TREATMENT PROCEDURES IN DENTISTRY

ROOT CANAL TREATMENT:

Overview

A root canal is a treatment to repair and save a badly damaged or infected tooth. 

The procedure involves removing the damaged area of the tooth (the pulp), cleaning and disinfecting it and then filling and sealing it. 

The common causes affecting the pulp are a cracked tooth, a deep cavity, repeated dental treatment to the tooth or trauma. 

 The term "root canal" comes from cleaning of the canals inside the tooth's root.

What to Expect During a ROOT CANAL:

If you think you need a root canal, consult your dentist. There are a number of steps that occur over a few office visits.

1. X-ray – if a dentist suspects you may need a root canal, he will first take X-rays or examine existing X-rays to show where the decay is located. 
2. Anesthesia – local anesthesia is administered to the affected tooth. Contrary to popular belief, a root canal is no more painful than a filling.
3. Pulpectomy – an opening is made and the diseased tooth pulp is removed.
4. Filling – the roots that have been opened (to get rid of the disease pulp) are filled with gutta-percha material and sealed off with cement and covered with a Crown when needed.
   
   
   TOOTH REMOVAL/EXTRACTION PROCEDURE:
   
   
   Overview  If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other dental treatment. But when there's too much damage for the tooth to be repaired, the tooth may need to be extracted — or removed — from its socket in the bone.
   
   Beyond damage and decay, here are some other common reasons for tooth removal:
   Some people have extra teeth that block other teeth from coming in.

• Sometimes baby teeth don't fall out in time to allow the permanent teeth to come in.
• People getting braces may need teeth extracted to create room for the teeth that are being moved into place.
• People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
• People receiving cancer drugs may develop infected teeth because these drugs weaken the immune system. Infected teeth may need to be extracted.
• Wisdom teeth, also called third molars, are often extracted either before or after they erupt in the mouth. They commonly come in during the late teens or early 20’s. They need to be removed if they are decayed, infected, or if there is not enough room in the mouth
  
  

  Understanding:

  
  

  There are two types of extractions:
  
  
  

  • A simple extraction
     
  • This is performed on a tooth that can be seen in the mouth. General dentists commonly do simple extractions. In a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses an instrument called forceps to remove the tooth.
    
  • A surgical extraction 
     
  • This is a more complex procedure, which is used if a tooth may have broken off at the gum line or has not erupted in the mouth. 
  • Oral maxillofacial surgeons typically perform this procedure, though general dentists can also perform them. 
  • The doctor makes a small incision (cut) into your gum to surgically remove the broken tooth or impacted wisdom tooth. 
  • It may be necessary to remove some of the bone around the tooth or to cut the tooth in half in order to extract it.
   

  Most simple extractions can be done using just an injection (a local anesthetic); you may or may not receive drugs to help you relax. 

   

  For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia through a vein (intravenous). Some people — such as patients with specific medical or behavioral conditions and young children — may need general anesthesia.
   

  If you are receiving conscious sedation, you may be given steroids, as well as other medicines in your intravenous sedation line. 

   

  The steroids help to reduce pain and swelling after the procedure.
   

   

  During a tooth extraction, you can expect to feel pressure, but no pain. 

   

  If you feel any pain or pinching, tell your dentist.

   

  Planning:

  
  

  Having a tooth taken out is a surgical procedure. You can expect some mild discomfort even after simple extractions. 
• Research has shown that taking drugs that include ibuprofen, such as Advil^®, Motrin^® and others, can greatly decrease pain after a tooth extraction. 
•  Take the dose your doctor recommends, 3 to 4 times a day.
• Take the first pills before the local anesthesia wears off, and continue taking the mediations for 3-4 days following or as your dentist has recommended.  
• Surgical extractions generally cause more pain after the procedure than simple extractions. 
• The level of discomfort and how long it lasts will depend on how difficult it was to remove the tooth. 
• Your dentist may prescribe pain medicine for a few days. Most pain disappears after a couple of days.  
• Here are a few tips to help minimize your discomfort and speed recovery:
• You can put ice packs on your face to reduce swelling. Typically, they are left on for 20 minutes at a time and removed for 20 minutes. 
• If your jaw is sore and stiff after the swelling goes away, try warm compresses.
• Eat soft and cool foods for a few days.
• A gentle rinse with warm salt water, started 24 hours after the surgery, can help to keep the area clean. Use one-half teaspoon of salt in a cup of water. 
• Most swelling and bleeding ends within a day or two after the surgery. Complete healing takes at least two weeks.
• You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was.

 
If you need stitches, your doctor may use the kind that dissolves on their own. 

This usually takes one to two weeks. Rinsing with warm salt water will help the stitches to dissolve. 

Some stitches need to be removed by the dentist or surgeon.
Call your dentist or oral surgeon if,

• The swelling gets worse, instead of better.
• You have fever, chills or redness.
• You have trouble swallowing.
• You have uncontrolled bleeding in the area.
• The area continues to ooze or bleed after the first 24 hours.
• Your tongue, chin or lip feels numb more than 3 to 4 hours after the procedure.
• The extraction site becomes very painful -- This may be a sign that you have developed a dry socket.
  FILLING/RESTORATIONS  :
  
  
  Overview 
  
  
  

  A filling helps to restore a tooth damaged by decay back to its normal function and shape, and helps prevent further decay by eliminating areas where bacteria can enter the tooth. 
  
  Your dentist will consider a number of factors when choosing which type of filling material is best for you; this includes the extent of the repair, whether you have allergies to certain dental materials, where in your mouth the filling is needed and the cost.
  
  
  There are various types of fillings available including.
  
  
  Composite Fillings 
  
  A composite resin filling is made from a mixture of plastic and fine glass particles and matches the color of the tooth. 
  
  Thus, composite fillings are used most often on front teeth or the visible parts of the tooth. 
  
  Composite fillings bond directly to the tooth, reducing the drilling needed (like for a amalgam filling) and they are stronger than amalgam fillings.
  

  
  Amalgam Fillings 
  
  Amalgam fillings are made from a mixture of metals including mercury and silver, and thus doesn’t match the color of your teeth. 
  
  This type of filling is used most often for fillings in the back teeth. 
  
  These fillings are very strong and usually last at least ten years if not longer.
  
  
  Gold Fillings 
  
  Gold fillings are made from gold allow which is extremely durable. 
  
  
  This type of filling lasts longer than any other type.
  
  
  Gold fillings do not match the natural color of your teeth and are expensive, they usually cost six to ten times more than amalgam.
  
  
  Ceramic Fillings 
  
  Ceramic fillings are made of porcelain and are tooth colored, so they look natural. 
  
  Ceramic fillings are more brittle than composite resin and can break but they are also more resistant to staining. 
  
  Ceramic fillings are expensive, and can cost as much or more than gold fillings.
  
  
  Glass Ionomer
  
  Glass Ionomer fillings are made from acrylic and fluoroaluminosilicate, a component of glass. 
  
  This type of filling is very strong and most often used in people with a lot of decay in the part of the tooth that extends below the gum. 
  
  It is also used for filling baby teeth.
  

  Understanding

  To help minimize the pain associated with getting a filling, your dentist may choose to administer a local anesthetic, like Lidocaine. 
  
  Next, your dentist will remove decay from the tooth, using a drill or laser.
  
  Once all the decay is removed, your dentist will shape the space to prepare it for the filling. 
  
  Different types of fillings require different shaping procedures to make sure they will stay in place. 
  
  Your dentist may put in a base or a liner inside the tooth to protect the tooth's pulp (where the nerves are).
  
  Certain types of fillings get hardened by a special light. With these fillings, your dentist will layer the material, stopping several times to shine a bright light on the resin.
  
  This cures (hardens) the material and makes it strong.
  Finally, after the filling is placed, your dentist will use burs to finish and polish the tooth surface.
  

  Planning:

  
  

   
• After a filling procedure, there are a variety of side effects that can occur after the anesthesia wears off.  
• The tooth may be sensitive to pressure, cold air or liquids or sweet foods. 
• Some people many experience numbness, tingling, and some minor pain around the injection site. 
• These side effects often subside within a few hours of the procedure.   
• Sensitivity should decrease in one to two weeks. Until then, try to avoid anything that causes it. 
•  If your tooth is extremely sensitive or your sensitivity does not decrease after two weeks, contact your dentist's office for an appointment.
   
• The most common reason for pain right after a filling is that the filling is too high; your dentist can adjust the filling by checking the occlusion (bite) of your teeth and removing sufficient of the excess filling material to decrease the pain.
   
• Another less common type of discomfort after a filling is a very sharp shock that appears only when your teeth touch. 
• This is called galvanic shock, and happens when two metals (one in the newly filled tooth and one in the occluding tooth) touch, producing an electric current in your mouth. 
• This would happen, for example, if you had a new amalgam filling in a bottom tooth and had a gold crown in the tooth above it.
  
  
  
  
  
  DENTAL SEALANTS:
  
  

   

  Overview

  Sealants, also referred to as dental sealants, consist of a plastic material that is placed on the chewing (occlusal) surface of the permanent back teeth — the molars and premolars — to help protect them from bacteria and acids that contribute to tooth decay. 
  
  The plastic resin in sealants is placed by a dental hygienist into the depressions and grooves of the chewing surfaces of back teeth and a light is utilized to cure it to the enamel which acts as a barrier, protecting the enamel surface of the teeth from plaque and acids.
  
  
  Thorough brushing and flossing helps remove food particles and plaque from the smooth surfaces of teeth, but toothbrushes can't reach all the way into the depressions and grooves to extract all food and plaque. 
  
  
  Plaque accumulates in these areas, and the acid from bacteria in the plaque attacks the enamel, causing cavities to develop. 
  
  While fluoride helps prevent decay and helps protect all the surfaces of the teeth, dental sealants add extra protection for the grooved and pitted areas. 
  
  Sealants can help protect these vulnerable areas by "sealing out" plaque and food debris from the occlusal surfaces of the teeth.
  

  Understanding

   

  Placing dental sealants is usually painless and doesn't require drilling or numbing medications.
  
• First, the dental hygienist will polish the surface of the tooth with a pumice material to remove plaque and food debris from the pit and fissure surfaces of the teeth selected for sealant placement.
• Next, the hygienist will isolate and dry the tooth so that saliva doesn't cover the pit and fissure surfaces. Then the hygienist will etch the surface of the tooth in the pit and fissure areas, rinse off the etching material and dry the tooth.
• The hygienist will apply the dental sealant material to the surface of the tooth with a brush; a self-curing light will be used for about 30 seconds to bond the sealant to the tooth surface.
• Finally, the dental hygienist and dentist will evaluate the dental sealant and check its occlusion. Once the dental sealant has hardened it becomes a hard plastic coating, and you can chew on the tooth again.