Smile SenseA guide to your smile!

Burning mouth syndrome is a painful condition where you feel a scalding sensation on your tongue, lips and roof of the mouth.It’s often associated with medical or dental conditions nutritional deficiencies, a dry mouth , allergies or as a side effect of medication.

Other terms used are Glossodynia, Glossopyrosis, Stomatodynia.

Symptoms:

Symptoms tend to come in late in the morning, peak at noon and ease of by night.

• Soreness
• Swelling
• Tingling or numbness of tip of tongue
• Bitter or metallic taste of mouth
• Dry mouth
• Continuous pain
• Aggravated by spicy  or acidic food

Caused by:

Local factors -

• Denture
• Mechanical factors
• Habits – Bruxism
• Allergic stomatitis – Dental restorations, food, preservatives, additives
• Bacterial, fungal or viral infection.

Systemic factors -

• Deficiencies – Iron, Vit B12, Folate, Zinc
• Endocrine  – Diabetes, Thyroid, Hormones
• Decreased salivation
• Medications
• Depression, anxiety

What to do to help?

• Avoid alcohol
• Avoid tobacco
• Sip water frequently
• Chew sugar free chewing gum
• Suck on ice cubes.

Also the systemic and local factors should be eliminated first.

Dental hygienist are well trained personnel who are an important part of the dental office.

What can a Dental Hygienist do?

• Cleaning or scaling of gums
• Whitening of the teeth
• Simple fillings under supervision of the dentist
• Fluoride applications.
• Application of dental pit and fissure sealants
• Taking diagnostic X-rays.
• Extraction of milk teeth under Local anesthesia spray / solution under supervision of the dentist.

Usually to become a dental hygienist it takes a 2 year degree or diploma. A dental hygienist is a well respected profession with good opportunities of remuneration.

To learn more about dental hygienist in United States, CLICK HERE

To learn more about dental hygienist in Australia, CLICK HERE

To learn more about dental hygienist in Canada, CLICK HERE

To learn more about dental hygienist in Europe, CLICK HERE

3D dental X-Ray is a easy, quick, cost effective and the latest development in dental imaging systems.

They along with compatible software can produce a 3 dimensional image to accurately confirm a diagnosis which was earlier not possible on 2 D X-Rays.

It takes around 200 exposures in a time span of 8 to 15 seconds. This is followed by reconstruction of the scan in around 30 seconds to 5 minutes. The radiation dose ranges from 36 – 74 µSv.

Some companies provide proprietary software for 3 D reconstruction. Others  let you choose open ended software.

Usually they are DICOM or PACS compatible for easier viewing.

3D dental X -Ray can be used in:

• General practice
• Implant and oral surgery
• Orthodontics
• Endodontics

Credit: Sirona Imaging systems, Imaging sciences international

Well it is, but in small quantities.

Chocolate is good for your teeth and your overall health too. Chocolate contains polyphenols and flavinoids which are anti oxidants that inhibit the growth of bacteria that causes decay of the teeth.

Chocolate also has cocoa butter which has a coating effect which prevents the plaque from attaching to the teeth.

Chocolate is good at one ounce per day. It tastes good, doesn’t hurt your teeth and is good for your body too.

And now the down side. Dark chocolate has lots of calories, nearly 150 per ounce. That alone is a big problem that sets all the good aside.

So chocolate is not an issue if you know how to control yourself while having it. Have fun…

Inhalation sedation, relative analgesia or RA uses Nitrous Oxide ( laughing gas) to produce sedation.

Laughing gas was discovered by Humphery Davy in 1772. It has no colour, smell or causes no irritation.

• A mix of Nitrous Oxide and Oxygen in the ratio of 30:70 is used.
• Nitrous oxide reaches the brain within 20 seconds and relaxation and pain killing properties are seen in 2 -3 minutes.
• Depth of sedation can be adjusted by the operator from moment to moment.
• The duration of action can be appropriately controlled. Nitrous oxide is eliminated from the body within 3 -5 minutes after it is stopped.
• Inhalation sedation is very safe and has virtually no harmful effect on the heart, lung, liver, kidney or brain.

How does it work?

Nitrous oxide is delivered using an apparatus. It mixes nitrous oxide and oxygen in required amounts and supplies it to the patient using canula and tubes with mask attached to it. The mask is placed on the patient’s nose. Patient inhales the gas. Modern machines have a double layer of mask with the outer layer being vacuum suctioned. This prevents any spillage of the gas.

Side effects:

Over sedation or increased nitrous oxide in the mix can lead to auditory problems, hallucination, dizziness and vertigo.It can also lead to nausea. To prevent nausea, it is advised to eat 4 hours before the procedure. Also if such unpleasant experiences surface, the patient should immediately tell the dentist or rip off the mask.

Inhalation sedation dentistry is safe and very efficient. Requirement of equipments, space and special training for the dentist and his staff makes it less popular buts its safety is a great advantage.

The most common current method used for conscious sedation in dentistry, is use of certain oral medications, like, anti – anxiety or sedative hypnotic drug.

The most common group of drugs are Benzodiazepins, antihistamines and insomnia medications.

Following are some of the popular drugs ( generic name) used and where:

• Triazolam – 0.25 to 0.5 mg one hour before appointment. Rapid onset of action and anterograde amnesia.
• Midazolam – 7.5 – 15 mg one hour before appointment. Ideal for short appointments.
• Lorazepam – 2 – 4 mg one hour before appointment. Useful for appointments longer than 2 hours.
• Temazepam – 30 mg one hour before appointment.
• Flurazepam – 30 mg one hour before appointment.
• Diazepam – 10 mg one hour before appointment. Most commonly used drug.

Dosages can be titrated and various medications can be used as the dentist wishes based on his analysis of the patient and experience.

Side effects:

• Retrograde amnesia – Little or no memory is a sometime useful side effect specially for the patient.
• Dry mouth – nearly all the medications cause dry mouth. This is though useful for the dentist as it makes things easier for him as he doesn’t have to deal with the saliva.
• Less post operative soreness – With sedation, apprehension and hypersensitivity to pain is reduced, thus reducing the likelihood and severity of post operative soreness.

Drug interaction:

A detailed medical history and use of software to check for drug interaction virtually eliminates and harmful drug interaction.

Oral sedation dentistry is thus a very effective and safe way to reduce anxiety and make a patient comfortable during the dental procedure.

Sometimes referred to as ‘ comfortable sedation’ or ‘ relaxation sedation’ . The purpose of sedation dentistry is to allow a dentist to work effectively by helping a patient become as comfortable as possible by the use of sedative medications. It provides a relaxing and anxiety – free experience for certain people receiving dental treatment. According to Dental Organization for Conscious Sedation, 30% of of population avoids dentist due to fear.

The term ‘ Sleep sedation’ is often used in this context. That is misleading, as during this procedure, the patient is required to be able to verbally communicate with the dentist.

History of Conscious Sedation :

In the past certain drugs used to be administered to Intra – veinously ( IV) to provide sedation to the patient.

Certain dentist has been using Valium to create a relaxing environment for the patient. It also has amnesic properties and has been used since 1960′s for this purpose.

Inhalation sedation or Nitrous oxide ( Laughing gas) has also been used. It is a very safe and good form of conscious sedation. Its only disadvantage being expensive and bulky equipment and training required.

Currently, the favourite form of conscious sedation dentistry is oral sedation dentistry using oral drugs.

Whom does it benefit most?

• Person with high dental anxiety and fear.
• Severe gag reflex
• Time constraints. Chronic or acute jaw soreness
• Person with back or neck problems
• Patient who has difficulty getting numb.
• Extensive treatment needs.

Sedation in any form should not be used for a procedure but for a patients.

To read more on

Oral Conscious Sedation Dentistry, CLICK HERE

Inhalation Conscious Sedation Dentistry, CLICK HERE

Have you recently changed your dentist or shifted to a new area or want to go in for a fresh opinion? You should be well aware of all the various procedures that will take place once you reach the dental office.

It is always better to fix an appointment over the phone or internet. This reduces waiting time for you.

The first appointment establishes a relationship with your doctor, provides all the necessary understanding of your specific dental requirements to the dental team and sets a tone for the future appointments.

• The dental team will ask you about your past dental experiences, current concerns and your general awareness of your dental health.
• They will also ask you about your past dental and medical history ( please bring any relating documents and prescriptions if possible).
• A thorough examination will follow starting with screening for cancer, TMJ problems, bone, teeth and gums etc.
• During this process, dentist and his dental team will speak to you about your dental treatment requirements and about how to go about it.
• If your current visit is after a considerable period of time, you will most probably require a clean up of the gum. That will be started.
• Also X-rays, photos or impression for models of your teeth might be taken for diagnosis or future referral.
• Further appointments may be required to solve all your current dental concerns and requirements. You might be required to be referred to an in house specialty consultant for your specific need too. All such details will be explained along with the financial implications.
• The first appointment should NOT be hurried through as it builds the basis for all your future appointments.

Dental treatments may require careful planning and follow up visits which ultimately lead to a better smile for you. The first visit is hence the most important cog in the wheel.

Biphosphonates ( also called Diphosphonates) is a class of drug that prevent the loss of bone mass, used to treat osteoporosis and similar diseases. Biphosphonates inhibit digestion of bone cells by osteoclasts.

Uses of Biphosphonates ( To prevent bone loss):

• Osteoporosis
• Paget’s Disease of bone ( Osteitis deformans)
• Bone metastasis
• Multiple Myeloma
• Primary hyperparathyroidism
• Osteogenesis imperfecta

Biphosphonates and Osteonecrosis:

Long term use of heavy doses of Biphosphonates is believed to cause jaw death in some patients.Osteonecrosis occurs as blood supply to the bone is decreased. Mandible is twice as frequently affected as compared to the maxilla and in most cases occurring after high dose Intravenous administration during cancer treatment. 60% of the cases have a history of recent dental procedures and hence administration  of biphosphonates should be delayed till the completion of all dental procedures ( preferably done under antibiotic coverage).

Points to remember at the time of biphosphonate therapy:

• Consult your physician about any dental treatment you need to undergo. Some physicians advocate cessation of biphosphonate treatment for a few months to get your dental treatment done. Effectiveness of such cessation is questionable as biphosphonates stay in the body for years.
• Preferably get all dental treatments done before the start of biphosphonate therapy ( preferably under antibiotic coverage).
• If Osteonecrosis sets in, long term use of antibiotics and antibacterial mouth rinses are advocated to prevent further complication.

Use of Biphosphonate may be crucial depending upon the severity of your bone loss and hence a decision of it’s continuation or otherwise should be taken only after due consultation with both your physician and dentist.

For most part we work with 32 teeth, gums and surrounding structures, and our work involves demanding inspection and evaluation. Inadequate and inappropriate lighting and glare not only increases eye fatigue but also has a negative effect on overall worker fatigue.

Ergonomists recommend proper point source lighting for close inspection work. Proper point surface lighting reduces errors when workers use appropriate enhanced lighting systems.

Dust, fog, moisture beads and water spray affect the quality and volume of light. With age, the lens of our eye becomes more cloudy and rigid and we require brighter light source and reading correction.

A variety of solutions are available to enhance the visual acuity in the clinical setting.

Lets discuss the least costly and most easily done ones first.

• Clean the dust and smudges from your overhead light with a soft cloth and non abrasive cleaner to avoid scratches.
• Periodically wipe the mouth mirror surface with mouthwash dampened gauze to prevent the beading of moisture.
• Warming the mouth mirror in warm water eliminates fogging.
• Mirrors used in intra-oral photography are kept clear when warmed on a heating pad covered by a soft towel.

Now there are other various method to enhance visual acuity:

• Replace worn out, scratched overhead light covers, face shields and moth mirrors.
• While autoclaving use mirror covers to prevent scratches and extend mirror life.
• Consider upgrading to Zirc’s Crystal mirror which is made with a special surface which reflects more light than rhodium and produces more accurate colour rendition.
• Double sided or lighted mirrors and Orascoptic DK fiber optic periodontal probe also improves visualization.
• Point source lighting is available through lighted high speed handpiece, ultrasonic handpieces, inserts or specialty devices like Isolite.
• Auxiliary headlights typically attached to magnification loupes provides hands free illumination coupled with magnified image.
• Lightweight, portable, cordless LED systems are becoming more popular especially as the quality of light improves.

Thus it is worthwhile considering to add or upgrade illumination to increase your comfort zone at your clinical setting thereby preventing needless workplace related injuries and reducing  the physical stress.