A to z Dentistry

In dental invasive procedures, local homeostasis is improved by means of using antifibrinolytic agents as adjuvant therapies, in addition or instead of replacement therapy.
Some authors [5, 6, 21, 22] have suggested the use of tranexamic acid, both topically and systemically, in order to reduce bleeding complications after a dental surgery.
Topically, this drug is applied into the socket after a tooth extraction, and systemically, a dose of 1 g (or 30 mg/kg) is given preoperatively, orally, or in infusion.
On the other hand, desmopressin (a synthetic analog of vasopressin) has been also successfully used as intravenous infusion or intranasal spray, in cases of mild/moderate hemophilia, prior to dental treatment; this vasoactive drug has demonstrated an up to 4.7-fold increase of factor VIII level in plasma, sufficient to allow a safe oral management

osmf stages-

As proposed by Kakkar and Puri, for the purpose of treatment, the patients can be graded on the basis of the clinical condition.6

Grade I: Only blanching of oral mucosa without symptoms

Grade II: Burning sensation, dryness of mouth, vesicles or ulcer in the mouth without tongue involvement

Grade III: In addition of Grade II, restriction of mouth opening

Grade IV: In addition to Grade III palpable bands all over the mouth without tongue involvement

Grade V: Grade IV and also tongue involvement

Grade VI: OSMF along with histopathlogically proven cancer.

Injection hyaluronidase 1500 IU, 0.5 ml injected intralesionally twice a week for 10 weeks. Dexamethasone 1.5 ml with 0.5 ml intralesionally biweekly for 5 weeks

9 Natural Toothache Pain Remedies for Children
When your child experiences dental pain, it requires immediate attention, or it can lead to serious issues like bacterial blood infections and tooth loss. If you’re not able to visit a pediatric dentist right away, try these home remedies for toothache.

Warning: Do not use the foods mentioned in this list if your child is allergic to them.
1) Rinse with Warm Salt Water

One tried and tested way to relieve tooth pain is a saltwater rinse. This is an effective first-line treatment as salt kills bacteria and the warm water eases discomfort and reduces gum swelling. Take a glass of warm water, mix in half a teaspoon of salt, then use the mixture as a mouthwash.

2) Use Garlic Paste

No one wants garlic breath, but if garlic relieves toothache then why not? Known for its antibacterial properties, including killing the harmful bacteria that cause dental plaque, garlic also acts as a pain reliever. Crush up a clove or two to make a paste and apply it on the affected area with a cotton swab. Adding a pinch of salt will help reduce irritation caused by infection.

3) Apply a Cold Compress

Place an ice pack or cold compress on your child’s outer cheek near the affected area. This helps relieve pain by constricting blood vessels and reducing swelling and inflammation. Hold the compress on the painful area for 20 minutes and repeat every few hours.

4) Use Peppermint Tea Bags

Peppermint is the yummiest pain reliever for kids. Peppermint tea bags can be used to numb pain and relax sensitive gums. All you need to do is put freshly-used peppermint tea bags in a freezer for a few minutes. Then place them between your kid’s cheek and gums to relieve toothache.

If you don’t have teabags, mix a few drops of peppermint essential oil with clove oil, apply to a cotton ball, and place it against the irritated area.

Tooth Sensitivity after Dental Crown Treatment
Broken, cracked, or otherwise damaged teeth are a problem for many people, but these problems can be treated with dental crowns.

For most people, dental crown treatment helps alleviate dental pain and restores oral health, but some may experience temporary tooth sensitivity after treatment.
tooth sensitivity after dental crown treatment, including how long it lasts and how you can prevent it.

What Causes Tooth Sensitivity after Dental Crown Treatment?
Although dental crown treatment usually helps alleviate dental pain, tooth sensitivity may occur after treatment. Tooth sensitivity may be temporary or it may be a sign of something more serious. Let's take a closer look at some of the causes of tooth sensitivity after dental crown treatment.

Temporary Tissue Inflammation
When tooth sensitivity develops after dental crown treatment, it's often a temporary side effect of the procedure itself and will resolve within a few days.
This type of temporary sensitivity is generally a result of tissue inflammation that can occur within the pulp tissues, which may become irritated during the dental crown procedure.
In most cases, tooth sensitivity caused by inflammation will resolve on its own as the tissues heal. Taking anti-inflammatory medications, such as ibuprofen, can help reduce pain in the interim.

The Dental Crown Doesn’t Fit Correctly
When placing a dental crown, portions of the tooth are removed to help the crown sit at the same level as the tooth did prior to treatment and the crown is checked for proper fit.

Despite taking measures to ensure a proper fit, sometimes a dental crown may sit just a little bit too high or not quite right after placement. This can cause irritation when chewing and biting, leading to tooth sensitivity.

The Tooth’s Nerve Is Damaged
When tooth sensitivity persists after dental crown treatment, or becomes worse, it may be a sign of nerve damage.

Sensitive Teeth

Hydent K Paste (ABBOTT)
👉Hydent-K Oral Gel is used for caries, dental hypersensitivity, dental caries, toothaches and other conditions.
👉It helps control plaque and improves the health of gums.

Key Ingredients:
(1)Potassium Nitrate
(2)Sodium Monoflurosulphate
(3)Triclosan

Key Benefits:
👉Potassium Nitrate is used to prevent cavities and to reduce pain from sensitive teeth.
👉Triclosan is a biocide used in toothpastes and other dental products to control plaque and improve the health of the gums.
👉Sodium Monoflurosulphate works by making the teeth stronger and more resistant to decay caused by acid and bacteria (dental caries)

DENTAL CARE

ferrule effect

Ageusia-(LOSS OF SENSE OF TASTE)

Injury to the chorda tympani nerve during an ear surgery, laryngoscopy, or any dental surgical treatment can lead to changes in the taste perception. The presence of any infection or trauma can also lead to injury of this nerve carrying the sensory taste fibers from the tongue. Any damage to the lingual branch of the ninth cranial nerve during tonsillectomy may also result in taste loss.[3][4] The taste bud cells become altered in certain systemic disorders which can secondarily lead to loss of taste through neuropathy or changes in the environment of the oral cavity. The disorders include autoimmune diseases (Sjogren syndrome), hypertension, diabetes mellitus, renal disorder, liver disorder, and hyperthyroidism.

SODIUM HYPOCHLORITE-

The use of sodium hypochlorite as a final irrigant is not recommended when Resilon/Epiphany is to be used as the obturating material. This is attributed to the formation of an oxygen inhibition layer which could impair the polymerization of Resilon.
Alternatively, the canal should be rinsed with distilled water, saline, or chlorhexidine digluconate

What Are The Types of Tongue Thrust

There are several variations, and most of them are related to orthodontic problems:

Anterior open bite – is the most common form of tongue thrust. In such cases, the lips do not close properly, and a child often has an open mouth and tongue protruding beyond the lips. Generally, you can identify the patient has a large tongue along with this type of tongue thrust.
Anterior thrust – the lower lip pulls in, and the lower incisors and the upper incisors protrude extremely from their normal position. An anterior thrust will usually result in overexertion of the patient’s chin muscles (mentalis).
Unilateral thrust – in which the bite is typically open on either side.
Bilateral thrust – posterior teeth from the first bicuspid through back molars can be open on both sides, and the anterior bite is closed. The bilateral thrust is the most difficult to correct.
Bilateral anterior open bite – the only teeth that touch are the molars. The patient’s bite is entirely open on both sides, resulting in frontal teeth that never touch. Typically, patients with a bilateral anterior open bite will also have large tongues.
Closed bite thrust – both the upper and lower teeth are spread apart and flared out. The closed bite thrust is typically a double protrusion.

PHYSICAL FORMS OF GUTTA-PERCHA
1. Solid core GP points
Available as standardized and non-standardized points
(beta phase).
• Standardized points: Correspond to instrument taper and apical gauge
• Non standardized points: Variable taper, the tip of point to be adjusted after apical gauging to obtain an optimum fit and apical seal.
• Used with cold lateral condensation with warm vertical compaction.

2. Thermomechanical compactable GP

3. Thermo plasticized GP:
Available in injectable form (alpha phase). Special heaters are provided in the systems to attain flowable temperature of GP. The apical seal is accomplished with the plugging of master cone and then the injectable GP is backfilled.
• Solid core system
• Injectable form.[2]

4. Cold flowable GP.
It is eugenol-free, self-polymerizing filling system in which the gutta percha in powder form is combined with a resin sealer in one capsule. It exhibits viscoelastic property of thixotropism and therefore has a better flow under shear stress which, in turn, provides good sealing ability.

Phases and Properties of gutta percha

-Alpha (α) form
Brittle at room temperature
Gluey, adhesive and highly flowable when heated (lower viscosity)
Example: Thermoplasticised gutta-percha used for warm condensation obturation technique

-Beta (β) form
Stable and flexible at room temperature
Less adhesive and flowable when heated (high viscosity)
Example: Commercially available gutta-percha used for cold condensation obturation techniques

-Gamma (γ) form
Similar to α- form, unstable

Rotary files brand -
Coltene files
Dentsply
Neoendo
Super endo
Mani files
Waldent files
Woodpecker files

MTA -

Direct pulp capping
Direct pulp capping is a procedure in which the exposed pulp is covered with a biocompatible material. The objectives of the treatment are formation of dentin bridges to wall off outside stimulation and preservation of healthy pulp tissue. MTA has been proposed as a potential medicament for capping of pulps with reversible pulpitis because of its excellent tissue compatibility. It is much superior to the routinely used calcium hydroxide based on the tissue reaction and the amount and type of dentin bridge formed.
Pulpotomy
MTA may be used as an alternative pulpotomy agent in immature teeth with pulp exposure to stimulate pulp healing with dentin bridge formation and complete root formation.
Root end filling
Endodontic surgery followed by root-end filling may at times be necessary for certain teeth where routine endodontic treatment is not possible. This procedure involves surgical exposure of the root apex, root resection and plugging the apical foramen with a suitable material that provides complete apical seal, is non toxic, non resorbable, dimensionally stable and radio opaque. MTA forms a good marginal seal and stimulates hard tissue formation (Cementum) can be used as root end filling material.
Apexification
In recent times, mineral trioxide aggregate (MTA) has gained widespread popularity for the apexification procedure. It produces apical hard tissue formation with significantly greater consistency than calcium hydroxide. MTA, a biocompatible material, can be used to create a physical barrier. It also helps in the formation of bone and periodontium around its interface.
Revascularization procedures
MTA can be used for coronal seal in revascularization procedures.
Ref - Podili s et al. Mineral Trioxide Aggregate (MTA): A Comprehensive Review. J Adv Med Dent Scie Res 2021;9(7):19-24.

MTA consists of fine trioxide powder (tricalcium oxide, silicon oxide, bismuth oxide) which sets in the presence of moisture and hydrophilic particles (tricalcium silicate, tricalcium aluminum)
Materials widely used to repair perforations include amalgam, Super EBA (Bosworth, Skokie, IL), composites, and recently MTA (Pro-Root MTA, Dentsply, York, PA and MTA Angelus, Londrina, PR, Brazil), Biodentine (Septodont, Saint Maur des Fosses, France) and EndoSequence (Brasseler USA, Savannah, GA)
It was reported that MTA could create both incomplete and complete barrier with mild tissue inflammation when used in apexification.
In a study which included MTA as a perforation repair material, it was shown that MTA did lead to any bacterial leakage based on a 45-day evaluation

Ref article-http://www.oraljournal.com/

Recapitulation

Recapitulation is important regardless of the technique selected (). This is accomplished by taking a small file to the corrected working length to loosen accumulated debris and then flushing it with 1-2 ml of irrigant. Recapitulation is performed between each successive enlarging instrument regardless of the cleaning and shaping technique.

luting gic brands-

3M ketac molar
GC gold
Neo endo
D tech gic
Crysta luting gic
Voco meron
Ammdent gic
Micron gic

Cetrimide and Surfactants (irrigaition solution)

Cetrimide has been proposed to be used in combination with other irrigating solutions in order to improve their antimicrobial properties and reduce surface tension.

The mixture of CTR and chlorhexidine exhibits a higher antimicrobial activity against planktonic cultures [13, 106, 107] and bacterial biofilms [108–110].

When combined with chelating agents such as EDTA, citric acid, and maleic acid, it improves root canal disinfection [111], creating an extended residual antimicrobial activity [112].

The association of maleic acid with CTR maintains the extraction of calcium ions from dentine [113], thereby assisting to preserve the microstructure of root canal dentine [114], and increases the wettability of an epoxy resin root canal sealer to root canal dentine.

Cetrimide can also be found in various commercially available irrigating solutions such as Cetrexidin (Vebas, San Giuliano, Milan, Italy) a mixture of chlorhexidine and CTR that has more residual antibacterial effects (substantivity) and lower toxicity than 5.25% NaOCl [107]; Tetraclean (TC) (Ogna Laboratori Farmaceutici, Muggiò, Italy), a combination of doxycycline hyclate, citric acid, and two different detergents (propylene glycol and CTR) that has been proposed for use as a final rinse after NaOCl solution in root canal treatment because it has antimicrobial activity; however, it does not dissolve organic matter [16]; and QMix (Denstply Sirona, Charlotte, NC, USA) a mixture of chlorhexidine, EDTA, and CTR that has antimicrobial activity [], substantivity [
], and ability to promote smear layer removal ].

Emergency Treatment of Symptomatic Irreversible Pulpitis

Emergency treatment of symptomatic irreversible pulpitis requires access to the pulp chamber followed by removal of inflamed pulp tissue.
Next, cleaning and shaping of the root canal system should be performed.
Sodium hypochlorite has proven to be one of the most effective disinfectant agents and should be used to minimise the residual bacterial load within root canals.
The objective is to remove completely the irritating pulp tissue and provide the patient with pain relief.
A calcium hydroxide inter-appointment medicament placed in the coronal and middle third of the root canals will reduce remaining bacteria and inflammation (and thereby reduce pain) and prevent contamination between appointments.

Finally, a temporary filling should be placed to avoid coronal leakage during the period between appointments, and an appropriate nonsteroidal anti-inflammatory drug may be prescribed.

Antibiotics are not indicated in the treatment of asymptomatic irreversible pulpitis ].

Corticosteroid dressings should be used carefully as there is evidence that suppression of an inflammatory response by steroids allows bacteria to enter the bloodstream with ease.

Endodontic Emergencies

Endodontic emergencies can be classified according to the moment in which they occur [2].
Before treatment, the cause can be reversible or irreversible pulpitis, acute periapical abscess, or cracked/split teeth.

Patients under treatment can request urgent care after the first appointment of root canal treatment because of symptomatic apical periodontitis (flare-up) or tooth cracks/splits.

After root canal treatment, patients can also request urgent care because of symptomatic apical periodontitis (flare-up) as a consequence of a high restoration, root canal overfilling, root fracture, or in most cases, persistent apical periodontitis [4].

The vast majority of endodontic emergencies occur before root canal treatment (95%).
The most frequently affected teeth are molars (75%) with mandibular teeth (57%) causing emergencies more frequently than maxillary teeth (44%).
The most frequently diagnosed condition is symptomatic apical periodontitis (45%)

ref-Juan J. Segura-Egea and Jenifer Martín-González

Indications of intracanal medicaments
In cases of weeping canals, which are persistently wet, intracanal medicament could be used to dry and heal.
Eliminating occult pathogens inside dentinal tubules or in pulp space owing to its high alkalinity.
Helpful in rendering the root canal contents inert.
Neutralizing the acidic pH due to inflammation.
In cases of symptomatic patients, it can act as a barrier against leakage during inter-appointments.

Usages of steroids in dentistry
Steroids are commonly used to limit postoperative inflammation. In major surgical procedures, the main function of steroids is to decrease edema, trismus, pain, and hospitalization time. (6) They are used in conditions like recurrent aphthous ulceration, desquamative gingivitis, lichen planus, bullous pemphigoid, mucous membrane pemphigoid, pemphigus vulgaris, and erythema multiforme. Intralesional injections are administered for the management of mucocele, oral submucous fibrosis, and central giant cell granuloma. They are also used for the management of Bell’s palsy, Melkersson-Rosenthal syndrome, and temporomandibular disorders (TMDs).
To manage acute allergic reactions, corticosteroids are useful after the use of epinephrine and histamine blockers to prevent recurrent anaphylactic shock. They are used as the second line of drugs because of their slow onset of action. Because dexamethasone and methylprednisolone are contraindicated in acute adrenal insufficiency, hydrocortisone sodium succinate is the drug of choice. (7)
Corticosteroids are used as an endodontic anodyne. (8) Along with the broad-spectrum antibiotics, steroids are used as pulp capping agents because of their anti-inflammatory properties as follows: (9)
• Pulpovital = Prednisolone + Chloramphenicol + Neomycin
• Dontisolon = Prednisolone + Neomycin
• Septomixine = Dexamethasone + Polymycin Sulfate + Neomycin
• Cavity liners = 1% Prednisolone + 25% Chloramphenicol + 50% Gum Camphor to reduce postoperative thermal sensitivity.

Dr. Aviv Ouanounou, Department of Clinical Sciences, Pharmacology & Preventive Dentistry, Faculty of Dentistry, University of Toronto

There is some tip for doctors who are using portable xray. After few year of use ,battery problem starts. New battery is costly and just last for few month. Myself victim of such problem. I have genoray portable xray. Whose new battery last for only 9 mnth and costing ₹23000. After few research for cheap alternative and fortunately found the same. So i am sharing my experience so that others can save there hard earn money.
1) They are basically LiPo battery. Inside the battery there is 6 pencil cell. And these cell are easily replaceable by local battery maker. They can replace the battery with new battery of required voltage. Only thing is to look for discharge rate of battery which should be 50C or more. Then only battery can provide required current for shooting x ray of desired strength. Such battery can assembled for just 1000 to 2000 rupees.
2) Alternatively you can also buy such battery from any robotic sites or also can use drone battery by matching required voltage and capacity. Only thing look for discharge rate which should be range from 35C to 70C or more. Change the pin of the battery with your old battery. Such battery cost only ₹2500 to ₹4000. And give good backup. You can also buy charger separately for charging such battery that cost just ₹1200.
(research done by some other dentist)

Basal implants in Diabetic patients and smokers
Basal implants can likewise be set in extremely poor oral hygiene conditions like Chronic generalized Periodontitis.

As diabetes is associated with expanded weakness to infection, have decreased wound healing and gum problems, subsequently conventional dental implants are normally reversed in diabetes patients. Yet, basal implants work well in controlled diabetic patients since they are smooth implants which don’t permit bacterial settlement on the implant surfaces.

Contrarily, smoking impact the implant procedure because it obstructs the blood stream to the oral tissue like the gums, teeth, and bone, which can slow back the most common way of recuperating in the implant region. Smokers are profoundly inclined to gum disease and gingival downturn which leads to infections around the implant prompting failure. In the event of basal implants, since the load-bearing areas are far away from the spaces of the mouth impacted by smoking, they take up well.

1. Case selection is very important. If you feel you are not confident enough to do RCT of that perticular tooth, straight away refer to endodontist. Don’t take trial and error option
2. Use 4% articaine for inferior alveolar nerve block along with buccal infiltration for lower teeth especially for molars. It works like magic!
3. When doing access cavity if the patient is feeling pain, then hold the bur steadily without lateral movement and go apically towards the pulp and once the pulp gets exposed, give intrapulpal anaesthesia. Lateral movement of the bur causes more pain and this technique is not given in any book and with my experience I found out this technique. Try and let me know
4. Before entering pulp chamber make sure access cavity is free of dental caries. By doing this you are preventing the bacterial entry in to the pulp chamber. Many times I have seen GP dentist doesn’t clear the decay before access cavity preparation.
5. Add additional armamentarium to your endo practice like LED Airoter, Path finder files, Endo activator, side vented needles for irrigation, Lentilospiral, GP cutter, hand pluggers, ultrasonic endo tips.
6. Give more importance to Chemo mechanical preparation during RCT. Anybody can do RCT which looks good in the X-ray and hardly few know that it not the determinant for the successful RCT.
7. Practice Single or 2 visits Rct. More than that you will end up in more no of failed RCT.
8. Never keep the canal empty in 2 vist RCT. Always use intracanal medicament.
9. STOP using pulp devitalizers for heaven sake. If the pulp is vital, extirpate it completely in the first visit.
10. Never give open dressing which is most commonly practiced in private practice. You will end up in supplying more no bacteria to the already infected tooth.
11. Prescribe antibiotics only in case of swelling space infection or for prophylactic reasons. All the RCT doesn’t require antibiotic prescription.
12. Most importantly, charge the patient based on the time taken to do the RCT. Don’t fix the price of the RCT. Each case is unique, each case has to be considered on its own facts and merits and charge accordingly.
( Dr prithiraj endodontist)