Pregnancy and Oral care! 🤰

        Dental Precautions for Pregnant women

Patient Education Post - 3

Hello everyone! 🤗  I am here again with the all new topic regarding the things about oral health and pregnancy.

• Most of the people are unaware about the changes happening in their mouth before, during and after pregnancy. I think it is an absolute need to know about all the concepts regarding oral hygiene of a pregnant woman.

• While practicing, I had observed so many pregnant woman  with many dental problems, some were minor and some major too. How to tackle such conditions?

Don’t worry ladies. This blog is for you.

• The hormonal variations during pregnancy put pregnant females at a higher risk for developing various dental problems.

• Some studies show that the bacteria from gum diseases can actually get into the bloodstream and target the foetus potentially leading to ‘premature labour’ and ‘low birth weight’ babies.

• We need to understand, if oral hygiene is maintained well, pregnancy by itself does not cause periodontal disease.

• It is because of already existing local factors which lead to exaggerated periodontal disease progression under the influence of increased circulating hormones.

 Now, what are we supposed to do in every trimester of pregnancy? 

• 1st TRIMESTER (1-3 months) : 

1. First of all inform your dentist about pregnancy.

2. It’s  better to avoid dental treatment in 1st trimester.

3. Hormonal changes may cause inflammation (swelling) of gums. Use soft bristle brush and a bland (non aggressive) toothpaste to avoid vomiting. floss regularly to maintain your gums clean.

4. Do not brush your teeth immediately after vomiting or morning sickness. Instead rinse your mouth with water and use flouridated mouthwash.

5. Baby’s teeth begin to form 3 months into pregnancy. So your food will affect the development of teeth so have a  healthy diet.

6. Don't take over the counter medicine especially tetracyclines as it causes discoloration of your baby's teeth.

•  2nd TRIMESTER ( 4-6 months) :

1. The safest period for dental treatment remains the second trimester where complex procedures such as minor surgeries can also be carried out.

2. Take a diet which is more in calcium, vitamin C , vitamin B12 for healthy teeth.

3. Avoid intake of sugary food even though you are craving for them.

•  3rd TRIMESTER ( 7-9  months) : 

1.  Avoid any dental treatment.

2.  Be regular in maintenance of oral hygiene, brush your teeth twice a day and floss daily.

• Nursing : 

1. X-ray, local anaesthetics are safe during breast feeding.

2. If you have tooth ache, don’t take any over the counter medicine as it may affect baby’s health.

3. Consult your dentist to get your dental treatment done.

4. Wipe your baby’s gum with clean cotton cloth or cotton after every breast feeding or bottle feeding.

5. Never put your baby to sleep with milk.


      #myadvice

We often don’t realize that the oral health starts from the mother’s womb. Before you get pregnant, meet your dentist and make sure that your teeth and gums are in good condition. If not, get it treated as soon as possible.

• Conclusion :

       Maintenance of your oral health and maintenance of new born baby’s health is important. As your kids has to suffer consequences if you abuse yourself while pregnant. Keep your oral hygiene clean and stay healthy.
So spread this information to everyone around you. And make sure your teeth are healthy before pregnancy.

• References :

1. Oral health awareness and practices in pregnant females : A hospital-based observational study. Mayank Hans, Veenu Madan Hans, Namrata Kahlon, Piyush Kumar Rameshchandra Ramavat, Usha Gupta, Asim Das.
'Journal Of Indian Society Of Periodontology'

2. Oral health of pregnant females in central India: Knowledge, awareness and present status. Saxena Payal, Gupta Saurabh Kumar, Yadav Sumitra, Jain Sandhya, Jain Deshraj, Kamthan Shivam, Saxena Parul
‘Journal Of Education And Health Promotion'

3. Periodontology : A risk for delivery of premature labour and low-birth-weight infants. Rajiv Saini, Santosh Saini and Sugandha R. Saini.
‘Journal Of Natural Science, Biology and Medicine'

Easiest ways to search MB2

                

Dental Post - 2

#findmb2

Hello docs! I am here with a new topic of my blog that is about MB2.

Why MB2 is getting so much of importance nowadays? There are the reasons. Start welcoming MB2 as a normal anatomy of maxillary 1st molar.

Maxillary 1st molar is the tooth with the most complex and varied root canal anatomy. Most of the time ( say almost always) this tooth has one extra mesiobuccal canal that is named as mesiobuccal-2 i.e. MB2.

Methods to explore additional canal orifices :

1. Examination of the pulp chamber floor with sharp explorer ( DG 16 ), here we can use some test like following,


• Champagne bubble test – In this test we allow sodium hypochlorite to remain in the cavity and after some time bubbles may appear at the sites of orifices that gives the hint of hidden canal.

• Ophthalmic dye ( Fluorescein sodium, Rose Bengal) – When these dyes come into contact with vital or Non-vital pulp tissue they are readily absorbed  by the connective tissue elements of the pulp in the chamber. When exposed to blue light, these dyes fluoresce and that helps to locate pulp tissue. 

• Red line test – In vital teeth, blood frequently emanates from an orifice, fin, or an isthmus area. Like a dye, blood serves to map and visually aid in the identification of the underlying anatomy.

• White line test - When performing ultrasonic procedures without water in necrotic teeth, dentinal dust frequently settles into any available anatomical space. This dust can form a white dot within a hidden orifice or a white line within an anatomical fin, groove, or isthmus.

2.  Magnifying loupes 
3. CBCT
4. Surgical operating microscope

Where to look for MB2 ?

• Most of the time  MB2 is situated 3 mm from the MB1 canal towards palatal direction, 1-2 mm mesially from MB1 canal and 2-3 mm deep apically. So you have to dig in with these approximate values and you may get MB2 canal in most of the cases.

• If the tooth is more calcified, you may need to go more deep that is 2 mm  to 3 mm(or more) apically. One must groove MB2 canal towards the palatal aspect of the tooth, not in the direction of the palatal canal.
• In maxillary 2nd molars, the MB2 tends to be closer to the MB1 canal than in 1st molars.
• DENTIN SHELF – In most of  patients the MB2 is typically located under the layer of dentin that sits on the pulp floor. This layer  is called the dentin shelf. Removal of this dentin shelf is necessary so that our eyes can locate the hidden canal.

How clinician should be aware of MB2 canal in every case?
                                     ‘Our eyes can see what our mind knows' 

• Most of the endodontic canal detection procedures have relied on the dentist’s tactile dexterity and mental image of canal system.
• A clinician must know the basics of variable anatomical structures present in different teeth. In maxillary 1st molars the percentage of presence of MB2 canal has reached to 93%.
• Modify the access preparation to a rhomboidal shape as compared to the classical triangular outline.
• Searching MB2 is not that simple. If one grooves the floor in the wrong direction i.e. too mesial or too distal one may perforate.
• MB2 can be most difficult to find and negotiate in a clinical situation as many of the times they are narrow, curved and calcified.
•Start troughing with above mentioned values. Use of ultrasonic tips or ultrasonic
scaler becomes very useful here as they are very convenient, efficient as controlled

troughing is possible and improves visualisation. Once you  get the catch refine the access, make it straight. And then start negotiating the canal with no. 8 file and then continue with 10 , 15 and 20 number K file  respectively. 4% preparation is sufficient for MB2 canal.

• To categorise the canal system in each root, Weine described four different types of configurations as follows :
1. Single canal from the pulp chamber to the apex
2. Two canals leaving the chamber but merging short of the apex to form a single canal
3. Two separate canals leaving the chamber and exiting the root in separate foramina
4. One canal leaving the chamber but dividing short of the apex  into two separate canals with separate foramina
• In case if you have doubt about merging canals, then you can place master gutta percha cone in one of the mb canal and either 10/15 number K file  or gutta percha cone in another canal. If you feel any resistance and file/gutta percha cone is not reaching upto the working length then that gives the confirmation about merging canals.

‘My first MB2'

It was a case with 16…first I got three canals and I finished preparation with these canals that are MB1, Distal and Palatal. And then accidentally I got one catch which was just palatal to mb1 and when I inserted 10  k file I felt so much of resistance. That time I noticed that is nothing but MB2. ( It’s easy to search when you finish the preparation of main 3 canals)...that moment.. really memorable as it was my 1st MB2… in college I never got MB2 may be I never worked in that way. Then I completed preparation till F1 protaper and obturated. And finally the case was completed. So  after that I always search for mb2 and got it in many cases too. So I hope you people will start noticing mb2, happy searching!

My 1st MB2

Conclusion :

      Failure to detect and clean 2nd mesiobuccal canal system will result in decreased long term prognosis. Detection of all the possible canal is utmost important step to maximise endodontic success rate. 

References : 

1.  Detection of second Mesiobuccal canals in Maxillary first molars using a new angle of computed tomography. Ali Murat Akram, Cihan Yildirim,  Emre Culha, Erhan Demir, Mehmet Ertugrul Ciftci .' Iranian Journal Of Radiology'
2. Endodontic management of a maxillary first molars with unusual location of segons Mesiobuccal orifice. RVS Chakradhar Raju, Naresh Sathe, Chandrasekhar Veeramachaneini. ' Journal Of ConservatuCo Dentistry : JCD' 
3. LOCATING CANALS ,Strategies, Armamentarium and Techniques by Clifford J. Ruddle, DDS . Advanced Endodontics. 
4. Use of ophthalmic dyes in root canal location. Sashi Nallapati BDS and Gary Glassman DDS

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 😃😃