Root Canal Treatment:

Overview:-
Alternative names
Description
Risks
References

What is Root Canal Treatment:

A root canal is a dental procedure to remove dead or dying nerve tissue and bacteria from inside a tooth.

REFERENCE FROM A.D.A.M.

Alternative Names:
Endodontic Therapy

Description:
A dentist will use a needle to place numbing medicine(anesthetic) around the bad tooth.You may feel a slight prick when the needle is being inserted.
Next, your dentist uses a tiny drill to remove the top part of your tooth and expose the pulp. Pulp is made up of nerves, blood vessels, and connective tissue. It is found inside the tooth and runs to the jaw bone. Pulp supplies blood to a tooth and allows you to feel sensations such as temperature.


The infected pulp is removed with special tools called files. The canals (tiny pathways inside the tooth) are cleaned. Medicines may be placed into the area to make sure all the germs are gone and prevent further infection.
The cleaned tooth area is sealed with a soft, temporary material. Once the tooth is filled, a permanent crown may be placed on top.
You may be given antibiotics to treat and prevent infection.

Risks
Abscess
Loss of tooth
Nerve Damage
Tooth Fracture

References

Pogrel MA. Damage to the inferior alveolar nerve as the result of root canal therapy. J Am Dent Assoc. 2007;138(1):65-69.

Sore Throat or Tooth Infection or A Bigger Problem?

Lymphadenitis: Is Tooth A Cause?

A brief article on how pain in your tonsillar area or in your lymph nodes could be due to infection in the mouth.

Swollen Lymph Glands – Is tooth a cause?

A lymph node or lymph gland is a pea-sized organ of the immune system. They are an important part of the immune system and are widely distributed throughout the body, interconnected by lymphatic vessels. They act as the reservoir of immune cells and are tightly packed with white blood cells like T lymphocytes, B lymphocytes and macrophages. Lymph nodes also act like filters. They trap the foreign particles or cells, effectively removing them out of circulation.

What is the significance of these lymph glands?

Lymph glands along with the white blood cells help to fight infections caused by bacteria, viruses, fungi, etc. and trap allergens and foreign particles. As a response to these infections or disease process they may become enlarged due to inflammation. Swollen lymph gland is known medically as lymphadenopathy. The lymph glands may be enlarged due to infections, glandular fever, immune system disorders or even cancer. So a swollen or a painful lymph gland may indicate some underlying pathology. If required your doctor can find out the cause of enlarged lymph node with blood tests, X-ray or a biopsy.

What are the common causes of swollen lymph glands?

This swelling is usually a result of local infection. Local infection is contained in a particular area of the body, for e.g. head and neck. Typical examples are –

·         Skin or wound infections, such as Cellulitis or Erysipelas

·         Dental Abscess or pus

·         Common cold

·         Throat infections

·         Ear infections

Swelling may also occur due to virus or bacteria entering the blood and affecting the whole body. Sometimes bacterial infection may cause blood poisoning and develop into a life threatening condition. Some of the examples of these systemic causes are –

·         Rubella

·         Measles

·         Glandular fever

·         Staph infection

Rarely lymph glands may be swollen due to cancerous growth. You can differentiate the selling due to cancer when the lymph gland;

·         Slowly gets bigger

·         Is in an unusual location

·         Is painless

·         Is firm or hard in consistency

Some of the unusual causes of swollen lymph glands may be lupus, rheumatoid arthritis, cat scratch fever, toxoplasmosis, syphilis, tuberculosis, etc.

Can an infected tooth cause swollen lymph node/gland?

Yes. The bacteria or micro-organisms affecting the wisdom tooth and harbouring in the mouth is primarily due to strains of Streptococcus and Staphylococcus. In case of the partially erupted wisdom tooth that hides under the gum tissue, forming a pocket in the mouth - food accumulation is often observed. These are favourable conditions for micro-organisms to grow and usually result in acute infections around these teeth and collection of pus. Considering the fact that this is an inaccessible zone and the dependent position of the tooth often harbours infection, lymphadenitis is a common problem. This when ignored, infection spreads backward into the area of your tonsils and throat causing inflammation and pain in your lymph nodes.

Infection in the lymph nodes could also be due to the other teeth. The various lymph nodes closest to the offending tooth are affected depending on their location. Infection in the mouth could also be due to tuberculosis or syphilis. The diagram below illustrates the harmful position of a partially erupted wisdom tooth.

Symptoms and Diagnosis

Infected lymph nodes enlarge and are usually tender and painful.  Sometimes the skin over the infected lymph node looks red and feels warm to touch. Occasionally pockets of pus develop.

Enlarged lymph nodes that do not cause pain, tenderness or redness may indicate a serious disorder such as Tuberculosis, Lymphoma or Hodgkin's disease.

Usually lymphadenitis can be diagnosed on the basis of symptoms and its cause is an obvious nearby infection. When the cause cannot be identified easily, a biopsy or a tissue sample under a microscope and a culture may be needed to confirm diagnosis.

The video shows the lymph nodes in the head and neck region which are often affected due to infection in the oral cavity and surrounding areas.

When you should see a doctor?

See your doctor if:

·         you also have a sore throat or find it difficult to swallow or breathe

·         you also have unexplained weight loss or a persistent fever

·         your glands feel hard or don’t move when you press them

·         your glands have been swollen for more than two weeks or are getting bigger

·         your glands are swollen for no apparent reason and you don't feel unwell

Treatment and Prognosis

1. Treatment depends on the organism causing the infection.

2. For a bacterial infection, antibiotics are usually given orally or intravenously.

3. Warm compresses may relieve the pain in inflamed lymph nodes.

4. Usually once the lymph node infection has been treated, the nodes shrink and pain subsides.

5. Sometimes the nodes remain firm but no longer feel tender.

6. Abscesses must be drained surgically.

                7. For a tooth related infection, the tooth should be removed or treated .

The video shows the lymph nodes in the head and neck region which are often affected due to infection in the oral cavity and surrounding areas.

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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
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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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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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