BASIC KNOWLEDGE ABOUT ROOT CANAL TREATMENT

MOST OF THE PATIENTS WHO NEED ROOT CANAL TREATMENT ARE CURIOUS TO KNOW ABOUT THE TREATMENT. SOME OF YOUR QUESTIONS WILL BE ANSWERED AND YOU WON'T BE WORRIED AFTER READING THIS.


Tooth is composed of protective hard covering (enamel,dentin, cementum) encasing a soft living tissue called Pulp. Pulp contains blood vessels, nerves, fibers and connective tissue. The pulp extends from the crown of tooth to the tip of roots where it connects to the tissues surrounding the root.

Why do you feel pain?

When the pulp gets damaged or infected, due to tooth decay, gum diseases, injury to the tooth by accident, it causes increased blood flow and cellular activity and pressure cannot be relieved from inside the tooth and causes Pain.

How can you tell if pulp is infected?
When pulp becomes inflamed, it may cause

• Toothache on taking hot or cold, Spontaneous pain
• Pain on Biting or on lying position
• Drainage(Pus discharge)
• Swelling

Why do you need root canal and what is root canal?
To relieve this pain, as tooth cannot heal by itself, root canal treatment is done to save the tooth by removing the infected pulp, then cleaning and shaping of root canals is done, and then filled up with the gutta percha (permanent filling) material to prevent recontamination of the tooth. Tooth is permanently restored by this procedure.

Alternatives to root canal?

If tooth is severely damaged, extraction (tooth removal) is the only option left.

How many visits?
Nowadays, single sitting root canal is available. Usually, it can be completed in 2-3 visits but sometimes, the condition of tooth infection can take a longer time.

                                                   

Will you feel pain during or after treatment?

NO, with the use of Local Anesthesia, you will be comfortable and pain free. But for few days, you may feel sensation if pain and infection were present prior to procedure, this can be relieved by medication.

Will the tooth need any special care or additional treatment after RCT?
One should not bite or chew on that treated tooth as tooth gets weakened after RCT so it may fracture the tooth. To avoid this, you should go for capping (crown) of that tooth for best results.
Do not forget to maintain good oral hygiene by brushing, flossing, mouthwash, and routine dental check ups.

WORRIED FOR YOUR CHILD'S TEETH? PART-2

CHILD 3-6 YEARS OLD (HIGH RISK):

Parents should understand the importance of oral health.
Regular check ups required which helps in reducing the risk of caries , building the doctor patient relationship, both child and parents start trusting doctor, and even prepares child for the dental procedures.
Fluoridated tooth paste- 1350-1500 PPM , upto full length of Head of Brush.
Fluoridated varnish application- Atleast 2 times per year.
    Fluoride varnish is the fastest safest acceptable procedure.
    For such patients, formulation can be used- 1400ppmF + 0.3% chlorhex + 0-5% cetylpyridinium chloride. This helps in protection against antibacterial activity.



Most important is an investigation of DIET. Parents should be advised to maintain the diary of what one is eating for the whole day which will help in detecting the main cause like child is having more sugary products which are causing the risk of caries or now in digital world, there are many applications available on app stores, one can download and maintain the diary.

DIET CHART

CHILD ABOVE 7 YEARS AND YOUNG ADULTS:

Fluoridated tooth paste - 1350-1500ppm, full length of Head of Brush, Twice daily.
Night tooth brushing with fluoridated tooth paste is  more important.
Don't rinse after brushing (just spit out) to maintain fluoride concentration.
Reduce both frequency and amount of sugar intake
Fluoridated varnish application by Dental Professional twice a year
Varnish during orthodontic treatment becomes more important (as oral hygiene maintainance is challenging)

FLUORIDE RINSE

CHILD ABOVE 7 YEARS AND YOUNG ADULTS (HIGH RISK):

In addition to every other steps,

Fluoridated tooth paste- 2800ppm for above 10 years and 5000ppm for above 16 years of age.
Fluoride rinse should be done everyday, the timing should be different to that of brushing.
Fissure Sealants by Dental Professionals provide better protection.
Fluoride Varnish Application - more than 2 times per year.

FISSURE SEALANTS

Fissure Sealants in combination with investigation of diet, oral hygiene and varnish fluoride application are the best measures for such patients.




SUMMARY:
1. Reduce both frequency and amount of sugar intake.
2. For preschool kids, brushing under parents supervision.
3. Fissure sealants for permanent molars as soon as tooth erupts.
4. Range of fluoridated tooth paste 1000-5000 ppm.
5. Varnish application by Dental Professionals 2 times/year and more than 2 times/year for high risk caries.
6. Investigation of Diet.
7. Good Clinical Advice and Regular Dental Checkups.

WORRIED FOR YOUR CHILD'S TEETH? PART-1

HERE ARE SOME OF THE PREVENTIVE MEASURES YOU CAN FOLLOW TO MAINTAIN ORAL HEALTH OF YOUR CHILD.

CHILD 0-3 YRS OLD: 

Breast feeding is important for a child's health as it helps in nutrition, growth of orodental area, and orthodontic treatment prevention.
Breastfeeding should be stopped when child is around 1 yr old.
Wipe the infant's gums and tongue regularly.

FREE FLOW CUP

From 6 months, I would like to prefer Free Flow Cup for fruit juices. Fruit juices are equally risky but you can manage the frequency intake. Moreover, baby can sleep with bottle in his mouth but can't with free flow cups so reducing the chances of ECC (Early Childhood Caries).

EARLY CHILDHOOD CARIES

             REDUCTION OF SUGAR INTAKE IS IMPORTANT (BOTH DAY AND NIGHT)

FINGER BRUSH

CHILD 1 YEAR OLD:

Feeding should be stopped.
No added sugar.
PARENTS SHOULD BRUSH TEETH
Brushing should be started as soon as the first tooth erupts.
Fluoridated Tooth Paste - <1000ppm, only a smear or size of Rice grain
Sugar free medicines can be given.
Reduction of sugar intake (frequency & amount) 


CHILD 3-6 YEARS OLD:

Tooth brushing should be under the parents supervision. (Don't let them do alone), to be done Twice daily
Fluoridated Tooth Paste- 1000-1350ppm, Pea sized.
Recommendation- Not to rinse after brush (just spit) as it can maintain fluoride concentration
Sugar free medicines
Reduction of sugar intake (frequency & amount)

FLUORIDATED VARNISH APPLICATION by Dental Professional should be done twice a year as it causes remineralisation and have caries inhibiting effect. 
        Varnish adhere to enamel-- longer time stay of fluoride-- Prevention
          After varnish application, DONOT EAT/DRINK FOR 60 MIN.

HOW TO FLOSS YOUR TEETH?

            DENTAL FLOSS


Dental Floss-
   It is either a bundle of thin nylon filaments or plastic (teflon or polyethlene) ribbon used to remove food and dental plaque (thin biofilm or layer of bacteria that is present on the surface of tooth) from interproximal (between two teeth) areas of the teeth.
     
Variety-  Flavoured or Unflavoured, Waxed or Unwaxed.

• Waxed makes it easier to slide, advised to use in children.

Floss holder/dental floss stick-  2 types- Knife shaped, Y shaped.

Tool for flossing, suitable for Parents in helping Children or individuals with Special Needs.










Technique-

Take 12-18 inches of floss and grasp it so that you have couple inches between your hands.

Slip floss between teeth and into area between teeth and gums as far as it will go.






Floss with 8-10 VERTICAL STROKES (UP AND DOWN) to dislodge food and plaque.

To remove the floss, use the same back and forth motion to bring the floss up and away from the teeth.


For Full Video, https://youtu.be/GOE6OGsOLGI

How often- Atleast ONCE a day. especially before going to bed.

Caution- Clean gently, try not to injure the gums.

PRODUCT REVIEW

3M ESPE RELYX U200 SELF ADHESIVE RESIN CEMENT

• Manufacturer: 3M
• Cost: Around INR 7000
• You can buy it from DENTALKART

Composition:

BASE PASTE	CATALYST PASTE
Methacrylate monomers containing phosphoric           acid groups	methacrylate monomers
Methacrylate monomers	alkaline basic fillers
silanated fillers	silanated fillers
initiator components	initiator components
stabilizers	stabilizers
rheological additives	rheological additives
	pigments

Mixing time: 20 sec

Setting time: 6 min/ light cure each surface of tooth for 20 sec

Features:

• Excellent bond strength.
• Comfortable and easy delivery in automix syringe
• Comfortable handling
• Optimal consistency for dispensing and seating
• Flexible dosing
• Time-saving
• A great choice of tips allows always easy application of paste directly into the cavity
• Low risk of air bubbles and voids
• Simple and time-saving one-step solution.
• Only a few working steps required
• No pre-treatment such as etching, priming or bonding necessary
• High-performing self-adhesive resin cement.
• RelyX™ U200 Cement is strong where it counts and offers high adhesion, resistance to discolouration, long-term stability and almost no post-operative sensitivities.
• Its exceptionally simple handling, dispensing, treatment and overall working conditions makes this cement a favourite for dentists who are counting on uncompromising quality.

Indicated for the permanent cementation of:

• All-ceramic, composite, or metal inlays, onlays, crowns and bridges
• Posts and screws
• 2- or 3-unit Maryland bridges
• 3-unit inlay/onlay bridges
• All-ceramic, composite, or metal restorations to implant abutments

Advantages:

• Time-saving - no etching, priming or bonding.
• Virtually no post-operative sensitivity.
• Easy removal of excess.
• Optimal consistency.
• Strong and moisture tolerant.

 Packaging:

       
          1 Clicker Dispenser (11 g), 1 mixing pad

•  Delivers pre-measured doses for consistent and economical mixing
• Choice of dispensed amount – 11 g dispensed in 80 clicks (approx. 40 applications)
• Improved mixing through new technology

Directions to Use:

STEP 1- Clean the tooth surface using polishing brush, water and air.

           Note- Do not use hydrogen peroxide as it may irritate the tissue.

STEP 2- Dispense a little quantity of cement onto the mixing pad. If its automix, you just need to push the plunger. If its the clicker variant, push down the white part of the product and push the plunger. Clean the opening after use.

STEP 3- Mix the dispensed cement using the spatula for 20 seconds. 

STEP 4- Light cure for 1-2 sec and remove the excess cement using the blade or explorer. Setting time is 6 mins including the working time or light cure per surface for 20sec.

STEP 5- Finish and Polish.

SEDATION IN CHILDREN

NITROUS OXIDE (N2O) AS CONSCIOUS SEDATION

• Route - Inhalation 
• Dose - 40% N2O +60%  O2 

• It causes DIFFUSION HYPOXIA when sedation is reversed at the end of procedure. This can be prevented by maintaining 100% oxygen for 5-10 min. after sedation procedure.                                                                                                                                
•  5-25% N2O : Modern Sedation, Diminution of fear and anxiety, Marked Relaxation.      
•  25-45% N2O : Dissociation Sedation and analgesia, Floating Sensation, Reducing blink rate, Euphoric state (laughing gas). 
•  45-65% N2O: Total Anaesthesia, Analgesia, Amnesia (AAA)   

• ContraIndication of N2O: COPD, Asthma, Resiratory infections, Sickle Cell Anemia, Otitis Media, Epilepsy.

         SIDE EFFECTS OF OTHER SEDATIVES IN CHILDREN

1. Barbituarates
   -PARADOXICAL  HYPER EXCITABILITY than sedation in some children.
                           
2. Ketamine 
   -Route- IM, DISSOCIATIVE  type of anesthesia.
3. Promethazine
   -Route- Oral , used with caution in child with SLEEP APNEA or family history of SUDDEN INFANT DEATH SYNDROME (SIDS)
4. Chlorpromazine                                                                 
   - Used in combination with Mepridine and promethazine  (LYTIC COCKTAIL)
5. Diazepam                                                                                    -THROMBOPHLEBITIS , ATAXIA                                                           
6. Midazolam                                                                                  -Dose:Oral: 0.25-1 mg/kg, Max. 20mg; IM: 0.1-0.15 mg/kg, Max. 10mg; Syrup: 2mg/ml; Injectable: 1mg/ml & 5mg/ml vials
   -RESPIRATORY DEPRESSION

14 IMPORTANT FEATURES OF TEETH

• SMALLEST PRIMARY TOOTH - LOWER CENTRAL INCISOR                                                      
• SMALLEST PRIMARY MOLAR - MAXILLARY 1ST MOLAR                                                         
• MOLAR TUBERCLE OF ZUCKERKANDL - PRIM. MAX. 1ST MOLAR                         (Well developed cervical ridge is called tubercle of zuckerkandl)                                 
• PRIM. MOLAR RESEMBLING PERMANENT PREMOLAR - PRIM. MAX. 1ST MOLAR                                    
• PRIM. MAX. 2ND MOLAR RESEMBLES - PERM. MAX. 1ST MOLAR                                          
• PRIM. MAND. 2ND MOLAR RESEMBLES - PERM. MAND. 1ST MOLAR                                       
• PRIM. MOLAR DOES NOT RESEMBLE ANY PERM.TOOTH - PRIM. MAND. 1ST MOLAR                                     
• LONG SHARP MESIOLINGUAL CUSP - PRIM. MAND. 1ST MOLAR                                                
• FIFTH CUSP OR CUSP OF CARABELLI - PRIM. MAX. 2ND MOLAR                                                       
• MOD PREPARATION CONTRAINDICATED - PRIM. MAND. 1ST MOLAR                         (due to anatomy of pulp)                                                                                     
• CERVICAL MESIOBUCCAL RIDGE - PRIM. MAND. 1ST MOLAR                                                        
• PRIM. TOOTH MOST SUSCEPTIBLE TO CARIES - MAND. 2ND MOLAR                                    
• TEETH LEAST INVOLVED IN NURSING BOTTLE CARIES - MAND.INCISORS                                     
• TEETH MOST INVOLVED IN NURSING BOTTLE CARIES - MAX.INCISORS                                                                                                                                                                                        REF. -   WHEELER'S DENTAL ANATOMY                                                                                                                                      TEXTBOOK OF PEDODONTICS BY SHOBHA TANDON