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Routine Dentistry |
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The most common routine procedures undertaken in dentistry are based on
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Gum Disease |
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It is most commonly caused by plaque. Plaque is a thin, nearly invisible film adhering to all the tooth surfaces, colonized by micro organisms. This plaque mineralizes to form a hard deposit called Calculus/ Tartar. Calculus so formed becomes a local irritant for the gums, causing Gingivitis. |
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Symptoms
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An early symptom of Gingivitis is bleeding gums and a change in the gum colour- from a healthy "coral pink" to an inflamed red colour. Swelling and recession may appear later on. These symptoms, though painless (and thus often get overlooked) are harmful in the long run. |
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Treatment
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Gum disease, at this painless stage is reversible with a thorough brushing and with use of inter-dental cleaning aids. Regular check-ups also help in warding off such diseases. A simple procedure of Scaling (removal of accumulated calculus plaque and other deposits) is done with ultrasonic instruments in modern dentistry. The natural tooth structure is not affected and there is minimum post operative discomfort.
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In some cases the gingival swelling and infection continues inspite of scaling and prophylaxis. In such cases, a minor surgical procedure called Gingivectomy is performed in the affected area, under local anaesthetic. The surgery removes the enlarged and infected tissue.
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Gingivitis, if left uncontrolled, progresses to it's next stage- Periodontitis.
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PERIODONTITIS
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The supporting ligaments of the teeth get affected due to the presence of tartar. The gums become enlarged with a rolled edge separated from the teeth resulting in a periodontal pocket. |
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Symptoms
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Gum bleeding may appear as early symptoms. Tooth shifting and pus discharge on pressure from gums appear at a later stage due to bone loss.
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Treatment
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The periodontal pocket is usually painless and can be treated with a small surgical procedure "Curettage" where the tartar along with the diseased soft tissue lining of the pocket is removed. When the supporting bone also gets affected, the treatment involves a flap surgical procedure, where in the full thickness mucosal flap of the affected area is raised and the diseased tissue is removed.
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With the advent of modern dentistry hope is now available even for the so called hopeless cases of the past such as where teeth have become mobile due to loss of supporting tissue. Bone Grafting and augmentation, done under anesthesia can be performed for the removal of diseased tissue. Endodontic procedures can be done if necessary.
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Tooth Decay |
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Dental Carries
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Caries is the decay and crumbling of the substance of the tooth. A diet high in sugar is one of the causative factors.
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Caries are induced by the action of bacteria on carbohydrates (mainly from the diet), which is attached to the tooth by means of a pellicle (a thin colourless film formed within two hours of brushing) derived from the saliva. This entity consisting of the pellicle, bacteria and carbohydrates is called Plaque.
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The acid formed by the breakdown of carbohydrate by bacteria gradually decomposes the enamel of the tooth. If left un-repaired, the acid goes on to completely destroy the entire tooth, exposing the dentine. This causes tooth ache and the exposure of the pulp and allows infection to reach the bone and finally forms pus.
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Areas Susceptible to Caries
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The first and most vulnerable site for caries is the developmental pits and fissures. The shape of pits and fissures on the occlusal surface of the tooth contributes to their high susceptibility to caries. In modern dentistry such susceptible areas can be sealed off with sealants. Sealants is very minor and conservative painless procedure.
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The proximal surfaces, i.e. surfaces between two teeth are particularly susceptible to caries because of the extra shelter provided to plaque due to proximal contact area.
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Root Caries |
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There is an increase in the prevalence of root caries in older people due to the gingival recession compounded by an absence of good oral hygiene and also because the root surface is rougher than enamel and readily allows plaque formation.
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Conservative Cavity Preparation |
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Modern dentistry tries to be as conservative as possible. In the past, in silver amalgam fillings, a definite cavity preparation was required, wherein some amount of healthy tooth structure was also removed to give retention form for the filling. However, with the new "conservative" policy, in metal free restorations only the decayed part of the tooth is excavated and suitably restored.
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Silver amalgam (an alloy of Mercury and other metals), has since decades been the most common filling material. However, it was observed that this resulted in a high incidence of bulk fracture, metal corrosion with time, leakages, discolouration, pain/ sensitivity, caries formation under fillings etc. Thus this procedure has now been replaced by more sophisticated metal free restorations.
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Advantages of Metal Free Restorations
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Restorations are that they are bonded, aesthetic, tooth coloured (hence not easily visible) and provide flouride release which helps in the prevention of further caries formation.
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Bonded fillings has changed the face of modern dentistry, since the interface between the filling and the tooth was the most vulnerable part where the decay used to restart, in bonded fillings wherein there is a chemical as well as a mechanical bond between the tooth and the restoration. This interface is less vulnerable to tooth decay. |
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Root Canal Therapy |
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Earlier, if the decay had reached the pulp, the tooth would have to be removed, but now due to the advancement of modern dentistry, even badly decayed teeth can be saved by means of a procedure called Root Canal Therapy (RCT).
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Bacteria is the most common cause of inflammation and infection of the pulp. They enter the pulp through the tooth decay. The toxin from the bacteria, which has already destroyed the tooth pulp can further leak out of the root ends into the jaw bone and result in pus formation.
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Root Canal Therapy is done |
- To remove bacteria and the infected pulp from the pulp chamber and root canals.
- To completely fill the canals and pulp chamber with a sterile filling material to prevent future trouble.
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Once RCT is performed, inflammation in the bone around the root ends can heal and the tooth is saved.
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It is seldom that RCT fails, but if it does a procedure called Apicectomy is done where the apical section (root end) is excised to remove the pus around the apex surgically. |
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