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What is Sialolithiasis –Definition, Pathogenesis, Clinical features, Treatment, Histopathology, Sialography.

Sialolithiasis

Definition- sialolithiasis is a pathological condition, characterized by the presence of one or more calcified stones (sialliths) within the salivary gland itself or within its duct.

Pthogenesis

The exact mechanism of formation of sialolith is not known. It is generally believed that initially a small and soft nidus forms within the salivary glands or its ducts due to some known reasons.

The nidus is made up of mucin, protiene acteria and desquamated epithelial cells.

Once a small nidus frms, it allows concentric lamellar crystallizations to occur due to the precipitation of calcium salts.

The sialolith increases in size with time as layer after layer o salts become deposited , just like growth rings in a tree.

Small sialoliths can be expelled in the mouth with the salivary secretions but bigger sialoliths continue to expand until a duct is completely closed.

It is important to note that the formation of sialolith is more common in relation to the submandibular gland and it’s duct.

sialolithiasis

Clinical features

Age- Sialolithiasis usually occurs among the middle aged adults, however, some cases are reported in children.
Sex- There is slight male predominance.
Sites- 70% in submandibular salivary gland and its ducts. Parotid gland is next

Clinical Presentation-

  • In many cases sialoliths do not produce any symptoms and are detected only on routine radiographic examination.
  • Chief complain ; intermittent pain, recurrent sumbandibular swelling, discomfort during meals.
  • Pain is drawing or stinging in mild cases but stabing and sharp in severe cases.
  • Stone in the duct can be palpated by bimanual palpation with both the fingers.
  • During examination the flow and clearness of the saliva should be checked.
  • Persistent swelling of the duct due to chronic obstruction by the sialolith eventually leads to chronic sclerosing sialadenitis.
  • Multiple stone or bilateral cases of sialolithiasis can also be seen.
  • Formation of fistulas, sinus tract, ulcerations in the area may develop in chronic cases.
  • Necrosis of gland acini and lobular fibrosis may occur which results in complete loss of secretion from the gland.
  • Parotid stones often cause firm swelling over the ramus of the mandible, the swelling over the ramus of the mandible, the swelling also increases during meals.

How Sialolithiasis is diagnosed
  • Radilography of sialolithiasis
  • Submandibular sialolithiasis are easily detected by mandibular standard occlusal radiograohs which typically disclose the presence of calcification in the floor of the mouth.
  • Whn a sialolith is located in submandibular gland area then a lateral jaw radiograph will be helpful in location the exact position of the stone.
  • Panaromic radiographs usually detect the parotid gland stones.
  • If only branches of the submandibular gland duct are affected a posterior occlusal film submento vertex and some time a lateral jaw film may be required.

 Sialography of sialolithiasis
  • Sialogrohy refers to the method by which detection of salivary stones within the glad or its duct is done by giving a retrograde injection of a radiopaque dye within the  duct system and obtaining a radiograph thereafter in order to see the size and distribution of the sialolith.
  • Ultrasonograhy and CTscan
  • These are also excellent non invasive technique useful in detecting the sialoliths

Macroscopic appearance
  • On gross examination, sialoliths appear as round or oval rough or smooth solid masses, which vary considerably in their size.
  • These stones are heavily calcified and are often multi nodular although some stones are found in small aggregates.
  • The color of the stone is usually yellowish or yellowish white.



Why Are My Teeth Getting Stained ?

Question- I go to my dentist regularly and get my oral prophylaxis & cleaning done in every 6 months, My teeth become pearly white after cleaning and their are no stains but they start getting stained in no time ! I can see visible stains after 3 weeks.Why are my teeth getting stained even when I brush properly.

Although teeth staining have multiple causes but the above case is a simple case of poor oral hygiene practice. I'm not saying that the person is not will to keep his teeth clean but he is actually practicing wrong oral hygiene techniques like not knowing proper brushing technique, not flossing and brushing only once in the morning.

Cause of teeth getting stained after scaling and cleaning:
teeth getting stained
Stained between teeth Img: www.smileartistry.com.au

After professional cleaning surface of your teeth become absolutely clean but as you start eating a soft Dental pellicle start to form on your teeth.It is a protein film that forms on the surface enamel by selective binding of glycoproteins from saliva.

When not cleaned and flossed properly oral bacteria start to make colonies on this pellicle layer and hence they for a layer called as Plaque. This plaque can take the colors of foods and beverages your consume and it looks like a staining on your tooth.when you get your teeth scaled and cleaned at the dentist he removes this plaque. When people does not get this Plaque cleaned and it keep on accumulating it becomes Calculus which is a calcified structure.

Foods & Habits That Cause Your Teeth to Get Stain


Tea Or Coffee:
Tea Or coffee contains such kind of plant extracts that have very high tendency of sticking as stains on your teeth. No matter what type pf tooth paste you use, no matter what type of brushing you do, if you are consuming tea or coffee more then once a day every day in a year then your teeth will catch stain.Either get a professional cleaning or change your habit.

Smoking: Tobacco smoke contains nicotine and tar these two ingredients are the main culprit for the smoking stains. tar has a black staining and nicotine has a yellowish staining property. So a smoker will have a blackish and line at the junction of the gums and tooth and yellowish hue on the teeth. Leave the habit, Get your teeth cleaned.

Red Wine- Red wine is made up of grapes which have natural colors these natural colors will bind with the tooth surface and result in teeth staining, but this process is low and mild and occurs to them who consume red wine regularly.

Some Cold drinks and Energy drinks: Cold drinks and energy drinks have coloring agents in them. These agents can deposit on the plaque of the tooth and then get solidify.

Some berries and veggies: I really don't think that veggies should be blamed for the staining of teeth but clinically it have been seen that there are some berries and veggies which have colored juices in them which can stick to the plaque and impart

Solution to Get Rid of Repeated Teeth Staining

Avoid stain producing habits and food.
Brush twice a day with correct brushing technique.
Use floss once a day.
Use inter dental brush to clean gaps between teeth.
Get oral prophylaxis done every 6 months.
Keep oral hygiene good.

What is The Blue Light Dentist Use : Is It Harmful ?

So you have been to the dentist and you saw a wand like thing in dentists hand which he puts in
patients mouth then it emits bright blue light with sound of beep !

No need to wonder what is that blue light emitting thing in dentists office.

 I'll Explain what is it, how it works and is there any chance of harm from it.

Blue light that dentists use is called as curing light.

How does blue curing light works ?

Blue dental light
Image Via : Wikimedia.org
It is a gun like machine which have electronic parts inside it. The source of current is the regular 220 volt AC current but a chip inside the machine converts it into much lower DC current and then it supplies it to the light emitting source.( Some guns are battery operated)

The light emitting source is a Quartz Halogen Or LED ( Light emitting diode) attached to the head of the gun. LED bulb have the capacity to produce high intensity of light with very effective use of electricity with least heat production as compared to other bulbs. hence a LED is used. (Don't miss judge it with lasers or any other thing) .

To make an angulated head a fiber optic cable is fitted at the head ahead of the LED bulb, this fiber optic cable can carry light to the head even when angulated at various angles.

Why is the dental curing light blue in color ?

It is mostly blue in color because the light is of longer wavelength which helps in deeper penetration of the light for better curing of the material. The wave length of the light may range from 370 to 510 nm. This light falls in blue spectrum of the VIBGYOR.

What is the blue curing light used for ?

This light is used for setting light activated filling materials.
In Technical Terms- There are dental restorative materials which come in semi solid or powder liquid form when mixed and packed into the cavity they get activated and start setting. Some material are photosensitive- That means setting reaction is initiated after light exposure. Blue curing light is used to cure this kind of dental materials.


Is the blue light harmful ?

No it's not harmful for the tissues inside your mouth or other skin or mucosal tissue, BUT it should never be directed to the eye or in other words you should not look directly into the light, because it have so much of intensity that it may harm retina of eye.

What is a orange colored shield ?

Due to the above cause there is a light barrier or orange color which dampens the light intensity if the operator is working and want to see the field of work.  For patients a orange colored glass will be given, if not given you should better keep your eyes closed.

Why Are My Teeth Getting Sensitive

Teeth getting sensitive means you are feeling sharp electric like pain on taking cold, sweet or sour food, this kind of pain is short in duration and it subside immediately after removal of stimuli.

If that is what you are experiencing then you are suffering from a clinical condition called as Dentin Hypersensitivity Or Sensitive Dentin.

Teeth crown is made up of outer Enamel layer (Don't have nerves), Dentin layer (have nerve ending in it) & Core of Pulp (nerves and blood vessels). Teeth root is made up of outer Cementum and then Dentin layer.

These enamel and cementum works as insulation to underling dentin from temperature and osmotic stimuli. So now you can figure it out that when ever enamel or cementum is damaged and dentin is expose people start to feel sensitivity while eating cold or sweet food.

Causes of Teeth getting sensitive:
Teeth Getting Sensitive
Picture showing Causes of Sensitive Teeth 


Gingival recession or receding gums: This is most common cause of teeth sensitivity gums cover the root which intern is covered by the cementum. when gums recession occurs then root get exposed and by the time when cementum is removed from brushing then tooth become sensitive. Heavy brushing and periodontal disease are two causes or gum recession.

Tooth wear: This is second most common cause: As you know that wear and tear is a natural process but when this process occurs at high speed and your enamel is lost at fast speed then your teeth does not get time to perform any kind of protective mechanisms. Hence tooth become bad before time and you can experience tooth sensitivity. Example of tooth wear- Attrition from teeth to teeth contact ( physiologic), Abrasion ( tooth brush trauma- Pathologic), Abfraction ( combination of both), Erosion ( chemical damage from the acid erosion of the enamel from consuming excessive cold drinks, Gastro esophagial reflux and many more)

Dental decay: Yes decay can also cause teeth sensitivity as decay causes destruction of enamel it exposes the dentin and when ever cold or sweet food comes in contact with that decayed tooth patient may feel sharp pain. which subsides on removal of the stimuli.


Treatments: Depend upon the grade and cause of sensitivity.

Removal of cause and treatment of underlying pathology followed by Desensitizing toothpaste, Desensitizing gel & Professional Dental treatment will completely cure your sensitive Teeth.

You can Check These Desensitizing Tooth Pastes If you want one.

Why are My Teeth Getting Loose

Teeth Getting Loose
Gum disease
Let me first make it clear what is the meaning of Teeth Getting Loose: You feel mobility in your teeth while eating and chewing, You may also feels that your teeth are not so strong while biting on solid food, some patient even complain of pain on biting with spongy and swollen gums associated with mobile and loose tooth.
All these signs indicate that the there is some underline condition which is compromising the bond between your jaw bone, gums and teeth and anchorage of your teeth are getting weak. Looseness of teeth indicate that your periodontium is not strong. Periodontium is comprised of Periodontal ligament, surrounding jaw bone and cementum of the tooth root.
Basic understanding of strong and healthy anchorage of tooth.
Periodontal disease
Periodontium
Teeth are anchored in the jaw bone with the help of periodontal ligament these are nothing but bone to the tooth root. cementum on the surface of the tooth root give attachment to the periodontal ligament this set up is called as periodontium. and it healthy for complete and strong anchorage.
collagen fibers which connect the jaw 
In Periodontal diseases like periodontitis and gingivitis this periodontium is compromised there is bone loos which causes the jaw bone level to come down and and expose the rot surface which intern leads to loos of attachment of periodontal ligaments. all this process results in loos of tooth anchorage and teeth getting loose.
How can you know if you have periodontal disease?
By self examination and by visiting your dentist.Take a mirror and go in well lit area preferably in natural light. then check for the color of the gums- healthy gums have pink color without any redness or blue hue, redness is the very first sing of gum diseases, Now check for the gum position- it should be at correct place not to low and not too high low means your gums are receding and high means they are swollen both are signs of gum problems. Now check for consistency of the gums; press your gums with your finger tip & it should feel firm and it should not be painful. If it feels spongy and painful that indicates gum problems. Bleeding tendency; If your gums bleed easily while brushing, flossing or while using tooth picks then it's high time for you to see your dentist.
Who are at the risk of gum disease and loose teeth?
Gum disease mostly affect the adults but this dose not exclude the children, Children and adults who dose not keep there oral hygiene properly are at equal risk of the gum diseases.
Other medical conditions like diabetes and pregnancy and other hormonal problems may also increase the chances of gum problems and teeth getting loose. Smoking worsens the gum problems because it dose not allow the gums to heal.
How can I avoid periodontal disease?
You can avoid periodontal disease by keeping your oral hygiene at the best, Just brush twice a day and use floss daily. If you think that your brushing is adequate then you are advice to use 2% chlorhexindine mouth wash daily after brushing. visit your dentist for oral prophylaxis and teeth cleaning every 6 to 8 months depending upon your oral hygiene conditions.
Correct brushing technique is very important learn about correct brushing technique and use it. If your manual dexterity is not good the you can use electronic tooth brushes for cleaning your teeth.
Is periodontal disease curable?
Gingivitis is easily curable and it's prognosis is very good, when you go to your dentist he will first examine your gums and check for the pocket depths using perodontal probe, after doing this he will advice you for teeth cleaning or oral prophylaxis. In this process a dental hygienist will use hand instruments or electronic scaler to clean all the surface of your teeth. This process will remove plaque and tarter from your teeth surface and you will get rid of gingivitis.
Periodontitis is actually difficult to cure because its origin is complex and most of the time it is modified by the medical conditions. First your dentist will check the pocket depth (it is a pocket formed between gums and tooth) and then depending upon the pocket depth he can suggest you about Scalling, dental curettage, Root Planning Or Flap Surgery.
Regular visit Good periodontist (specialist for treating gum disease ) and a good patient will eventually cure the problem.

Cauliflower Like Growth in Mouth !

Papilloma definition-  Papilloma is a common benign neoplasm arising from epithelial tissue of oral cavity and is characterized by an exophytic growth of the stratified squamous epithelium.

These lesions  constitute about 2 % of all oral neoplasms and it is belived by any investigators that they are cused by the human papilloma virus.

Clinical features

Age: mostly third, foruth and fifth decade of life
Sex: Both sexes are equally affected.
Site: Tongue lips, buccal mucos, gingiva, hard and soft palate.

Signs and symptoms: Clinical presentation


  • ‘Cauliflower like’ growth which is slow growing exophytic an small, it is usually painless unless traumatized. It have several small finger like projections on the surface. ( Images are graphic that is why we have not given it here check it at google images of papilloma)
  • Size is from millimeter to few centimeter in diameter.
  • Base is either pedunculated or brad based (sessile) but always well circumscribed lesion.
  • Some time it may appear as ovoid swelling with corrugated surface.
  • The surface of the papilloma is white because of highly keratinized epithelium.
  • A non keratinized lesion appears pinkinsh or grayish in color and it is softer in consistency.
  • Rarely an endophytic papilloma can be seen which grows inwardly.
  • Papillomatosis is a condition in which multiple papillomas are developed inside mouth.


Histological feature
Papilloma
Histological slide of papilloma


Proliferating stratified squamous epithelium in the form os multiple fingers like projections

Every single finger like process has a vascular connective tissue core in cener which conatins few inflammatory cells.

Covered with squamous epithelium which shows hyperkeratosis. and acanthosis.

Although most of the papillary projections are long and finger like there can be small round and blunt projections.

Sometimes there may be development of superficial ulcerations and secondry infection because in the oral cavity these lesions are often subjected to trauma.

Differential diagnosis

  • Verruca vulgaris
  • Focal dermal hyperplasia
  • Verruciform xanthoma
  • Verrucous carcinoma 
  • Fibro epithelial polyp.


Treatment

Surgical excision of the lesion including the base recurrence is rare.

What is Hairy Tongue: Pathogenesis Clinical Features and Treatment

Definition Hairy tongue is an unusual condition which occurs due to hypertrophy of the filliform papilla of the tongue along with loss of normal desquamation process This eventually leads to the formation of a pigmented thick matted layer on the tongue surface heavily coated with bacteria and fungi.

Pathogenesis: Why hairy tongue occur 
Hairy tongue
Hairy tongue

Normally the keratinized surface layers of the tongue papillae are continuously desquamated thourg
friction of the tongue with food, rough palate and upper anterior teeth. After desquamation tongue papillae are replaced by newer epithelial cells from below.

Lack of tongue movement due to local or systemic disease disturb the regular shedding of the keratin of the tongue papilla especially the filliform papilla.which lengthens and produces a hairy appearance on tongue surface.

Such hypertrophic papillae are often coated with microorganisms and become discolored by retaining pigments from foods, medicines and chromogenic bacteria etc.

Clinical Features of hairy tongue how does it look


  • Hairy tongue commonly affects the mid dorsum of the tongue.
  • Hypertrophy of the filliform papilla produces a thick matted layer on the dorsal surface hairy tongue in extreme cases may produce a thick lathery layer coating on the tongue surface and this condition is often known as early or encrusted tongue.
  • Hypertrophied filliform papilla often brushes sfot palate and produces gagging reflex.
  • Hairy tongue in many cases produces bad breath.
  • There can be irritation to the tongue due to accumulation of food debris and microorganisms.
  • Hairy tongue is considered as mirror of general health. Because it is associated with various systemic disease.


Treatment of hairy tongue.

  • Cleaning and scraping of tongue everyday
  • Application of topical keratolytic agents
  • Consumption of yogurt
  • The effected tongue papilla often rapidly returns to normal when long term antibiotics or oterh drugs are discontinued.


What Is Laser Filling For Treating Tooth Cavity

laser fillingDental cavities are becoming inevitable and dental restorative procedures are become more advanced day
by day. Laser filling is one of such advancement.The most commonly used lasers in dentistry are ND- Yag laser, Helium Neon laser, Ruby Laser.

LASER stands for Light Amplification by Stimulated Emission of Radiation.

In simple language a laser filling is a restorative procedure in which the decayed portion of the tooth is removed with the help of specially designed dental laser and then it is restored with the help of tooth colored cosmetic filling.

Details: 
The objective of any kind of dental filling is same:- Remove the decay and restore the tooth in biocompatible

and functional manner. Laser filling also follow these basic steps.

Step one: Take an X ray of tooth and see that cavity should be small and it should not be close to the pulp (nerve) of the tooth.

Step two: Remove the carious lesion using dental laser. A water jet is continuously flowing while the laser is removing the decayed tooth material from the cavity. This kind of removal does not produce vibration or heat while removing the cavity hence patient comfort is good and easily achieved.

Step Three: After removing the decayed portion of the tooth the cavity is disinfected by using chlorhexidine gluconate  solution. Cavity is irrigated and dried for the filling.
dental laser
Dental laser

Step Four: A biologically compatible restorative material like light cured GIC or Composite resin is used for filling and binding the prepared cavity. After placing and curing the restorative material normal anatomy and function of the tooth is restored.

Step Five: Occlusion is checked with the help of occlusal bite registration paper and high points are removed.

What are advantages of laser filling

No vibration because no use of drill or burs this makes it more comfortable and  easy for patient.
No Shot of anasthesia is required: Actually it depends upon the pain tolerance of the patients but in most cases no shot is required.
Fast: It really takes few minutes to complete the removal of caries and do the filling.

What are the drawbacks of laser filling

Can't be used in large cavities
Expensive
Can be performed by very few trained dentists ( Lack of availability)


                

What is a Dental Mirror Used For

Dental Mirror is a small round mirror placed on a handle with variable degree of angles to it. These mirrors can have different convergence like concave, flat or convex but mostly concave is used.

What is a dental mirror used for? 

There are three main uses of dental mirror by dentists.

1. Indirect vision- It is obvious to understand that there are lot's of areas in mouth where direct vision is not possible, Either dentist have to bend upside down or patient have to get fully supine and extend back which is very uncomfortable situation for both of them so mouth mirror will help. A dental student will learn dentistry by learning to work in indirect vision using mouth mirror or so called dental mirror, And they really deserve some respect.


Dental Mouth Mirror
Indirect Vision & Illumination with mouth mirror Img Via www.hu-friedy.com

2. Indirect Illumination- Same reason given above it is difficult to illuminate every deep and detailed areas of the mouth with dental chair light. So the dental mirror is used for illumination of the particular areas of mouth by reflected light from dental chairs light. Use of concave dental mirror really help in this kind of illumination.

3. Retraction- Retraction in dental surgery means retracting the surrounding tissue like tongue and cheek to expose the areas for proper vision and accessibility for instrumentation. Retraction of cheek and tongue is easy with help of dental mirror,  just place the mirror side of the mouth mirror toward the tissue and pull it away from the site of operation. As the mirror is smooth that is why patient don't feel irritation. A trained dentist will quickly switch between illumination, retraction and vision while doing a dental treatment. Again Respect For These Artists.

There are many ways for gripping and holding mouth mirrors like pen grasp, three finger grasp etc. but that is out of scope of this article, Various types of  mouth mirrors are present in the market today but No4 and No5 are used mostly with concave mirror on it.
So Now yo know What is a dental mirror used for Now share it with your friends using share buttons bellow
You can buy same kind of kit for cleaning your teeth from Amazon here.

What is a Dental Milling Machine

Dental Milling Machines are machines used to produce dental prosthesis like crowns and bridges and implant prosthesis by the process of computer added designing and computer added manufacturing process CAD CAM. As the name suggests dental prosthesis are made by milling a block of ceramic or zerconia or metal aloy into desired design.

Use of Dental milling machine have been introduced in 1980 but real use has started from 1990, in early days they have been cumbersome to use and too big to handle, this restricted its use to dental labs.
Dental milling machine
Dental Milling Machine

Components of Machine- Machine basically includes a Scanner, Computer and Milling Machine.

Scanner which scans the area of teeth and mouth on which prosthesis is going to be build. If scanner is

present at the chair side in a dental clinic then scanning can be done directly in mouth, if scanner is not present chair side then an impression is taken and model is prepared and then scanning is done on the dental model.

Computer and software do all the calculation and designing of the dental prosthesis. It takes the data from scanner and builds a 3 D picture of it then builds a prosthesis on that #D picture this data is then given to the milling machine so that it can start milling and start manufacturing the prosthesis.

Dental Milling Machine is a fitted with small heads which includes different kind of burs or milling points.
these are diamond coated heads of different shapes and designs made for different purposes of milling.


How is it different from older conventional dental crown and bridge prosthesis.

  • Dentist will first examine your mouth and diagnose the disease and problem.  
  • He will treat the defect by removing decay and treating infections by root canal treatment. 
  • In third step dentist will prepare the area for receiving prosthesis. 
  • He may take and impression for making model or he may directly scan the portion on which prosthesis is going o be made.
  • This dental model or scanned data is send to lab where it is feed to computer and then it makes a digital 3 D model of that scanning.
  • digital prosthesis is prepared on that 3D model and then this data is given to the milling machine. 
  • Milling machine prepares the exact replica of the 3D design.
  • This prosthesis is send back to dentist for checking and applying in patients mouth. 
A Video of complete process From Datron Dental Milling Machine