Panoramic X ray
The Panoramic x-ray or Panorex as it was initially called is considered the 'work horse' of dentistry. The Panorex is a large single x ray film that shows the entire bony structure of the teeth and the face. It covers a much wider area than a traditional intra oral film showing structures outside of their range including sinuses, temperomandibular joints as well as the position of the wisdom teeth. The panoramic x ray has the ability to scan the region of oral pharynx and surrounding tissues thereby increasing the dentist's diagnostic capabilities. The uninterrupted panoramic film is the most commonly used for obtaining clearly portrayed image of orofacial structures in dentistry. Other dental xrays include:
Bitewing x ray uses the least amount of radiation. It shows the upper and lower back teeth in a single view. They are used to detect decay between the teeth and to show how well the upper and lower teeth line up. Bitewing also indicates bone loss and the presence of severe gum disease or dental infection.
Periapical x rays show the entire supportive system of the tooth from the exposed crown to the end of the root and bones. They are used to detect dental problems below the gum line or the jaw. They also help to detect impacted teeth.
Panoramic x rays belong to the broad category of x rays called tomographs. The amount of radiation needed to expose a panoramic film is about the same as the radiation needed to expose two intra oral films. It is advised to use lead apron during panoramic x ray. In panoramic x ray, the x ray source passes around the patient and behind their head at a slight upward angle. Use of a lead apron helps in optimal prevention of the patient's body from scatter radiation of the panoramic x ray beam. Special panoramic lead aprons are available that cover both the back and front of the patient without interfering with the path of the X ray beam.
- Cysts, tumors, bone irregularities are also revealed in panoramic x ray.
- Impacted teeth that may be buried deep inside the jaw bone are shown in panoramic x ray.
- Panoramic x ray is usually taken when the wisdom teeth (third molars) are being evaluated.
- Panoramic x ray is used in dental implant surgery as it clearly reveals the possible complications in mandibular nerves.
- Panoramic x ray can also identify some not so common problems such as calcification within the carotid artery that may be indicative of a potential stroke.
- Panoramic films are especially good for forensic purposes in the identification of otherwise unrecognizable bodies after plane crashes or mishaps.
Gingivitis
Gingivitis involves inflammation of the gums surrounding the teeth. Due to this, the gums become soft and swollen and usually red instead of a healthy pink. The inflammation of the gums is a defense mechanism put up by the body's immune system to prevent the growth of bacteria which along with the remnant food particles and plaque form tartar. This cannot be removed by simple brushing or flossing.
What Causes Gingivitis Disease?
The primary cause of gum disease is plaque. However, there are various other reasons why gingivitis disease develops.
- Gums become sensitive when there are hormonal changes in the body, such as during puberty, pregnancy, menopause and menstruation. During pregnancy, hormonal changes and tartar induce excessive growth of gum tissues resulting in the formation of lumps commonly referred to as pregnancy tumors. These tumors prevent bacteria from being removed effectively during brushing, thus resulting in gingivitis disease.
- In post-menopausal women, a painful condition called desquamative gingivitis may develop, for reasons yet unknown. In this condition, the outer layers of the gums come away from the teeth and lose their solidity, resulting in the exposure of nerve-endings which causes acute pain.
- Long-term use of contraceptive pills can also result in gingivitis.
- Diseases that affect the immune system such as HIV or cancer may also affect the gums. Diabetes when uncontrolled, can affect the gums. On the other hand, gingivitis disease may also be a pointer to systemic disorders.
- Some medications can also cause gum disease as they restrict production of saliva which prevent the formation of tartar. Some medications used in the treatment of angina and seizures can cause abnormal growth of the tissues in the gums.
- Habits, such as smoking, do not facilitate the easy self-repair of the gums. A severe form of gingivitis, known as Trench mouth or ANUG (Acute necrotizing ulcerative gingivitis) is mostly found in the case of smokers. ANUG is also reported in the case of incapacitated persons under severe stress. Acute pain, swelling, bleeding and bad breath develop very quickly in this condition and also the gums turn grey.
- If gingivitis runs in the family, then there is a greater chance of a person getting it. Poor oral hygiene is a major contributor to gingivitis.
- Dental appliances not properly fitted or improper alignment of teeth may also cause gingivitis.
- Dietary imbalances, vitamin deficiencies, and drug reactions can also result in gingivitis.
- Gingivitis disease is also often caused by fungal and viral infections.
Symptoms of gingivitis
There is usually no pain associated with mild form of gingivitis. Hence it may go unnoticed. However, there are certain symptoms that warn that treatment for gingivitis is needed:
- When the gums are swollen, soft, or red.
- When gums bleed during, or after brushing.
- When bad breath or bad taste in the mouth persists even after brushing and flossing.
- When the gums recede.
- Deep pockets are formed between teeth and gums.
- Visible deposits of tartar.
If the dentist finds that someone is particularly prone to formation of plaque, he may recommend use of special implements to remove plaque, such as toothpicks, electric toothbrushes etc. This treatment for gingivitis would suffice when the gingivitis disease is in the early stages.
For reducing the pocket depth between teeth and gums, which can also cause gingivitis, dentists undertake root-planing and scaling. In addition dentists may also administer minocycline microspheres. For women who have desquamatic gingivitis, hormone replacement therapy could be beneficial. However, adverse effects of the therapy could prevent their recommendation. Instead, corticosteroid rinses and pastes which can be directly applied on gums may be more commonly recommended.
Pericoronitis is acute, painful inflammation of the gingival tissue over a partly erupted tooth (as in the case of a wisdom tooth). The treatment for this would include removal of the debris beneath the gingival flap and irrigation with saline. This may be followed up with extraction, particularly when there is recurrence of the episode.
Cosmetic Dentist
A cosmetic dentist is a general dentist with an added dimension. Besides performing the functional requirements of a dentist, the cosmetic dentist pays close attention to the appearance of the dental work. Cosmetic dentistry is not generally taught in dental schools as part of the normal curriculum. A cosmetic dentist, in addition to qualifying as a dental graduate needs to pursue additional training after graduation and undergo specialist accredited training in the field. Cosmetic dentistry covers a multitude of procedures that improves the beauty and health of one's smile. Cosmetic dentistry can be as simple as re-contouring of one or more teeth or as comprehensive as an aesthetic and functional rehabilitation. Cosmetic dentistry can brighten a dull teeth, whiten stained teeth, close gaps between teeth, repair chipped teeth, mask metal fillings and straighten crooked teeth.
- When a person's teeth are short or long, stained or chipped, misaligned or over crowded, a cosmetic dentist renders multiple cosmetic dentistry treatments and transforms the unattractive smile of a patient.
- A cosmetic dentist places porcelain veneers over the teeth to mask virtually any cosmetic problem.
- A cosmetic dentist can remove the coffee, tea and cigarette stains from the teeth. These stubborn stains cannot be removed by brushing alone. Special teeth whitening procedures can help eliminate these superficial stains. Staining caused in teeth due to aging or medication usage can also be removed.
- A cosmetic dentist addresses minor cosmetic issues including jagged or chipped teeth and noticeable gaps between teeth. Dental bonding is an ideal solution for such minor imperfections. The cosmetic dentist uses a tooth bonding material and masks these imperfections.
- Tooth decay is one of the commonest of problems among all ages. A cosmetic dentist recommends filling the cavity with tooth colored white filling or reinforces the tooth with dental inlays or onlays.
- For a severely cracked and damaged or fractured tooth, when filling or dental inlays or onlays do not work, a cosmetic dentist uses 'dental crown' or caps.
- Old and unsightly crowns can also be replaced with ultimate all-ceramic crowns.
- A cosmetic dentist provides viable treatment options for patients with missing tooth or more teeth. 'Dental implants supported by dental bridges' are the most modern permanent solution to this problem. Sometimes patients can also opt for full and partial dentures.
- The modern alternatives of 'invisalign invisible braces' are used by cosmetic dentists in place of traditional metal braces to attend to crooked, misaligned or overlapping teeth.
- A cosmetic dentist renders gum disease treatment for painful, swollen or inflamed gums. A 'gummy smile' or excessive uneven gums are often helped with a 'gum life procedure'.
- Excessive tooth wear and grinding are often linked to jaw joint problems and headaches. A cosmetic dentist helps to alleviate these problems by using 'occlusal splint' or in severe cases treat with full oral rehabilitation.
- Depending upon the unique aesthetic needs and physical characteristics that change with age, the cosmetic dentist adopts useful procedures that are more suitable for achieving the look an individual desire.
- 'Combined techniques' are frequently used in smile design to create an ideal and natural looking smile. An example is 'bleaching' may be followed with 'minor orthodontics' and completed with porcelain veneers.
Techniques adopted by a cosmetic dentist
A cosmetic dentist adopts latest dental techniques to improve the treatment and reduce the 'chair time' of the patient. Some of the latest techniques are:
- Laser technology that adopt a 'no drill' technique
- Digital x ray technology
- Conscious sedation
- Computerized anesthetic delivery
- Diagnodent-laser cavity detection
- Tooth whitening
Bibliography / Reference
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