Selective Caries Removal Protocol

Dental Post - 3

Hello everyone! Hope you all are doing good 😀
This blog is to simplify our concepts of caries removal strategies. 

Previously the aims of carious tissue removal were to remove all bacterially contaminated and demineralized tissue, without any discrimination about different qualities of carious tissue like hardness, moisture and colour, even at the expense of the dental pulp, with high risks of pulp exposure, especially if performed in deeper lesions.

So, by avoiding this, 

Q. : “How can we achieve the best longevity for the tooth?” 

A. : By preserving  remineralizable  tissue and  Achieving an adequate seal by placing the peripheral restoration onto sound dentin and/or enamel, thus controlling the lesion and inactivating remaining bacteria by ‘Selective Caries removal protocol'.

What is Selective Caries removal protocol? (SCR Protocol) 

• Selective removal protocol aims at preventing pulp exposure while successfully restoring a tooth that has a moderate to very deep carious lesion, where the tooth has no signs or symptoms of irreversible pulp pathology.

  Selective caries removal protocol can be done in two ways : 

1. Selective Carious Tissue Removal To 'Firm Dentin' 

• In moderate lesions that is lesions not reaching the inner one third of dentin and with no anticipated risk of pulp exposure should be excavated to a caries-free DEJ and firm dentin.

2. Selective Carious Tissue Removal To 'Soft Dentin'

• In advanced (deep) lesions that is  lesions reaching the inner one third of dentin and with anticipated risk of pulp exposure should be excavated to a caries-free DEJ and soft dentin.

• In the periphery, achieving a good seal and maximizing restoration survival are prioritized, with peripheral enamel and dentin  being hard at the end of the removal process. 

• Generally while excavating caries, terms like ' complete' or ‘Incomplete’ are used. It remains completely unclear what is completely or incompletely removed. Is it…bacteria? soft dentin? discolored dentin?  degraded collagen? 

• Caries removal strategies should be termed according to what is done, i.e., descriptively, instead of what one aims to remove or retain. So following terms have been agreed on to describe the dentin which is left or removed.

Basically there are 3 types of dentin :

1. Soft dentin

2. Firm dentin

3. Hard dentin

• Soft Dentin/ Infected Dentin :

- Soft dentin is also called as outer carious dentin/infected dentin.

- It is characterized by the presence of bacteria, low mineral content and irreversibly denatured collagen.

- It is necrotic, contaminated and dose not self repair.

- Clinically it lacks structure and can be easily excavated with hand instruments.

• Firm Dentin / Affected Dentine : 

- Firm dentin is also called as inner carious dentin/affected dentin.

- It is characterized by demineralization of intertubular dentin and initiation of intratubular fine crystals at the advancing front of carious lesion. 

- Because of the caries demineralization process, firm dentin is softer than hard Dentin.

- Although organic acids attack the mineral and organic contents of dentin the collagen cross-linkings remains intact in this zone and conserve as a template for remineralization of intertubular dentin.

- Therefore, provided that the pulp remains vital, firm / affected dentin is remineralizable.

- The trasition between soft and firm dentin can have a leathery texture, particularly in slowly advancing lesions and has been called  ‘Leathery Dentin'.

- Clinically firm dentin does not deform when an instrument is placed into it, but it can be scrapped off with medium pressure.

• Hard Dentin : 

- It represents the deepest zone of caries lesion assuming the lesion has not yet reached the pulp.

- It may include tertiary dentin, sclerotic dentin and sound dentin.

- Clinically hard Dentin requires a strong force to engage the dentin and it cannot be removed without a sharp cutting edge or bur. A scratchy sound can be heard when dragging an explorer across hard dentin.


What is the rationale of this technique? 

- The rationale behind this technique is that the microorganisms, in the carious tissue left behind during selective removal, are deprived of micronutrients from the oral cavity when the carious lesion is hermetically sealed.

- The microorganisms then become less potent thereby slowing down or arresting the carious process.

- This leaves the pulp-dentinal complex with conditions that are favorable for depositing reactionary dentin over the pulp.

 Some Important Consideration : 

• In recent years, Polymer burs are used for Selective removal of caries and it is described as “dentin safe,” it means that it removes only carious dentine; the bur will be self-limiting when it reaches sound, healthy dentin.

• A sealed tooth-restoration interface is critical for the success of the restorative procedure. When a proper seal is NOT obtained, or when/if the seal is compromised, marginal leakage and ingress of bacteria/luids/nutrients will allow lesion progression.

• Removal of the bacterial infection has been seen as an essential part of all operative procedures; however, even removal of dentin up to hard dentin in deep, advanced caries lesions does not ensure a “sterile” dentin as bacteria have been found to be present in all dentinal layers in deep caries lesions.  

• So, Evidence indicates that when a good seal is present the lesion will arrest, therefore it is not necessary to remove all of the dentin that has been compromised by the caries process.

• Caries  detection solutions such as 1% acid red  in propylene glycol have been developed to help stain the infected layer, these dyes bind and stain the demineralized dentin matrix and do not stain bacteria exclusively. 

• Complete removal of all stained tooth structure in the preparation therefore ultimately leads to significantly larger preparations than the traditional visual-tactile method of evaluating for caries removal, so their use is no longer recommended.

• Patient should be clearly informed that in the treatment of advanced (deep) dentin caries some leathery and soft dentin may remain under the restoration. 

• Remaining caries affected dentin has many implications, including higher risk for endodontic complications not because “caries was left under the restoration” but because deep caries was present to begin with.

• If the patient is not willing to accept the risks, then the alternative, either complete caries removal with a higher risk of complications like endodontic therapy, postoperative sensitivity or tooth extraction, should be presented.

• Teeth that are restorable only by use of full cuspal coverage restoration generally are not appropriate for the SCR technique because of the difficulty of evaluating the tooth for possible failures such as continuing caries activity under the full coverage restoration.

I hope this blog makes your concepts clear !
Thank you.. stay home and keep reading blogs😉

मी तंबाखू बोलतेय!

Patient Education post - 4

नमस्कार मंडळी 😊

यावेळी मी काहीतरी नवीन करायचा प्रयत्न केला आहे.

हो. हा blog मी मराठीत मांडण्याचा प्रयत्न केला आहे आणि विषयही तेवढाच महत्त्वाचा,डोळे उघडणारा आहे. 

आजकाल खुप लोक तंबाखू च सेवन करतात.काही काळानंतर त्यांना त्याची सवयही होते.या सवयीमुळे तोंडात किंवा संपूर्ण शरीरात बरेच बदल घडून येतात.याच नक्की कारण काय आणि यातून मार्ग कसा काढायचा याबद्दल स्वतः तंबाखू काय म्हणू इच्छिते हे पाहूया.

मी तंबाखू बोलतेय!

डॉक्टरांनी वर सांगितलेल्या माहितीनुसार व शिर्षकावरून तुम्हाला अंदाज आला असेलच की आज आपण ‘माझ्याविषयी’ बोलणार आहोत.चला तर मग मी माझी ओळख करून देते.

सर्वात आधी,फ्रान्स मधल्या JEAN NICOTE या व्यक्तिने सन १५६० मध्ये माझी ओळख जगाला करून दिली.सुरुवातीला माझा उपयोग बऱ्याच चांगल्या कामासाठी होत होता.जसे‌ की,जखमांवर उपचारासाठी किंवा वेदना कमी होण्याकरिता वापरले जायचे. 

काही वर्षांनंतर,वैज्ञानिकांनी केलेल्या अभ्यासानुसार असे समजले की माझ्या वापरामुळे अनेक घातक दुष्परिणाम होत आहेत.

मी एवढी वाईट कशी ? 

• माझे अस्तित्व माझ्यात असलेल्या द्रव्यरूपी हृदयामुळे,म्हणजेच निकोटिन मुळे आहे.निकोटिन किटकनाशक हि आहे.माझ्या रोपट्यातील किमान ६४% निकोटिन हे पानांमध्ये साठवले जाते.
• माझ्या सेवनानंतर,निकोटिन वेगाने रक्तप्रवाहात मिसळू शकते.निकोटिन त्वचेतून तर शरिरात चटकन शिरतेच पण,धूम्रपानातील धुरांमार्फत ते श्र्वसनमार्गात सोडले की लगेच रक्तात मिसळते.निकोटिन रक्तात मिसळल्यापासुन १०-२० सेकंदात संपूर्ण शरीरात पसरते आणि मेंदूपर्यंत ‌पोहचून नशा चढल्याचा अनुभव देते.त्यामुळे आपल्या मनात मानसिक व शारीरिक स्वास्थ्याची तात्पुरती व फसवी भावना निर्माण होते.
• निकोटिनचा हा परिणाम काही काळाने शुध्द रक्त पुरवठ्याने कमी ‌होतो.हिच भावना परत मिळविण्याच्या हेतूने माझं पुन्हा सेवन केले जाते.यामुळे काही काळात माझे व्यसन लागते. 

मी तुमच्यासाठी कशी घातक आहे ? 

माझ्यामुळे तुमच्या शरीरात मुख्यतः तोंडात बरेच बदल घडून येतात.जसे की,

1.दातांचा रंग बदलणे.

2.दातांची झीज होणे.

3.दातांना किड लागणे.

4.हिरड्यांचे आजार होणे.

5.दाताच्या सभोवतालच्या हाडाची झीज होऊन दात हालू लागणे.

6.तोंडाला वास येणे.

7.तोंडामध्ये काळे/पांढरे चट्टे पडणे.

8.तिखट व गरम अन्नपदार्थ खाल्यावर आगआग होणे.

9.तोंड कमी उघडणे.

10.जबड्याचा,जीभेचा व तोंडातल्या इतर भागांचा कॅन्सर  होणे. 

माझ्यामुळे होणाऱ्या कर्करोगाच्या 'शक्यता' दाखवणारी लक्षणे: 

1.तोंडामध्ये कुठेही (जीभ,गाल,ओठ,टाळू,घसा)पांढरे चट्टे दिसणे.

2.तोंडामध्ये फोड येणे.

3.हिरड्यामधुन रक्त किंवा पू येणे.

4.दात अचानक हालू लागणे.

5.कुठलीही जखम भरण्यास वेळ लागणे.

6.तोंडामध्ये बऱ्याच दिवसांपासून असलेली सूज किंवा गाठ.

7.कुठल्याही भागात अचानक आलेले बधिरपणा.

मला निरोप कसा द्याल ?

मला निरोप देणं तस थोड अवघडच आहे म्हणा, पण तरी अशक्य नाही. माझ्या वापरामुळे फक्त तुम्हालाच नव्हे तर तुमच्या सभोवताली असणाऱ्या कुटुंबियांना व मित्रपरिवाराला घातक दुष्परिणमांना तोंड द्यावे लागते. माझ्या दीर्घकाळ वापरामुळे सरासरी १५ वर्ष आयुष्य कमी होते आणि दिवसा अंदाजे २५०० लोक मृत्यूला तोंड देतात.

• मला निरोप देण्यासाठी रोजच्या जीवनात काही बदल करा जसे की, 

1.सुरुवातीला,तुमच्या नावडत्या सिगारेट चे ब्रँड विकत घ्या.

2.सिगारेट किंवा मला खाण्याची नेहमीची वेळ बदला.

3.सिगारेटच्या पाकिटावर रबर गुंडाळून ठेवा..जेणे करून काढताना विचार कराल.

4.नेहमीच्या हातात सिगारेट न पकडता दुसऱ्या हातात पकडा.

5.दारू किंवा वेगळी ड्रिंक्स घेणे टाळा.या गोष्टी सिगारेट व माझे सेवन करण्यासाठी    आवड निर्माण करतात.

6.रोज सकाळी उठून व्यायाम,मेडिटेशन करणे. 

7.रोजच्या रुटीनमध्ये काही सकारात्मक बदल करा जसे की चांगली पुस्तक          वाचणे..  कॉमेडी फिल्म्स पाहणे..जवळच्या व्यक्तींना फोन करून बोलणे…त्यांना    भेटणे.

8.झोपताना लवकर झोपा आणि झोपायची एकंदरित वेळ वाढवा.

9.चहा किंवा कॉफी चा प्रमाण कमी करा ज्याच सेवन सतत तुम्हाला सिगारेट        किंवा  तंबाखू ची आठवण करून देईल.

10.भरपूर प्रमाणात थंड पाणी प्या..लस्सी किंवा ज्यूसेस प्या.

11.दिवसातून कमीतकमी एकदा मेडीटेशन (दीर्घ श्वास घेत एका ठिकाणी लक्ष       केंद्रित  करणे) करत जा...ज्याने तुम्ही रिलॅक्स व्हाल आणि टेन्शन कमी    होईल.

12.जेवणाची वेळ चुकवू नका.जेवणात योग्य प्रमाणात फळे व पालेभाज्या खा.

• माझे सेवन बंद करण्यास मदत करणारी काही औषधी (medicinal) पद्धती: 

तुम्ही स्वतः करत असलेल्या प्रयत्नांना जोड म्हणून या काही मेडिसिनल पद्धती नक्कीच यशस्वीरित्या तुमचा माझ्यासाठी असलेला व्यसन बंद करण्यास मदत करतील.

1.निकोटिन रीप्लेसमेंट थेरेपी( NRT): 

NRT मुळे माझ सेवन बंद केल्यावर दिसणारी लक्षणे कमी होतात व माझ व्यसन पूर्णपणे बंद करण्यास मदत होते.NRT मध्ये वापरल्या जाणाऱ्या पदार्थांचे जास्त दुष्परिणाम होत नाहीत आणि त्यांचे व्यसन ही लागत नाही.NRT मध्ये खालील काही गोष्टींचा समावेश होतो.

    
    • चघलायच्या गोळ्या ( Chewing gums ):

या गोळ्या दिवसातून कमीतकमी १०-१५ वेळा खाऊ शकतो.निकोटिन च्या गोळ्या वापरण्यासाठी एक विशिष्ठ पद्धत आहे.निकोटिनच्या गोळ्या तोंडात आगआग होईपर्यंत किंवा हिरड्याना टोचल्यासारखी भावना येईपर्यंत चघळा.त्यानंतर ती गोळी हिरड्या व गालाच्या मध्ये ठेवा, जोपर्यंत टोचाण्याची भावना कमी होत नाही.त्यानंतर पुन्हा ३० मिनिटे तीच गोळी चघळा आणि हीच कृती पुन्हा करा.या गोळ्या चघळण्याआधी १५ मिनिटे व चघलेपर्यंत काही खाऊ पिऊ नका.

    
    • पॅचेस ( Nicotine Patches ): 

निकोटिनच्या पॅचेस त्वचेवर लावल्यानंतर,निकोटिनटीचा स्त्राव शारितात सतत होत असते.निकोटिन शरीरातून चटकन शोषले जाते व पूर्ण शरीरभर पसरते.या पॅचेस वेगवेगळ्या आकारात उपलब्ध असतात.या पॅचेसचा वापर न चुकता रोज होणे आवश्यक आहे आणि रोज सकाळी त्या पॅचेस बदलावे.अशा प्रकारे कमीतकमी ८-१२ आठवडे वापरावे.

2. औषधे ( Pills ):
        काही निकोटिन-विरहित गोळ्या मला सोडण्यासाठी व सोडल्यावर दिसणारी लक्षणे कमी करण्यासाठी मदत करतात.यासाठी डॉक्टरांना भेटा व लवकरच उपचार सुरू करा.

3. तज्ञ डॉक्टरांचा सल्ला: 

       डॉक्टरांचा योग्य सल्ला व समुपदेशन (counselling) तुमच्या वागण्यात नक्कीच बदल घडवून आणेल.खालील काही गोष्टींबाबत जास्त माहिती देऊन तुम्हाला योग्य मदत करतील.

       १.मला बंद केल्यावर दिसणाऱ्या लक्षणांबाबत माहिती देणे किंवा त्यांना             कशा पद्धतीने तोंड द्यावे याबद्दल मार्गदर्शन करणे.

       २.तुमच्याशी व्यक्तिगत स्तरावर संवाद साधून तुमच्या समस्या समजून 
         घेणे आणि त्याबद्दल मार्गदर्शन करून काही उपाय सांगणे.

       ३.कुठल्या गोष्टींमुळे/प्रतिक्रियेमुळे पुन्हा माझे किंवा सिगारेट चे व्यसन             लागू शकते याबद्दल माहिती देऊन समजावणे.

       ४.Stress management म्हणजेच कुठलीही काळजी असेल किंवा             टेन्शन असतील तर त्यांना कसं हॅण्डल करावं आणि ते कसं कमी             करून व्यसनमुक्त राहू शकतो हे पटवून देणे.

जाता जाता एकच म्हणेन..

“आयुष्य संपवण्यापेक्षा…तंबाखूचे व्यसन संपवणे कधीही चांगलं”..!! 

धन्यवाद.

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 😃😃