Monday, November 26, 2012

Ask me no questions, and I'll tell you no lies.

               The title of the post is a saying by Oliver Goldsmith which personifies the subject i am writing upon.. 

           It seems like some of the patients that we see, read this quote before coming to the doctors.. Well as hard nuts as we are, we do ask questions and a lot of them at that.. 

            The details of the patient or as we call it the Case History of the patient which involves a set of questions to be put forward to the patient - starting from Name, Age, Address, occupation to the Complain and the the details about it and also about the other parts of the body and sometimes about the parents and children too.. 

          I dont understand why do some patients have to lie about these things and that also to a doctor.. the noble profession as we call it.. We are here to alleviate your misery not to gain some vital info about your house or family.. 

           Each and everyone of these questions is necessary to us for forming a diagnosis to your disease and to  treat you well. And if you tell lies about any of this you are hampering your own health and treatment and God forbid if some complication occurs, you shall never be able to forgive yourself.. 

         Even a phone number or your correct and full address is necessary sometimes.. We arent here to spam your phones with msgs or to flirt (female patients look astonished when we ask their age) so better we get all your details correctly and well informed then to play with your own lives..
          Here I would give you 3 examples of patients giving me wrong / incomplete information in the last 1 month and putting their lives or their children lives in danger..

1. A Female scheduled to undergo a surgery didnt tell us about her pregnancy until it gained a complication 1 week after the surgery was done.. She put herself under the stress of surgery, put herself under the Xrays and the complication later and then decided to abort the child..

2. A 8 yr old child who was scared to visit a dentist and had very little medical history suffered a Brain Stroke on the dental Chair and had to be immediately shifted to the hospital and underwent a Brain surgery..

3. A 28 yr old Patient fills up a form and details of all his brother and gets his treatment done just for faking a bill and getting reimbursed for it.. 

              So i request you to kindly give all your details as they are in your full knowledge to the doctors and we shall treat you to the best of our capability.. Remember we are all under Hippocrates oath and your information remains with us only..
Lastly, I pray to God that you dont have to come to us at all.. 

Keep Smiling.. 

Monday, October 15, 2012

Why Is Dental Treatment Expensive?

So am back after some hibernation with a sensitive topic which is on every patients lips whether in pain or not…
While Dentists are fortunate to be involved in a helping profession, they are also small businessmen who run a private for profit business.
Getting started in dentistry is expensive and can leave young dentist's with a large debt load of Lacs of rupees in debt. Opening a dental office is also expensive with real estate at all time high and rentals. Dental offices are costly to build and even well established dentists can feel financial pressures.
Fees are of intense interest to many people shopping for a dentist on the internet and often patients seem to be shopping for affordable dentistry. This is all well and good, but usually it is wise when seeking ‘bids’ to stay away from the low bidder (unless you’re our government?)
As one of my wise dental assistants once pointed out ‘Jitna sugar daaloge utni meethi cheez milegi”. Similarly where dentistry is concerned good work takes time and usually has a fee that properly reimburses the dentist for his time. And operating costs being the same in an area, quite naturally the ones doing at a low cost are cutting corners somewhere.
Most patients demand that their dentist stay current both with their continuing education and expect that their dentists use first rate materials. Similarly dental laboratories that dentists employ to achieve create beautiful and well fitted dental restorations are not inexpensive either. It is not surprising that that a high percentage of any dental fee goes to paying operating expenses. Most dental offices have operating overheads of 60-70 percent or more.
Salaries and benefits for well trained dental staff can be expensive since they expect compensation that is competitive with the market place and they most talented employees can easily find work with other dental or medical facilities.
Although dentistry can be treated like a commodity just like any other, it is an ART and also a science. Often in dentistry as in life, it not what you do that’s important, it’s how you do it! An excellent filling is better than a poorly fitted crown. Many dentists do things differently and invariably some offer better results than others. 

Tuesday, August 21, 2012

What are the best ways to maintain a healthy mouth?

This article attempts to explain some of the habits that people can develop that will help insure the ongoing health of their mouths. I will list my top ten list. Most of the these are no brainers, but still i see people not following them but here goes.
1.Take responsibility for your mouth!
2.Brush and floss your teeth on a daily basis
3.Schedule regular checkups and cleanings at the dentist
4.  Ask the hygienist or dentist to check your brushing and flossing technique
5.Do not chew on bones and ice cubes 
6.Wearing a night guard is usually recommended for patients.
7. Refrain from excessive drinking of carbonated sodas
8.Diet plays a large role in keeping our teeth healthy.
9.Do not wait until you have pain to visit your dentist
10.Find a good dentist (meee) and try to stick with them

Clearly there are many additional habits that play a role, including ., not smoking, and controlling acid reflux, I invite readers to add to this list with their own suggestions in the comment section.

Tuesday, June 5, 2012

Wisdom Tooth Demystified

Wisdom Teeth
Hello All,
         Over the last one month or so, i have been flooded with problems of people over twitter and my clinic mainly with one condition.. 
Wisdom tooth. So i decided to Demystify this condition for you a little bit.. 
Wisdom tooth: Why r they known as Wisdom tooth.. Simple reason is that it erupts at the age of 18 - 25 yrs when a person is supposed to attain wisdom.. Although eruption of this doesnt guarantee any wisdom.. :) 
It is the Last of the Molar teeth which are present in our mouths and they are total 4 in number..
Why there is a problem with them everytime.? Now as we have evolved over a period of thousands of years, our eating habits have also changed and so Nature decided to give us smaller jaws to do away with these wisdom teeth. So whenever a person has smaller jaw, these wisdom teeth shall not get a proper space for them to erupt and so hence the problem.. If we see the ratio now 30% of females dont have one or more wisdom teeth (Now that again doesnt mean they have less wisdom but just that they are more evolved ..:) )

What are the problems that can happen because of these wisdom teeth : 
There are various problems that can develop with these teeth majorly being Impaction or failure to erupt, Pathology such as cysts or ameloblastoma, decay, Posteruption malposition, Non function, Difficulty with hygiene which in turn damages adjacent teeth also and Pericoronitis (Inflammation of gums over the tooth)
Symptoms : The most regular symptom is PAIN... Its a throbbing kind of pain and lasts for days till intervention is sought by medications or by surgery. The medications temporarily relieve the pain but it usually keeps coming back after few months..

For Partially erupted or Non erupted teeth the only treatment is Extraction. Extraction should be performed as soon as the dentist determines that the tooth is impacted. Removal of Impacted teeth becomes more DIFFICULT with advancing age with the bone getting dense and more complications coming in.
The dentist should typically not recommend leaving the impacted teeth in place until they cause difficulty.
When ultimately the tooth has to be removed, better get it done rather than waiting for more days..
Precautions as a patient:
Personally I would recommend to get the tooth extraction done by an Oral Surgeon Whos a specialised dentist (MDS) for all these procedures.
       As i always say with other dental treatment, Even Tooth Extractions DO NOT PAIN.. With anesthesia It is as easy a procedure as all others are.. After extractions there shall be some discomfort n some precautions to be taken which shall be explained by the dentist.
       Any other queries or doubts i shall be more than happy to clarify.. Connect me through!/princebds

Friday, June 1, 2012

My crown broke, What should I do?

               If your crown breaks, you should call a dentist and get an appointment as soon as you are able. Hopefully your dentist will see you within a day or two. If they can't see you within a week, I would call a different dentist or better yet ask them 'nicely' if they can refer you to a good dentist who will be able to see you sooner.

               It is best to see a dentist soon, because it is often hard for a patient to evaluate the extent of his damage. Sometimes, a patient without much pain has sustainned a significant injury to a tooth. Fortunately, most times having your crown break isn't such a big a dental emergency. Most times when the patient is seen the crown either needs to be replaced or smoothed.

                Some times the remainder of the crown is sharp and can irritate or cut the tongue.
If the underlying tooth is exposed, sometimes the tooth is sensitive to air or cold liquids. That means the pulp inside the tooth is still alive(a good thing!). Although this is anoying and can be a pain, nothing will happen to the tooth in twenty four to 48 hours. Teeth do not decay in one week. It takes time for decay to develop

               Occasionally, when a patient calls and says "my crown broke", what actually has occured is the tooth under the crown has broken off and the crown has come out. This can be a bigger emergency. When the patient does come in, the remainder of the tooth has decay and sometimes it requires endodontic treatment. Often these teeth do not hurt, since the pulp is already dead. Some teeth have sustained vertical fractures and in a worst case scenario the tooth needs to be removed.

Tuesday, May 1, 2012

What is the best toothpaste?

          I get this question asked all the time. The answer is there is no one best toothpaste. I will attempt to give some general information that might be helpful.

         First it should be pointed out that in terms of preventing plaque build up and gingivitis the differences between different toothpastes is very small. Mostly it is the toothbrush and our technique that makes the difference!

           When choosing a toothpaste use common sense. Aside from the obvious fact that it is not the best choice to buy one made in China at the moment, I believe that less is more. I believe in using toothpastes with fluoride. Choose one that doesn't make multiple promises. A Whitening, tarter control toothpaste with other special properties sounds like a great idea, but the truth is that people have sensitivities to some of the ingredients and the more that are included, the greater the likely hood that you may have a reaction. 
           Also India has a host of Ayurvedic toothpastes with ingredients that would sometimes put researchers to shame.. Please stick to a reputed company which has passed through years of scientific research and development rather than pastes by some local guru or some local shopkeeper.

          Another finding is that the use of Sensitivity reducing toothpastes have increased quite a lot over the years, the major reason being the marketing of these products.. Let me tell you, that you should not use these products unless the cause for sensitivity is known and the doctor prescribes you these toothpastes.

       When I purchase toothpaste for myself I find a 'basic' version, that doesn't promise whitening or tarter control. It can be hard to find on the supermarket shelf, since the 'fancier' toothpastes cost more and the supermarket makes a bigger profit from them. Do not get roped into thinking that spending more for a product promising additional benefits will actually get you a better toothpaste!

Friday, April 13, 2012

Teeth Whitening Case

       Well just putting out a recent case showing how easy it is to get those stains removed which stop from making us smile...
        This patient came to us quite very Unhappy about the stains that he had got from a continuous 10 yrs of smoking, paan and gutka chewing... 
        Finally after my insistence he decided to kick off this Bad habit and for this firstly for motivation he thought of getting his teeth in order.. We did a normal cleaning and polishing of his teeth and then we proceeded to get on with Bleaching to remove those stains of his teeth..
Pre - Operative Photograph

And after giving him 45 mins of a single sitting have a look of what his teeth have turned into...

Post - Operative Photograph

To Read more about what TEETH WHITENING is all about Click Here

Friday, March 23, 2012

"If nothing hurts me my mouth must be OK, right?"

               This is a line of reasoning I hear from patients at my dental office too often. The patient is usually explaining why they have waited so long to come in and they explain that they assumed nothing was wrong since they had no pain. 
              Unfortunately most dental problems don't hurt until they are rather advanced .Most often dental interventions are best performed at the beginning of the problem when they can't be taken care more easily and inexpensively
             Sometimes by the time the patient becomes aware of a problem it is too late for the dentist to come up with a "simple fix". If a small cavity is detected a dentist can easily repair the tooth with a small filling, but a tooth with a large cavity may require a root canal or a crown or even an extraction. 
              Early detection of dental problems is key to keeping your mouth healthy and happy and frequent cleanings and check-ups allow dentists to achieve this worthwhile goal!  

For details please go to   

Friday, March 9, 2012


            Patients commonly explain that 'Bad teeth run in the family" and also they say that Since childhood their teeth condition has been very bad…  The implied message is that they themselves are not to blame for the state of their mouths.
To be very blunt, "bad teeth" are almost always a result of bad habits..
              My grandmother & grandfather wore two full dentures by the time they were middle aged… Although I do not know for sure, I believe the choices they made and maybe their lack of a good dental IQ are the reasons for their extensive tooth loss… And my parents do have some problems, but now since they have been under my strict care, things are better..
                 Although I am far from perfect, I do not smoke; I brush regularly with a tooth brush, floss and get regular cleanings. These habits are most likely responsible for overcoming any 'genetic predisposition' that might lead to tooth loss.
              While genetics obviously plays a role in determining the likelihood of developing all sorts of health problems, so do a person's habitual patterns of behaviour.
                 While "crooked" or misaligned teeth are most often genetically influenced, the actual health of the teeth and gums is more affected by how we take care of them, than any other factor.  Brushing at least twice per day, flossing regularly, not using tobacco products, and limiting sugar intake are key elements in oral health.  It is also generally accepted that seeing your dental professional at least twice per year for examination and cleaning is necessary to prevent dental health issues.  This routine will also allow your dentist to "catch" problems when they are small, easier to treat, and less costly in the long run.
Remember a Stitch in time saves Nine…. 

Saturday, January 28, 2012

Digital Dentist

Advantages of Digital Dental Radiography

            Well, our office has been using the digital radiography since September of 2009 and I thought this topic might be good one for a blog post.
For sure, not having to develop film saves a lot of time every day and my patients almost universally approve of my upgrade to digital radiography. They like being able to easily view images of their teeth and are happy when they hear that the images are achieved with much lower radiation settings. This is the most obvious advantage of digital radiography; Patients receive a much lower dose of radiation(90% less) than they would from the use of traditional X ray films. I find I can produce usable images with a Tenth of the radiation that I used to produce film images.

Another feature of digital radiography is their ability to easily produce enlarged images of the teeth. In the last year I have found that found that showing enlarged images of their teeth to patients makes it much easier for them to understand my treatment recommendations and the digital enhancement features of my software program (Vatech) I use can help with the visualization of problems.

I also appreciate of the ease of emailing these images to specialists. I am able to get almost "instant second opinions" for my patients. Almost every day I send a radiograph to either my endodontist, prosthodontist or oral surgeon, in order to get their input for one of my patients. This is a great service since not only do my patients not have to pay an additional fee for the consultation, but prior to this I would have mailed their film to the specialist and I would have waited several days for the feedback.

Although I must confess that I sometimes miss the "richness" old fashioned film produced images, there is no going back for me. The advantages of digitally produced dental images far out way any disadvantages and I am fully committed to this new digital age!

Saturday, January 14, 2012

Some Common Queries

Continuing with the common problems that patients have.. 
Today i have decided to come out with Root Canal Problems...

         This is the most common question that i am asked from everyone.. including Non Patients also.. and when i say it doesnt.. Patients become all the more suspicious..:)
 Root Canal Doesnt Hurt... Period..

                  With proper anesthesia root canals can be a pain free procedure. Most teeth respond to regular local anesthesia injections. For Maxillary (upper teeth) dentists usually employ a combination of buccal infiltration and a palatal injection. For Mandibular teeth(lower teeth)a mandibular or mental block is used.

               Some teeth do seem to be hypersensitive at the time that root canal is started and patients still can report some sensitivity when a dentist attempts to access the pulp chamber. When this happens I sometimes use an additional intrapulpal injection in order to achieve complete anesthesia. Usually this injection does the trick for my patient and their endodontic procedure can be completed without further discomfort.

Can Successfully treated Root canal tooth experience occasional Pain/ Tenderness?

            Sometimes root canal treated teeth, that we consider a success, do have some "low grade inlammation ". The teeth are not infected but are not entirely without tenderness.

          Another possible explanation of continued symptoms it that some teeth have a small undetected crack and heavy chewing may cause some small movement of the the crack.

         If symptoms are disturbing sometimes a retreatment of the root canal can cause the tooth to become less symptomatic. After all, most of our check radiographs are two dimensional and do not show the root canal system as it acutally is. Small discrepencies in the 3-D fill also may be responsible for symptoms.

          Also for these types sometimes we do have an additional sitting or two.. But normally Root Canals are generally done in single Sittings.

Do ask me If any query on Dental problems is there... Would like to help it out.. 

Thursday, January 12, 2012

Gum Disease and Human Health

             This post is a result of a sad news I heard on twitter in the morning that a middle aged man had a sudden heart attack and he couldn't survive that. 
             Now we all know of the common reasons of why we have BP, Heart problems, Diabetes and we all so much take care of the reasons and feel happy of taking low fat Ice creams, Diet coke, Exercising, Yoga, Meditation and what not. But there's some other major reason which i thought we should all know bout.
             So i decided to shed some light on the relation of Dental problems and in particular Gum Problems with our very common diseases that we so so commonly see now a days.
There's a whole new subject on this now, calling it Periodontal Medicine which deals with the inter relationship of Dental problems with the other chronic disease of the body.
Gum Problems and Diabetes
                                         Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes.
                                          Tooth and gum problems can happen to anyone. A sticky film full of germs, called plaque, builds up on your teeth. High blood glucose helps germs, also called bacteria, grow. Then you can get red, sore, and swollen gums that bleed when you brush your teeth. People with diabetes can have tooth and gum problems more often if their blood glucose stays high. High blood glucose can make tooth and gum problems worse. You can even lose your teeth
                                          Gum Problems have been listed as a Side effect of Diabetes long ago and they are interrelated in both ways. Uncontrolled Diabetes leads to higher rate of gum problems and more gum diseases leads to Uncontrolled Diabetes.

Gum Problems and Heart Disease
                                  Gum disease and heart disease appear to be related, thanks to several extensive studies in the early 2000s which suggested that people with periodontal disease were twice as likely to also have coronary artery disease, along with other heart-related health conditions.
                    People with severe gum disease often experience bleeding gums, and nicks and cuts in the gums can provide a way for bacteria to enter the bloodstream. If the bacteria is not attacked by the immune system in time, it can reach the heart and may cause an infection such as endocarditis or damage other organs.
                     In addition, some oral bacteria appear to secrete sticky proteins which can allow them to adhere to the walls of the arteries, rather than being swept away by the flow of blood. As the bacteria accumulate, they contribute to the narrowing of the arteries called Atherosclerosis also called "hardening of the arteries," develops when deposits of fats and other substances in your blood begin to stick to the sides of your arteries. These deposits, called plaques, can build up and narrow your arteries, clogging them like a plugged-up drain. If these plaques ever block the blood flow completely, you could have a heart attack or stroke, depending on the location of the blockage.
                     So now it comes down to How do u prevent it...  Well Prevention is as simple as maintaining a good oral health.. 
                      To maintain the best oral health, you should:

  • Establish and maintain a healthy mouth. This means brushing and flossing daily and visiting your dentist regularly.
  • Make sure your dentist knows you have a heart problem.
  •         Carefully follow your physician's and dentist's instructions, and use prescription medications, such as antibiotics, as directed.

Other Problems which are affected by Dental Problems and have been conclusively established
Pregnancy -  The birth weight of the baby gets affected and the mother can go for a Pre term labor because of the Gum Disease
Osteoporosis - Because Gum Disease can cause loosening of teeth and also resorption of bone around the teeth it also can result in increase in osteoporosis specially for females.
Respiratory Disease - Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage.

Monday, January 9, 2012

Some Common Queries

I have decided to post some of the common queries which are regularly asked by the patients and also they get confusing answers while they keep asking the general population...

So lets get started.

What does it mean when someone says "I never have any cavities"? 

                    As a practicing dentist I sometimes encounter new patients, who have loved their previous dentist and are especially proud of how their teeth 'never need work'. 

                   I often hear this remark with a sense of dread; Although it can mean they have great teeth, it sometimes can be a tip off that their prior dentist was not detecting some dental problems. In such a situation, It can be awkward telling them the bad news, and I am always concerned that my potential new patient will not believe me If it turns out that they do have a number of dental problems.

                   After all they trusted and loved their old dentist and I am the 'new dentist in the area'. Often patients do not want to believe bad news and seek a second and third opinion ( often from their friends and family) before having a unwanted dental procedure.

Should Wisdom tooth ever get a Root Canal Done.?

                  The answer is sometimes. If a wisdom tooth has a deep cavity and has a pulpal exposure it can be a good candidate for endodontic therapy if it has erupted in a cleanable position and is in good function. Like other posterior teeth, after having a root canal wisdom teeth should be crowned. In my practice I recommend full metal crowns for wisdom teeth(and second molars), since the chewing pressure they can experience can make porcelain breakage more likely when porcelain fused to metal is used.

                If the wisdom tooth is not fully erupted or difficult for the patient to clean, then root canal is not the best option for dealing with a compromised pulp. Instead extraction is the best option. In this event, often the opposing wisdom tooth is extracted as well, since without an opposing tooth present, it may extrude over time.

Hope these are helpful for you... any more queries or any comments on these are surely welcomed...
Every day i shall be trying to post some query or other.. so Follow this blog regularly and follow the good dental habits too... 

Friday, January 6, 2012

Happy New Year! Some Dental Resolutions for the New Year!

Happy New Year to everyone! May it be happy, healthy and prosperous!

Just wanted to give some dental resolutions that could be implemented with a little effort to ensure a great smile for the New Year:

  1. Brush 2 minutes twice a day...yes, I said 2 minutes (not 1 minute or 30 seconds or once a day). It really does take that long to clean the majority of surfaces your mouth decently.
  2. Floss...yes, I know you tend to do it before dental appointments. However, 40% of your teeth are not being cleaned if you don't do it and a substantial percentage of cavities start in those areas
  3. Clean your tongue. I would say 95% of patients don't do this. A couple of quick swipes on the tongue is usually enough.
  4. Reduce your intake of candies/sweets: it will reduce the incidence of cavities, improve your blood sugar and weight.
  5. Drink more water. In moderation, this a great thing, especially after staining drinks like coffee, tea and wine. Want to reduce all that coffee/tea stain between hygiene appointments? Take a sip or two of water after you finish your drink.
  6. Regular maintenance appointments. Seeing your Dentist for a checkup and scaling is truly the dental version of the oil change. Prevention is always the best option.
  7. Get things fixed while they are small (don't procrastinate). Dentistry seemingly operates on an exponential cost scale as things get more involved and complex. Getting a restoration that costs a couple of hundred rupees  is much better for you and your pocket than letting it turn into a multi-thousand rupees root canal/core/crown or implant