Most common questions that patients ask us when they visit our dental office

Our first blog and it's gonna be on something that I have always wanted to address since the first year of dental school. Patients' knowledge of their own teeth and the threats that they can pose. 

We often see patients walking in with lots of doubts in their heads and willing to explore and learn different treatment methods. Some of them even look up online for more information before their appointments. What gives me the most pleasure is explaining the entire process like the way our professors used to back when we started learning about what dentistry is. Once it struck me that most patients ask a common set of questions that never get appropriately answered. And that's how I landed up here, inclined towards learning more about my field and imparting the same knowledge to my patients and young dentists who are still looking for some simpler answers. 

Let's tackle the most common questions that we get asked regularly.

1. How does scaling work? Will it result in chipping off of enamel?

A. Understand the basics. Most commonly used methods of scaling at present are hand and ultrasonic scaling. Both the scaler tips are mostly made up of stainless steel. Ultrasonic scalers convert high frequency electrical waves to high frequency sound waves. Hand scaling has now become obsolete.

NO, scaling does not result in chipping off of enamel. However, it does result in minute scratches and roughness on the outer surfaces of tooth that are only detected by a scanning electron microscope. The incidence of damages depends on the type of method, instrument and technique of scaling. Several studies and clinical trials have concluded that ultrasonic scaling with stainless steel tips result in least amount of damage and titanium tips and curettes produce most damage and surface roughness. Further, hand scaling causes more irregular patterns and deeper scratches. Scaling has to be carefully done for teeth showing defects like enamel cracks, early caries or resin restorations.

2. Why is it said that PFM (porcelain fused to metal) crowns would affect a MRI scan?  

A. A potentially dangerous combination with a few reported cases. MRI is a diagnostic imaging tool in medicine that uses a powerful magnetic field and radio waves to create images of body parts to be examined.

Dental procedures like crowns, complete and partial dental prostheses, fillings, orthodontic brackets and implants use a wide variety of metals in their fabrication. Metals that possess ferromagnetic properties for example iron, cobalt, chromium oxide, nickel and alloys like stainless steel are found in traces in these restorations. Common complications that may happen if you have metal prostheses in your body during an MRI scan may be-

• Projectile accidents due to the crowns getting pulled off the teeth or bending and breaking of the crowns because of vibration resulting from interaction of metal and the strong magnetic field that may cause pain
• Discomfort or even accidental swallowing of the crown
• Failure of prosthesis due to its dislodgement
• Thermal burns if the metals absorb the magnetic energy and affect the surrounding tissues in the oral cavity

Hence, it is advisable to opt for a ceramic, porcelain or composite restorations in a dental setup and consult your dental surgeon before a MRI scan.

3. Immediate implant: A single sitting procedure?

A. In short, NO. Implants can be immediate or delayed. Before an immediate implant is planned, a CBCT scan prior to the surgery is done and bone depth, width and density are examined. The same goes for delayed implants but it is advised to wait for 3-4 months before the implant placement. Immediate implants are placed on the day the offending tooth is extracted and left for healing for the next few months. As new bone forms around the titanium screw, it gains more and more strength and prepares to receive a crown mimicking a natural tooth. 

4. My fillings came out again. Why?

A. It is a common complication in dentistry. It may be happening because of the following factors:

Technical factors-

• Contamination of the cavity or the material by saliva or water spray 
• Compromised sealing along the margins of the cavity
• Improper cavity design
• Mixing of the materials in an inappropriate ratio
• Inadequate curing of composite restoration
• Not allowing the material to set for as long as required before moving to the next step
• Wrong selection of the material
• Air entrapment during placement

Patient factors-

• Disturbing the restoration by the use of toothpicks or any sharp objects
• Biting too hard on the tooth that has received a restoration
• The cases of cervical abrasion are often treated with glass ionomer cements or microfilled composites. But patient's deleterious habits of brushing with a hard toothbrush and in a wrong technique may result in dislodgement of the restoration.
• For patients having bruxism or in simpler words, teeth grinding are in a greater risk since it puts the tooth under unnecessary forces.

5. I am experiencing pain my tooth! Should I get my tooth extracted?

A. The question is, why? The patient should be comfortably seated in your dental chair after he or she visits your dental office first. A proper case history is taken and the patient is clinically examined. Then investigations are done. If it is suggested that the tooth can be saved through a variety of treatment methods then it is good news for the patient, right? Extraction is contraindicated in several cases and in some patients with certain health conditions and it should be considered the last line of treatment when there are no other possible methods.

6. Do my bleeding gums indicate that I may have cancer?

A. Bleeding gums are certainly something for you to worry about but cancer? Absolutely not. Unless you have an underlying condition that may eventually affect your oral health. Your bleeding gums are a result of inflammation due to accumulation of plaque and tartar on your tooth surfaces. They harbour thousands and thousands of species of microorganisms that lead to a condition called Gingivitis. 

Gingivitis that remains untreated may progress to Periodontitis that is inflammation of your periodontal ligament that is located between the tooth and the bone that surrounds it. Periodontitis once occurred cannot be reversed. To prevent gingivitis, proper care of teeth has to be taken. Scaling should be done once in every 6 months and the patient has to incorporate the use of floss and mouthwashes in his or her oral care regime.  

7. I see a small cavity but it hurts.

A. Appearances can be deceptive, right?

Your tooth is basically made up of 3 parts. The outermost layer is enamel, then comes dentin and they protect the innermost part called the PULP that has nerve endings, blood vessels and special cells that provide nutrients to the tooth and its surrounding hard and soft tissues. Sometimes, what seems like a small cavity may turn out to be a huge one on its discovery. Radiographic scans like RVG and OPG 

often fail to show the extent of a decay in a tooth because it is so well hidden. Pain occurs if the decayed portion of a tooth has almost touched or invaded the pulp and caused its inflammation which is called Pulpitis. This eventually leads to the death of the pulp if left untreated and causes infection around the tip of the root of the tooth affecting the bone and gums attached to it. 

                                                                                            

8. I heard that my relative underwent a tooth extraction and it affected her eyes. Is it true?

A. There are zero chances that a tooth extraction will ever affect a person's eyes. However, improper technique of local anaesthesia administration during operative procedures involving upper front teeth might, although in rare cases, cause damage to the middle face. The infraorbital nerve that comes out the infraorbital foramen located just above the upper premolar teeth. This nerve supplies the skin of lower eyelid, upper lip and lateral side of the nose, upper central incisor, lateral incisor, canine, premolars and mesiobuccal cusp of first molar. The injection needle may sometimes accidentally pierce the infraorbital nerve and affect the parts that it supplies. Hence, the injury depends on the injection technique and not the tooth being extracted. 

9. My 4 year old child has a decayed tooth. Can we get extracted?

A. If your child has a small cavity in the milk tooth, then restoration has to be done. If your child has pain in that tooth and x-ray shows infection in that tooth, he or she has to undergo either of the two types of root canal therapy called Pulpectomy or Pulpotomy. If most of the tooth structure is lost and infection is persistent then extraction has to be done. The tooth would've fallen out on its own if the development of the successive permanent tooth had been complete. 

But in cases of extraction of milk tooth, after the procedure the space has to conserved by space maintainers. If these retainers are not used, it may lead to drifting of the surrounding teeth towards that space and cause its closure. This results in interference in eruption of the successive permanent tooth and may lead to crowding of teeth in the future that has to be corrected orthodontically. Sometimes, the parents don't consent to root canal therapy due to fear of failure of treatment or non compliance of the patient and the tooth is removed. Care has to be taken to avoid this.

10. Regular use of mouthwash  

A. Mouthwash is an integral part of your daily oral care routine. There are medicated and non-medicated varieties. Medicated mouthwashes are prescribed to those patient who have undergone periodontal or surgical procedures or for prophylaxis. 

Most common is Chlorhexidine. But usage more than what is required may lead to staining of teeth and loss of taste sensation in the long run. Non-medicated mouthwashes made up of essential oils are prescribed to those who complain of bad odour, are prone to decay of teeth and for daily use to maintain their oral hygiene. Hence, mouthwashes have to be used regularly to prevent caries and accumulation of plaque. Although care should be taken to not use them immediately after brushing and wait for 10-15 mins.

In conclusion, we hope we could answer the queries and explain them clearly. We would be glad to do the same again!