Trauma To The Tooth

Fractured, Loosened or Knocked-Out Tooth? 

Fractured tooth:

The Upper front teeth are prone to injury and fracture.If after injury, a tooth is not sensitive to air, most likely the superficial surface of the tooth has been harmed.

The hard protective layer of your tooth is called Enamel. This layer on injury does not cause pain.

Even if the enamel has sustained a small chip,immediate treatment is not required.

Fractures of the intermediate layer of your tooth(dentin) are usually painful or very sensitive when exposed to air or food. PEOPLE WITH SUCH FRACTURES SEEK DENTAL HELP QUICKLY.

The innermost part of the tooth is called the pulp. This is the life of your tooth. It has nerve and blood supply to the tooth. If injured it is very painful and you may be able to see a red spot or some blood will appear in the fracture.

In such cases, root canal treatment may be required to remove the remaining pulp before it dies and causes more pain/infection.

Loosened Tooth:

If an injury loosens a tooth in the socket or if the surrounding gum tissue bleeds a great deal, a person should see a Dentist immediately.

Milk tooth/Deciduous Teeth: If its a milk tooth, damaged and mobile, it may be removed to prevent harm to the permanent tooth.

Permanent tooth if loosened due to injury, the professional may do a procedure called splinting in the clinic. However, it is advised to hold the tooth in place for five mins with digital pressure until you reach the dentist.

Such teeth may require a root canal treatment eventually.

They may also change colour over the period of years and get brownish to black in appearance.

Discolouration Of The Tooth Subjected To Trauma

Knocked out or dislodged teeth:

Knocked out baby teeth should not be re-implanted for fear it will damage the permanent tooth bud.

A knocked out permanent tooth requires immediate treatment.

The tooth should be rinsed off and placed back in the socket in the right direction. If that is not possible,the tooth should be placed  in a glass of cold milk In either case, the tooth and the patient should be taken immediately to the dentist within 20 mins to 30 mins.

If a tooth is re-implanted within 30 minutes, the likelihood that it will stay healthy is good.

The longer the tooth is out of the socket, the worse the chance for long term success.

The dentist usually splints the tooth to the surrounding teeth for 7-10 days.

Re-implanted teeth eventually need root canal treatment.

In case the bone around the teeth has got fractured, the tooth may have to be splinted for 6 to 10 weeks.

In case of intrusion into the socket, its most likely going to come back to its position. However, consultation with a Dentist and x rays are mandatory.

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Dr.Sreenita Chowdhury
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The Tongue Speaks

THE TONGUE DISORDERS:  

Is your tongue disturbing your peace of mind? Does your tongue speak?

Well, tongue disorders could be many and discomfort in any form-taste/trauma or pain could be annoying.

Injury: Traumatic injury is the most common cause of tongue discomfort. The tongue has many nerve endings for pain and touch and is more sensitive to pain than most other parts of the body. The tongue is frequently bitten accidentally but heals quickly.

A sharp broken tooth or filling could do considerable damage to this delicate tissue.

Your dentist could relieve you from the offending cause.

Hairiness: 1.An overgrowth of the normal projections on the top of the tongue(villi) can give it a hairy appearance.

Trichoglossus is a Parrot family having brush tipped tongue.

2.The tongue may also appear hairy after fever, after antibiotic treatment or when hydrogen peroxide mouthwash is used too often.

Hairy appearance on top of the tongue should not be confused with Hairy Leukoplakia found on the sides of the tongue, which is a characteristic of AIDS.

Improper scraping in cases of Hairy Tongue could cause Halitosis(bad breath)

Discoloration: The discoloration on the superficial aspect of the tongue could be due to varied reasons like-smoking,chewing tobacco,eating certain food products, or presence of colored bacteria growing on the tongue.

Medicines causing discoloration- like Bismuth preparations for an upset stomach.

These can be removed with a tongue scraper.

Redness of the tongue:Pernicious anaemia or vitamin deficiency.

Pale tongue:Iron deficiency anaemia.

Scarlet fever:Strawberry to Raspberry colour.

Kawasaki syndrome:Strawberry red tongue.

Vitamin deficiency(Niacin:Vit.B3, Pellagra):Smooth,Red and Painful tongue.

Inflamed Tongue(Glossitis):Red,Painful and Swollen tongue.

Burning Mouth Syndrome:Painful and burning tongue.

Whitish Patches on the tongue If accompanied with fever,dehydration:It could be the second stage of Syphilis, Oral thrush(fungal infection), Lichen Planus, Leukoplakia Or mouth breathing.

In geographic tongue, some areas of the tongue are white and rough whereas others are red and smooth. In this case , no treatment is required. The area of discoloration may move around period of weeks to years.

Alarming Signs In The Tongue-  

Dental Examination Includes Screening For Oral Cancer

Sores and Bumps: Sores on the tongue could be due to Oral Herpes Simplex Virus infection, Canker Sores ,Tuberculosis, Bacterial infections or Early stage syphilis, Allergies,Immune disorders.

Small bumps on both sides may be harmless. A bump on one side may be cancerous.

Signs of cancer: Unexplained red or white areas, sores or lumps(particularly hard) on the tongue- esp if painless.This could result due to tobacco habits, pipe smoking, cigars and nicotine products.

Sometimes associated with Syphilis.

Sites for oral cancer:Sides of the tongue or on the floor of the mouth.

Rarely on top of the tongue. Could be in case of Syphilis.

Discomfort: Irritation could be due to acidic food or toothpastes, some drugs, injury and infection.

Oral thrush or candidiasis can cause intense pain.

Discomfort is best treated by the process of elimination.May be change in diet, changing toothpastes brands,removing sharp edges of teeth or disturbing metal crowns or amalgam(silver) fillings.

Candidiasis is often treated with an anti-fungal drug such as Nystatin, in the form of mouth rinse and lozenges.

In most of these conditions there may be disturbances in taste and the main cause needs to be addressed to for relief.

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Snoring /Laborious Breathing- Can Your Dentist Help You?

Sleep Apnoea Syndrome

Sleep apnoea syndrome is a group of serious sleep disorders in which breathing repeatedly stops long enough during sleep to decrease the amount of oxygen and increase the amount of carbon dioxide in the blood and brain.

Sleep Apnoea occurs when breathing is temporarily interrupted during sleep.

There are three types:
1.Obstructive Sleep Apnoea
2.Central Sleep Apnoea
3.Mixed Sleep Apnoea

Obstructive Sleep Apnoea:

1.The most common type.
2.Caused by blockage in the throat or upper airway.
3.Affects mostly the middle aged men and women.
4.Most commonly seen in obese people who sleep on their back.
5.Smoking and excess use of alcohol worsens sleep apnoea.
6.Lung disorders contribute to lack of oxygen.
7.In children, enlarged tonsils or adenoids can cause obstructive sleep apnoea.

Central Sleep Apnoea:

1.Rarely seen.
2.Mainly caused due to dysfunction in the part of the brain that controls breathing (brainstem).
  
The role of the brainstem in breathing:
The brainstem is very sensitive to the changes in the blood level of carbon dioxide ( a by product formed in the metabolism of oxygen).

When the level of carbon dioxide in the blood rises due to inefficient breathing, the brainstem signals the respiratory muscles to breathe harder and faster to remove carbon dioxide while breathing out(exhalation).

What happens in Central Sleep Apnoea-
a.The brain stem is less sensitive even with high carbon dioxide level in the blood.
b.There is prolonged hyper ventilation to counteract the affect of carbon dioxide.
c.Sometimes due to a poor response of the brainstem... breathing paused might get prolonged.
d.Brain tumour is a reason for the poor functioning of the brain stem too.
e.Ondine's curse is a form, wherein people may not be able to breathe at all except when they are fully awake.

Mixed Sleep Apnoea:

A combination of the above two.

Symptoms:
1.Abnormally slow and shallow breathing.
2.Pause in breathing abruptly for more than ten seconds.
3.Snoring
4.Episodes of gasping, choking, pauses in breathing and sudden awakening.
5.Memory often impaired.
6.Sex drive may be reduced.
7.Involuntary naps during the day.
8.Risk of stroke,heart attack and blood pressure is increased.
9.Obese people have interruption in the easy movement of the chest wall.
10.Drowsiness, fatigue,irritability,headaches,slowness of thought and difficulty in concentration.

Prolonged sleep apnoea may lead to heart failure and malfunction of the lungs.

Treatment For Obstructive Sleep Apnoea:
1.Losing weight
2.Quit smoking
3.Avoid excess use of alcohol.
4.Heavy snorers must avoid sleeping aids and anti-histamines.
5.Nasal infections and allergies should be treated.
6.Anti snoring pillows available prevent snoring/ elevating the head of the bed.
7.A surgical procedure called uvulopalatoplasty removes a small piece of tissue hanging at the back of the mouth .

How Can Your Dentist Help???

Removable oral appliances, fitted by dentists can help relieve Obstructive sleep apnoea and snoring in many.
These appliances help keep the airway open.

Most appliances separate the jaws and push the lower jaw forward so the tongue cannot move backward to block the throat.
Others hold the tongue forward.

Other Measures:

1.Continuous Positive Airway Pressure(CPAP with/without humidifier)

2.Enlarging the airway through the throat called (uvulopalatopharyngoplasty)

Treatment For Central Sleep Apnoea:
1.CPAP
2.Oxygen through nasal prongs.
3.Acetazolamide and theophylline are used occasionally.

Have a peaceful sleep.
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Dr.Sreenita  Chowdhury
sreenita28@gmail.com

Get Wiser With Your Wisdom Tooth- Know Why Does It Bother You?

Easy insight to the details in Wisdom Tooth Removal:

Impacted teeth are teeth that become stuck beneath the gum and underlying bone and are thus unable to emerge or erupt properly.

What is Impaction? Why does it happen?
Impaction is usually caused by the over-crowding of teeth, thus leaving insufficient room for a new tooth to emerge.
Impaction can occur when a baby tooth is lost before the new tooth is ready to emerge, which allows the remaining teeth to drift into the space reserved for the new tooth.

However, most teeth that become impacted are wisdom teeth because they are the last permanent teeth to come in and the jaw lacks enough space to accommodate them.

Impacted teeth are likely to become infected, thus they are usually removed.
Often, the removal can be done in the Dentist's office with the person remaining awake, with use of local anesthetic or with sedation to calm the patient.

Sometimes the surgery is performed in a hospital with the person asleep, with the use of general anesthetic.
These procedures are all painless in the Dental office as you are under anesthesia.
However, to avoid post-operative pain one must follow all instructions religiously as the doctor advises.

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Dr.Sreenita Chowdhury

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Septicaemia From Oral Infections

Cellulitis From A Tooth-ache?

Hi friends!
Today's write up is related to sepsis caused due to tooth infection.

The concept of sepsis:

The body attacks an infection with large numbers of white blood cells;
Pus is accumulation of these white blood cells,dead tissue and bacteria.

Usually pus from a tooth-infection drains into the gums first.
The gums swell near the root of the tooth.

Depending on the location of the tooth, the pus may drain into the soft tissues(cellulitis), causing swelling in the jaw or drain to the floor of the mouth, in the area of the cheeks or even to the skin.

In the lower back teeth especially the wisdom tooth area, the infection may spread to the tonsillar area. During the severe stages, it is often referred to as secondary infection.

However, there is something known as the dangerous area of the face.

Any dental infection in the area of your front teeth are potentially dangerous.

Due to special nature of the blood supply to the human nose and surrounding area, it is possible(although very rare) for retrograde infections from the nasal area to spread to the brain.

Rule out dental infections before it spreads via your tooth roots into your circulation resulting in a huge swelling and causing septic risk encroaching into the vital areas.

A dentist treats an abscess or cellulitis by eliminating the infection and draining the pus, which requires oral surgery or root canal treatment.
Often antibiotics are prescribed, but removing the diseased pulp and draining the pus are important.
These infections may spread to various areas of the face and through tissue spaces spread rapidly.

Note: 
1.During pregnancy the risks are to the foetus.
2. In patients with valve defects and septal defects or prosthetic replacements in the heart, the bacteria can cause infective endocarditis.
3.Diabetics are poor in immune response, hence problematic.
4.Immune deficiency like AIDS- Such infections may be fatal.


Causes of Cellulitis from Oral Infection:

1.Decay in the teeth
2.Deep gum infections
3.Decayed Root Stumps
4.Generalised Bone loss with deep pockets.
5.Perapical infections( infections below the roots of the teeth)

The infections that tend to spread are mainly those which do not have a path of drainage.
 Kindly visit your dentist to assist you fight the infection.


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Dr.Sreenita Chowdhury

sreenita28@gmail.com
www.tutdental.com

Say No To Bad Breath

Halitosis: Understanding Bad Breath?

Halitosis(bad breath) can be real or imagined.

When real, its most often caused by a combination of food lodged between the teeth and poor oral hygiene that results in gum disease.It may also be due to decay and germs in damaged teeth.

Odors from foods that contain volatile oils, such as onions and garlic, pass from the bloodstream into the lungs and are exhaled.
Oral hygiene cannot remove these odors.

Certain diseases also produce bad breath.

Liver failure- mousy odor

Kidney failure-Urine like odor

Severe uncontrolled Diabetes-Acetone breath like(nail polish remover)

Lung abscess (a collection of pus)-severe halitosis

A tumour in the esophagus/stomach may cause foul smelling liquid or gas be regurgitated into the mouth.

Halitosis that is imagined is called psychogenic halitosis, in which a person believes that his breath smells bad when it actually does not.

This problem may occur in people who tend to exaggerate normal body sensations.

Sometimes psychogenic halitosis is caused by a serious mental disorder such as schizophrenia.

A person with obsessional thoughts may have an overwhelming sense of feeling dirty.

REMEDIES:

1.Physical causes can be corrected or removed. For example- people can stop or avoid eating garlic,onions and other spiced foods and can improve their oral hygiene.

2.Daily use of a tongue scraper to clean the top and the back of the tongue is effective.

3.Many mouthwashes are available but , their usage is best justified after a couple of  professional round of cleaning(scaling) and polishing.

4.The mouthwashes need to have chlorophyll.

5.The effects of the topical mouth rinses do not last for more than couple of hours.

6.Psychogenic halitosis can be treated with doctors reinforcing the non-existence of halitosis.

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Dr.Sreenita Chowdhury

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