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Indian Association of Conservative Dentistry and Endodontics

I want the best for me

Everybody wants the best in everything for them, especially when its concerned with their health care. Restorations or most commonly referred to as FILLINGS which are the major phase of conservative dentistry are no exception. Times have changed, the way we look at things have changed. You may no more be interested in having a golden crown like a yester times hero, previously people wanted to know that they have been to the dentist by exhibiting their vibrant metallic fillings but nowadays its not so. If your friend finds out and asks you “Hi your new fillings looks pretty good... who is the dentist who did it ? ” it would sound very embarrassing for you and its a pretty bad publicity for the dentist. However metallic fiilings still exists, exclusively for back teeth under special circumstances. One more major change in the way of approach is that the concept of sacrificing even the healthy tooth material for the sake of making the restoration durable has changed, conservative dentistry have moved on even to ultra conservative dentistry the next generation dentistry. But however remember, Esthetics, Function, Durability are the three facets of your restorations. Your dentist would neither like to compromise on any of the above 3 nor you would want it to happen. However selecting the best for you would be a decision by your dentist after thorough clinical examination and discussion with you.

Tooth Decay

Tooth decay, also known as dental caries, is an infection usually bacterial in origin that causes a cavity in the hard tissues of the tooth. Tooth decay, is one of the most prevalent chronic diseases in the world. Tooth decay occurs when foods containing carbohydrates (sugars and starches) are left on the teeth. Initially, tooth decay may appear as a small chalky area, which may eventually develop into a large cavitation. The affected areas of the tooth change color and become soft. There are three layers of the tooth: enamel, dentin and pulp.If decay involves only enamel, preventive pit and fissure sealants are recommended. When decay extends from enamel to dentin, hypersensitivity of tooth occurs and can be treated with fillings. In advanced stages of tooth decay involving pulp, you might experience a tooth ache especially after consuming sweet, hot, or cold foods or drinks and treatment involves root canal treatment can be done.

Dental restorations

A dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure.

Types of Dental Restorations

There are two types of dental restorations: direct and indirect.

Direct restorations involves placing a soft or malleable filling into the prepared tooth and building up the tooth before the material sets hard. Eg: Amalgam, Composite.

Indirect restorations involves fabricating the restoration outside of the mouth using the dental impressions of the prepared tooth. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The impression is sent to a dental laboratory, which creates the dental restoration. At the next appointment, the dentist cements the restoration into the prepared cavity and adjusts it as needed.

Amalgam

Amalgam or most commonly called as the silver fillings are a group of restorations which have served as one of the strongest type of restorations since around 100 years. It has been a direct type of restoration which has stood the test of time and at times has been the only material that was available to the dentist in history. It's not a silver material as all think, but silver is a component of the restoration. Amalgam as you know is a synonym for blend. However in this blend, mercury is a component. There were times when the mercury content in amalgam was put forth for severe criticism, which was followed by a temporary ban on the material in few places of the globe.

However, the major U.S. and international scientific and health bodies, including the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.

Whatever said and done, if esthetics is not a major concern ie if a filling is in the back teeth, if strength is the major concern and if all the other circumstances permit the preparation of the tooth for an amalgam restoration, these types of restorations may be the best ones for you.

Glass Ionomers

Glass ionomers are a group of versatile direct tooth-colored filling materials. This type of cement has some unique features especially its strong bonding or the sticking nature to the tooth. These have some USP s especially their fluoride ( a chemical that is capable of preventing tooth decay or making the tooth more resistant to decay ) releasing ability to the tooth. They are used for restoring cervical abrasions ( These are primarily loss of tooth structure in the neck part of the tooth ie near the gums ), small wear facets on the grinding surface of the tooth. used for small fillings in areas that need not withstandheavy chewing pressure. Glass ionomers also are used to cement dental crowns.Thay are tooth-colored so the filling looks more natural.They contain fluoride that may help prevent further decay.A low incidence of localized allergic reaction is seen with Glass ionomers.

Composite Resin

Composite is a mixture of acrylic resin and powdered glass-like particles that produce a tooth-colored filling. This type of material may be self-hardening or may be hardened by exposure to blue visible light. Composite is used for fillings, inlays and veneers. Sometimes it is used to replace a portion of a broken or chipped tooth. The color and shading can be matched to the existing tooth thus it looks more natural.Composite is a relatively strong material,providing good durability in small to midsizedrestorations that need to withstand moderate chewing pressure. Fillings are usually completed in a singlevisit. They often permit preservation of as much of thetooth as possible. Does not corrode and the frequency of repair or replacement is low tomoderate. Inlays & Onlays

Procedure for Inlays & Onlays

Requires two dental appointments.

First appointment - Removal of decay Shaping of cavity Impression of upper and lower teeth

Second appointment - Metal try in Finishing and polishing Cementation

If the procedure is sensitive, local anesthesia is administered.

Advantages of dental inlay and onlay: Esthetic if tooth colored materials are selected Less time in the dental office per appointment. Strong restoration compared to direct restorations

Disadvantages of dental inlays and onlays: More number of appointments

Bad Breath (Halitosis)

Bad Breath (Halitosis) is an unpleasant odor exhaled in breathing. Identifying the cause of bad breath is the first step toward treating this preventable condition. Persistent bad breath or a bad taste in your mouth may be warning signs of underlying causes.

Bad Breathis also caused by Food –Garlic Onions Smoking Alcohol Dentures Periodontal or gum disease Enlarged tonsils or adenoids Systemic diseases such as diabetes, liver disease, or kidney disorders Pregnancy Not brushing regularly Medications.

Treatment for Halitosis

Specific treatment for halitosis will be determined by your physician or dentist based on:Health of your mouth Cause or origin of the condition Extent of the condition.

Root Canal Treatment

Any insult to the tooth in the form of dental caries or trauma crosses a limit within your tooth, ie if they have caused any irreversible damage to your tooth it may result in irreversible pain to you. In simple terms the infection has reached the heart of the tooth, the pulp. Logically when the heart is injured, it will send you a red alert and you need to pay some immediate attention. Your endodontist will advice you a root canal in that case. Root canal treatment is a procedure which involves removal of the infected tooth material and the pulp, intense cleaning and disinfecting of the root canals and filling the root canals till the root tip with an inert material that will provide an efficient seal till the root tip.

Two things may be of primary concern to you. One, is root canal a painfull procedure?

The answer is NO, it's a pretty comfortable procedure. The entire procedure will be done only under local anaesthesia. In special case scenarios when local anaesthesia alone may not be sufficient you may get your treatment done under conscious sedation (refer conscious sedation for further details). Post operatively, pain for 2-3 days is not very rare but the endodontist would prescribe the necessary analgesics (pain killers) required for you. Prescription of antibiotics is under the discretion of the dentist and would be suggested in case of a severe infection that would mandate the use of antibiotics.

Two, How many visits do I make to the dentist for completion of my RCT?

The answer is One or more. RCT at times can be completed in a single sitting. However, every single tooth is different, certain special case scenarios would definitely mandate one or few more additional sittings for the dentist to make it doubly sure that the root canals are clean and disinfected to the maximum. In simple terms, additional sittings would always be dictated by the tooth to the dentist.

Pit & Fissure Sealants

Sealants are a safe and painless way of protecting your children's teeth from decay.

A sealant is a protective plastic coating, which is applied to the biting surfaces of the back teeth.

Purpose

The sealant forms a smooth, protective barrier, by covering all the little grooves and dips in the surface of the tooth. Dental decay easily starts in these grooves.

Sealants are a safe and painless way of protecting your children's teeth from decay. A sealant is a protective plastic coating, which is applied to the biting surfaces of the back teeth. The sealant forms a hard shield that keeps food and bacteria from getting into the tiny grooves in the teeth and causing decay.

Procedure

Sealants are only applied to the back teeth - the molars and premolars.

The tooth is thoroughly cleaned, prepared with a special solution, and dried.

The liquid sealant is then applied and allowed to set hard - usually by shining and ultraviolet light onto it.

The process is usually quick and straightforward taking only a few minutes per tooth. The tooth is thoroughly cleaned, prepared with a special solution, and dried. The liquid sealant is then applied and allowed to set hard - usually by shining and ultraviolet light onto it.

The procedure is totally pain free, and the teeth do not feel any different afterwards.

No, it is totally pain free, and the teeth do not feel any different afterwards.

Sealants usually last for many years, but your dentist will want to check them regularly to make sure that the seal is still intact. They can wear over time, and sometimes the dentist needs to add or replace some sealants to be sure that no decay can start underneath them.

The sealant forms a smooth, protective barrier, by covering all the little grooves and dips in the surface of the tooth. Dental decay easily starts in these grooves.

Ideal Age

Two stages

Sealants are often applied as soon as the permanent teeth start to come through. This is usually between 6 and 7 years of age. The rest are usually sealed as soon as they appear which can be any time between 11 and 14 years of age.

Most dentists offer fissure sealing. In many cases it is available only privately. The cost varies from dentist to dentist, but it is usually good value. Ask for a written estimate of the cost before you start any treatment.