Delhi Dental Center By Dr. Amit Goswami

Table of Contents

1. Cosmetic Dentistry -- Treating a Gummy Smile

2. Splinting Of Teeth

3. Prevent Your Children From -- Early

4. Childhood Caries (Nursing Bottle Caries)

5. Dental Health Care Concerns during Pregnancy

6. Future of Dentistry

7. Dental Implants Vs Dental Bridges in New Delhi

1. COSMETIC DENTISTRY--TREATING A GUMMY SMILE

The Smile is the most recognizable signal in the world. Smiles are such an important part of communication that we see them far more clearly then any other expression. Just as a nice smile can act as a powerful communication tool, an unpleasant one can have an equally powerful negative impact – that’s why patients seek orthodontic treatment. As society raises the bar on an acceptable smile, we have more patients reporting for smile make-over job at our Dental Center. But Gummy Smile is one aspect which may still vex up. In this article we are giving you an insight about gummy smile and its treatment modalities available at Delhi Dental Center -- to get a desirable, predictable and achievable result. As society raises the bar on an acceptable smile, we at our Delhi Dental Center are having more number of patients reporting to get smile makeovers by correcting there gummy smiles .

GUMMY SMILE : The gummy smile is a condition known by an excessive display of maxillary gingival during smiling. 2 mm or more of maxillary gingival exposure while full smiling can be treated as gummy smile. Gummy smiles are classified according to the amount of gum tissue that shows in relation to how much tooth structure is displayed while smiling. These classifications are determined by measuring the patients gum tissue as a percentage of total tooth length. Gummy smiles ranges from mild, moderate, and advanced, to severe gummy smiles.

MILD GUMMY SMILE – If the amount of gum tissue shown while smiling is less than 25% of the entire length of the teeth, it is considered as mild gummy smile.

MODERATE GUMMY SMILE – If the amount of gum tissue shown while smiling is between 25% - 50% of the entire length of the teeth, it is considered as moderate gummy smile.

ADVANCED GUMMY SMILE – If the amount of gum tissue shown while smiling is between 50% - 100% of the entire length of the teeth, it is considered as advanced gummy smile.

SEVERE GUMMY SMILE – If the amount of gum tissue shown while smiling is more than 100% of the entire length of the teeth, it is considered as severe gummy smile.

ETIOLOGY:

1. Vertical maxillary excess, skeletal and dental.

2. Short anatomical upper lip.

3. Hyper functional upper lip – elevator muscles.

4. Gingival hypertrophy.

5. Short or insufficient clinical crown length.

6. Combination of any of above.

TREATMENT PLAN

Once the diagnosis is established and etiology becomes apparent there are two treatment options

1. Orthodontic option.

2. Surgical option. – Periodontal.

3. Surgical crown lengthening.

4. Botox.

5. Le-fort 1 osteotomy.

ORTHODONTIC OPTION

• Intrusion of teeth will help to reduce gummy smile and proclination of teeth, as the teeth intrude, gums also follow the intrusion but not at the same rate.

• Developing vertical maxillary excess may be corrected by Appling orthodontic forces with help of a head gear.

SURGICAL OPTION

• PERIODONTAL -- It includes simple gingivectomy up to about 2mm. • Surgical crown lengthening -- When there is short clinical crown in combination with increase

gingival display, it can be corrected with removal of crestal alveolar bone. • Botox -- Increase gingival display due to hyper active muscle may be corrected by botox,

the upper lip becomes flaccid and falls down there by decreasing gingival display.

• Orthognathic surgery -- Sever cases of 8mm or more gingival display are best corrected by this method.

CONCLUSION:

Patient cases reporting to our center for gummy smile correction usually doesn’t fall purely in any of above category. Overlapping etiological factors may contribute to difficulty in analyzing the case. However the above mentioned diagnostic criteria help to arrive at a proper “etiology based diagnosis” followed by logical treatment planning.

2. SPLINTING OF TEETH

Trauma to the teeth can be transmitted to the supporting structures, which get damaged. This can cause mobility of the teeth. Such mobile teeth may require splinting for a specified period of time till the supporting tissues heals and the tooth becomes stable. Splinting is a procedure where the teeth are supported in its position for a period of time. Splinting involves binding a group of teeth together so that the biting forces are shared by a large number of teeth instead of being born by the affected tooth Splinting of teeth can be done either by composite material or by fiber splinting .

RATIONALE OF SPLINTING PERIODONTALLY WEAK TEETH:

Predominantly, lingual splinting - of mandibular anterior teeth and palatal splinting - of maxillary anterior teeth.

Splinting is a procedure which is done, if incisors are very mobile but maintainable in mouth, then six anterior teeth are joined at the incisor 1/3rd to increase support – that is from canine to canine.

BENEFITS:

1. It allows the patient to chew comfortably.

2. Mobile teeth become firm – patient can use regular brush, inter-dental brush etc. without the fear of knocking down teeth.

3. As splinting is done in conjunction with other periodontal therapy,such as scaling / curreatage / root planning / flap surgery etc, it also is an adjunct to preservation of hard and soft tissue.

4. Enhances patient self confidence.

RATIONALE OF SPLINTING IN TOOTH INJURY:

Injured anterior teeth should be stabilized for less than three weeks as it will allow periodontal fibers to repair rather than a bony healing (may lead to ankylosis).

-- Tooth luxation needs stabilization for – 2 -3 wks.

-- Tooth subluxation needs stabilization for – 1 -2 wks.

-- Tooth extrusion needs stabilization for – 1 -2 wks.

-- Root fracture needs a longer splinting time such as 1 -3 months, as this will allow the calcified tissue to heal.

OTHER AREAS OF APPLICATION OF SPLINTING:

• ORTHODONTICS – As a Retainer after orthodontic therapy.

– As a space maintainer.

• IMPLANT DENTISTRY – As a Maryland bridge using stock denture teeth in anterior segment.

– For reinforcing implant over denture.

FOLLW UP and MAINTAINANCE:

At the time we at Delhi dental center do a splinting procedure, we explain to the patient about the new feeling he or she is going to experience of teeth being bound together and need for hygiene maintenance. The brushing and tongue cleaning technique has to remain same as before, but flossing technique has to be modified for splinted area – floss should be threaded in between the embrasures on the cervical end. Inter dental brushes are recommended for larger embrasures. We usally call the patient after one week to check on hygiene maintained then after one month and then six monthly for routine check-up and hygiene maintenance.

CONCLUSION:

Using tooth splinting a dentist can stabilize mobile anterior teeth quickly, with long term reliability. It grants high esthetic results and enhances patients confidence to use them freely and smile. Patient photograph links – http://picasaweb.google.com/delhidentalcenter/TreatmentForMOBILETEETH#

3. PREVENT YOUR CHILDREN FROM - EARLY CHILDHOOD CARIES (NURSIN BOTTLE CARIES)

The term describes a dental condition which involves the rapid decay of many or all the baby teeth of an infant or child. The teeth most likely to be damaged are the upper front teeth since they are the first teeth to erupt and thus have the longest exposure time to the sugars in the feeding bottle. Baby Bottle Tooth Decay is caused by long exposure of a child’s teeth to liquid containing sugars generally when the baby falls asleep with a bottle containing milk or juice or a pacifier dipped in honey. By the time the condition is noticed by the parents it may be too late and extractions of the decayed teeth may be necessary. As a result, your child may suffer from long term disorders which include speech impediments, possible psychological damage, crooked or crowded teeth, and poor oral health.

Early Childhood Caries (ECC) also known as baby bottle tooth decay or nursing bottle caries poses a grave threat to a child’s milk teeth and overall development. The term describes a dental condition which involves the rapid decay of many or all the baby teeth of an infant or child. The teeth most likely to be damaged are the upper front teeth since they are the first teeth to erupt and thus have the longest exposure time to the sugars in the feeding bottle. The lower front teeth tend to be protected by the tongue as the child sucks on the nipple of the bottle or the breast. Early Childhood Caries (Baby Bottle Tooth Decay) is caused by long exposure of a child’s teeth to liquid containing sugars generally when the baby falls asleep with a bottle containing milk or juice or a pacifier dipped in honey. The liquid pools around the front teeth. During sleep, the bacteria living in every baby’s mouth, turns the milk sugar or other sugars to acid which causes the decay. By the time the condition is noticed by the parents it may be too late and extractions of the decayed teeth may be necessary. As a result, your child may suffer from long term disorders which include speech impediments, possible psychological damage, crooked or crowded teeth, and poor oral health. A large volume of children we examine on a daily basis will fall under the category of early childhood caries hence a closer look at ECC is presented here.

Causative factors:

� Use of baby bottle at nap time(day or night) � On- demand feed ( both by bottle as well as breast feeding) especially at night. � Use of juices or aerated drinks in the nursing bottle.

� Poor oral hygiene measures.

Ramifications:

� General discomfort and pain sometimes leading to swelling and fever. � Poor dietary habits as the child will prefer a soft diet. (And kids being kids most of the times this

soft diet is sometimes sweet which adds to the problem). � Sub optimal nutrition leading to poor overall growth. � May sometimes affect the developing permanent tooth underneath (the permanent tooth may get

discolored, deformed, etc.) � Difficulty in acquiring speech skills in some cases. � Probability of malocclusion on premature extraction of milk teeth.

Advice to parents:

� The first dental examination of a child by a dentist needs to be done when the first tooth arrives in the mouth and no later than the first birthday.

� Cleaning of tooth/teeth must begin as soon as the first tooth erupts. � Use of nursing bottle at nap/bed time should be stopped as early as possible. � Nursing bottle to be discarded around the first birthday (easier said than done but an effort should

be done). � Using of a cup for drinking to be done. � Mid meal snacks to be avoided (for older kids). � Child must be taught the use of dental floss as early as possible. � Give plain water after a bottle of juice, milk, or formula (or when awake, sip on it for long

periods of time as a pacifier).

For further reading you can log on to my website

www.delhitdentalcenter.com

www.delhidentalcenter.com/pediatric_dentistry.php

4. DENTAL HEALTH CARE CONCERNS DURING PREGNANCY

Dentists often hear their pregnant patients saying, "For every child she bears, a woman loses a tooth." This indeed is a myth, this old saying might have borne some truth someYears ago, but today women are better educated about their teeth and dentists understand more about her altered physiological and psychological state, neglect in oral hygiene or postural position during treatment. Teeth related problems could result in compromised nutritional status to the fetus and therefore needs immediate attention.

PHYSIOLOGICAL CHANGES DURING PREGNANCY:

Pregnancy results in several physiological changes. Changes occur in the endocrine, cardiovascular, respiratory, and urinary and the gastrointestinal systems.

First trimester is very critical. During this period serious complications and abortion can occur.

ENDOCRINAL CHANGES – During pregnancy placenta secretes three major hormones; namely estrogen, progesterone and chronic gonadotrophin. These hormones ensure viability of placenta and the fetus.

CARDIOVASCULAR CHANGES – In pregnancy there is increase in cardiac output and gradual increase in mean blood pressure which reaches its peak by early part of second trimester and returns to normal level on completion of the term.

RESPIRATORY CHANGES – Include increased metabolic rate with an increase in maternal oxygen uptake by 20 percent.

HEMATOLOGICALY – There is an increase in blood volume up to 40 percent by the end of pregnancy. Iron deficiency anaemia is also a common feature in pregnancy.

Increase in Glomerular filtration rate is common in pregnancy.

Decreased gastric motility is a common feature during pregnancy.

These physiological changes result in alteration in drug absorption, metabolism and excretion.

� Decrease in plasma proteins results in modification in drug binding which alters activity of given drug.

� Increased renal filtration rate increases excretion of drugs.

� Increased biotransformation of drugs in the liver result in decreased availability of drug. � Decreased gastric motility enhances absorption of hydrophilic drugs which are poorly absorbed

normally.

Healthy mother and good foetal care make less complication during pregnancy.

FOETAL CONCERNS:

Foetus is susceptible to malformations during the first and second half trimester as it plays important role in the formation of organ system while the remainder of pregnancy is devoted to growth and maturation with diminished changes of malformation. A notable exception to this is the foetal dentition, which is susceptible to staining and enamel hypoplasia due to tetracycline and nutritional deficiencies.

ORAL FINDINGS IN PREGNANCY:

It’s very important for you to take good care of your dental health while you are pregnant. This is because hormonal changes a woman undergoes during pregnancy may have an effect on her teeth, increases her risk of developing gum disease and her bad oral health can affect the health of her developing baby.

PREGNANCY GINGIVITIS:-

� Plaque related mild gingivitis to extensive periodontitis is common in pregnancy. This is largely due to exaggerated inflammatory response to local irritants mediated by elevated levels of estrogen and progesterone.

� Gingivitis in pregnancy begins in marginal and inter-dental papillae in the first trimester. � Pyogenic granuloma / pregnancy tumor – is seen in 1 percent of expectant mothers. It is seen as a

sessile or pedunculated asymptomatic soft tissue mass in maxillary anterior region. The gingival mass usually doesn’t need any much treatment – it resolves after child birth and removal of local irritants.

� Professional dental scaling twice or thrice during pregnancy, as well as frequent daily brushing and flossing will greatly reduce gums swelling and risk of developing pregnancy tumor.

DENTAL CARIES – An increase in sugar intake increase the incidence of caries, caries can also be attributed to poor diet and lack of oral hygiene. Regurgitation of acidic stomach content can result in erosion of the lingual surfaces of maxillary anterior teeth, a fluoride mouth wash to neutralize the acidity in mouth is recommended.

Dental Care during Pregnancy:

Here are a few suggestions for maintaining good oral hygiene.

Before Getting Pregnant:

Get a dental check up appointment at a dental clinic as you are planning for pregnancy. In this way the dentist will clean your teeth, examine your gums and teeth, if any problem is identified that can be treated well in advance. It's always best to complete any major dental treatment prior to pregnancy.

During Pregnancy:

o Tell your dentist which trimester you are in as he can plan for the treatment accordingly, dental treatments in first and second half of third trimester should be avoided.

o Morning appointments should be avoided in first trimester due to vomiting. o Tell your dentist about the medications you are taking. Antibiotics such as

penicillin, cephalosporins, erythromycin and clindamycin are used with no apparent toxic manifestations while streptomycin, chloramphenicol and metronidazole are associated with foetal defects when used during pregnancy. Yellow or brown discoloration of teeth can be caused by tetracycline during the formative phases of tooth development.

o Avoid dental X-rays during pregnancy. If X-rays are essential (such as in a dental emergency), your dentist will use extreme caution to safeguard you and your baby. Advances in dentistry have made X-rays much safer today than in past decades.

o Due to hormonal changes in pregnancy there is increased risk of gum diseases. Get your teeth professionally cleaned during your second and early third trimester.

o Keep good oral hygiene practice by doing regular twice a day brushing and flossing of your teeth. Use a regular mouth wash too.

o If morning sickness is keeping you away from brushing your teeth, change to bland-tasting toothpaste during your pregnancy. Ask your dentist or hygienist to recommend brands.

o Eat a healthy and well balanced diet. Your baby’s first teeth begin to develop about three months into your pregnancy. Healthy diets containing dairy products, cheese, and yogurt are good sources of these essential minerals and are good for your baby’s developing teeth, gums, and bones.

o Avoid sugary and sticky foods and remember -- the more frequently you snack, the greater the chance of developing tooth decay.

o AMALGAM FILLINGS – there is a controversy on the use of amalgam restorations in pregnant persons. It is a good practice to minimize exposure of pregnant patients to mercury. Amalgam fillings should not be removed or placed

in pregnant persons, if unavoidable; a rubber dam should be used while placing amalgam filling.

Post-PartumBlues: It is estimated that over 50 percent of women experience some degree of depression after a pregnancy. Studies demonstrate that estrogen and progesterone levels change, similar to the hormonal variances that many women experience during their menstrual cycle. Sheer exhaustion, apprehension about new responsibilities and anti-climactic shock may contribute to a sense of an overwhelming burden. It is natural and quite common for many women to take time to refocus attention on them after having a child. Don’t despair! Resuming your normal lifestyle, including a visit to the dentist, is crucial to the recovery process. A woman cannot be the best mother if she fails to maintain her own mental and physical well being.

Here are some helpful hints:

- Do not be afraid to seek help taking care of the baby. - Rest and regain your strength. - Eat right and try to get some exercise. The better you feel about yourself, the better you will feel about everything else. - Talk to other people who understand what you are going through. - Your family and friends need to know that you need their support. Be sure to visit your dentist regularly during and immediately after your pregnancy.

5. FUTURE OF DENTISTRY

New and Improved Dental Procedures

Many people avoid dental treatment because of bad treatment experiences they have had earlier in there lives. As a result, some people may not have gone to a dental clinic for 15 to 20 years or more.

I think what people should know is that -- dentistry as a whole has literally transformed in the last 10 to 15 years. The most notable and important changes have been in the science and technology and the modern equipments that we use in our clinics now a days as compared to what we did 15 years back. Cutting edge research in dentistry and high-tech gadgetry has dramatically changed the way of dental treatment in this century. “Dental offices are using these new technologies as they help in making dental care safer, more efficient and less fearful for the dental patient.” Says Dr. Amit Goswami

The most notable and important changes in dental science has been used for the reduction of pain, improvement of root canal therapy, replacement of teeth with dental implants, and the revolution in cosmetic dentistry, specifically porcelain veneers and the white(tooth colored) resin fillings. Now we can do dental extreme makeovers and full mouth rehabilitation with ease and much faster as compared to earlier times.

Many dentists have these equipments in their offices now, says Dr. Amit Goswami from Delhi Dental Center – New Delhi -India. He lists some other advances that are on their way into new dental clinics.

INTRA ORAL CAMERA -- is a miniaturized camera that allows patients to view the inside of their own mouths live on a LCD screen mounted on dental chair. It's a wonderful device and patients love it. It's a wonderful way to educate the patient because they can see what problems they have with their own eyes."

LASERS -- Already used for some soft tissue procedures such as removing lesions, and for tooth whitening purposes, many dentists feel they will be used soon to zap tooth decay, precluding the need for tooth restorations or fillings. DIGITAL RADIOGRAPHY – “This technology involves a tiny intra oral sensor that replaces conventional X-ray film and is wired directly to a computer screen. When placed in patients mouth it generates a digital image for diagnosis, in a same manner as X-rays does, but with much less radiation dose.” says Dr. Amit. It’s much faster and easier than X-ray too.

KINETIC CAVITY PREPRATION – This is also known as” air-abrasive technology,” in this procedure tiny aluminum particle is carried by a stream of air, spraying away decay without the sound and vibration of a dental drill.

BONDING AND ADHESIVES -- These materials allow tooth and veneers, for example, a better fit, resulting in minimal drilling, greater strength, tighter seals, and more natural color blending with the tooth. Now we have several types of adhesives specifically designed for special functions, all adhesives and bonding agents now have several generations of them in use.

ENDODONTIC EQUIPMENTS – In this range so much of advancements have been in pace that we perform root caal treatment with so much of ease these days. Now we have endomotor, endodotic microscope to visualize things better.

DENTAL IMPLANTS – They are in use in dentistry since last 30 to 40 years , but now so many new designs and techniques have come up that they are been used in almost so many cases that earlier we haven’t even thought about that.

DENTAL SOFTWARE – Now we have patient education software to educate a patient about his dental health and treatment procedures too. We have practice management software’s, dental animations etc. Computers and new computer-driven technology do not depersonalize the relationship between doctor and patient. "Quite the contrary," says Dr. Amit -- "They allow more effective scheduling, -- they allow more personalized follow-up for treatment, -- they consolidate information; and they educate the patient. But the big plus is that they allow the dentist to provide better treatment. They are going to revolutionize dentistry and the sooner the better."

Modern methods and technology have greatly improved most dental treatment and may provide a pleasant surprise for those who have avoided dental care for many years.

6. DENTAL IMPLANTS VS DENTAL BRIDGES IN NEW DELHI

Contents

• Dental Bridges Vs Implants : • Dental Implants are a Functional and Desirable Alternative to Conventional Bridges and

Dentures.

Dental Implant is a small and sturdy, titanium post that acts as -- artificial roots structure. Dental implants are placed into your jaw where the root of the tooth once was and fuses with your jawbone to forms a secure foundation for the new tooth replacement and so are the closest substitute to natural teeth available.

Once in place, the implant can be used to attach different types of dental restorations, can be used to support single crowns, bridges and dentures. Whether you are missing one tooth, several teeth or all of your teeth, dental implants may be an option for you. These are very durable and can last a lifetime. They require the same maintenance as our natural teeth; this includes brushing, flossing and regular dental check-ups.

We all feel that our teeth are important. But, when your smile begins to affect your quality of your life, the health, function and appearance of your teeth take on a whole new meaning. Nobody needs to have a unhealthy or missing teeth, or the embarrassment of slipping dentures. Now, with dental implants, your dentist can restore your missing tooth or teeth without needing to grind down adjacent teeth (as we do in crowns & bridges) or employ traditional dentures (teeth supported by the ridge). You will again smile with confidence. No other dental procedure can give you a more natural look or anchor crowns more securely.

Dental Bridges Vs Implants:

At D.D.C. we strongly believe and think that our patients can be served better with implants rather than conventional bridges, when ever applicable. Dental implants are self supporting, easier to keep clean, do not rely on adjacent teeth for support or strength, do not require removal of enamel layer of your natural teeth for preparation of the adjacent natural teeth, and have a longer life expectancy than bridges.

We at our D.D.C. make the decision between dental implant and bridge easy by keeping dental implants affordable.

Dental Implants are a Functional and Desirable Alternative to Conventional Bridges and Dentures.

Dental Implant Supported Over-Dentures:-

Dentures have to be taken out and soaked at night. During the day, they can also look unnatural as some times they use to float on the jaw bone and rub your underlying gums painfully. Dentures and partials dentures make it difficult or impossible to eat certain foods. Dental implants can now be used to anchor partial dentures and full dentures. This prevents the slipping, irritation, and pain associated with “floating” partial and full dentures. Dental implants also eliminate the need for dental adhesives. This allows you to enjoy eating the foods you previously avoided. With dental implants, your partials or dentures are firmly anchored to the jawbone, causing them to feel much more like natural teeth. New and often existing dentures can be secured with 2 or more dental implants. This incredible procedure dramatically increases denture comfort and chewing effectiveness while stopping bone loss often associated with prolonged denture use. This is an easy and less expensive way to quickly improve the life style of a denture wearer. Additional implants can be added in the future to further help in supporting the denture thereby making it even more comfortable. Some of our most satisfied patients are patients that received dental implants as part of their denture treatment. For further reading on dental implants and different treatment modalities you can read these links form my website

Dental implants over view

http://www.delhidentalcenter.com/dentalImplants.php

Conventional dental Implants:-

http://www.delhidentalcenter.com/conventional_implant.php

Immediate dental implants:-

http://www.delhidentalcenter.com/imideate_implant.php

Single tooth replacement:-

http://www.delhidentalcenter.com/single_tooth_Implants.php

Implant bridges:-

http://www.delhidentalcenter.com/implantbridge.php

Implant over-denture:-

http://www.delhidentalcenter.com/implant_overdentures.php

Full arch implant bridge:-

http://www.delhidentalcenter.com/fixed_implant_bridge.php

For further assistance simply ask Dr. Amit Goswami. After a thorough exam and dental x-rays, we can help you determine if dental implants are right for you. We offer free consultations to those interested in implants. You can mail me at – delhidentalcenter@gmail.com