Dental Trauma In Children

The Teeth-ing Troubles

Dental Trauma:     

Prognosis is good in cases of dental trauma with immediate treatment.
KEY TO SUCCESS: SEEING THE PATIENT AS SOON AS POSSIBLE
Points to remember-
1.Avulsed permanent teeth should be replanted immediately.
2.Avulsed primary/milk tooth should never be replanted as there are possibilities of ankylosis.
3.Crown or root fractures have different modalities of treatment depending on the position of the fracture.

Principles of Treatment:

1.Emergency Treatment-
Elimination of pain;
Protection of pulp;
Reduction and immobilization of teeth;
Suturing of soft tissue laceration
Antibiotics,Tetanus,Analgesics,Chlorhexidine mouthwash

2.Intermediate treatment
Pulp therapy
Orthodontic treatment considerations
Semipermanent restorations
Review-1month/3months/6months /2years

3.Permanent treatment
Usually deferred until 16years

PREVENTION OF TRAUMA ESPECIALLY DURING SPORTS:

For Further Information
Contact: smileoracles@gmail.com
Dr.Sreenita Chowdhury, New Delhi, India

The Child and Oral Health Problems

The Teeth-ing Troubles

The Child and Oral Health Problems

The anxious child:


Techniques for behaviour management come with experience of treating children over a period of time.


There are various behaviour modification techniques that we follow at Smileoracles’ Multispeciality Dental Centre to make the child friendly to the Dental office and the staff. Its quite natural with the fear of the unknown and being unable to understand the sequence of events during the procedure, the child remains apprehensive.


The techniques we follow to comfort the child:

1.Sedation:Oral and intravenous drugs like midazolam and chloralhydrate can be used.
2.Hypnosis
3.General Anaesthesia
4.Lasers in Dentistry


The Child with toothache:
It is quite natural for a child with toothache to be irritable, uncooperative and not be able to eat comfortably. For children less than 4/5years of age inability to express the discomfort in the oral cavity often aggravates the problem and further makes treatment extensive and complicated.

It is advisable to get periodic dental check up very soon the first tooth erupts.

At Smileoracles’ Multispeciality Dental Centre we take special care to make your child painfree with our specialized team of doctors.

Assisted guidance in other problems associated with Oral cavity:
1.Abnormalities in tooth exfoliation and eruption.
2.Abnormalities of tooth number.
3.Abnormalities of tooth structure
4.Abnormalities of tooth form.
5.Abnormalities of tooth colour.

Extraction Versus restoration of primary teeth:


Despite a welcome reduction in the prevalence of dental decay,the dilemma of whether to restore or extract a primary tooth is still familiar. In making a decision at Smileoracles’ number of factors are considered.
1.Age
2.Medical History: Pulp therapy in medically compromised like heart disease is inappropriate. These are possible sources of recurrent bacteremia. In haemophiliacs, extraction should be avoided IF POSSIBLE.
3.Motivation and cooperation of parents: The parents must understand the benefits of maintaining the child’s primary dentition.Unfortunately, a small proportion of the population still regard a dentist that fills primary teeth with suspicion- after all ,everyone knows that the baby teeth will not stay forever!!
4.Caries rate
5.Pain
6.Extent of the lesion
7.Position of the tooth
8.Presence/absence of permanent successor.
9.Malocclusion

Severe Early Childhood Caries

Cause: Frequent intake of sugary and sticky food stuff.

Nursing Caries/Bottle caries: Frequent consumption of sugar-containing drink especially from a feeding bottle. It is also attributed to prolonged on demand breast feeding, especially at night, from the lactose in breast milk.

Rampant Caries: Rapidly progressing caries affecting many teeth in the primary and permanent dentition.

Deep Dental decay involving the pulp/nerve tissue:
Vital and Non-vital Pulp Therapy-


1.Pulpotomy- For infected tissue limited in the coronal portion
2.Pulpectomy-For infected tissue down below the root canals with possibilities of abscess.


Lasers in Paediatric Dentistry:
Biolase- The most promising pain-free dental management with Hard tissue lasers for children.

For further information:
Email: smileoracles@gmail.com
Dr.Sreenita Chowdhury

Importance of Milk tooth and Concerns in Paediatric Dentistry

The Teeth-ing Troubles

Pediatric Dentistry:

Diagnosis:
Dental caries a rapidly progressing condition in children. The accurate diagnosis of the disease is of prime importance prior to development of treatment plan.
Radiographic diagnosis and a proper history( especially diet and food habits) is essential before treatment is commenced.

Treatment Plan for children:

Why is it important to treat a child’s dentition before he/she reaches adulthood?

A good dental status in the young age often assures a healthy dental condition even during adulthood. The positive attitude towards dental health more often establishes a healthy diet and prevention of oral health problems.


The treatment plan in children will take account of the following considerations:
1.Behaviour Management
2.Prevention of dental decay
3.Restorative treatment
4.Developing Occlusion
Restorative treatment without prevention is of limited value. Hence,we emphasise on a modified diet. Most often a combination of prevention,restoration and extraction is indicated for most children with caries/dental decay in primary/milk teeth.

Other considerations:

Pain or evidence of abscess/infection.
1.Temporization of open cavities
2.Use of medicated fillings
3.reduction of bacterial count(Streptococcus mutans)
4.preliminary coronal seal enhances the chances of pulpal recovery.

Delivery of care:                               

1.Counselling of the parents
2.LA/Sedation/GA- Risks vs Benefits of each
3.Planning of operative care at a pace appropriate to the child’s ability to cope.
4.Consideration of medically compromised children(like heart diseases, small stature,systemic diseases)

For further information
Contact: Dr.Sreenita Chowdhury
Dentist, New Delhi, India
smileoracles@gmail.com

Zimmer One Piece Implant

The Teeth-ing Troubles

Patient's Cosmetic Concerns In Dentistry

The Teeth-ing Troubles-Cosmetic needs and patient satisfaction

Ref: American Dental Association Newsletter

http://www.quintpub.com/journals/ejed/abstract.php?article_id=14383#.U4zpqPZOWcw

Achieving patient satisfaction, step-by-step

 It’s not uncommon for cases that start out with low esthetics to be accompanied by high patient expectations. Researchers publishing in the summer 2014 issue of The International Journal of Esthetic Dentistry described how to manage such circumstances using the case of a 27-year-old woman with amelogenesis imperfecta.
Caused by protein mutations involved in enamel formation, the genetic developmental disorder causes light and dark discolorations and atypical crown shapes. The subject’s chief complaint was dark and white opaque staining. However, she was also bothered by teeth that overlapped and an asymmetrical gingival margin. Researchers hoped to sacrifice as little healthy enamel as possible, while still meeting high expectations for an improved appearance.
The initial clinical examination did not reveal the true depth of the staining, so in agreement with the patient, a step-by-step treatment plan was adopted.
The first treatment step consisted of a home bleaching process. The patient noticed a positive change and was motivated to seek further improvement.
Step two was a microabrasion technique. Only the most superficial enamel layer was etched and removed with an abrasive paste and a rubber cup. Again, in the follow-up visit, the patient noticed improvement and wanted to continue treatment. This time the goal was to correct the position and shape of her front teeth.
All conditions were ideal for step three, a plan to restore the maxillary incisors and canines with ceramic veneers. At the outset, corrections were performed digitally, and foreseen changes were transferred into a wax-up. The dentist used the resulting mock-up to serve as a communication tool and discuss the prospective outcome with the patient.
Both were satisfied with the result during a try-in session, when veneers were inserted with glycerin gel in order to improve color assessment. All involved with the treatment plan were “very satisfied with the final treatment outcome,” authors reported.
“The patient was heavily involved in the process of decision-making and, therefore, her esthetic expectations could be integrated into the final treatment,” authors commented about the success. “For the predictability of the treatment, a meticulous prediagnostics and a stepwise treatment protocol is crucial; otherwise the outcome may be compromised.”

American Dental Association Family Nutrition: Message to the children and parents

The Teeth-ing Troubles

Antiplatelet drugs, anticoagulants and elective dental surgery

What Are the Risks of Having a Stent?

Why do you need to be cautious before a dental extraction??




There is an increased risk of bleeding when patients taking anticoagulant or antiplatelet drugs require surgery.This risk must be balanced against the risk of harm if treatment is stopped. For many minor procedures aspirin or warfarin can be continued. Patients having non-cardiac surgery may be able to continue aspirin, but clopidogrel should be stopped unless there is a high risk of thrombosis. Patients taking warfarin may require bridging anticoagulation around the time of major surgery.This involves replacing the warfarin with unfractionated or low molecular weight heparin. Consultation with a cardiologist is particularly recommended if a patient with a coronary stent requires surgery.

Figure A shows the coronary arteries located on the surface of the heart.

Figure B shows a stent-widened artery with normal blood flow. The inset image shows a cross-section of the stent-widened artery.

In figure C, tissue grows through and around the stent over time. This causes a partial blockage of the artery and abnormal blood flow. The inset image shows a cross-section of the tissue growth around the stent.



Risks Related to Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI), the procedure used to place stents, is a common medical procedure that is sometimes referred to as coronary angioplasty. PCI carries a small risk of serious complications, such as:

Bleeding from the site where the catheter was inserted into the skin
Damage to the blood vessel from the catheter
Arrhythmias (irregular heartbeats)
Damage to the kidneys caused by the dye used during the procedure
An allergic reaction to the dye used during the procedure
Infection

Another problem that can occur after PCI is too much tissue growth within the treated portion of the artery. This can cause the artery to become narrow or blocked again. When this happens, it's called restenosis (RE-sten-no-sis).

Using drug-eluting stents can help prevent this problem. These stents are coated with medicine to stop excess tissue growth.

Treating the tissue around the stent with radiation also can delay tissue growth. For this procedure, the doctor threads a wire through a catheter to the stent. The wire releases radiation and stops cells around the stent from growing and blocking the artery.


During any dental procedure which might involve bleeding, a consultaton with the cardiologist is mandatory and bridging treatment with Low molecular weight Heparin and close monitoring is mandatory.

For more information
Kindly contact
Dr.Sreenita Chowdhury
sreenita28@gmail.com