Monday 21 December 2015

EMERGENCY DENTISTRY !

                                    EMERGENCY DENTISTRY!

Have you ever suffered the most annoying or painful ache in your jaws? A stabbing horrifying pain that appeared out of nowhere, travelling through your jaws, into your head, and literally stopped you from doing whatever that you were currently doing at that moment? It throbs, hurts, and now all of your attention is suddenly on the pain. Well, the first thing you would think of is seeing a dentist! But just right then, you realized that most of the clinics were closed???

Most often an unfortunate incident occurs either only after working hours, or it happens to be a public holiday. It is always during times like these when a tooth decides to crack, or a painful cavity appears out of nowhere, or perhaps a swelling comes about, or worse... an accident occurs! Emergency situations like this need to be attended to as the pain can be unbearable. Fortunately we have 24 hour operating hospitals that would attend to our problems at the 11th hour, but even then we have to wait and survive through the night with all the pain until the dental surgeon on-call sees you. What do you do in the mean time? Well, here are some answers ...

If you ever woke up with a throbbing pain in the middle of the night not knowing what or how did it happen, firstly take a deep breath and relax! Throbbing pain running along your jaw, radiating to your head near the temporal region, and sometimes behind your ears and side of neck indicates a nerve issue. Due to the nature of our brain, any nerve pain originating from one tooth would be translated as the whole nerve bundle been triggered. Therefor, a simple trigger from the nerves of a tooth would trigger the entire distribution of the nerve course, relating in pain on the entire region of distribution. It is the similar situation for a patient undergoing a heart attack, where he feels his entire left arm and neck affected by the pain while the source of the sensation is actually the heart. It is known as "referred pain"

Nerve pain can be a death sentence if left untreated. It is hard to point out where it is coming from, but most often it originates from a very deep cavity affecting the nerves, or simply your wisdom tooth! The best solution is to primarily have 2 tablets of Paracetamol 500mg stat! Note that if you are allergic to Paracetamol, you should consult your physician for alternative drugs - though Paracetamol allergy is extremely rare. Firstly, we will need to understand how does pain come about. When the tooth nerves are affected or infected, they send out signals to the brain. The brain perceives this as PAIN impulse, hence causing us to feel physical pain. At the same time, damaged tissue releases chemicals called prostaglandin which amplifies the electrical signal of the nerves to the brain. The purpose of having Paracetamol is to reduce the effect of prostaglandin at the brain level. This somehow temporarily increases our pain threshold and suppresses the pain. By this time, try contacting the hospital if necessary to get through the dentist on-call. 

While waiting, you could also try "warm salt water gargle"Salt is an hyper osmotic chemical that would help in killing the bacteria around the infected site, while increasing the pH balance in the oral cavity making it more alkaline - bacterias struggle to survive in this environment. However, the next step would be to take painkillers known as "NSAID" (Non Steroidal Anti-inflammatory Drug). These group of drugs reduces pain at a higher level as compared to Paracetamol, while having an anti inflammatory effect. The enzymes responsible for producing prostaglandins are known as Cox-1 and Cox-2. The NSAIDs work by chemically blocking these enzymes, causing less pain and less inflammation. Examples of such drugs are Aspirin, Ibuprofen, and Naproxen. However, it is important to remember that these drugs if consumed on an empty stomach could cause gastritis. Therefor, consume these drugs after a small meal as precaution. 

These steps should be enough to take care of the pain throughout the night. The following morning, it is important to seek dental treatment immediately to treat the source of infection. Remember, the remedies above are merely relieving us from the pain symptom and not treating it. Hence the causative factor for the pain needs to be addressed professionally. 

Tooth cavities are common findings in the mouth. The nature of pain that follows depends on the extent of toot decay- initial caries, progressive caries, advance caries. The deeper and more aggressive the decay process gets, the pain increases. This is due to the bacteria invasion of the enamel layer penetrating into the dentine, where the nerve endings are located. The distribution of the nerve endings are more dense towards the pulp horn and roof of the pulp chamber. This causes a sharp shooting pain in the tooth when hot or cold water touches the tooth. At this stage, restoring the cavity with some filling materials as long as the pulp is not exposed can save the tooth. However sometimes due to the nature of the bacterial invasion, the dentine lying just above the pulp chamber can get affected and result in a severe throbbing ache. In such cases, seeing a dentist becomes inevitable. In case you were unable to see a dentist right away, go to the local pharmacy and purchase a bottle of "clove oil". Get some clean cotton and roll it into a small pellet. Dip the cotton pellet with clove oil and immediately soak the tooth cavity with it. Leave it in there for sometime and you will find a huge sense of relief from the pain. It is important to try to clean the cavity with vigorous salt water gargle before soaking it with clove oil filled cotton pellet. Clove oil is an essential oil extracted from the clove plant. It contains Eugenol, which acts an a natural antiseptic and analgesic. Another alternative to clove oil would be benzocaine, which is an anesthetic agent in a form of gel sold in the pharmacy.


Accidents are the last thing that you need during a holiday. Unfortunately, it can happen at any time and in worst ways. It is important to understand the complexity of the situation as it could result in a long term damage and loss if the injury sustained from the accident isn't managed well. The first thing to do in an accident is to make sure that the victim did not loose consciousness. This is important as he/she could have swallowed or choke on any fractured tooth. If a fractured tooth was sustained, the broken piece of tooth should be located if possible. The exposed part of the tooth could be rinsed with saline (salt water), thereafter placing a "clean" gauze of the site. The patient could gently bite on the gauze to prevent further bleeding. If the tooth has avulsed completely (the whole tooth came out), immediately locate the tooth and wash it gently with salt water. Do not rub or scrub the tooth at all! Next, preserve the tooth in a bottle of milk, or saline, or the patient's saliva if possible. As for the exposed tooth socket, rinse gently with saline and get a clean gauze to bite on. Never use a tissue or cotton in replacement. At the worst case, a clean handkerchief would be good. The art to stop any active bleeding is good compression. Now, you could call the nearest available dental surgeon to attend to the situation immediately. There is a good chance of implanting back the avulsed tooth back into the socket (with a semi rigid splint) if it is done within the same day - ideally within 2 hours! 
The trick to such an emergency is to remain calm, save the tooth (if any), keep the affected area clear from infections via saline rinse, and not forgetting compression to reduce the bleeding. After that, get in touch with a dental surgeon who knows how to handle such a case. An early intervention makes a huge difference to the outcome of the treatment. 

For further tips and remedies for dental pain, kindly contact us at +6012-2621067, or email us at dryogeshbds@yahoo.com .


Tuesday 22 September 2015

Dentophobia !




Did you know that there are over 500 different types of phobias in the world? Health professionals describes phobia as " an extreme or irrational fear of or aversion to something ". Each and every one of us might have a phobia that we are aware of, yet it is different from one individual to another.


One of the common phobias is actually the Dentophobia. This occurs to people who suffer from fear of seeing the dentist. It is usually caused by a traumatic experience with a dentist from the past that has instilled fear in them. Uncle Samad is one of them, who had undergone dental treatment years ago as a teenager replacing his upper front teeth. 

" I swear i wouldn't step foot in a dental clinic EVER since i last had my treatment done 25 years ago"

Uncle Samad was a state rugby player who lost his upper front teeth from a rough tackle by his opponent. It was a head on collision with another player from the opposite direction. He woke up with blood all over himself and a sharp throbbing pain on his upper jaw. The tackle had caused him his front 2 teeth. He was about 32 when this happened. The immediate response was to send him to the nearest government hospital to get his teeth fixed. He was brought in to the Emergency Deaprtment and where his broken upper front teeth had to be removed. 

"The pain of getting through the night was a nightmare. Since then, I get cold feet when i think of dental clinic. Its like being paralysed at the thought of visiting a dentist. Sometimes, it is much easier just to bare with the pain"

Unfortunately for Uncle Samad, his little wish of never seeing a dentist didn't last him for long. Reality hit him when his upper set of false teeth (dental fixed prosthesis-bridge) started to get loose and infected. He wasn't the happiest person to think that he will need to get his upper teeth fixed, but he decided to wait and prolong the visit to the dentist until one day it finally dropped out. Now he had NO choice but to eventually succumb to the hands of a dentist, to replace his upper missing teeth. However the difference was that he had now lost 4 upper teeth in total, as compared to previously losing only 2. This was a result of waiting and procrastinating his dental treatment for over two decades!






Dental phobias are very stressful and could cause anxiety attacks in extreme cases. Uncle Samad was terrified about seeing us. However, he knew he had to get his teeth fixed. He learnt about  us through an interview on the BERNAMA news channel about Cosmetic Dentistry. After watching the program his dental fears had calmed down a little, and so Uncle Samad decided to give it a try.

We had a good session chit chatting with him, understanding his fear from dentists while he expressed what he wanted. He tried sourcing for permanent fixtures for his defective dental condition.   We knew the exact fixtures that Uncle Samad needed. It had to be better than the last one, stronger than before, and aesthetically acceptable. So in a nutshell, an anxious patient having a low smile line and a long upper lip needed replacement for 4 upper teeth. He needed implants.

We planned on installing the implants at bone level using Swiss made implants with simultaneous  GBR (Guided Bone Regeneration). A combination of autograft and allograft was used to enhance bone growth on the implant site.






The implant placed on upper left was a little more subgingival due to the bone height of the alveolar ridge at that site. After a good 4 months of healing while being on a temporary bridge, the final prosthesis was constructed- made from Zicorn core, finished with a porcelain touch.





We also decided to crown a few more teeth on the upper jaw. This was necessary from the aesthetic point of view, and also to aid in the occlusion. Uncle Samad was satisfied with his new set of teeth. He is now a good friend of ours. It is very encouraging to see him battling his phobia from seeing a dentist every time he meets us, as he is able to relate to us as a healthcare practitioner who cares for his needs, feelings and most importantly understanding his deep seated fear.










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Sunday 19 July 2015

The Plastic Man

Have you accidently ever bitten on a small piece of stone, or plastic while chewing on your delicious meal? Its like a jolt of pain shooting to your head, blowing your brains apart!! Now imagine biting through this piece of plastic everyday for 25 years. Can you bare the discomfort of chewing your meals with a heavy piece of acrylic for your breakfast, lunch, tea, dinner, and supper??  The answer is = DREADFUL ! 

Mr. Akram has been trying to get comfortable with his upper dentures for at least 25 years now. He has literally celebrated a silver jubilee of 25 years of horror, trying to eat and chew through that heavy piece of acrylic! Mr. Akram didn’t have the best options for treating his teeth when he was very young due to unethical decisions made by his previous dentist. He had lost most of his upper teeth as a result of extraction.



Dentures had been his only option to replace his missing teeth back then. Ever since, he had to suffer to learn how to eat using a set of false teeth, with his tongue constantly in contact with the acrylic on his upper palate. He couldn’t taste his food, since his tongue does not touch his palate ( the upper part of the mouth ). His speech was affected, where he had to learn to speak and pronounce words clearly with the presence of the denture. Overtime, the denture got loose once the bone started to resorb. This occurs as a result of loosing teeth over a period of time, as the bone around the extracted tooth socket tends to resorb due to absence of the tooth. This causes a change to the anatomy of the gum and mouth resulting in reduced support to the denture. It is a series of unfortunate events that a denture wearer has to live with, not forgetting the fact that they will have to remove their dentures at night before their sleep.


                                



Mr. Akram had decided to end his tourment. He paid us a visit, seeking advice on his dental dilemma. He was keen on getting rid of the denture for once and for all.  He asked for some professional advice, and we started analyzing his case. We ran a full dental examination on him, observing his smlie line, width of mouth opening and his facial profile.


            





We had then begin our cosmetic treatment for Mr. Akram. We planned an upper Zicornia bridge for him, mimicking his original teeth shape, size and profile as much as possible. Within 2 weeks, his new bridge had arrived. It looked like a set of polished diamonds, ready to be installed.

            


The bridge was inserted into his mouth. It was a MATCH ! The color, texture and fitting was perfect, and Mr. Akram was overwhelmed. He was very happy with his new prosthesis. He had now a new set of teeth, feeling like brand new ones.

           
            

Mr. Akram was satisfied with his new set of teeth. They were better, stronger, whiter and much lighter than his previous denture. He was able to speak comfortably, smile confidently, and above all, he could now TASTE HIS FOOD! What a relief … no more plastic tastes, no more rocks to bite from !! With his new Zicornia bridge, he was able to appreciate his food better… say Good Bye to plastic roof!

                  





















  

            







Saturday 18 July 2015

A Good Day to Smile - Understanding the Law beyond Just a Beautiful Smile...

Not everyone is born with a perfect set of teeth, beaming white and crystals glowing as they smile. A good smile comes from a beautiful lip line, high cheek bones and an attractive set of teeth. But what happens if you were blessed with such a fortune of a smile, but with defected teeth??

Smiles are just mesmerising when it feels right...

Rampant caries is a very common disease of the dentition. It is an aggressive, devastating type of  decay of the teeth due to invasive bacteria, and the lack of  protective mechanism to the teeth itself. Very simply, we prevent decay  (demineralization of the enamel and dentine) by our day to day routine of brushing and flossing. What we do not realize is that there are more than just this 2 methods to restore balance to your oral hygiene. Its connected to our daily activities and lifestyle, which plays a big role in keeping our teeth healthy and protected.



Study the list of options below. Interesting as it may be, these might just enlighten us on the complexity and the dynamics on how tooth decay can be prevented.

1.              Proper diet – less sugar and starchy food, flruoride
2.              Proper brushing method
3.              Brushing frequancy – 2 times daily
4.              Flossing
5.              Mouth rinse
6.              Eating timing
7.              Eating frequancy
8.              Adequate rinsing
9.              Water intake
10.          Frequant visits to the dentist

Lets take number 8 for instanse. Adequate rinsing simply means cleansing the teeth with a form of liquid ( water,mouthwah,saliva ) to remove any reminants of food particles or pelicle layers over the tooth surface.  Any cause of deficient rinsing, or inability to rinse efficiently would be a major causative factor for decay to form. So could you imagine a child with impaired salivary production sufering the consequences of rampant caries due to his/her inability to produce adequate saliva to wash away all the food particles? The impact to the child is severe, as while he suffers from lack of confidence to smile and interact with children of  his age, his teeth is undergoing damage every second. Such cases require good dental intervention and a proper treatment plan for the child.

We had a patient, 19 year old male from Perth who had similarly suffered from xerostomia (inabillity to produce saliva) and faced issues with his teeth. He had generalized caries, some of which has caused his teeth to be non-vital and presented with dental abcess. It was quite sad to see a young individual sufering from multiple carious lesions due to his natural inability to produce adequate saliva.



 He has a good long future ahead of him. However looking at his current condition, he might not even pass 25 before all his teeth are fully damaged. This young man needed help, and the sooner he received it the better it would be. So we designed a treatment plan for him, bearing in mind about his diet, hygiene level and most importantly his inability to produce enough saliva. It was not an easy task as if also involved smile designing. Our team had initially proposed veneers and fluoride therapy.




 However we realised that his with state of tooth decay, the palatal and lingual surface where the veneers end were at risk of having recurrent caries- thus causing the veneers to vulnerable to failure. Despite being the best and most minimally invasive treatment, veneers were perhaps not the best option for him. Well, given the limitations at this point, the only option left were Zicornia crowns. This is simply due to their nature of being compatible with his  gums, which were going to help him in the long run, and as well as securing his teeth from any further damage due to lack of salivary flow.  The saliva acts as a source of lubricant to wash away food particles and sugar that might adhere to the tooth surface, as well as providing the first line of defence against regular oral bacterias. It was absolutely necessary to now protect the whole tooth for this reason. 

teeth with normal salivary flow



teeth with limited or no salivary flow


Mr. Marten Stroh, our German technician was designated with the job task to design a precise set of Zicornia crowns for our patient. It was constructed to match his teeth profile, size and shape. These new crowns were measured and fabricated from the Zicorn core, then later adjusted with the overall occlusion for the patient. Finally, they were given a superior polish touch with a glaze to it that made the crowns very smooth - ideally for easy cleansing. 





When the crowns were finally fitted in for the patient, the results were satisfying. He looked amazing, with his new set of white crowns dominating his smile. A job of such precision, deserved a moment of joy for both the patient and our team. We were just glad we were able to make a difference to a persons life. 






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