Dentistry

Endodontics is the speciality of dentistry that deals with treating disease inside the tooth. If a tooth has been badly decayed or traumatised the pulp inside the tooth can become infected. When the infection goes beyond the tips of the root a dental abscess can form. To treat or prevent this dental abscess the dentist cleans out all the necrotic pulp tissue from within the pulp chamber and root canals. Once the tooth is sufficiently cleaned out and as sterile as possible, the root canal system is sealed off.

A small percentage of root treatments do fail, especially if they are only done long after the abscess develops. However, many teeth are successfully saved from extraction, and root treatments are a valuable treatment option against teeth extractions. Radiographs are important for root canal treatment. They are taken before, during and after root canal treatment to determine the approximate length of the roots and their particular shapes and curvatures.

First, the dentist removes decayed and weak parts of the tooth. An opening into tooth’s pulp chamber is prepared, allowing access to the openings of the root canals. These are cleaned with special hand and motorised instruments and constantly rinsed to aid in debris removal and canal sterilisation. In some, but not all root canal cases, the canals may be dressed with various medications and sealed with a temporary filling material to allow time for the infection to clear before they are filled. Placing a suitable final restoration filling is almost as important as the root treatment itself. Teeth, with large amounts of damage, may need a post (a metal or fibre-reinforced resin rod) down one or more canals, to anchor the filling securely onto the root of the tooth.

However, if the access opening is closed, root treated teeth will always be weaker than natural teeth, and prone to cracking or splitting. A serious fracture could mean removing the tooth that was so carefully saved with the root canal treatment. A good way to avoid such a disaster is to crown the tooth. If a tooth has an abscess it can firstly cause severe pain, but not always. Some abscesses can be surprisingly painless. Nevertheless, the infection at the root tips can spread, into the surrounding bone and soft tissues, and cause more serious infections with swelling and pain. Bacteria also enter the bloodstream and can infect other parts of the body. Unfortunately, the only alternative dental treatment a dentist can suggest is to remove the infected tooth.

Often, teeth necessitating root canal treatments, are weakened from the large tooth decay cavity, and cannot easily be simply extracted. Many require surgical removal. Initially, the removal of the tooth may save costs. However, in the long term replacing the missing tooth is far more costly than root treating it and restoring it with a suitable restoration, usually a crown. Dentists advise against leaving gaps.

A crown/cap is the dental restoration for a broken or weak tooth caused by decay or large fillings. Also, crowns can be used to make a dental bridge which is used to replace several missing teeth. Using a tooth-coloured material that does not leave a black line at gum level characteristic to the enamel and dentine complements the rest of your smile through ceramic crowns and bridges. Crowns and bridges are also known as cosmetic dental treatments as they restore and enhance your beautiful smile and also the confidence. For patients who are missing a tooth or series of teeth, all-porcelain dental bridges may offer the ideal solution for dental restoration. At our dental department, we place dental bridges that provide a natural appearance, reduce a patient’s risk of gum disease, and correct speech and bite difficulties.

In addition, dental bridges eliminate the possibility that your remaining teeth will shift to fill the gap left by a missing tooth. The most common type of dental bridge is the porcelain fused to metal full porcelain bridge. All metal bridges are the strongest but don’t look natural while ceramic bridges that are the most natural looking. If the patient has a missing tooth, the dentist will replace that tooth cavity with a dental bridge. The anchor teeth are prepared and an impression is made of the prepared teeth to send to the dental technician. A temporary plastic dental bridge may be fitted over the prepared teeth to protect them while the final bridge is being manufactured. Once the fit, shape, and colour of the bridge is satisfactory the dental bridge is cemented in place permanently. A very natural looking end result is achieved.

Millions of people face tooth loss every year, but luckily there are several options in modern-day dentistry to replace the teeth with treatments dental implants, fixed bridges, and dentures. People are advised dentures for the missing teeth by the dentists for the following reasons:

• Teeth adjacent to the gap (where the tooth was lost) begin to shift (move) towards the gap and cause functional bite problems
• Missing teeth can result in bone loss and shrinkage of your jawbone over time
• Missing teeth can cause your facial muscles to sag (due to lack of support) and make you look much older than you are

Dentists use two main types of dentures to replace a missing tooth, full dentures which replace a full set of either upper or lower teeth and the dental surgeons also use partial dentures which only replace a few missing teeth.

Veneers, or porcelain laminates, are custom made thin “shells” to fit precisely over the front of an existing tooth. They are permanently bonded in place with a special adhesive resin through this dental treatment. The finished result of ceramic veneers treatment is extremely strong and durable. Dental veneers are used for closing spaces, restoration of broken or chipped teeth, correction of uneven or crooked teeth.

An attractive smile and improved self-image are important benefits of orthodontic treatment. Crooked teeth without orthodontic treatment, can lead to tooth decay, gum disease, bone destruction, chewing and digestive difficulties, speech impairments, tooth loss, and other dental problems. Orthodontic treatment can be started at any age. Any person of any age has the wish and right to look beautiful and as it is a cosmetic treatment, anyone can go for it. But most problems are easier to correct if detected at an early age before jaw growth has slowed. Some orthodontic cases have to be treated with surgery also.

The teeth whitening process can be carried out in the dental surgery using stronger “power-bleach” products, or by using bleaching gel placed in a bleaching tray and worn at home or work. There are several teeth whitening products from various manufacturers, requiring different periods of treatment days. Most home use rules require one or two weeks of treatment. Tooth whitening or tooth bleaching is a process for lightening the colour of your teeth. The tooth whitening treatments are safe and effective methods of restoring natural teeth to a lighter colour. Natural tooth substance is not removed or altered in any way. Tooth bleaching proves effective – approximately 95% of the time, removing the discolouration and the staining in the tooth. The teeth whitening process occurs via oxidation. Free oxygen radicals attach to the stains on your teeth (oxidation). This causes the stain to disappear.

Oral and Maxillofacial Surgery is the surgical speciality of dentistry. It includes the diagnosis, surgical and related treatments of a wide spectrum of diseases, injuries, defects and aesthetic aspects of the mouth, teeth, jaws, face, head, and neck. Oral and maxillofacial surgeons are the bridging element between dental and medical specialities. They have the expertise and thorough understanding of both aesthetics and function to treat and care for patients who have conditions as follows:

• Pre-prosthetic Surgery (Surgery for better fitting of dentures)
• Dental implant surgery (to replace missing teeth, rehabilitation of patients having undergone surgery for tumours, to retain facial prostheses)
• Oral and dentoalveolar surgery (removal of impacted and buried teeth, cysts, etc.)
• Orthognathic surgery (Jaw and facial deformities)
• Facial trauma surgery (facial bone fractures and related soft tissue injuries)
• Reconstructive surgery of the face
• Cleft lip and palate surgery and other facial deformities
• Facial plastic surgery (Rhinoplasty, facial implants, etc.)
• Temporomandibular Joint Disorder (TMJD – excessive and reduced opening of jaws)
• Snoring and sleep apnea correction surgery
• Tumour/Cancer surgery of mouth and face

Dentoalveolar surgery is surgery related to diseases of the teeth and their supporting tissues. A tooth which fails to erupt through the gum tissue is, called, “impacted.” Most commonly impacted tooth is the third molar or wisdom tooth, but other teeth can also become impacted. An impacted tooth may cause permanent damage to adjacent teeth, gum tissue, and bone structure. Impacted teeth may also cause cysts and tumours that can destroy large portions of the jaw. Many times, impacted wisdom teeth are not treated until symptoms are present.

Loss of bone in the upper and/or lower jaws can result from injury or trauma, tumour surgery, or long-term denture wear. Using bone grafts from either the patient’s own bone or bone substitutes, the Oral and Maxillofacial Surgeon can improve both the quantity and quality of specific hard tissue. Soft tissue grafts can be utilised to improve the architecture of the soft tissues. This provides a solid foundation for dental rehabilitation, which in turn aids nutrition and speech. Implants can also be used to anchor both oral and facial prostheses.

Dental implants are frequently the best treatment option for replacing missing teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements placed directly in bone. Use of implants makes patients no longer suffer from ill-fitting removable dentures or bridges. Dental implants offer a long-lasting, comfortable and functional alternative. Dental implants are placed directly into the jawbone where they heal for a few months and fuse with the bone. Thereafter a permanent crown is fixed to the implant post, resulting in a natural and long-lasting replacement that performs like your healthy, natural teeth. If properly cared for, dental implants can last a lifetime.

Oral and maxillofacial surgeons treat and repair injuries to the face, jaws, mouth, and teeth. Oral and maxillofacial surgeons are experts in treating trauma, including fractures of the upper and lower jaws and orbits, and the cosmetic management of facial lacerations. Their knowledge of how jaws come together (occlusion) allows them to repair complex facial fractures. Trauma can be a result of major events like a fight, sports injury or automobile accident. Younger children often sustain damage to teeth or supporting structures from falls. Such traumatic injuries can usually be effectively treated on OPD basis avoiding costly hospital treatment.

TMJ Disorders and Facial Pain

The Temporomandibular Joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet. It permits the lower jaw (mandible) to drive and function. A common cause of facial pain and headache is disease or dysfunction of TMJ. Located where the lower jaw and skull meet, the TMJ is the ball and socket joint that enables the lower jaw (mandible) to move and function. TMJ disorders display a number of symptoms that may include earaches, headaches, and a limited range of movement. Patients may also complain of clicking or grating sounds in the joint, or pain when opening or closing their mouth.

A variety of problems and diseases cause TMJ disorders. In order to properly diagnose and treat the problem, oral and maxillofacial surgeons conduct a clinical examination and utilise a number of diagnostic procedures, including imaging studies (radiograph, CT, MRI). Usually, non-surgical management (soft diet, anti-inflammatory drugs, physical and/or bite splint therapy) is the first step. For certain conditions, joint surgery may be an appropriate option. Lysis and lavage of joint have proven effective in resolving these conditions. More complex joint surgery may be indicated for advanced conditions

The diagnosis of pathology in the maxillofacial region is an important part of the oral and maxillofacial surgery practice. If indicated, biopsies and other tests can be performed to diagnose the problem and develop an appropriate treatment plan. Early detection and treatment of oral lesions greatly improve the patient’s prognosis. Lesions may be managed medically and/or surgically. Research shows a number of factors that may contribute to the development of oral cancer. The most common is the use of tobacco and alcohol. Others include poor oral hygiene, irritation caused by ill-fitting dentures and rough surfaces on teeth, poor nutrition, some chronic infections and combinations of these factors. Everyone can perform oral cancer self-exam each month. Oral and Maxillofacial surgeons are best positioned for treatment of oral cancers as they carry out the removal of disease and replacement of removal part simultaneously to achieve a good functional and aesthetic result.

Differences in skeletal growth between the upper and lower jaws may lead to both functional and psychological difficulties. Functional difficulties may include problems with chewing, swallowing, speech or TMJ performance. Some abnormalities may only involve misaligned teeth and can be corrected orthodontically with braces or other appliances. Serious growth disturbances, however, require surgery to realign the upper and lower jaws into a more normal relationship and make eating, swallowing, speaking and breathing easy. The oral and maxillofacial surgeon performs special corrective jaw surgery to produce a more balanced, functional skeletal relationship for the patient, which is often performed in conjunction with treatment by an orthodontist.

Snoring and obstructive breathing patterns during sleep occur in a significant section of the population and can range from snoring to periods of true apnea, where breathing ceases for a brief period of time. Obstructive Sleep Apnea can lead to excessive daytime sleepiness, poor work performance, and such cardiovascular disorders like hypertension, arrhythmias, and congestive heart failure. Oral and maxillofacial surgeons are trained to diagnose and treat this condition.

Study of patient’s surgical and dental background and ability to reconstruct facial structures damaged through trauma have added to the expertise of oral and maxillofacial surgeons. Before any cosmetic procedure is performed, the oral and maxillofacial surgeon will request a thorough medical history to evaluate the patient’s overall general health.