Dentistry after Covid 19

We all know Covid-19 is a 'Black Swan' Event in our lives.. 
Dentists and Dentistry is in a period of Flux.
Its a time to Reflect, Revive and Restart.

                We being Healthcare providers are at the fore front of this and also at maximum risk to the infection.  Because of this risk, we have had to shut down our practices for a great financial loss to ourselves. Health is definitely above wealth.

            Now that we are now thinking ahead and thinking of restarting our practices in a matter of weeks from now atleast for emergency cases and less aerosol practice, 
the focus has now shifted to how to open up and still feel safe of the infection in our practice.

The guidelines have been issued and are being modified by DCI, IDA, CDC and various other bodies on what to do and what not. 

The only thing left is for us to make a choice - 

- How we should implement it. 
- Is it possible for all practices to implement all the guidelines. 
- Do we have such big practices that we can put up a traige area, changing room and waiting area and what not.
- Also we have different types of clientele. Is it possible for every patient to bear the cost of the new guidelines and that too for every visit. 

Or will it lead to a permanent change on how dentistry is practised. 
Will we see more of group practices or will it pave a way for Dental Insurance to enter in a big way.. 

What all problems will it lead to? Will the virus make a comeback because the guidelines were not followed properly.? Will it lead to persecution of the patient or the practice if a positive case is found out?

Well I guess we will have to wait for all the answers.. 

But Be positive. Remember - Whatever happens, happens for Good. 

When does a Tooth Need a Crown

               I got the idea for this post from teaching at the dental college. Different instructors seem to have different criteria for when its time to treatment plan a crown. I tend to crown teeth when there is sufficient tooth structure missing to put a tooth at greater risk for a future fracture. If such a tooth needs a replacement filling I usually recommend a crown instead, since this will tend to protect the tooth from the forces involved with chewing and protect the tooth from future harm. While replacing a large restoration with a new filling may be tempting, usually this is not optimal treatment. I believe that larger fillings fail more frequently than smaller fillings and when they do it places the tooth at an additional risk for the need of endodontic treatment or  tooth loss.

                  When treatment planning a tooth with a large failing restoration, I often find  that the tooth structure will not be sufficiently supported by another possibly larger new filling.When this is the case,  it's best to restore the tooth with a crown (or an onlay). I often explain this to my patient and add that when it's time to fix a restoration, it's best to fix it right and choose the best option available.

                  Patients sometimes counter that they cannot afford to  spend the money involved with having a crown made ( or would rather not). After hearing this I often point out that we can go ahead a place a large filling but if it may put the tooth at risk of developing a more significant problem. If their tooth later ends up needing a root canal or even needs to be extracted,  a significantly greater sum will be required.              I add this information because I need to confirm that my patient truly understands the reasons for my recommendation and that I have  informed consent to proceed with placement of a large filling. Often, after some back and forth conversation, my patient may change their mind and  have a crown made instead of a filling , but if  they don't, I can often place the large filling, with a clear conscience!

Sensitivity after a Crown placement

              There are two types of sensitivity that can commonly experienced after a crown is cemented. One is sensitivity to biting pressure and the other is sensitivity to cold (and or hot) liquids. If a patient is  experiencing either of these after a permanent crown is placed, then probably the best thing to do is to let their dentist know.

                  Sensitivity after a permanent crown is placed is not that uncommon. If a patient reports sensitivity, I check their bite, since a high bite can be irritating to the ligaments holding a tooth and can even cause pulpal sensitivity. A patient should be able to close there mouth comfortably without feeling any pain. If when they close their mouth (without chewing any food) they experience pain from a new crown, the bite should be adjusted.

              If a patient can comfortably close their mouths, but does experience pain on heavy chewing, I usually ask them to wait and see if the pain gets better with time. A crown cementation can sometimes irritate the pulp and with time this irritation can diminish. This can take months to go away and if a patient is willing, its usually best to wait. If I see them at their next recall, the tooth is still sensitive to chewing or when drinking cold liquids, I take a radiograph and if no pathology is evident, I usually try to get the patient to wait longer, since the only real other options are to perform a root canal on the tooth or to cut off the crown and place a temporary crown with a sedative filling. Which of these I would choose, if I feel the need to treat the tooth, is dependent on whether I believe the pulp has a reversible or irreversible pulpitis.

              Deciding whether a pulpitis is reversible is not always easy, but the prior history of the tooth has a lot to do with the decision. If a tooth was assymptomatic prior to me working on it initially, I am more likely to choose to remove a crown and place a temporary. If a tooth had a pre-existing crack in it or was symptomatic prior to me preparing it for a crown, I am more likely to recommend the patient visiting an endodontist and have a root canal done through the crown.

               I feel that the pulp is still vital and not infected, there is usually no harm in watchful waiting, since with enough time sensitive crowned teeth can calm down. I explain this to my patient and if the symptoms are bearable we often wait for the symptoms to slowly go away. If the symptoms are worsening instead, we can always choose the root canal option.

Why Dental Diagnosis are sometimes In-Exact.

              Even after after taking x-rays and performing a thorough clinical examination of a patient in pain, it is not always possible to make a definitive diagnosis in just one visit. Sometimes there are multiple possible causes for a patients discomfort. Often a patient having pain originating from one quadrant has multiple restorations and more than one can be  experiencing pain.

             Just last week a patient came in after a trip to Chennai complaining of pain. She hadn't slept all night. My clinical examination showed that the pain was coming mostly the area around lower back tooth , which had previously had a root canal, post and crown. The mesial papilla of the tooth  was swollen and painful. It had a pocket of 5-7 mm, and No drainage.  Clearly her pain could be due to a failing root canal or a fracture of one of her roots or also because of side teeth fillings. The x-rays taken were non conclusive.
                     To make the diagnosis more complicated the Patient had a bad cold and throat infection and fever. So the pain could have been worsened by Sinusitis or general malaise of the patient, which would definitely get better within 2-3 days with medication.

             I placed the patient on Antibiotics and it was decided that the best course of treatment was to do nothing more for the present but to speak with her in the following week to see if she was experiencing any improvement. If there was no improvement he could then check her again to see whether there was an actual tooth problem that required treatment.

                  Although patients in pain often want immediate relief, sometimes the best way to handle  a problem is to do nothing. This is especially true when the dentist is not sure what is causing the problem and there is a possibility that the symptoms will go away if the patient is given enough time. If the problem persists for more than a week or two , the patient should come back to the dentist in order to have him better diagnose the cause of the symptoms and often the source of the problem may become more apparent if given additional time.

Wisdom Tooth Demystified

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..

Treatment: 

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
www.dentalclinicnoida.in
www.facebook.com/dentistnoida
https://twitter.com/#!/princebds

Teeth Whitening Case

Hello,

       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

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... 

What to Eat After Dental Surgery?

                   Good diet and nourishment is of utmost significance especially when a person is recuperating from a dental surgery. If one knows what to eat and eats the appropriate diet, it guarantees quick recovery and also reduces the possibility of excessive dry socket and blood loss. Post oral surgery phase is a very critical stage and must not be managed without the supervision of dental specialists. In case the patient has been prescribed some antibiotics, he may have to exclude dairy products from his diet chart. In fact, for a couple of days following the surgery the patient should go in for either drinking beverages such as tea or water or foods that are soft.

• In the post dental surgery period, a person needs to know what to eat and must include sufficient amount of fibre and protein in the diet. Liquids should also form a predominant part of the diet. Good dietary liquids include nourishing fruit and vegetable juices, milkshakes, energy drinks, instant breakfast drinks and fruit smoothies.
• Immediately after oral surgery, oatmeal, soft scrambled eggs, soft fruits, well cooked rice and cream of wheat should be included in the diet of the patient.
• Avoid carbonated or aerated beverages, hot fluids and spicy food after oral surgery.
• The patient must eat those food items that do not cause irritation to one’s surgery spot. Foods such as puddings, yoghurt, custard, vegetable broth, ice-creams, applesauce, cream soups, and mashed potatoes are soothing to the spot of surgery.
• Anything that needs to be sucked should be stringently avoided as this can hinder the blood clot formation in the mouth, resulting in excessive bleeding.
• Though meat and the dairy products are an excellent source of protein and energy, they need to be avoided. Instead, you can eat mashed potatoes, soft cheeses and tofu. Moreover, food items including canned fish, poached fish, hummus, meat loafs, mashed pinto beans and shredded meat are supposed to be included in the diet as they do not require much of chewing. Peanut butter, seed and nut oils are also recommended.

What to eat after dental surgery is an important query that needs to be addressed to every patient. The latest innovations in the field of medicine and pharmacy have made the surgical methods and process less agonising and more tolerable on the part of the patient. As the patient is under the influence of medication when he returns home, he must ensure that he sticks to the prescribed painkillers and must not eat anything without the approval of the doctor.

A Periodontal case

A Male pt aged 46 yrs came to us with a problem of swelling in his Lower right Back tooth region.. Pt had a history of a previous flap surgery with bone grafting done around 4 yrs back.. On examination he had deep pockets generalised, expecially in the molar areas.. we had an OPG of 2009 and we again advised for a latest OPG.. and this is wat we got...

OPG - 2009

OPG - 2011

This is wat we did for the Right Lowers for the Patient..

We did a Root Resection for the patient... the tooth is Grade I mobile but it is stable and we r reviewing it closely...
This photo is at the end of 2 weeks of the procedure.
After 1 yr the tooth is still in a very good condition..
Heres an Xray after 1 yr of the procedure..

This a great way to save teeth if the patient is willing to go the long way and if he trusts the Dentist..