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Dental Treatment: The A To Z Of Dental Treatment

Dentistry

What Does Dental Treatment Mean?

The branch of medicine dealing the anatomy, pathophysiology and treatment of the diseases of the teeth and associated structures is known as dentistry. Teeth are embedded in the sockets in jaws, surrounded by other soft tissues. These include:

  • Gingiva: Commonly referred to as gums, covers the roots of teeth
  • Alveolar bone: Lies beneath the gingiva, provides support and protection to the teeth
  • Periodontal ligament: A thin sheet surrounding the teeth, providing nutrition and support
  • Cementum: A fibrous band mainly acting as an anchor for teeth.

 

Structures within the teeth include:

  • Enamel: The hardest part in the human body, consisting of calcium and phosphorus minerals.
  • Dentin: Composed of dentinal tubules, forms the bulk of tooth structure, responsible for the color of teeth
  • Pulp: It is the heart of teeth, providing blood and nerve supply to the teeth.

Dentistry involves the study of all these structures and we at MedcureIndia provide information regarding it.

Causes Of Dental Diseases:

  • Improper brushing: Maintenance of good oral hygiene is a must for overall functioning of teeth and related structures. Absolutely no brushing or poor brushing leads to accumulation of calculus and plaque around teeth. These in turn lead to gingival swelling, bleeding of gums, halitosis (bad breath), periodontal issues such as bone loss and mobility of teeth. On the contrary, too much/vigorous brushing leads to wearing off enamel known as bruxism.
  • Dental caries is progressive loss of tooth structure exposing the enamel, dentin and pulp leading to pain and tenderness.
  • Excessive consumption of pan/tobacco/gutkha leads to a host of precancerous and cancerous conditions in the oral mucosa. Smoking releases nicotine which also leads to the damage of oral mucus membrane.
  • Habits: These include thumb sucking, tongue thrusting, pin/needle pricking between teeth in childhood which lead to a condition called malocclusion. This pertains to malaligned teeth in the form of spacing between teeth, crowding of teeth or forwardly placed teeth.
  • Genetic mutations in the intrauterine life lead to congenital anomalies such as cleft lip/palate, crouzin syndrome, hemifacial microsomia, Treacher Collin syndrome, Pierre Robin syndrome etc.
  • Trauma may also occur in the head and neck region along with tumors of soft and hard tissues of the face and skull.

Signs & Symptoms Of Dental Diseases:

These are categorized into two groups.

Symptoms which the patients complain of include:

  • Swelling and pain in the gums, bleeding on brushing, bad breath
  • Mobility of teeth
  • Cold/hot sensation of certain teeth
  • Pain during mastication/chewing
  • Irregularly placed teeth, missing teeth
  • Reduced mouth opening

Signs which the dentist observes during examination include:

Clinical examination: The patient is examined for:

  • Any visible stains/plaque/calculus, pain/tenderness on percussion of sensitive teeth, periodontal pockets, alveolar bone loss, missing teeth, impacted teeth, habits and mal positioned teeth.

Radiographic examination: A variety of radiographs are taken at different angles to confirm the findings of the clinical examination.

Diagnostic Tests For Dental Diseases:

  • Primary diagnostic test: This is done with a set of instruments like mouth mirror, probe and excavator to locate the site of disease/complaint, palpate the tooth for the extent of pain and tenderness, probe the depth of periodontal pockets. Gloved fingers maybe used to check for gingival swelling. A torch may also be used to check for oral lesions.
  • Radiographic tests:
  1. Most commonly used is the intraoral periapical radiograph IOPA which covers the crowns and roots of three to four teeth per film per quadrant. It is used to study the extent of dental caries.
  2. An orthopantomogram OPG gives view of full dentition in a single film along with parts of adjacent structures such as maxilla (upper jaw) and mandible (lower jaw).
  3. A lateral cephalogram gives view of skull from right side helpful in studying the soft tissue outline, tongue, pharynx in addition to maxillary and mandibular teeth and bony landmarks.
  4. Cone beam computed tomography CBCT gives a three dimensional view in cases of impacted canines, cysts in jaws, fractures of the mandible, or to study the anatomy of the bones of skull and face.
  5. CTs and MRIs are recommended to study the pathologies of salivary glands, temporo-mandibular joint disorders and soft tissue spaces and organs of skull and face.
  • Blood test: A complete blood count, hemoglobin estimation and ruling out of bleeding disorders are done in cases requiring wisdom teeth removal and gingival flap surgeries.

Types Of Dental Diseases:

  • Periodontal diseases: These include gingival, alveolar bone, periodontal ligament and cementum diseases. Gingival inflammation, bleeding, pus discharge occur as a result of poor oral hygiene techniques. These in turn may lead to formation of periodontal pocket formation, loss of lamina dura, bone loss, recession, fenestrations, dehiscence and furcation involvement. These are acute, chronic according to the duration and mild to moderate and aggressive as per the stage of disease.
  • Periapical diseases: As a result of dental caries, the infection may advance to the pulp causing periapical infection. On IOPA examination, the lesion appears totally radiolucent and hazy. It may also advance to a cyst if left unattended.
  • Malocclusion: This is not a diseased condition of dental specialty but rather a state of mal alignment of teeth. These include forwardly or backwardly placed teeth, crowding, rotations or spacing between teeth. In addition to these, narrow and wide upper and lower arches, ectopic eruption of teeth, canine impactions, mesiodens, supra erupted teeth, facial asymmetries all fall under malocclusion category.
  • Dry socket: It occurs due to non healing of the socket post extraction. It causes tremendous pain and swelling with a foul odour and discharge within the socket and in adjacent structures. It is often treated with an aggressive antibiotic and analgesic coverage.
  • Mucosal flaps known as operculum maybe seen adjacent to erupting wisdom teeth. These are gingival masses which get inflamed due to accumulation of food debris beneath them causing infections.
  • Impacted teeth: It is very common to encounter impacted wisdom teeth within the upper and lower jaw. These teeth are the last ones to erupt and hence may or may not find adequate space in the jaw to erupt in full occlusion. Hence they stay where they are inside the jaw, may or may not cause pain, in certain situations may house a cyst. 

Treatment Of Dental Diseases:

  • Exodontia: It includes extraction of mobile teeth either due to bone loss or periapical pathologies. A variety of impacted wisdom teeth are also It is a procedure carried out in local anaesthesia with different injection block techniques. Anti analgesics and antibiotics are prescribed after it for the proper healing of socket.
  • Maxillofacial surgery: It is the stream concerned with the trauma and oncology of the head and neck region. Rhinoplasty refers to the correction and contouring of the nose. Cheiloplasty concerns surgical treatment of the lips. Congenital defects such as cleft lip/palate require surgical corrections such as Z plasty and pharyngeal flaps.

Orthognathic surgeries aim at correcting malocclusions with an underlying skeletal deformity. Bilateral sagittal split osteotomy BSSO aims at advancing or shortening of the mandible. Lefort I/II/III osteotomies work on the maxilla for reduction, advancement or impaction.

Distraction osteogenesis is yet another approach for the surgical correction. It uses intra as well as extra oral distractors for bone growing in bone deficient areas of face.

  • Periodontal surgery: A thorough scaling and root planning is all that is required for removal of calculus/plaque and food debris from teeth. In certain periodontitis, flap surgeries maybe needed. A part of gingiva is cut, the exposed part of tooth and bone cleaned and the flap is placed back in its position. Bone grafts may also be placed in order to promote bone healing, bone deposition to correct bone loss and furcation involvement.
  • Orthodontia: A variety of malocclusions are corrected by fixing braces/brackets over the facial side of teeth and pulling them with wires in their required positions. These remain in the oral cavity for a period of 18-24 months till the correction is achieved. On a routinely basis, metal brackets are used, however for esthetic concerns ceramic ones are in use too. Certain simpler types of malocclusion can also be corrected by using removable appliances which can be removed by patient as per their convenience and achieve results in 8 to 12 months time.

In lingual orthodontics, brackets are attached on the lingual/palatal side of teeth to bring about correction of malposed teeth. It is esthetically more acceptable since the brackets are not visible. However, a good oral hygiene becomes difficult to maintain. Also not all malocclusions can be treated with lingual approach.

A recent trend is the use of invisalign clear align therapy by a lot of orthodontists these days. These are transparent trays of variable thickness the patient is advised to wear full time in successive appointments till the correction is achieved.

  • Conservative dentistry: It aims at preserving the tooth structure by excavating the carious part. The tooth is then restored with a variety of cements. Glass ionomer cement GIC releases fluoride which rebuilds the tooth structure, most commonly used. Tooth colored materials such as composites are also used very commonly in dental practice.
  • Root canal treatment: Yet again the most commonly employed treatment modality, involves removal of pulp, cleaning of pulp canals and dissolving the periapical infection. It is routinely followed by a permanent crown restoration over the brittle tooth in the form of metal or ceramic caps.
  • Prosthetic treatment: These involve replacing the missing teeth. A complete denture set is fabricated for geriatric people to restore their masticatory function. Removable and fixed partial dentures also can be used to replace a certain set of missing teeth. These can be metal, ceramic or porcelain materials. Extraoral branch including replacing eye, nose and ears with artificial prosthes is also done under this category.
  • Implants: These are titanium screws of variable sizes which are inserted surgically into the jaw bone and left for a period of 12 weeks for osseointegration. After this period, artificial clinical crowns are attached to the upper open part which ultimately become the teeth in occlusion. Surgical implants include zygomatic, maxillary, nasal, mandibular implants which are used to join the osteotomy cuts during surgical procedures.

Complications & Risk Factors Associated With Dental Diseases:

  • Post operative swelling, oedema and infections following extraction of teeth may occur due to faulty injection technique.
  • Hypertension, smoking, tobacco, diabetes, bleeding disorders complicate extractions, flap surgeries, root canal treatment.

Success Rate In India:

Extractions have a cent percent success rate with only 0.1 percent chances of post operative infections. Orthognathic surgeries achieve 78 percent desired results over a 5 year period. Cleft lip and palate surgical approaches give 90.87 percent successful results. The routine root canal, scaling and prosthesis gives a near hundred percent successful result.

Why Medcureindia?

One of the leading medical tourism team in India, MedcureIndia makes sure its clients always remain in a great state of health. Hence our prime moto is continuously working towards the betterment of our clients. We keep our knowledge updated regarding all the recent advances in the dental treatment strategies and direct our clients to these as per their needs assuring the best outcomes.