WHY TOOTH BECOME SENSITIVE AFTER JUICES LIKE LEMON,GRAPE ETC.?

The outer layer of tooth is Enamel which is tougher than bone.
Though it is a dead tissue, it does have certain touch sensation. It is because of the inner layer which have living cells. The enamel is 
more tougher and will stop the cold and hot sensation to the greatest possible, not allowing to reach the inner layers. This is mainly done by the outer protein formed on the enamel.This is formed by the salivary proteins.This is very tough and more resistant to heat and cold.

But this layer can easily be removed by acids that are present in fruit juices like lemon,pineapple,grapes, water melon etc. These juices remove the layer formed on enamel (enamel pellicle) allowing the sensitivity to heat and cold, carry to the inner layers.
So, our teeth gets sensitized after these juices. But remember that this layer will again form on its own within 24-48 hours by precipitation of proteins from saliva.

Vigorous brushing or use of courser powder for brushing also result in removal of the pellicle   in the early stages and enamel itself in later stages.

Most of the desensitizing pastes will contain chemicals like silver nitrate, strontium chloride etc .  These metalic salts will precipitate the proteins from outer layer of enamel forming a tough outer layer which resist conduction of heat and cold. In this process they utilize the water (which 3-4% and gets reduced with age and causes brittleness of enamel as it reduces further). Prolonged use of these desensitizing pastes will result in more water loss from enamel and enamel will become brittle and chip off.

Physiological management by repeated intake of water number of times with little quantity will help a great in this situation. 

FLAP OPERATION/FLAP SURGERY

When normal length of alveolar bone get reduced, the tooth/teeth loose bone support and start moving.Repeated gum swelling because of food stagnation
will lead to bone loss. Swollen gums will leach exudate along with blood which enhances local infection and bone loss.Though it is genetically influenced, through good local factors it can be controlled.Local factors like proper brushing of the teeth morning and night; massaging of the gums can control this bone loss.
      In flap surgery the gums are opened under local anesthesia and the denuded bone and granulation tissue ( clusters of micro blood vessels) are removed-curettage. The lost bone is replaced by artificial bone in the form of granules and sutures are placed. Over the sutures, some protective paste is placed in order not to dislodge the replaced bone powder. On 9-10 day the sutures are removed.
       The success of treatment depends on good maintenance of oral health like proper brushing of teeth morning and night, gums massaging, salt water gargling etc.

       Not all the replaced bone is taken up by natural bone. Some replaced bone will be dissolved. Due to shrinkage of the damaged gums ( which are now healthy) spaces will come in between the teeth which is inevitable.

DO BOTTLE FEEDING CAUSE FORWARD POSITIONING OF FRONT TEETH IN KIDS??

Feeding milk with bottle during infancy is common. During bottle feeding the milk is drawn by child by sucking (-ve pressure) by constriction of cheek muscles. The nipple of the bottle is an artificial one which does not have the sense of touch and response. So the whole milk is dawn by negative pressure alone( in case of breast feeding, the mother ejaculate milk by touch sense response; so child need not exert more sucking pressure). This negative pressure will try to constrict the widening upper jaw. But the general tongue movements will counter it to the maximum.

After four (4)Yrs the upper teeth start erupting in to the oral cavity. They erupt like landing aeroplane- from back to front in a downward and forward direction with more force. If the child continues the bottle feeding at this time, the contracting force of cheek muscles and natural tooth eruption force will push all the upper front teeth forward resulting in forwardly positioned, spaced front teeth with 'v' shaped upper arch!!

WHY TEETH REMOVAL FOR BRACES??

In most Orthodontic cases teeth are removed preferably all first pre-molars with the help of braces.for want of space to take front teeth back with braces.Why so?

CAN WE CONTROL GROWTH OF JAWS ??

Yes! provided the child is in growth period. The growth cannot be started or stopped. But can be accelerated or retarded! The growth of jaws can be controlled well before 12 yrs in males and before 11Yrs in girls.This the pre-pubertal growth. By means of certain Orthodontic appliances, this is possible. This can be well done by Orthodontists alone.

So children abnormal proportions of jaw size, should be examined by Orthodontist as early as possible.

In the picture shown, the girl is aged 13+ yrs, Profile appears as if upper jaw is forwardly positioned. But cephalometric analysis shown that upper jaw is normal and lower jaw is deficient. By means of night wearing appliance,the lower jaw growth is accelerated in a forward direction. Within six months the deficient jaw gained its normal size in proportion with upper jaw.

HENCE PARENTS, GUARDIANS, TEACHERS AND HOSPITAL PARA MEDICAL STAFF PLEASE CHECK YOUR CHILDREN  FOR THE JAW PROPORTIONS, SO THAT THEY CAN BE CORRECTED AT AN EARLY AGE.  

DO BLEACHING OF TEETH HARM TOOTH STRUCTURE?

layers of tooth structure

YES! YES!! Generally t eeth are bleached to remove the color and make them look whiter. As has been told, the tooth enamel contain 3-4% of water in young ones and the water reduces as the age advances. With removal of water, the transparent, translucent enamel becomes opaque.  This happens more in people who takes pan, betel and tobacco.

    Colouring of tooth is two types. 
One is formation of colour on enamel surface. This is due to factors like use of iron tonics, which form Iron stain  and stains formed by chromogenic bacteria ( bacteria present in many people which is quite harmless except for producing color). These stains can be easily removed by surface polishing with fine pumice and motor rotating brush.

The second one is internal stains. These are as a result of embedding of colour within enamel /dentine ( as in case of dead tooth)structure. This cannot be removed with surface scrubbing. Hence we have to use some chemicals which penetrate in to tooth structure and removes colour along with water from tooth (oxidation) releasing nascent oxygen or chlorine. Generally carbamide peroxides are used. Due to this removal of water from tooth structure, the tooth become brittle and surface shows more tendency to absorb colour faster immediately after bleaching.  

CROWN PLACEMENT AFTER ROOT CANAL TREATMENT

After Root Canal Treatment is it necessary to put a cap or CROWN over that tooth????

normal tooth

tooth undergone RCT

Yes! After RCT the crown of the tooth should be covered with a crown. Generally the outer layer of tooth structure (Enamel) not supplied with nerves and blood vessels. But it shows some sensiitivity. It  is due to the high vascular  and nerves supply to its inner layer (DENTINE) Enamel contains only 3-4% of water in childhood. The texture and consistency  of Enamel is maintained by vascularity of dentine. As the age advances the water content of enamel further reduces. That is why (less amount of water) the chipping of edges of enamel increases with increasing age. In people with pan, tobaco and betel chewing the enamel looses its water content very fast and becomes more and more brittle leading to more chipping of enamel (this is the direct effect of pan, tobaco and betel on enamel). In case of RCT done teeth, the nerves and blood vessels are removed from pulp chamber. So the tooth is completely deprived of humidity. Enamel, the outer layer will start loosing its water content faster. Hence it becomes more brittle. In addition the crown is made hallow with holes prepared in opening the root canals. So the tooth becomes more more brittle and increased chances for crown fracture.To save the crown from breaking, it should be covered with an outer cover  the so called CROWN!!

FILLINGS FOR DECAYED TEETH

Tooth Decay is a common problem in all standards of people. It is mainly because of morphological nature of tooth surface with many grooves, pits etc on the surface of the tooth. These act as catch pits of food and if not cleaned  properly, lead to tooth decay. Though it is more controlled by hereditary, it can be controlled by local brushing. Early detection is important. The only remedy  in early stages is filling. This tells you the type of filling required at different levels of decay.

Stage I : Here the decay is in outer layer of tooth (enamel). This is very far away from inner nerves and blood vessels. Hence any type of filling which does not expand or shrink and which makes tight contact with tooth surface ( to prevent leakage) will work.

Stage II :Here the decay has entered the second layer of tooth (dentine). This is little sensitive zone. As the depth increases, the sensitivity increases.  So, the fillings in this stage should be a non-conductor of hot and cold. Or there should be a non - conductive material coat on inner aspect first and any other filling on outer layers. This would not allow the hot and cold transmission to inner nerves through filling.

StageIII : Here the decay process crosses the inner layer and reaches the blood vessels and nerves. Procedures like  pulpotomy are available. But success rate differs. The common treatment is ROOT CANAL TREATMENT (RCT), where the total pulp is removed and the chamber is filled with medicated sealents like guttapercha etc.

IMPACTED WISDOM TOOTH

WISDOM TEETH OR 3rd MOLARS:Wisdom teeth or 3rd molars(akhal dant) comes very late( between 16 to 60 yrs). In many people they cannot come out because of lack of space for them to come out. They have very small roots and compressed crown. they can not come out because front there will be tooth and behind the curvature of bone will be there. with this they come out a little and get stucked between bone and tooth. They start pressing the adjacent tooth causing lot of pain. Over this tooth there will be small bone extension and over that the gum flap. When the person start chewing, the gum at this region is crushed between impacted tooth and its opposite tooth. This leads to severe swelling and pus formation  of the gum flap on the impacted tooth. This subsides with antibiotics but reoccurs in many cases due to lack of space for it to come out. This common in the lower jaw. Rarely seen in the upper jaw. Treatment being surgical removal of the tooth!

WARM SALT WATER GARGLING!!

Warm Salt Water how it helps in oral health?
     Salt water making is important. Crystal salt is preferred to table salt. The salt should remain at the bottom after mixing with water. That mean super- saturated one.
      In the swollen gums the tissue fluid (exudate)fluid increases in the outer layers. This fluid  exerts pressures on the nerve tips causing discomfort and pain. Our aim is to remove the tissue fluid. Salt water being hypertonic solution(more viscid), when gargled the warm salt water remove the collected  tissue fluid by means of osmosis (pulling of less concentrated liquid by more concentrated fluid into it) there by reduces the pressure, pain and discomfort.
      Salt water also removes the stagnated food particles by penetrating in to the tooth and surrounding under cuts there by reduces the gum infection and tooth decay.
       Salt water being alkali in nature, it maintains the Ph of saliva in alkali nature and reduces the tooth erosion  chances.
       Night after salt water gargling, no rinsing with plain water again!!
 
 

GUM MASSAGE : Is it necessary to massage the gums around the teeth? Yes! Why ??

Gums are protective tissue around the tooth. It is provided with melanin pigmentation for protective mechanism.It is attached to the tooth and bone. The tip of the gum 1-2 mm is mobile and is movable. Gums should have natural stimulus through fibrous food. But because of modern food habits, this is not available. Hence we have to do with natural way by means of applying mild to moderate pressure on the gums with the ball of the index finger. This will enhance the blood flow to the gums and maintain their texture. Hence we advice gum massaging at brushing time and hand wash after meal.

WHY TO REPLACE A LOST TOOTH ?

     Lost tooth generally should be replaced as early as possible. It is to maintain the normal harmony between upper and lower teeth and between the teeth within the same jaw.  All the teeth tend to move in the direction in which space is available. When a tooth is lost, the teeth on either side of the extracte3d tooth  move towards the gap. This gives a gap distal to the moved teeth allowing food stagnation and gum infection. Infection further leads to bone loss.

      The tooth opposite to the lost tooth tries to extrude (come out of the socket, again creating spaces or gaps in either side to it. This again leads to food stagnation, gum infection and bone loss etc. 
In total whole occlusion of teeth is disturbed. 

Calculus (deposits in between the teeth):  Deposits in between the teeth is common. It is as a result of precipitation of salts of saliva on to the rough tooth surface. First the mucin from the saliva forms a layer on to the tooth surface because of its sticky nature. Later the salts from saliva gets impregnated over the mucin. It is more common in the lower teeth because all the saliva because of gravity gets accumulated between the lower teeth and the tongue where the salts get precipitated. If we casn avoid these stages, we can get rid of the calculus.

   Good brushing will not allow the mucin to stick to smooth tooth surface. The other is diluting the saliva not allowing it to get its salts precipitated. It is by means of increasing the number of water intake.  One ounce of water repeatedly a number of times will definitely help in preventing the deposits on the teeth,

TOOTH DECAY IN CHILDREN

 TOOTH DECAY IN CHILDREN

              Tooth decay in young children is mainly because of feeding milk with bottle. During night the child is fed with bottle and made to go to sleep. The milk being very good nutrition to the bacteria, the anaerobic bacteria (bacteria which grow in abscence of oxygen) multiplies fast and show its action on the milk components left in the child mouth producing lactic acid. This acid will show its action on calcium part of the tooth. The milk teeth being very soft in nature as their crystalline structure is weak, will yield to this acid  dissolution, chipping and blackening. This type of decay in children is called
  RAMPENT CARIES OR BOTTLE FEEDING SYNDROME.There is no treatment for rampent caries except for small fillings. Prevention is better.

After feeding the milk, feed water with another bottle to the child so that the sucking pressure with in flow of water will flush the teeth and stagnated milk reminants will be cleaned on its own.

Generally children will refuse brushing the teeth. In such a case, just give a kids brush and ask them to chew on it which cleans the teeth and removes stagnated food particles,

This helps a lot particularly in rampent caries.

spacing in milk teeth

Spacing in milk teeth is common. It is for

meant to accommodate the larger permanent teeth, Any attempt to close these gaps will block the normal eruption of permanent teeth which are underneath. Hence this space is a good sign of future dentition. Lack of such space, requires attention by Orthodontist.