Showing posts with label Dentistry. Show all posts
Showing posts with label Dentistry. Show all posts

Sunday, August 21, 2022

Dry Socket: More Painful Than The Tooth Extraction

 

Dry Socket: More Painful Than The Tooth Extraction


Having a tooth pulled may be one of the most anxiety-inducing dental visits you will ever experience. But having the tooth pulled comes with an anesthetic of some sort, so you may feel nothing more than the prick of a needle (not pleasant, but tolerable). The true pain from having a tooth pulled comes from developing a dry socket (alveolar osteitis). The pain of alveolar osteitis can be unbearable, but it is almost always avoidable.


What Is Dry Socket?

The socket is the hole in the mouth left from the extraction of the tooth. It is typically protected by a clot that prevents the nerve from exposure to air and elements. According to the Mayo Clinic, dry socket occurs when the clot is dislodged before the extraction site has had a chance to heal. Once the clot is gone, the nerve is exposed to everything from the air you breathe to the food you eat, which can be extremely painful.


How Do I Treat It?

Over-the-counter medications like aspirin or ibuprofen can help relieve the pain, but it can become so severe that you may need a prescription pain medicine from your dentist or oral surgeon. If you believe you have lost the clot from your extraction site, contact your dentist right away. The dentist may need to clean the socket and pack it with gauze to protect it. To prevent the risk of infection, you may need to take an antibiotic. At home, you may be asked to rinse regularly with salt water to encourage the socket to heal.


How Do I Avoid It?

The American Dental Association recommends avoiding drinking from a straw or smoking after having a tooth extracted. If you take birth control pills, the estrogen in the pills can prevent effective clotting, so talk to your dentist or oral surgeon about the best time of the month to perform the surgery. Be sure to disclose all medications to your dentist, even those taken over the counter, to make sure nothing you take will add to your risk of dry socket. Follow all of your dentist's recommended follow-up care after your tooth extraction and be sure to go to your post-extraction follow-up appointment to avoid any complications.



Tuesday, January 13, 2015

Odontogenic Tumor : Defination & Classification

 

Definition: Odontogenic Tumors or neoplasms are a complex group of lesions derived from the dental formative tissues or their remnants ( tissues associated with the development of tooth and its supporting structures ). The constituent tissues in each of these neoplasms can resemble the various tissues found during normal odantogenesis,from inception of the tooth germ to tooth eruption.


The tooth formation or odontogenesis begins in the 6th week intra-uterin life and it originates from the oral epithelium covering the maxillary and mandibular alveolar processes .During the initial period “bud-like” swellings appear from the basal layer of the oral epithelium at specific location where individual teeth will appear from in future .


CLASSIFICATION OF ODONTOGENIC NEOPLASMS (TUMORS) 


Benign Odontogenic Neoplasms 

Ameloblastoma a kind of odontogenic tumor in left jaw:

Case courtesy of Dr Frank Gaillard, Radiopaedia.org


1.  Neoplasms of epithelial tissue origin 

a. Ameloblastoma

b. Squamous odontogenic tumor

c. Calciflying epithelial odontogenic tumor (CEOT)

d. Clear cell odontogenic tumor.


2.  Neoplasms of mixed tissue origin (Made up of both epithelium and mesenchymal tissues)

a. Adenomatoid odontogenic tumor (AOT)

b. Ameloblastic fibroma

c. Ameloblastic fibro-odontoma / fibroden-tinoma

d. Odonto-ameloblastoma

e. Complex odontoma

f. Compound odontoma

g. Calcifying epithelial odontogenic cyst.

3.  Neoplasms of the mesenchymal tissue origin 

a. Odontogenic fibroma

b. Odontogenic myxoma

c. Cementoma

d. Famillial gigantiform cementoma

e. Cementifyin fibroma

f. Bening cementolastoma


Malignant Tumors

1.  Odontogenic carcinomas :

a. Malignant ameloblastoma

b. Primary intra-alveolar carcinoma

c. Malignant variants of other epithelial tissue neoplasms

d. Malignant changes in odontogenic cysts.

2.  Odontogenic sarcomas :

a. Ameloblastic fibrosarcoma

b. Ameloblastic carcinosarcoma

c. Ameloblastic fibrodentinosarcoma


Neoplasms of Debatable Origin 

• Melanotic neuro-ectodermal tumor of infancy 

• Congenital gingival granular cell tumor (congenital epulis)

Tuesday, January 6, 2015

Ameloblastoma Complete Info (with Pictures)

 

Definition

Ameloblaatoma is a benign locally aggressive neoplasm arising from the odontoenic epithelium and it is the most common odontogenic neoplasm of the oral cavity.


Etiology

Exactily not known however , the following factors may predispose the formation of ameloblastoma:

  • Trauma.
  • Infection.
  • Previous inflammation.
  • Extraction of tooth.
  • Dietary factors.
  • Viral infection.


Clinical Features

  • Incidence Approximately 1 percent among all oral tumous.
  • Age- second, third,fourth and fifth decade of life , the mean age of occurrence is about 32 years. This lesion occurs more commonly in blacks than whies.
  • Sex-  Males are affected more often females.
  • Site- Ameloblastoma in most of the cases involve the mandible (80%), especially in the molar-ramus area (70%) , although some lesions may develop in the premolar (20%) or symphysis (10%) regions.
  • Maxillary tumors also commomly involve its posterior part  and the lesions ofter have a tendency to invade into the antrum (15%) or the nasal floor.
  • Extraosseous ameloblastomas can rarely occur mostly in relation to the gingival.


Clinical Presentation


  • Clinically ameloblastoma commonly presents a slow enlarging,painless,ovoid or fusiform,bony hard swelling of the jaw.
  • The lesion causes expansion and didtortion of the cortical plates of the jawbone and displacement of the regional teeth; these are often leading to gross facial asymmetry.
  • Pain ,paresthesia and mobility of the regional teeth may be present in few cases.
  • Most of the be patients report with a typical long time history of presence of an “abscess” or a “cyst” in the jow bone that was operated on several occasions but has recurred after each attempt.
  • Lerger lesions of ameloblastoma often cause severe expansion ,destruction and thinning of the cortical plates , which often result in “fluctuation”or “egg shell cracling” of the affected bone.
  • Pathological fractures”,may occur in many such affected bones.
  • The mucosa overlying the tumor appears normal and the regional teeth are usually vital.
  • In some cases , smaller lesions may remain asymptomatic for a longer duration of time and are detected incidentally during routine radiographic examinations.
  • Many untreated lesions may reach to an enor –mous size with time.
  • Sometimes larger lesions may perforate the cortical plates and protrude outside the bone as a modular mass.
  • Maxillary tumors can invade into the maxillary air sinus and extend further up to the orbit or the nasopharynx;thereby or nasal obstruction,etc.
  • Some of the lesions may progress to ethmoidial air sinuses or even up to the cranial base.
  • Extraosseous ameloblastoma often produces a small ,nodular growth in the gingival.


Radiological Feature

  • Radiographically ameloblastoma usually pre-sent a well-defined,multilocular ,radiolucent area in the bone with a typical “honey-comb” or “soap-bubble” appearance. Few lesion can be unilocular too.
  • The lerger lesions often couse expansion,dis-tortion or even perforation of the cortical plates.
  • In radiograph the lesion typically exhibits an irregular and “scalloped”margin. 
  • Resorption of the adjoining normal teeth is often seen in rapidly growing lesions.
  • Ameloblastoma can cause expansion of the lower border of mandible. An irregular,”scallo-ped margin “ are often the typical features of ameloblastoma.
  • An the neoplasm progresses it sometimes become associated tooth (mostly the third molars) and in such cases the lesion may be resemble a dentigerous cyst.


Differential Diagnosis

  • Odontogenic keratocyst (Primordial cyst)
  • Dentigerous cyst
  • Central giant cell granuloma
  • Central hemangioma
  • Aneurysmal bone cyst
  • Fibromyxoma.


Macroscopic Features

  • On naked eye examination the tumor presents a cylindrical or fusiform swelling, which expands the bone so the severely that it can bebroken by digital pressure (egg-shell crrackling).
  • Perforation of the bone with subdequent protrusion of the tumor outside the bony wall is often noticed.
  • Cut section of ameloblastoma often appears as a “grayish-white”mass ,which contains some ‘cyst-like ‘ spaces. However no calcified is usually found within the tumor.
  • Some lesions are made up entirely of solid tissue mass although most of them have some cystic spaces of varying size within them.
  • Some intratumor cysts are large and contain either a straw colored fluid or a semi solid gelatinous material.
  • Sometimes one or two teeth may be present within thw lesion.


Histopathological Features

Histologically ameloblastoma shows neoplastic proliferation of odontogenic epithelial cells mostly in two distinct patterns ; (i) Plexiform type and (ii) Follicular type.


Plexiform Ameloblastoma

  • In this variant of ameloblastoma the neoplastic odontogenic epithelial cella proliferate in the form of “ contimuous anastomosing strands”. 
  • This patterm of neoplastic cell proliferation is also often called a “ fishnet like” pattern of arrangement.
  • The peripheral layer of cells tall columnar in nature and they often resemble the amelo-blasts.
  • Reverse polarization of the nucleu of these bordering cell is indistinct.
  • The cells situated at the center portion of the strands often resemble the stellate reticulum cells;while the cells located  berween the columnar cells and stellate reticulum cells often resemble the startum intermendium.
  • The intervening connective tissue stroma is usually thin , with minimum cellularity and often it show multiple areas of cystifications , which may be either large or small in size .


Follicular Ameloblastoma 


  • In follicular type , the neoplastic odontogenic epithelial cells proliferate in the from of multiple , discrete , follicles or islands within the fibrous connective tissue stroma.
  • Each follicle-like structure is bordered on the periphery by a single layer of tall columnar cells resembling ameloblasts. these cells have well-defined neclei situated away from the basement are called “reverse polarization” of the cell nuclei.
  • The cells located at the center of the follicles are loosely arranged and are triangular in shaps;these cells are widely seiarated from one another and they often resemble stellate reticulum cell (normally seen in the bell stage of odontogenesis)
  • While the cells located in berween the peripheral and the central group of cells appear as the stratum intermedium.
  • Occasionally a distinctive zone of hyalinization is seen surrounding the follicles.
  • Microcyst formation is often observed inside these follicles and the cysts sometimes may be large enough to occupy the entire inner part of the follicles.
  • Most of the follicular ameoloblastomas exhibit cyst formation particularty if the lesion is large.
  • The intervening connective  tissue strimas is delicate in nature and it consists chifly of collagen bundles,fibroblasts and blood vessels etc.
  • Extraosseous ameloblastoma consists of basaloid cells or they may even resemble the conventional intraosseous ameloblastomas.


Other Histological Types of Ameloblastoma

Besides the plexiform and the follicular types some other histological types of ameloblastomas can occur and they are as follows :


Acanthomatous type of ameloblastoma: It occurs in relation to follicular ameloblastoma and in this type the stellat reticulum-luke cells at the center of the follicles undergo squamous metaplasia. Sometimes the neoplastic epithelial cells can even produce “keratin pearls” whith the follicle the meoplastic cells may exhibit individual cell keratinization.


Granular cell type of ameloblastoma: In this type the cytoplasm of the stellate reticulum like cells and even the ameloblast like cells appear swollen and the cells are often densely packed with multiple, coarse,eosinophilic granules.Histologically this lesion often resembles “granular cell myoblastoma” and ultrastructural studies indicate that these geanules are either lysosomal elements or residual bodies.


Besal cell type of ameloblastoma: this lesion shows excessive proliferation of cuboidal shaped,bassaloid cells in narrow strands with the absence of stellate reticulum or other located cells The tumor often resembles basal cell carcinoma.


Cystic type of ameloblatoma: these lesions often exhibit multiple,small,microcyst formation inside the tumor.Some of the cysts are large in size


Desmoplastic type: In this type the epithelial islands or the strands are amall in size and the cells are ceboidal in shape and darkly stained.The cells of the epithelial components are widely separated by dense fibrous tissue. In this cells often penetrate into the surrounding trabacular bene.


Histogenesis of Ameloblastoma

Ameloblastoma develops from the odontogenic epithelial cells or their remnants but the exact cell of its origin is not very clearly known.According to different investigators, the possible cells or tissues from where ameloblastoma may arise are as follows.


  • Enamel organ of the developing tooth gern 
  • Cell rest of Serre (remnsnts of dental lamina)
  • Epithelial lining of the odontogenic cysts especially the dentigerous cyst.
  • The basal cell layer of the oral epithelium (rarely)
  • Cell rest of malassez.


Treatment

Surgical enucleation of the tumor and thorough curettage of the surrounding bone.Sometimes radical surgical approach may have to be adopted in case of repeared recurrences of the lesion Some tumors may cause distant matastasis.


Friday, May 6, 2011

6 Steps and Tips to Improve Your Tooth Carving.

 

For a dental students tooth carving is one of the first difficult task which he/she encounters in dental school. I faced same problems when I was a dental student but I loved tooth carving because I knew about the fact that tooth carving is basic step in building the dexterity required to become a successful dentist.

Today I'm writing down all my tips and learning in point wise and summary fashion. You may not find this in any dental books online or offline in this way. But most important thing is that- 

it requires attitude and commitment to learn this art.


STEP 1. Read and understand the tooth anatomy

1.Before your guide gives you the demonstration- first thing you must do is read the anatomy of that tooth. If you will go empty mind its difficult to absorb anything from demo.

2.While reading the anatomy make point wise notes of the each surface of tooth. Facial, lingual, Mesial etc.

3.My favorite book for dental anatomy is Wheeler's Dental Anatomy, Physiology and Occlusion use it. it's a must and best standard text book.

4.Don't rely on memory keep this notes and Wheeler's book beside you while you are carving the tooth.


STEP 2. Get proper instruments   

   

1.Get a good quality Lecron carver for yourself. While buying the carver check for the sharpness of carver, don't take blunt carvers.


2.A Metal scale ruler is best for measuring dimensions, vernier caliper can also be used for perfection.


3.Take good quality of carving wax it should neither be too soft or too hard. too soft will be distorted and too hard will be difficult to carve.


STEP 3. Keep an ideally carved tooth in front of you

Ask some one like your teacher or fellow classmate or senior who are good at carving to do an ideal tooth carving for you, 


This have two benefits- 

1. You have an Ideal carving to look and learn,

2.You get a extra demo when you see your friend or senior carving the tooth. If no body is there to carve for you then get an Extracted tooth. 


Step 4. Start Carving

1.At the time when you start carving you should have good understanding of the anatomy of the tooth.

2.Start with gross carving of different surfaces - starting with facial then lingual, then mesial and distal, occlusal being the last.

3.While doing the gross carving keep measurements 1mm greater then what is needed this 1mm will be used in fine carving and finishing. 

4.After doing the gross carving, go for the fine carving for producing the details

5.Wipe the finished tooth with a piece of gauze. be careful not to apply pressure.


Step 5. Remove Distraction & Concentrate 

1.Find a comfortable place where there is least distraction.Carving needs lots of concentration,observation and learning don't take it casually.


Step 6. Do Imaginary carving

1.Just take a wax block and carve what ever comes in your mind, keep a model in front of you or just imagine and carve a sculpture.

2.This need not to be perfect or amazing, 

3.I'm asking you to do this because it have following benefits.-

You don't have to be perfect or follow any measurement so you carve with more relaxed mood. 

It will keep up the interest of carving.

You start to learn the properties of wax- how much pressure to apply and how to remove and cut wax. what to do what not to do. its a basic process of learning.


Bonus Tip no 7: Practice, Practice, Practice

Keep on trying and practicing to carve, It can not be mastered in one day,

More you carve better you get.

When you practiced enough with certain tooth, help your friends if they ask for it, Don't carve to complete their quota but give them demo and share your learning. 

Monday, January 3, 2011

How to Improve your Practical Hand or Dexterity In Dentistry.The Secret of that Perfect Hand.


Being a Dentist we are bit different from other health professionals.We treat our patients by working actively inside their mouth and we have to develop superior manual dexterity to achieve best results.

Consider average mouth opening of a person,it is not more then four fingers wide and what about the visibility and accessibility of our operating field? It’s weird!


 We work in a field in which people struggle to put a ‘Burger’ and we are expected to do miracle and yes we are doing miracles.

We perform detailed, meticulous procedures on a minute scale and margin of errors are in micro fractions, our instruments are sharp and invasive, loss of concentration will result in damage to vital tissue which is unacceptable.

I think its enough of self praising!


So what is this so called Good practical hand ?


Use of fingers involve fine motor skills It is called as Clinical dexterity in proper terms and it is skill in performing task especially with hands.


Clinical dexterity or abilities to perform task with hands develop over time,starting with primitive gestures such as grabbing at objects to more precise activities that involve precise eye–hand coordination.Improving your clinical dexterity involves practice of same procedure multiple time in controlled way, In this way small muscles of your hand will be conditioned for the procedure. This is called as developing Fine motor skills and these are the skills that involve a refined use of the small muscles which control the hand, fingers, and thumb. The development of these skills allows one to be able to complete tasks such as writing, drawing, buttoning and finally doing dental procedures.


 How motor skills are developed?

You must know that there are two types of motor skill.


Gross motor skills include lifting one's head,turning,moving head etc.Generally large muscles develop before smaller ones, thus, gross motor development is the foundation for developing skills.

Fine motor skills include the ability to manipulate small objects,and various eye–hand coordination tasks. Some examples of fine motor skills are using the pincer grasp (thumb and forefinger) to pick up small objects,like holding endodontic files.


Two Essential Things that affects your motor skill:


1.Hand-eye coordination:

One more important factor for a dentist is good hand-eye coordination. Hand–eye coordination is the coordinated control of eye movement with hand movement, and the processing of visual input to guide reaching and grasping along with the use of proprioception of the hands to guide the eyes.


2.Correct Positioning : 

Positioning is very important for engagement in fine motor tasks. A dentists seat should allow him to sit comfortably with his feet placed firmly on the floor. His hips, knees, and ankles should be at 90 degree angles, with his torso slightly forward. His operating field should be approximately at the level of his elbows when his arms are at rest at his side.Keep in mind that trunk stability is necessary for good mobility of the arms, hands, and fingers.


Interesting Fact: Ambidexterity is a specialized skill in which right and left both hands are equally dexterous and dentist can use any one of his hands as dominant one while working.


How can you build your skill by the time you proceed in your dental school :


 1.Start with simple manipulation of dental materials: how to hold spatula and bowl. What is the correct technique of mixing? Don’t dare to underestimate it. it will build foundation of your dexterity as well as your confidence and in bonus you will learn about properties of dental materials. If a dentist cant manipulate plaster or alginate it’s hopeless.


2.Wax block carving: Enjoy your carvings. Carve the anatomy of ALL teeth not for completing quota but for fun. Never ask anybody to carve for you. Dedicate as much time as you can in understanding and reproducing the anatomy of tooth. Not only teeth but you can do your imaginary carvings .Get an idea from your surroundings try to carve it on wax block and if you make something good don’t keep it to yourself Show it to your classmates, teachers and seniors get appreciated, this is the secret of building positive attitude, every time you get appreciated your confidence is improved your hand is improved.


3.Making miniature models/ sculptures: out of dental materials like plaster and modeling wax is one of the favorite things I did in my college time. I used to make something out of any dental material which can be manipulated. Fortunately I got Best crafts award in   “Colors 2009” annual function. Try doing!! its real fun. Beside it will improve your dexterity and confidence.


4.Preclinical Work: Take your preclinical very seriously. This is the step before handling real patients. This is to prepare and train you for your clinical work. If you try to skip it or take it lightly. You are going to do blunders in your patient’s mouth. Become through with the basic theories try to do work as ideal as possible. Complete your quotas and work hard to do so.


5.Clinical Work: A sound practical knowledge is necessary for doing clinical work it’s the humans on which we are working on. we have to read lots of literature to understand and build good practical knowledge. It’s important to note that I am not asking you to mug-up the theories, I am asking you to understand it, analyses it and be able to Execute it when needed.While working on patients be calm and controlled try to execute the ideal work style ( I know it not 100% possible but try to be close to it) if you know you will have particular patient in particular days ex- extractions in  oral surgery posting  then do your preparations. Find books on local anesthesia read the technique for blocks arrange a skull and mandible find some one good in that to demonstrate you the landmarks and technique. Try making mental map and imagine it in patients. Believe me if you are prepared you will be less anxious and more confident. Try to apply this in every department, if you know you have to treat patients be prepared for it. Never go empty head you will not get anything accept your frustration and scolding from your teachers.


Pattern of learning for Dentists- [ The Read, See and Do] formula

READ- your text before any Demonstration, don’t go blank for any demonstration.


SEE – Observe carefully with full concentration what your Teacher or Guide is demonstrating. Humans have amazing photographic memory use it.


DO- Try to execute it as soon as possible our memory is very volatile try not to rely on it. Doing soon means you retain most of the part of demonstration.


So now we know how it works and how it can be developed. First and foremost thing is your interest in dentistry. The person aspiring to become dentist should be self motivated and ready to accept this challenging field. This field require long period of Training, Patience, Hard work, Endurance and Dedications. (It’s important to note I have not written the word intelligence because I don’t think it’s need in starting because you will develop it by time if you have above mentioned qualities).


Its not important where you start its important where you end.


Conclusion

This article is not for those who want to achieve there goals by hook and crook or just want a degree.I am writing this article for those who want self improvement and want to achieve there goals by there work and prove themselves.This field is for tough people and hard workers don’t opt it if u don’t think you are one of them otherwise you will end up in frustration and failure and if you are dedicated then don’t worry because one day you will develop these qualities and achieve success.