Dental Exams and Cleaning

A comprehensive dental exam will be performed by your dentist at your initial dental visit. At regular check-up exams, your dentist and hygienist will include the following:

• Examination of diagnostic x-rays (radiographs):

  Essential for detection of decay, tumours, cysts, and bone loss. X-rays also help determine tooth and root positions.

• Oral cancer screening:

  Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.

• Gum disease evaluation:

  Check the gums and bone around the teeth for any signs of periodontal disease.

• Examination of tooth decay:

  All tooth surfaces will be checked for decay with special dental instruments.

• Examination of existing restorations:

  Check current fillings, crowns, etc.

Professional Dental Cleaning

Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists. Your cleaning appointment will include a dental exam and the following:

• Removal of calculus (tartar):

  Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface. Calculus forms above and below the gum line and can only be removed with special dental instruments.

• Removal of plaque:

  Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (poisons) that inflame the gums. This inflammation is the start of periodontal disease!

• Teeth polishing:

  Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Digital X-rays

X-rays (radiographs) are the most common and widely available diagnostic imaging technique. Dental X-rays are pictures of the teeth, bones, and surrounding soft tissues to help find problems with teeth and bone.

Radiovisiography (RVG): RVG is the latest X-ray technology in dentistry which helps in a better diagnosis. A high quality digital image can be obtained immediately. As compared to the conventional X-ray there is reduced radiation exposure to the patient.

Digital radiography: It is a novel method of medical imaging which uses digital X-ray sensors instead of conventional films to produce images. This technology provides faster imaging, detailed radiographs and quality digital images. Digital radiography constitutes a system with components that include a digital image receptor, a digital image processing unit, an image management system, image and data storage devices, interface to a patient information system, a communication network and a display device with operated controls. Digital radiographs are stored in the form of digital data and can be displayed on a computer monitor.

An Orthopantomogram (OPG) or panoramic dental X-ray can show a wide view of jaws, teeth and roots. It displays the nasal area, maxillary sinuses, jaw joints, teeth, upper jaw, lower jaw and surrounding bone on a single film. OPGs are used by Dentists to determine the status of wisdom teeth, to reveal cysts, tumours, bone irregularities and more.

Fluoride Treatment

Fluoride is the most effective agent available to help prevent tooth decay. It is a mineral that is naturally present in varying amounts in almost all foods and water supplies. The benefits of fluoride have been well known for over 50 years and are supported by many health and professional organisations.

Fluoride works in two ways:

Topical fluoride strengthens the teeth once they have erupted by seeping into the outer surface of the tooth enamel, making the teeth more resistant to decay. We gain topical fluoride by using fluoride containing dental products such as toothpaste, mouth rinses, and gels. Dentists and dental hygienists generally recommend that children have a professional application of fluoride twice a year during dental check-ups.

Systemic fluoride strengthens the teeth that have erupted as well as those that are developing under the gums. We gain systemic fluoride from most foods and our community water supplies. It is also available as a supplement in drop or gel form and can be prescribed by your dentist or physician. Generally, fluoride drops are recommended for infants, and tablets are best suited for children up through the teen years. It is very important to monitor the amounts of fluoride a child ingests. If too much fluoride is consumed while the teeth are developing, a condition called fluorosis (white spots on the teeth) may result.

Although most people receive fluoride from food and water, sometimes it is not enough to help prevent decay. Your dentist or dental hygienist may recommend the use of home and/or professional fluoride treatments for the following reasons:

• Deep pits and fissures on the chewing surfaces of teeth
• Exposed and sensitive root surfaces
• Fair to poor oral hygiene habits
• Frequent sugar and carbohydrate intake
• Inadequate exposure to fluorides
• Inadequate saliva flow due to medical conditions, medical treatments or medications
• Recent history of dental decay

Remember, fluoride alone will not prevent tooth decay! It is important to brush at least twice a day, floss regularly, eat balanced meals, reduce sugary snacks, and visit your dentist on a regular basis.

Sealants

A sealant is a thin, plastic coating applied to the chewing surface of molars, premolars and any deep grooves (called pits and fissures) of teeth. More than 75% of dental decay begins in these deep grooves. Teeth with these conditions are hard to clean and are very susceptible to decay. A sealant protects the tooth by sealing deep grooves, creating a smooth, easy to clean surface.

Sealants can protect teeth from decay for many years, but need to be checked for wear and chipping at regular dental visits.

Reasons for sealants:

• Children and teenagers – As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.
• Adults – Tooth surfaces without decay that have deep grooves or depressions.
• Baby teeth – Occasionally done if teeth have deep grooves or depressions and child is cavity prone.

What do sealants involve?

Sealants are easily applied by your dentist or dental hygienist and the process takes only a couple of minutes per tooth.

The teeth to be sealed are thoroughly cleaned and then surrounded with cotton to keep the area dry. A special solution is applied to the enamel surface to help the sealant bond to the teeth. The teeth are then rinsed and dried. Sealant material is carefully painted onto the enamel surface to cover the deep grooves or depressions. Depending on the type of sealant used, the material will either harden automatically or with a special curing light.

Proper home care, a balanced diet, and regular dental visits will aid in the life of your new sealants.

Brush and Floss

Brushing and flossing are important components of your oral hygiene routine. Tooth decay and gum disease are prevented through the maintenance of good oral hygiene.

Important points to remember while brushing include:

• Brush your teeth twice a day with a soft-bristled brush and ADA-accepted fluoride toothpaste. An electric toothbrush may also be used.
• Place your toothbrush at a 45-degree angle to the gums and move the brush in a back and forth motion, gently.
• Brush the outer side of teeth followed by the inner side and then the chewing surfaces of the teeth.
• Move the tip of the brush in an up-and-down motion to clean the inside surfaces of the front teeth.
• Use disclosing tablets, at regular periods, to reveals any plaque left on your teeth
• Replace your toothbrush every three months or earlier, if the bristles begin to fray out

Flossing is essential to remove the accumulated plaque (sticky substance that forms on the teeth) between your teeth. You may notice some bleeding in your gums during flossing, which usually improves with continued flossing as the gums become tighter.

Follow these steps to floss your teeth:

• Floss your teeth at least once a day
• Cut 18 inches of dental floss and wind it around the middle finger of one hand and the rest around the middle finger of the other (Finger Wrap Method)
• Hold the floss between the thumbs and forefingers and insert it between the teeth, toward the gums
• Curve the floss into a U shape against each tooth and gently slide it below the gum line.
• Move the floss mildly up and down to scrape off the plaque
• For flossing upper teeth, use 12 inches floss and tie the ends together to form a loop (Circle or Loop Method)

Regular brushing and flossing can help prevent tooth decay, gum disease, bad oral odour, accumulation of tooth stains, reduce the need for fillings or other expensive treatment, and can help improve the overall health of your body.

Brush and floss regularly, eat a well-balanced diet, and visit your dentist for regular dental check-ups, in order to maintain a good dental health. Your teeth may last you a lifetime if you practice basic dental care.

Oral Hygiene Aids

Oral hygiene aids are tools used to keep your teeth and gums healthy and prevent tooth decay and gum disease. Some of the common oral hygiene aids include:

Toothbrushes:

There are a wide range of toothbrushes available. Dentists generally recommend electric toothbrushes as they are more efficient than the manual ones. Electric toothbrushes have a rotating or vibrating motion to help remove plaque and food particles around the teeth and gums. Replace your manual toothbrush every three months or earlier, if the bristles begin to fray out. Brush your teeth twice a day with an ADA-accepted soft-bristled brush.

Dental Floss:

Dental floss is commonly used to remove the food particles and plaque accumulated between your teeth. The dental floss is made from nylon filaments or ribbon composed of polyethylene and is available in a range of colours and flavours. It is advised to floss your teeth at least twice a day, after brushing. Care should be taken during flossing, as vigorous flossing can damage your gum tissue and cause bleeding gums.

Inter-dental Cleaners:

In addition to dental floss, your dentist may also recommend use of miniature brushes, called inter-dental brushes or cleaners. Inter-dental brushes are available in different sizes and gently clean the sides and the spaces between the teeth.
Tongue Cleaners: A tongue cleaner is an oral hygiene aid used to eliminate fungi, bacterial build-up, and food debris from the tongue’s surface. The bacteria and fungi that grow on the tongue are associated with bad breath (halitosis) and general health problems such as diabetes, heart disease, respiratory disease and stroke. Tongue cleaners are usually made of metal or plastic and are designed to fit the shape of your tongue. Tongue cleaning should be followed by brushing to avoid absorption of dislodged bacteria and fungi.

Rubber Tip Stimulator:

Rubber tip stimulators are highly effective oral hygiene aids to remove plaque around the gum line and stimulate blood flow in the gum tissue. Use the rubber stimulator to gently trace along the inner and outer gum line. It should be stored in a cool dry place and used once daily. The tip needs to be replaced when it begins to wear out.

Oral irrigators:

An oral irrigator, also called a water jet or water pick, is a device used to remove the debris below the gum line. By continuously spraying tiny jets of water into the pockets of the gum, oral irrigators can remove harmful bacteria and food particles and reduce the risk of gum disease. These tools should be used in addition to brushing and flossing and not as an alternative. Professional dental cleaning is recommended at least twice a year to remove deeper debris.

Mouth Rinses:

Mouth rinses are classified into two categories – therapeutic and cosmetic. Therapeutic rinses may require a prescription and contain active ingredients that fight cavities, bad breath, and plaque to prevent gum disease. Cosmetic rinses may temporarily control or reduce bad breath and are available without a prescription. Generally, mouth rinsing should be done after brushing.

To prevent future dental problems oral homecare procedures should be practiced on a daily basis. Consult your dentist for any queries regarding oral hygiene aids.

Dentures

A denture is a removable dental appliance replacement for missing teeth and the surrounding gum tissue. They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures – complete and partial dentures. Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain. A partial denture not only fills in the spaces created by missing teeth, it also prevents other teeth from shifting into the empty space.

A complete denture may be either “conventional” or “immediate.” A conventional type is made after the teeth have been removed and the gum tissue has healed, usually 4 to 6 weeks. During this time the patient will be without any teeth. Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process. Once the tissues shrink and heal, adjustments will have to be made.

Dentures are very durable appliances and will last many years but may have to be remade, repaired, or readjusted due to normal wear.

What does getting dentures involve?

The process of getting dentures requires multiple appointments, usually over several weeks. Highly accurate impressions (moulds) and measurements are taken and used to create your custom dentures. Several “try-in” appointments may be necessary to ensure proper shape, colour, and fit. At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulties, however this will subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures. Proper cleaning of your new dental appliance, maintaining good oral hygiene, and regular dental visits will aid in the life of your new dentures.

Children’s Dentistry

Deciduous teeth are the first teeth that appear in a child’s mouth and are commonly referred to as “baby teeth” or “milk teeth”.

Children can face various dental problems during their development years. Some of them include:

• Dental trauma

  Children are more susceptible to falls and injury due to their curiosity and lack of motor coordination. Falls and injury can lead to dental trauma to the baby teeth. Dental trauma refers to an injury to the teeth and the supporting structures as a result of a fall, automobile accident or any other blow to the face.

• Baby bottle caries

  Baby bottle caries is the presence of severe caries (cavities) in infants or young children. It is a very common bacterial infection. It is also known as “early childhood caries “, or “nursing caries”.

• Teething problems

  Teething is a normal process of teeth erupting through the gums in infants. As the tooth penetrates the gums, the area appears red and swollen. This condition makes the baby irritable and the baby attempts to bite down on a hard object in order to relieve pain.

Treatment of these conditions will depend on the type of problem. Dental trauma is treated based on which part of the tooth has undergone trauma. Treatment for baby bottle caries will vary depending on which stage of caries is present. Teething problems can be solved by offering your child teething rings or healthy food like apples or raw carrots to chew on.

Minor oral surgical procedures generally undertaken in children are:

• Extraction of Primary teeth (baby teeth)

  This is the removal of the whole tooth and its root, with as less injury as possible. It is done with the help of small forceps that are specially designed for the small mouth. Anaesthesia is given so the child feels no pain during the procedure.

• Frenectomy

  This is a procedure which involves the removal of the tissue fold that connects the lips or tongue to the jawbone. Sometimes the frenulum is attached too high on the gums, causing space between the two upper front teeth. Or the frenulum is attached too close to the tip of the tongue. In either case, a frenectomy is performed surgically to prevent interference in mouth development.

• Treatment of infections

  Dental infections such as acute dental abscess, chronic dental abscess and chronic apical periodontitis may require minor oral surgery. Your oral surgeon makes an incision over the infected tissue and drains the pus.

Some of the important tips you should follow to keep your child’s teeth in good health include:

• Follow a regular tooth cleaning routine for your child to maintain good dental health.
• Use fluoride toothpaste to brush your baby’s teeth as soon as the first tooth erupts.
• Make sure your child brushes the teeth properly.
• Start taking your child to a dentist for a routine visit when they are about 2 years old.
• Enquire about having fissure sealants or fluoride varnish for your child’s teeth to prevent tooth decay.

Extraction

Wisdom Tooth Extraction

Tooth eruption is nothing but the process in which the tooth travels from beneath the jaws to enter the mouth and become visible to us. A tooth is called “impacted” if its path is obstructed by any other tooth, bone or soft tissue.

Depending upon the position of the impacted tooth inside the jawbone, there are four types of impaction:

• Mesial Impaction
• Vertical Impaction
• Horizontal Impaction
• Distal Impaction

An impacted wisdom tooth may cause gum swelling in the back of your mouth, difficulty or pain in opening your jaw, bad breath, bad taste in the mouth, and pain while chewing or biting.

X-rays of the wisdom teeth are taken to assess the positions, shapes and sizes of the tooth, the covering bone and the nerve. X-rays also locate cysts or tumors that may be associated with the tooth and to assist the surgeon to plan the surgical procedure.

In cases where there is sufficient space for the teeth to erupt such as with soft-tissue impaction, then a Pericoronal flap excision is done. The second option is surgical removal of impacted third molars between ages 16-20 if it is found that there is no space for them to erupt.

• Antibiotics and anti-inflammatory drugs are given to eliminate infection in the area.
• It is a minor surgical procedure lasting 20-45 minutes.
• The procedure is done under local anesthesia.
• An incision is made to open up the flap.
• The bone covering the tooth is cut to expose the tooth crown.
• The tooth is removed either in whole or by cutting it into pieces and removing the pieces out.
• Surgical wound is sutured.
• Removal of the stitch after a week.

Risks and Complications

Complications or risks associated with surgical removal include pain, swelling, infection, and bleeding.

Post-operative Instructions

• Use ice pack covered in a towel and place it on operated area from the outside (on the cheek) to reduce swelling.
• Bite down onto a clean gauze piece with pressure to stop bleeding.
• Eat soft food and drink lots of liquids.
• Brush your teeth gently in the area during the first few days after the surgery.
• Take prescribed medications and follow all instructions given from your surgeon.