that decide the duration of root canal treatment:

• Extent of infection: If your tooth has a severe infection, it can decrease the effectiveness of the anesthetics your dentist will use which means that it may take much longer for your teeth to get numb, and your dentist cannot start working until you are comfortable. Time for anesthesia can take 2-20 minutes.
•  Number of canals: If the tooth is an incisor it is likely that it has only 1 canal (although some have more), if it is a premolar it may have 1 or 2, if it is a molar it may have 3, 4, or 5. More canals take more time to be treated.
• Curvature of canals: Straight roots are normally faster to treat than curved roots.
  
  
  
  Best case scenario is 30 minutes, more complicated molar teeth may take the best dentist 2 hours.

The Procedure of the Root Canal Treatment

Contrary to popular myth of experiencing excruciating pain during root canal treatment the real fact is, it is as simple as other clinical dental procedures. Usage of new high- tech equipment, including sophisticated sonar-like instruments makes it a scare free experience. Effective local anesthetics, high torque handpieces, and titanium files make the procedure quick and painless with a high success rate.

The root canal treatment is being treated in the following manner.

• To start the treatment your dentist will administer anesthetic around the tooth and the area should be completely numb before the drilling commences. A covering is then placed around the tooth to keep it a clean work area.
• Then a hole is drilled through the tooth into the soft pulp to gain access to the chamber and the soft pulp is then removed by scraping and suctioning.
• Next, each root canal of the tooth is drilled out so that no trace of pulp or nerve is left.
• When it is all properly cleaned out an antibiotic paste or lotion may be applied to the insides of the tooth to kill off any remaining germs.
• A metal post may be inserted through the tooth into the jaw, to give the tooth additional stability and strength.
• The tooth is then filled in and capped with a filling.
• Antibiotic tablets may also need to be taken if there was a bad infection present.

Occasionally, for less than 5% of teeth, conventional RCT may not be successful under the following caess:

• Inaccessible canals
• Accessory canals
• Microscopic fractures and
• Unusual dental anatomy interference with treatment.

Post Treatment Complications of Root Canal Treatment

There are a few problems that may arise post the treatment is carried out.

• When the nerve is removed it may lead to the discoloration of the tooth.
• It is advisable to avoid root canal treatment among children and teenagers as this will impact the growing teeth as root canal treatment stops the growth of the teeth.
• Teeth that have had root canal treatment are at greater risk of fracturing and for this reason a crown is frequently fitted to the tooth that has had root canal treatment.
• Some teeth can not be saved by root canal treatment, even though the root canal treatment went well.
• It can lead to infection which means the root canal treatment will need to be redone or the tooth be extracted.
• Sometimes one of the fine instruments may break in the tooth during root canal treatment.  This may mean having to be referred to a specialist or having the instrument left in and being filled over.
• Sometimes the tooth may feel different, if the sensation persists it may mean the filling is too high or that there is another problem.  So, further work by a dentist may be required to repair the tooth further.

 

Pros and Cons of Dental Root Canals

Advantage	Disadvantage
The pain associated with root canal is negligible	Sometimes gums may get infected due to the pushing of infected tissues
Successful over 92% of all the cases	Canals are irregularly shaped, and if the canal is not accurately measured or branches of the canal were not discovered, it cannot be completely cleaned or filled requiring the procedure to be done again when this area becomes infected
Once treated, the tooth need no extraction	Until the infection is fully treated, there may be pain that can cause some problem
The treatment is for your health and not for any dental cosmetics

What is Tooth Extraction?

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Tooth extraction is the process of pulling out a tooth or teeth which is decayed beyond any repair or treatment.

Why Tooth Extraction

Your dentist will recommend tooth extraction under any one of the below mentioned circumstances:

• Repairing a damaged tooth is not practical in cases such as –

• Broken, cracked, or extensively decayed teeth

• Teeth that are not suitable candidates for root canal treatment

• Teeth associated with advanced periodontal disease (i.e., gum disease)

• Mal-positioned or non-functional teeth (e.g., wisdom teeth)

• Preparation for orthodontic treatment (e.g., braces or other alternatives such as Six Month Smiles treatment)

Tooth Extraction Procedure

Following is the common procedure that is followed worldwide for tooth extraction:

1. A cotton bud soaked in anaesthetics is rubbed round the tooth to be extracted on both the side front as well as back.


2. After a little wait, your dentist will start pushing a series of anaesthetics injections around the tooth to be extracted. A little bit of pain may be experienced while injecting.


3. After a while, another series of deeper anaesthetics injections are applied around the tooth to be extracted and if there is a tooth abscess, an injection will likely be placed into the abscess – which is extremely painful.


4. If the dentist is caring then there will be another few deep anaesthetics injections to make the area numb.


5. A small wait, then the dentist starts to peel down the gum from the tooth to be extracted, so that no flesh is left attached to the tooth - prevents the flesh being torn from the tooth when the tooth is extracted.


6. The dentist uses a pair of purpose built pliers to grip the tooth to be extracted, then starts rotating the tooth. This process is repeated till the tooth is ready to be pulled out at ease.


7. Once the tooth is extracted the dentist will then clean up the area, squeeze the area hard to remove any puss, push the loose gum tissue into the hole that's left and possibly crush the tooth socket to promote a firmer area - to encourage good healing.


8. The dentist will place a wet cotton gauze, rolled up, across the hole left by the tooth being extracted, asking you to bite down on it hard for the next 30 minutes, so as to encourage a solid blood clot to form. Being wet beforehand, the cotton gauze should leave the blood clot intact in the hole when the gauze is lifted out at home by your self.



Post Treatment Effect

Long Term problems from extracting a tooth:

• Once a tooth is extracted other teeth may tilt into where the tooth was extracted from, thereby making eating difficult and teeth that tilt to fill the gap are at greater risk of tooth decay. The tilt is normally forwards.



• In case of front tooth, extraction may result in adverse cosmetic appearance of the mouth.


• If it was a molar that was removed, chewing food may be difficult to achieve, particularly if it was a large molar that made up a large section of the chewing area.

• Further it may create problem while chewing food like bread crust or an apple, pieces can be pushed down into the extraction socket by the tooth opposing it, causing pain.


• Another long term problem is thinning of the jaw bone, particularly when several teeth have been extracted.


• If a nerve is damaged during a tooth extraction, it will likely to heal in several weeks to a couple of years and sometimes even the nerve will never recover fully. Symptoms can include loss of feeling - numbness - and tingling in any of the parts of the mouth, including the tongue.


Pros and cons of Tooth Extraction

Pros	Cons
Food and bacteria will hover around the wisdom teeth and surrounding teeth as well. Since it is difficult to remove the debris from the area, it finally results in tooth decay.	Wisdom tooth extraction is not a chosen method of treatment while presently suffering from an infection. Wisdom tooth extraction should be done after all infection subsides.
Sometimes wisdom teeth are only partially erupted leaving the surrounding gums a collection pocket for bacteria and food particles, a perfect foundation to initiate a gum infection which can easily spread to the cheek and even the neck	When post-op instructions are not properly followed, post surgical problems like bleeding, swelling, and additional pain will be experienced by the patient.
An eruption of a wisdom tooth will shift other teeth and cause mal positioning. When tooth becomes crooked it is not advisable to go for smile design.	After the wisdom tooth extraction, a dry socket condition may appear which is a blood clot formed in the area of extraction, only to dislodged and expose the vulnerable bone lying below. This painful condition would most likely occur from not following post-op instructions.
The wisdom tooth can become abscessed or an infectious cyst may form around the wisdom tooth, especially since hygiene in the area is more difficult.
For individuals needing dentures at some point, wisdom teeth should first be removed.