Frequently Asked Questions

Bleeding gums is an indication of (gingivitis) gum inflammation and /or infection. Do not neglect this as it could progress into periodontal disease. Many times dental scaling (cleaning) can correct gingivitis which is caused by accumulation of plaque and tartar. Scaling is relatively painless procedure and your dentist will check your gums and surrounding soft tissues for presence of pockets and bone loss to arrest or prevent further damage.

Periodontitis means a condition in which the patient has infection in gums and supporting bone. This may cause bad breath, loosening of teeth, abscesses or pus formation etc. Periodontitis can be treated by gum surgery and /or bone graft to save teeth.

With advances in dental materials and techniques, it is now possible to save a badly decayed tooth by doing root canal therapy, post and core build-up and crowns. Dentists generally try and save the natural tooth whenever possible unless it is badly broken, not restorable or non-functional.

Bad breath can be caused by multiple reasons, oral and extra oral. The most common intra-oral reason for bad breath is gum disease and dental decay other reasons could be enlarged tonsils, sinusitis, medications, stomach problems etc.

Space is created after a tooth is lost (i.e by extraction). This space over a period of time tends to close by drifting of other teeth. i.e. The adjacent teeth try to move and fill that space.

Opposing tooth too supra-errupts (move from the bone) and fill that space.

This not only creates mal-occlusion (gaps between teeth which tend to accumulate more tartar) but also the periodontium of rest of the teeth (i.e. gums & bone) is weakened and teeth may be lost with period of time.

So to maintain good health of other teeth, replacement is important.

A replaced teeth serve following functions :

• Aesthetics (Appearance & looks)
• Functions (Chewing)
• Speech
• Support for the soft tissues viz:lips, cheeks etc

Most common cause of bleeding gums & fetid breath is improper oral hygiene. Our teeth, if not aligned properly, or due to improper brushing can lead to plaque accumulation and over a period of time calcifies to form stone like layer on & in between teeth, which irritates the gums (Gingival) to cause bleeding which can further progress to bone and infect it leading to ultimately loss of teeth, if still unattended. This is a very silent and painless process, not giving any symptoms to the patient to come to a dentist. Thus, a regular checkup is mandatory for overall dental hygiene, because “Prevention is better than cure” goes very well for your dental health.

Scaling (Cleaning) & polishing can help stop the periodontal diseases. Scaling means removing the calculus (tartar) with an ultrasonic vibratory metallic tip with the help of jet of water, and if the tartar is below the gums, the deep cleaning is required which is normally done under local anesthesia and the root surface of tooth is cleaned, which is very sensitive and not as strong as enamel. Some cases require Periodontal Surgery (Flap Surgery) where the entire gums are raised and the root, bone and the tissues are thoroughly cleaned with a curette. Diseased tissues are incised (cut) and sutures are given, which are removed after 7 days of healing. The dentist’s job is completed and the patient’s job of regular maintenance of twice brushing, cleaning gaps if present with a inter proximal brush, massaging gums & regular follow up to assess one’s maintenance by dentist, the same way as a student is periodically assessed for its work by a teacher, a car by a mechanic & so on. Regular check up (Periodic recalls of 4-6 months) helps to even keep a check on cavity formation.

Most probably the condition is ‘pericoronitis’ i. e. when the wisdom tooth is erupting or not correctly aligned with the other teeth, the tooth is partially or completely covered by soft tissue mass (operculum) which tends to get inflammed and the pain is severe often radiating to the ear, eyes, lymph nodes and that area gets tender & swollen. Antibiotics & analgesics (pain killers) are prescribed if case demands. The other condition might be that, it may be carious (decayed). In either of the condition, if wisdom tooth is affecting the adjacent tooth, it is wise enough to get it extracted − surgically before it causes damage to adjacent tooth by root carries (most common).

Orthopantomograph (panoramic) radiography is x-ray of the whole mouth in which one can see the upper, lower dentition, the upper jawbone − maxilla, lower jaw − mandible, and the joints of mouth opening closing, TMJ and − the maxillary sinus. It can give a big picture and help the doctor and patient to get − a complete view of the oral cavity.

When: The root canal treated tooth is badly broken down and to replace the coronal portion of tooth with a filling, a support is required from the root. How: A very small screw (prefabricated – Post) is placed in one of the wide canals of the tooth and then a core build-up of permanent-filling of coronal portion is done which will receive a crown (cap).

With a tooth like dental material (composite) the fractured portion of tooth can be repaired and built-up to resemble the original size, shape & contour of the teeth. Porcelain veneers can be made to cosmetically build up the missing tooth structure. If the fracture is big, you might need a Root canal Therapy and crown.

When: The root canal treatment is required when the cavity is very deep, infecting the pulp. This may cause pain which comes on and off, progressing to nocturnal pain and finally necrosis of the pulp with infection going beyond the root of the tooth and at times pus formation and swelling. There can be severe pain in the infected tooth .Sometimes the pulp becomes nonvital or dead, in such cases there might be no pain but the infection is growing inside pulp. Why: R.C.T. saves the tooth which otherwise would go for removal (extraction). If natural tooth can be saved, there is no better treatment option other than R.C.T.

No. if the cavity is cleaned of the carious material and found not too close to the pulp or the patient does not experience discomfort, a treatment called indirect pulp capping is done, in which a medicated cement liner of calcium hydroxide is placed, which forms calcific barrier and protects the pulp, after which a permanent filling can be done, provided the pulp is vital (alive) checked with specific tests.

There are different options available for replacement of missing (lost) teeth. Removable, Fixed, Implants

Removable: It takes support of tissues and teeth both. It’s a removable plate with teeth and clasp (wire) which patient can place and remove by self (needs to be removed every night) So proper maintenance also required for same.

Fixed: In this, missing tooth is replacement taking support of adjacent teeth. So it becomes important that those teeth providing support should be sound. [In some cases restorations (fillings) or even root canal treatment for those teeth may be required.] And then, these supporting (abutment) teeth are shaped and reduced to receive crowns. So supportive teeth receive cap and missing tooth is replaced. (They are joined together) and this bridge is fixed by dentist and hence cannot be removed by patient.

Implants: In this, support for tooth to be replaced is taken, directly from the bone. So the bone should be sound enough. And then crown placed over the screw placed in the bone. It’s generally done in 2 stages with gap (interval) of 3-6 months (depending upon case).

Maintenance is most important

So whatever earlier treatment undertaken, needs to be reviewed at regular interval by the dentist.

Even if patient brushes twice, use floss & mouthwash. There are certain areas in oral cavity which are more prone to deposition of tartar which requires scaling. So, scaling every 6 months is essential.

If there is initiation of decay process, this can be best diagnosed by dentist (which may not be bothering you) and this can restored or filled before it progresses.

Preventive dental procedures in children involves Pit and Fissure Sealants and Fluoride application. Existing fillings are checked for any Secondary decay (decay around old fillings).

Every tooth has crown and roots. Crown is what you see in oral cavity and roots are deep down in the bone. There is pulp tissue (nerve) inside the tooth which is continuous both in crown and roots. This nerve is responsible for the sensation of pain, hot, cold etc.

When one gets pain which is intermittent only on cold or sweets, it generally indicates a reversible condition, i.e. there is decay in tooth but not so deep to involve a nerve, so only removing the decay and restoring it with a restoration (filling) can suffice.

But when the decay is deep enough, close to nerve or involving nerve, or with infection below the roots i.e. in the bone, only restoration (filling) cannot suffice. In this case decay and nerve from crown & roots till the apex need to be removed.

Canals in the roots are then thoroughly cleaned & shaped & disinfected and then filled with an inert material.

After the root canals are filled, the top or the coronal tooth structure is restored with a core build up material with or without a post. The tooth is then protected by a crown.

This root canal treated tooth serves its function of chewing, aesthetics and maintenance of space. Although this tooth is no longer vital.

Root canal treated teeth tend to be brittle and may fracture under chewing load. In order to protect the tooth and to prevent it from fracture, crown (cap) becomes essential.

Wisdom (third molars) teeth that do not have sufficient space to erupt, tend to erupt angulated causing pressure on adjacent teeth. This might lead to accumulation of food particles between 2nd & 3rd molar & eventually leading to decay of 2nd molar and of 3rd itself. These 3rd molars are generally impacted i.e. crown partly or fully covered by bone, and these teeth many a time have curved roots making removal of teeth difficult. So, in cases like these, gums around the tooth are separated or incised and the bone is drilled to get access (View) to tooth for extraction. And sometimes even sectioning of tooth also required for removal. After the extraction of tooth, the wound is cleaned and debrided. Gums are placed back to its position by sutures (stitches) which are to be removed after a week (most cases). Patient may expect swelling for day or two post extraction which is taken care  by medications. Generally 3rd molar post extraction are not replaced.