Irrigation Methods In Endodontics

               Irrigation : The Powerful weapon

Dental Post – 1

#Irrigatewisely

The success of endodontic treatment is completely relied on the principle of 3 dimensional cleaning and shaping root canal system by complete eradication of pathogenic microorganisms and necrotic pulp. And IRRIGATION plays central role in endodontic treatment.

How Irrigation works? Why it is important step? Which all solutions and methods are used ? And in what sequence it is used ?

I will try to explain this topic more practical point of view  because more of us  don't  know how to apply our theory knowledge when it is needed while doing cases. Let’s start.

What is irrigation and how it works?

Irrigation means flushing the root canal space with different irrigating solutions to remove all the inflamed pulp tissue and debris  and also to reach all the inaccessible areas where mechanical cleansing doesn't work well.

During the cleaning and shaping phases of an endodontic treatment it is possible to distinguish chemical  and mechanical cleansing. Mechanical cleansing, in addition to the removal of necrotic or vital pulp tissue leads to the formation of a thin layer of debris known as " smear layer". This SMEAR LAYER is made up of potentially infective organic and inorganic substances that must be removed from the canal walls, dentin tubules and root canal branches with the aid of root canal irrigants that is chemical cleansing.

Methods of Irrigation –

There are mainly four types :

1. Apical  Negative  Pressure  System (ANP) - This system is introduced to simultaneously release and remove the irrigant. These systems comprises a macrocanula for the coronal and middle portion and a microcannula for the apical portion, which are connected to a syringe for Irrigation. This system has the purpose to ensure a constant and continuous flow of new irrigant in the apical 3rd with safety and a lower risk of extrusion.
• Examples – Endovac system,  Endoirrigator plus

Cost Effective  Alternatives : You can attach metapex tip to suction tip which will remove the irrigant from the canal and normal needle syringe to release irrigant in the canal

2. Manual  Dynamic  Agitation (MDA) - It is a simple & cost effective technique which involves repeated insertion of a well fitting gutta percha cone in short vertical strokes to hydrodynamically displace & agitate an irrigant. Here the canal is filled with 5.25% sodium hypochlorite (NaOCl) & push pull strokes are performed manually, 1-2 mm short to the working length at an approximate rate of 100 strokes/min for minimum 30 seconds to 1 min.

3. Ultrasonic Irrigation system – Ultrasonic irrigation of the root canal can be performed with or without simultaneous ultrasonic instrumentation. When canal shaping is not undertaken the term PUI can be used that is ‘Passive ultrasonic irrigation'. PUI is the non cutting technique which reduces the potential for creating aberrant shapes in the root canal ( like apical zips, perforations). This method is more effective than  sonic activation and manual Irrigation as  it creates a higher speed and flow volume of the irrigant in the canal during Irrigation thereby eliminating more debris, producing less apical packing, better access of the chemical product to accessory canals and even the flush effect is produced by ultrasonics but not manual irrigation.
• Example – Endoultra

4. Sonic activation system - Most actual systems have smooth plastic tips of different sizes activated at sonic frequency by a handpiece . This effectively clean the main canal, to remove the smear layer  and to promote the filling of a greater number of lateral canal. Recently introduced technique uses a syringe with sonic vibration that allows the delivery & activation of the irrigant in the root canal at the same time.
• Example – PATS system ( air sonic activation), Endoactivator system, MM 1500

5. Needle Irrigation (NI) - In this method, solutions are delivered by a syringe and a 30 guage needle. The tip is placed as deep as possible( but 1-2 mm short to Apex) in the canal without wedging to permit backflow of the irrigant.

• Other cost effective alternative for activation of irrigant:

1) You can use ultrasonic activator tip which can be attached with your ultrasonic scaler.
2) You can attach Endoactivator tip to waterpik flosser.
3) 'U' files – They can be used in conjunction with 120° file holder that is endochuck which can be fitted onto an  ultrasonic scaler handpiece.

                                                                                                                                                     
 “Apical vapour lock effect” :                            

   Apical vapour lock is consistently formed during routine endodontic irrigation which impedes irrigant penetration till the working length thereby leading to insufficient debridement. This problem can be minimised by negative pressure irrigation OR techniques such as sonics/ultrasonics, Laser induced activation.

Sensitivity : A Common Problem

Sensitivity : A common Problem

Patient education post-2

Many people have come to me and said, “ Doctor, My teeth are sensitive. I can’t eat or drink properly”. What does it mean ?

Tooth sensitivity ( also known as dentinal hypersensitivity) is an increasing common dental problem. It is a sharp, severe, short term pain to any external stimulation for example cold drinks. 

 We all  should know, how it occurs? How can you avoid it? And if you feel severe sensitivity what treatment are available for it? I will try to solve these questions through this blog. 

If  intake of hot, cold, sweet or very acidic foods and drinks or breathing in cold air makes your teeth painful then you have sensitive teeth.
Because most of the cold/hot drinks attacks on the exposed inner part of tooth and stimulates inner sensitive part . Now what is this inner part of tooth, how it get exposed to external environment?

Let’s see the basic structure of teeth. Our teeth have mainly 3 parts : these are,

             Tooth structure

As you can see, that the outer covering of tooth  is Enamel. It is a protective layer and it is believed to be stronger than bone. When this strong layer is worn out due to some reasons( listed below) the inner part that is dentin gets exposed. This exposed part is very sensitive to  cold or hot drinks or sweet food, yogurt  and some alcoholic beverages . They provoke the inner layer and  causes sensitivity. Another reason for sensitive teeth is the exposure of root of the teeth caused by the loss of gum tissue ( Gingival recession).

What are the reasons for sensitivity?

•  Improper and aggressive brushing 
•  Use of hard bristled brush
•  Brushing for more than 2 times
•  Brushing in side to side movement
•  Use of ‘Tooth Whitening Toothpaste’ which contains harsh chemicals
•  Use of higher acidic mouth rinses
•  Poor oral hygiene 
•  Gum recession
•  Tooth decay
•  cracked tooth
•  Improper filling in the tooth
•  Continuous grinding of teeth
•  Severe acidity problem
•  Intake of acidic drinks/foods
•  Frequent vomiting 
•  Not maintaining balanced diet

These all above mentioned reasons are responsible for wearing away of protective layer enamel or receding gum line below the normal and hence  ultimately it leads to sensitivity.

“ If you are able to avoid all above mentioned points and  try to follow the correct methods of maintaining oral hygiene as I explained in my 1st blog ,you people can easily stay away from sensitivity.”

Now if you are facing sensitivity problem then What are the treatment plans available for it?

Management of sensitivity depends upon the severity of the sensitivity and the associated other oral findings. For that you need to consult your dentist to know the reasons behind it and correct treatment. I will tell you in brief about the treatment options.

1. Use of desensitizing toothpastes. Take a little amount of paste on your finger and rub over the area where you feel the sensitivity for 2-3 minutes and  then brush your teeth gently in circular motion.
2. Use of fluoridated mouthwash after brushing. Gargle it for atleast one minute.
3. Proper deep Cleaning(scaling) of your all teeth.
4. Application of fluoride gel 3-4 times at the interval of some specific time.
5. If the sensitivity is due to tooth decay filling can be done.
6. We can place cap(crown) and cover the exposed part of the tooth, if needed.
7. In severally worn out cases we can attempt Root Canal Treatment.

Be true to your teeth and they won’t be false to you.😄

-Soupy sales

Don’t Ignore your oral hygiene, as the sensitivity can be the early warning sign of more serious dental problems.
I hope this blog made your concept clear. Still if you have any doubt drop your question in the comment box.

See you till the next post ,Thank you😃

How to take care of our teeth?

Take care of your teeth!

Patient education post - 1

WHY IT IS IMPORTANT TO TAKE CARE OF OUR TEETH?

In India, people notices their dental problems very lately what we call it as Ignorance. It is a saying that ,” DENTISTRY IS NOT COSTLY BUT IGNORANCE IS”.

Let me tell you the importance of teeth in short. Adult oral cavity contains 32 teeth including wisdom teeth and child’s oral cavity contains 20 teeth. They are used mainly for mastication purpose that is chewing food to small particles which helps for proper digestion. Other than mastication they are used for proper speech and good appearance. Usually people Ignore milk teeth but it’s crucial to take care of them also, because even though milk teeth do not remain for life, there health is essential for  healthy permanent teeth which remains for life.

NOW THE QUESTION IS HOW TO TAKE CARE OF TEETH?

I will share some routine points which are really enough to avoid most of the dental problems. Just try those and let me know how good you are feeling.

What we need to do?
1. First and important most, brush your teeth regularly  twice a day with toothbrush and toothpaste.(brushing technique is given below)
2. Brushing time should be 2-2.5 minute not more than that.
3. Change your toothbrush in every 2 months.
4. Clean your tongue after brushing with the help of tongue cleaner.
5. Swish your mouth with water after snacking.
6. Dental floss can be used instead of toothpick to remove food particles stucked between the teeth where your brush doesn’t reach.
7. Mouthwash can be used to vanish out plaque and to keep your breath fresh.
8. Keep yourself hydrated.
9. Consult your dentist in every six months.

What we need to avoid? 

1. Avoid highly acidic foods.
2. Avoid teeth grinding.
3. Avoid sugary  foods/ sugary drinks.
4. Don’t smoke or chew tobacco.
5. Avoid brushing aggressively.
6. Limit snacks between meal.
7. Don’t use fingers for cleaning teeth and don’t use any  other products like charcoal powder or salt.
8. Don’t share your brush.
9. Don’t put your baby to bed with milk bottle.

Let’s see the right brushing technique.

• Brushing technique for normal dentition –   

• Brushing technique for patients with braces –
      
   

• For babies –
         
               

                                                                                                                           Silicone finger brush for cleaning baby’s teeth,gums  and tongue 

So how was the today’s post? Kindly drop your doubts and anything what you want to know more about.
See you till the next post!
Keep smiling 😃😃