Tooth sensitivity

OMGGGG !!!!! What a shooting pain was this !!!! For cold and hot and sweet and sour….For everything and on everything i eat…was this pain or sensitivity !!!! My dentist calls this sensitvity and i say this as PAIN….

Had you ever visited your dentist for this reason !!!! Or on least case, had you ever encountered this problem ??? And you doesn’t know whether it is a pain or sensitivity but for a few moment it had banged your head?? And you had no idea why this was happening !!!

This is something called as “Dentin hypersensitivity “. Tooth has only one sensation and that is pain sensation…Any insult that happens to the tooth structure will be elicited as pain. Depending on the level and depth of insult, we categorize it as either pain or sensitivity…

So why this sensitivity happens and what is the reason behind this !!! The outermost covering in the crown of tooth is called enamel and it is devoid of nerve supply thus protects the tooth from any sort of sensation. When this enamel wears off ( causative factors are many – either due to decay or trauma causing enamel to chip out or excessive grinding of tooth or toomuch of abrasion/attrition, or excessive brushing of teeth or receding of gums or gastric esophageal reflux causing acid erosion or bleaching the tooth ) on such case, the underline structure called dentin which contains nerve endings are exposed to the outer environment… Any substances that comes in contact with that particular portion will elicit pain.

This is not bound with the age limit( though elderly people are more prone), anybody can get it and lifestyle is an influential factor as well.

Only way to escape from this sensitivity is to occlude the exposed nerve ending.  But how far it could be kept occluded is questionable.

There is no universally accepted gold standard treatment for dentin hypersensitivity which reliably relieves pain for long term.

Depending on the severity, at home and in office methods are used.

Desensitizing toothpastes or mouth wash or chewing gums which contains potassium nitrate/citrate/chloride, strontium chloride/acetate , Calcium carbonate/calcium sodium phosphosilicate, hydroxyapatite are believe to have role in nerve desensitization with various mechanisms.

When the pain is severe, in office methods are implemented… Which includes dental sealants, or restoring the defective portion with the filling materials preferably which has the flouride content or with the use of mouth guard if the problem is due to teeth grinding.

How to prevent tooth sensitivity???

  • avoid using tooth abrading toothpastes
  • brushing teeth with soft or medium bristles
  • gingival recession can be avoided by healthy dietary and proper oral hygiene practices
  • devoid of stress
  • taking food at proper time
  • Limiting consumption of acidic foods and drinks

Tooth sensitivity still can be controlled with our quality of life.

 

Tooth avulsion and its management

What if a tooth gets knocked in an accident??? Is that so we lose that tooth permanently??? No, there are still ways to save those from further damage by acting promptly. Trauma can occur anytime. Depend on the amount of injury occured, it can be treated from the conservative way to an advanced procedures.

Irrespective of the level of injury, from mild blow to the massive tear, it is a must to visit your dentist immediately. This helps a lot to prevent from massive damage to the tooth and its supporting structures.

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Now, what can we do if a tooth completely comes out of the socket due to a heavy blow or an accident!!!! Can we fix our own natural tooth into our socket as before and give a rebirth to it???? Yes offcourse we can…But this is highly depends on how fast we act and how effectively we handle the avulsed tooth.

yes, there are certain procedures to be followed to preserve the structure from further damage so as to get the proper fixation of the same tooth without losing its quality and function.

It includes,

  • Hold the tooth only on the crown portion and DO NOT touch or scrap the root portion of the tooth ( touching the root portion will damage the periodontal ligament )
  • wash the tooth in the running water or milk for about 10 seconds. ( this ensures the wash off of infection)

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  • Rinse your mouth as well
  • Try to replace the tooth back into the socket using gentle, steady finger pressure ( do only if the person can able to tolerate the pain). Align the tooth properly and insert into the socket and hold it for 5 minutes

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If the tooth cannot be replaced into the socket, then care in transporting that tooth to the dentist becomes essential. The tooth must be carried in a moist vehicle to maintain the viability of the torn periodontal ligament.

The tooth SHOULD NOT be wrapped in a dry handkerchief or paper tissue because the periodontal ligament will become dehydrated.

Commonly available transport medium for the avulsed tooth includes,

  • Raw milk ( either place the tooth in the cup of milk or in a plastic bag with milk and place it in the cup of ice cubes)

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  • Tender coconut
  • own saliva ( simply place the tooth in the mouth inbetween the cheeks and the gums)
  • Least preferably plain water

Other solutions includes,

  • HBSS (hanks balanced salt solution)
  • physiological saline solution

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It is to be noted that extraoral time for an avulsed tooth optimally should not exceed 20 minutes for proper re plantation without quality degradation, the person must be taken to dentist immediately. The sooner the replantation, the better the prognosis.

 

References:

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Relationship between the heart and the tooth

Dentist : Hi Mr.(name), good morning, what’s your problem!! How can i help you ???

Patient : I wanted you to pull my tooth out. It’s shaking and it is painful sometimes, giving so much of trouble, i cannot eat properly………….and its go on

Dentist : Ok ok relax…. yes, your gums are weak and no adequate bone support as well, we will treat it appropriately, not to worry about it. But before proceeding, i just wanted to know about your medical history…Do you have any medical complaints??so that i can plan accordingly!!!!

Patient : uhh…… …………. (blank)

( * mind voice – i have heart disease, diabetes, hypertension…..even i have done surgery in my heart….should i tell !!!!!

Just to remove this shaking tooth, this guy will send me back for an opinion….all unnecessary stuffs…i know i am fit enough to handle this, then why to tell him!!! Nothing going to happen…quick treatment will be done if i hide…….)

Dentist : Excuse me sir?????

Patient : Huh… No nooo…. i dont have any other medical complaints…. You can start the treatment directly

Dentist : Are you sure????

Patient : Ya ya, i am very much sure about it. I am completely fit 

Dentist : uhh……………..(blank)

(* Mind voice – oops……now how to find out yaar!!!!)

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Haha have you ever put your dentist to this situation!!!!! Ho please don’t… In this blog i will share a few things about the link between the heart disease and tooth related treatments.

There are three main reasons why your dentist is so much particular about knowing your heart condition if you have heart disease,

  • To get access on platelet and clotting factor mechanism
  • To have control over arrhythmia ( irregular or abnormal heart beat )
  • Role of micro organisms and infective endocarditis

To get access on platelet and clotting factor mechanism:

Blood thinner medicine are thumb rule tablets given to every cardiovascular complaint person. This helps to prevent from further clot formation on the blood vessels. But when the person wants tooth removal, intake of the same medicine will cause uncontrollable bleeding. It is to be noted that tooth and its supporting structures are highly rich in blood supply and it is difficult to control bleed when the blood clotting mechanism doesn’t respond properly.

At the same time it is highly NOT recommended to stop the drug just like that. Only the cardiovascular specialist knows the exact condition of every pumping organ. It is always advisable to have their opinion before taking the dental procedure. When the risk factor for the heart is more or on the moderate to severe illness condition, an alternative drug protocol will be recommended where an alternative antiplatelet drug takes up the role or the treatment regimen will be altered by the dentist. If the heart condition is under control, he may advise to go on with the procedure by stopping the drug for 5days or so…

* Person with the history of stroke or high blood pressure also will be prescribed with blood thinners. It is always better not to hide any medical history to the physicians.

To have control over arrhythmia:

As i said before, tooth structure is highly vascularised. In order to prevent excessive loss of blood during dental procedures, local anesthesia(LA) also contains a few percentage of “adrenaline ” in it. This helps for the constriction of the peripheral blood vessels thereby preventing from the excessive blood loss. Though adrenaline in the LA possess only very minimal percentage ( about 1:100000 dilution), for the person with uncontrolled blood pressure, this value is enough to shoot up the condition.

As like on blood vessels, the adrenaline has its own action on the pumping organ as well. Adr generally increases the heart rate and muscular contraction. So now when the person is having moderate to severe heart illness, this may worsen up. On such conditions LA without adrenaline is preferred if it is suggested by the cardiologists.

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The role of micro organisms and the infective endocarditis:

It is well known that oral cavity is the main source of lodging micro organisms. Out of which, staphylococcus aureus and viridans streptococcus are the most predominant micro organisms which affect the inner wall of the heart called infective endocarditis. These bacteria quickly enters into the blood stream(bacteremia) to reach the heart valve. When the person is having heart valve defect or rheumatoid heart disease,  atmost care must be taken when going for the dental procedures. Antibiotic prophylaxis is a must for them. Without adequate precautionary steps, any procedures may end up into life threatening one.

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Not any medical history should be taken for granted. It is to be understood that human body is a complex structure and everything is inter connected…

 

References:

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Importance of restoring children’s tooth

One of the most frequent question we face in our regular practice.. Why to fill the tooth when anyways it is going to fall off at one point!!!! This is one of the valid question which need a responsible answer.

Before going into the main topic, It is very important to understand that…”tooth is a tooth”, irrespective of deciduous or permanent teeth, it has to be treated and restored. You may wonder why!!! And what is the necessary of doing so…but the truth is, every tooth has its own unique function like every organs in the body. On losing those, you may tend to lose its own funtionality along with its supporting structure which end up with a mess in oral cavity.

So now, let us focus on primary teeth ( also called as milk teeth or deciduous teeth)

what will happen if you dont restore the primary teeth???

  • Speech impairment or alteration in the phonetic or pronounciation:

Yes, it is a true fact that every position of the tooth(both front and back) plays a vital role in Kids speech ability and it is well known that it is the vital age to learn phonetics. Any missing tooth or an altered position of tooth leads to airflow imbalance causing mislead in phonation.

  • Misguidance in the eruption pattern of permanent tooth:

The eruption pathway of permanent teeth are guided by the preceding primary teeth. When there is a premature loss of primary tooth, more chances for the  succeeding permanent tooth to loss its path and may erupt either out of the alignment or do not erupt at all( which we call as impacted tooth).

  • Spread of infection to the succeeding permanent tooth:

When the primary tooth is left untreated for longer time, there are more chances for pus formation which inturn affects the underlying permanent tooth

  • Impairment in the jaw bone growth:

This is a rare scenario, when the child’s oral health is very poor causing premature loss of multiple teeth at the early stage of life, the growth of the supporting structures like gums , soft tissues and bones are affected and showing some sort of retardation later.

Now i hope it will be understood why it is so important to restore the primary tooth.

So how to manage them!!!! Let us have a brief of that.

It is not that easy to protect primary teeth as the primary teeth are more prone for tooth decay when compared to the permanent teeth.

  • Have regular follow ups with your child’s dentist
  • Hydrate your kid well with adequate water intake. This helps to prevent the PH drop in the oral cavity thereby helping the tooth from caries attack.
  • Maintain proper oral hygiene. Always help your kid to brush twice daily and make the habit of rinsing the mouth after every meal.
  • Whenever you spot a black or brown discolouration on the tooth, it is an alarming sign to start with the preventive interventions
  • Initial preventive methods start with the flouride application. Either by tooth paste or in office application as recommended by your dentist. (* It should not be taken by your own as overdosage of flouride has its own consequences)
  • Pit and fissure sealants. These are white coloured sealant material preferred for the initial caries attack which helps to prevent the tooth from further damages
  • When the decay is considerably deep, conservative management takes up the role. certain filling materials like silver amalgam( not preferred nowadays by most of the dentist due to the concern of mercury toxicity) , GIC and composites are used
  • When the kid elicits pain or sensitivity or mild swelling, it means the decay is on or close to the vital structure called pulp or sometimes the infection have crossed beyond the root (swelling condition). Here comes the next level of management where root canal treatment(pulpectomy) or pulpotomy are considered. Followed by stainless steel crown placement( so as to prevent the tooth from breakage).
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  • When the tooth is completely gone (grossly decayed), removal of the tooth followed by placement of space maintainer is recommended. This will help to retain the space for the permanent tooth to erupt.
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Likewise the milk teeth are prevented and restored. It is always better to take early intervention right from better oral hygiene.

References:

https://www.google.co.in/search?q=baby+with+teeth&rlz=1C9BKJA_enIN659IN660&hl=en-GB&prmd=ivn&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiCq4yY1erSAhXJKpQKHcYyC5QQ_AUIBygB&biw=768&bih=909#hl=en-GB&tbm=isch&q=baby+with+teeth+clipart&*&imgrc=VeF5Xu27r3hvfM:

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