08 August 2012
Pulpotomy as the complete removal of the coronal portion of the dental pulp followed by a placement of a suitable dressing or medicament that will promote healing and preserve vitality of the tooth.
The pulpotomy procedure involves removing the coronal pulp tissue that has undergone inflammation or degenerative changes and leaving intact the remaining vital tissue in the rootcanals which is then covered with pulpotomy agent to promote healing at the amputation site or an agent for fixation of the underlying tissue.
INDICATION FOR PULPOTOMY
- Carious primary teeth with infected pulp
- Irreversible inflamed pulp
- Failed in direct pulp capping
- Absence of spontaneous pain
- Absence of swelling or alveolar abscess formation
- 2/3 root length remaining
CONTRAINDICATION
- Permanent successor close to eruption
- An unrestorable tooth
- Less than 2/3 of root remaining
- Presence of fistula or swelling
- Evidence of necrotic irreversibly damaged pulp
- Uncontrolled pulpal hemorrhage
- Periapical or bifurcation or trifurcation radioluency
- Pathological resorption of pulp
- Dystrophic calcification(pulp stones)
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Medicaments available for pulpotomy
- Formocresol
- Mineral trioxide aggregate
- Glutaraldehyde solution
- Paraformaldehyde
- Calcium hydroxide powder
- Ferric sulphate
- Beechwood creosote
- Camphorated monochlorophenol
- Laser
- Electro surgery
- Creating
- ZOE
Pulpotomy technique
- Remove caries and determine site of pulp exposure
- Remove roof of the pulp chamber
- Remove coronal pulp tissue and control bleeding
- Appropriately use pulpal medicament
- Fill pulp chamber with cement/restore
08 August 2012 0
Pit and fissure sealants are marketed in variety of formats; they can be filled, unfilled, tinted, clear or opaque. They may be polymerized in variety of ways.
The first generation of fissure sealants is ultraviolet light cure, the second generation is chemically cured (autopolymerised) and third generation is visible light cure. The fourth generation fissure sealants are those containing fluorides.
TYPE OF FISSURE SEALANTS
A)
1. Three different kinds of plastics have been used as occlusal sealants:
a) Polyurethanes
b) Cyanoacrylates
c) Bisphenol a glycidyl methacrylate (BIS-GMA)
2. Resin based sealants
3. Glass ionomer sealants
4. Fluoride containing sealants
B)
1. Filled and unfilled
2. Light cured and chemically (self) cured
3. Clear and tinted.
INDICATION
- Presence of deep occlusal pit and fissures of newly erupted teeth (molars and premolars).
- Presence of lingual pits or palatal pits in relation to upper lateral incisors and molars.
- Presence of incipient lesion in the pit and fissure system.
- Children and young people with medical, physical or intellectual impairment with high caries risk.
- Children and young people with signs of higher caries activity and coming from non fluoride area.
CONTRAINDICATION
- Presence of shallow pit and fissure of molars and premolars.
- An open occlusal caries lesion with exetension into dentin.
- Presence of large occlusal restoration.
- Presence of proximal caries extending on to occlusal surface.
- Partially erupted tooth where in isolation is a problem.
- Unco-operative children
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TECHNIQUE FOR SEALANT APPLICATION
STEP 1: Prepare the teeth
-Clean the pit and fissure surfaces
-Utilize a dry toothbrush, properly cup with pumice or properly paste or air abrasion
-Use an explorer to remove any debris in the pit of fissure
-Rinse for 20-30 seconds
-Reevaluate surface for residual or loose debris
STEP 2: Isolate the teeth
-Use cotton rolls, dry angles and rubber dam.
STEP 3: Dry the surfaces
-Dry teeth with air for 20-30 seconds
-Check to make sure there is no moisture coming out of air syringe tip
STEP 4: Etch the surface
-Apply etchant as directed by manufacturer
-Usually between 30-60 seconds
-If using gel or semi-gel apply gel and let stand for allotted amount of time
-If using a liquid continue to apply etchant throughout the etchant time
STEP 5: Rinsing and drying the teeth
-Rinse surfaces for 60 seconds
-Check for effectiveness of etchant by drying with air, surface should appear “chalky white “
-If not, repeat etching procedure
-Placement of new cotton rolls and dry angles
-Dry teeth with air for 20-30 seconds
STEP 6: Application of sealant material
-Self curing: Mix equal parts of the two components
-Will polymerize in 60-90 seconds
-Light curing: Apply with syringe provided by manufacturer
-Apply curing light to material
-Will polymerize in 20-30 seconds
-Evaluate sealants for any voids, marginal discrepancies, or retention problems
-If noted return to step 2
STEP 7: Occlusal evaluation
-Check occlusion with articulating paper
-Adjustments must be made with filled resins
STEP 8: Setting re-evaluation sequence educating patient of the importance in having the sealants evaluated on six month basis
Baby bottle tooth decay also known as early childhood caries is a syndrome characterized by severe decay in the teeth of infants or young children. Baby bottle tooth caries is very common bacterial infection.
Causes and risk factors of baby bottle tooth decay:
This condition occurs when the baby’s teeth are exposed frequently and over a long period of time to the sugars presents in liquids such as milk formula and fruit juice. Bacteria in the mouth use these sugars as food.
They can produce acid attack for 20 minutes or longer. After many attacks the teeth can decay. This condition is known as baby bottle tooth decay or early childhood caries (cavities).
Mostly group of bacteria called streptococcus mutans and lactobacillus species are responsible for caries.
Symptoms:
- Upper front teeth appear teeth decay
- The decay looks like small dark holes or dark pits.
- Even broken teeth
- Pain and fever may also appear
- Difficulty in speaking or chewing
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TREATMENT:
1.FILLING:fill teeth by removing caries with dental hand piece and replacing it with material such as silver amalgam, composite resin, glass ionomer.
2.CROWN:“crown” or “caps” are used if teeth caries is extensive and there is limited tooth structure, which may cause weak teeth.
-large filling increase risk of tooth structure
-caries is removed and repaired and a crown is fitted over the remaining portion of tooth.
3.ROOT CANAL: When the nerve in tooth dies from caries or injury.
Pulp portion of tooth is removed along with caries of tooth. Roots are filled with sealing material. The tooth is filled and crown may be placed over tooth.
4.TOOTH EXTRACTION:when tooth is severe destroyed from dental caries and unable to restore teeth.
PREVENTION:
The good news is that tooth decay is almost completely preventable. You can help prevent tooth decay for your child by following the tips below:
-ORAL HYGIENE:
• Lower the risk of the baby’s infection with decay-causing bacteria. This can be done two ways – by improving the oral health of the mother/caregiver which reduces the number of bacteria in her mouth and by not sharing saliva with the baby through common use of feeding spoons or licking pacifiers and giving them to babies.
• After each feeding, wipe the baby’s gums with a clean, damp gauze pad or washcloth. This will remove plaque and bits of food that can harm erupting teeth. When your child’s teeth begin to erupt, brush them gently with a child’s size toothbrush and water. (Consult with your child’s dentist if you are considering using fluoride toothpaste before age two.)
• When your child can be counted on to spit and not swallow toothpaste (usually not before age two), begin brushing the teeth with a pea-sized amount of toothpaste.
• Brush your child’s teeth until he or she is at least six years old.
• Place only formula, milk or breast milk in bottles. Avoid filling the bottle with liquids such as sugar water, juice or soft drinks.
• Infants should finish their bedtime and naptime bottles before going to bed.
• If your child uses a pacifier, provide one that is clean — don’t dip it in sugar or honey, or put it in your mouth before giving it to the child. Encourage healthy eating habits that include a diet with plenty of vegetables, fruit and whole grains. Serve nutritious snacks and limit sweets to mealtimes.
• Ensure that your child has adequate exposure to fluoride. Discuss your child’s fluoride needs with your dentist.
- Diet for dental health
- Topical fluoride application
- Space maintainers
- Crowns
07 August 2012
Gold alloys contain gold, copper and other metals that results in a strong effective filling, crown or bridge.
Gold alloys are primarily used for inlays, onlays, crowns and fixed bridges.
There are two form of gold fillings, cast gold fillings(gold inlay and onlay) made with 14 or 18 kt gold and gold foil made with pure 24 kt gold.
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1.GOLD INLAY
Gold inlay is basically gold filling which fits within the contours of tooth. The gold inlay involves the occlusal and proximal surface of posterior tooth and may cap one or more but not all of the cusps.
Gold inlay is custom crafted in dental laboratory to precisely fit tooth so it takes two appointments to restore tooth with an inlay.
INDICATION:
1. Replace over amalgam restoration.
2. When proximal surface caries is extensive.
3. Gold inlay restorations for class-1, class-4, class-5, and class-6 cavity.
2. GOLD ONLAY
Gold onlay involves the proximal surface of a posterior tooth and caps all of the cusps.
A gold onlay covers and protects the biting surface of a tooth that is severely damaged and not possible with dental filling.
INDICATION:
1. In posterior teeth after root canal treatment.
2. As a splinting to improve stability of the teeth.
3. Partial coverage of posterior teeth where significant loss of coronal dentine.
ADVANTAGE:
1. Strength (can withstand occlusal forces)
2. Long lasting life (at least 10 to 15 years)
3. Naturally beautiful
4. Gold is pliable.
5. Gold is versatile.
DISADVANTAGES:
1. Expensive
2. Galvanic shock
3. More visit
07 August 2012 0
Glass ionomer cement (GIC) is a dental restorative material used in dentistry for filling teeth and luting cements. These materials are based on silicate glass powder and polyalkenoic acid.
TYPES:
Glass ionomer are classified into five types.
1. Conventional glass ionomer cements.
2. Resin modified glass ionomer cements.
3. Hybrid ionomer cements. (Also known as dual cured glass ionomer cement).
4. Tri-cure glass ionomer cements.
5. Metal reinforced glass ionomer cements.
INDICATION:
1. Type-2 glass ionomer for restorations.
2. Type-3 glass ionomer for liners and bases.
3. Type-4 glass ionomer for fissure sealants.
4. Type-5 glass ionomer for core build up.
5. Intermediate Restorations.
6. Restorations for decidious teeth.
7. Adhesive cavity liners(sandwich technique)
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ADVANTAGE:
- Inherent adhesion to tooth structure
- High retention rate
- Little shrinkage and good marginal seal
- Fluoride release and caries inhibition
- Biocompatible
- Minimal cavity preparation
DISADVANTAGE:
- Brittle
- Soluble
- Abrasive
- Water sensitive during setting phase
- Less aesthetic than composite
CONTRAINDICATION:
- Aesthetic requirement
- Area of high abrasion
- Area of high occlusal load
Dental composite resins are types of synthetic resins which are used in dentistry as restorative material or adhesives.
Composite resins are most commonly composed of BISGMA (Bisphenol Glycidyl Methacrylate).
Now UDMA (urethane dimethacrylate) and TEGDMA (Triethylene glycol dimethacrylate) are also being used.
Fillers used are quartz, silica, tricalcium phosphate, zirconium dioxide. They provide strength, hardness, rigidity to the material.
Coupling agent binds the resin matrix to the filler particles. Organic salines are commonly used coupling agents.
Coloring agents used are aluminium oxide, titanium dioxide.
Composite are divided into types depending upon the size, amount and composition of the inorganic filler.
TYPES:
- Conventional
- Microfilled
- Nanofilled
- Flowable composite
- Laser curing composite
- Packable composite
- Antibacterial composite
Placement of composite requires an etchant and bonding agent.
-On the bases of how they can be used the composite fillings are divided into two types
Direct dental composite
Direct dental composite placed by dentist in clinical one visit.
Composites are available in many shades so according to color of tooth shade is selected to give best esthetic results through single shade, dual shade and multilayering technique.
Before putting the resin in the cavity the area treated with an agent that is called as the etching process.
After etching and bond is applied which is cured by light then composite is placed and is cured with light.
Direct dental composites can be used for
- Filling gaps (diastemas) between teeth using a shell-like veneer.
- Minor reshaping of teeth.
- Partial crowns on single teeth.
INDIRECT DENTAL COMPOSITE
This type of composite is cured outside the mouth.
Indirect composites can have higher filler levels and are cured for longer times
As result they have higher levels and depths of cure then direct composite.
Indirect dental composites can be used for
- Filling cavities in teeth as fillings, inlays and onlays.
- Filling gaps between teeth using a shell-like veneer.
- Reshaping of teeth.
- Full or partial crowns on single teeth.
- Bridges.
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Dental amalgam is the most commonly used dental restorative material used for dental fillings.
Fillings made with amalgam are also known as silver fillings.
Amalgam consists of combination of metals, these include silver, mercury, tin, copper and small amounts of zinc, iridium or palladium with development of tooth colored materials to restore teeth, amalgam is used less often than in the past.
INDICATION:
Amalgum restorations for class-1 cavity, class-2 cavity, class-3 cavity, class-4 cavity and class-5 cavity.
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ADVANTAGE:
- Long lasting and strong, with stand the forces of chewing.
- Less costly than the other material
DISADVANTAGE:
- amalgam doesn’t match with natural color of tooth.
- amalgam doesn’t bond with natural tooth.
- Requirement of cavity preparation to keep filling in place.
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