Author Archives: dhanya

Wisdom tooth surgery

A normal individual has a complete set of thirty two teeth, sixteen on the upper jaw and sixteen on the lower jaw. We have three molars on each side of the jaw. The third molar, also known as the wisdom tooth, is the last tooth to erupt. The wisdom tooth erupts at the age of 18 to 24. There are instances when this tooth does not erupt due to obstruction in the path of eruption caused by several factors. The condition where tooth with fully formed roots fail to erupt due to an obstruction (normal or pathological) is known as impaction. Even the canines and the premolars can be impacted. There are several causes of tooth impaction:

1. Evolution- The food that we eat now is more refined, softer and starchy compared to the harder,coarser food early humans used to eat. As a result, our jaw has evolved over time, being smaller and less defined. Yet, the number of teeth has remained and all the 32 teeth have to fit into the space provided by the jaw. Therefore, the wisdom tooth which is the last to erupt has less space and remains buried beneath the soft tissues and bone.

2. Genetic factors- Certain genetic conditions such as amelogenesis imperfecta and cleidocranial dysplasia cause disturbance in the formation of tooth substance making it fail to erupt.

3. Endocrine disorders- Endocrine disorders such as hypopituitarism, hypothyroidism and hypoparathyroidsm interferes with the secretion of hormones that is involved with the growth, development and eruption of tooth. Lack of these hormones results in missing teeth, delayed or even failed eruption of teeth.

4. Extraction of primary molars- The permanent molars start erupting at the age of six to seven. Children sometimes have severely decayed deciduous molars requiring extraction before the permanent tooth erupts. This creates space into which the adjacent tooth erupts. As a result, the underlying permanent tooth has no space to erupt when it reaches the eruption time and remains unerupted. This condition may lead to malalignment of teeth requiring further extraction and orthodontic treatment in severe situation. To prevent this a space maintainer which is designed by the dentist is placed at the extraction socket of the deciduous molar and it remains there until the underlying permanent molar erupts.

5. Lack of eruption space- Some people have small sized upper and lower jaws and relatively large sized teeth. The last tooth to erupt will usually have no space to erupt, hence remain impacted.

6. Obstruction- Scar tissue, fibromatosis, cysts and tumours can also obstruct the path of eruption of tooth.

An impacted tooth need not removed unless it poses problem to the individual. A more conservative approach is practised in following situations:

1. When the tooth is asymptomatic and does not interfere with normal function of the patient

2. Absence of any pathology and infection which leads to pain, swelling and further spread of infection

3. Recent research has shown that impacted wisdom tooth does not cause movement of teeth in the anterior region and therefore cause crowding of anterior teeth (this condition is known as imbrication). Therefore, removal of wisdom tooth to prevent crowding is not justified

4. A more conservative approach is preferred in patients who are medically compromised. Surgical removal of and impacted tooth may cause more risks to such patients compared to its benefit.

5. Patients with bone cancer at the jaw region are not advised to undergo surgical removal of impacted tooth. This is because future radiation to the region where the surgery has been done can cause osteoradionecrosis causing more damage to the jaw and complications.

There are situations where surgical removal of an impacted tooth is advised:

1. Impacted tooth can lead to infection such as pericoronitis and abscess formation. The position of tooth can lead to food accumulation beneath the soft tissues and there areas are difficult to access with toothbrush. This will lead to infection, swelling and pus formation. Pericoronitis is the infalammation of the soft tissues surrounding the impacted tooth. If left untreated the infection can cause formation of abscess and lead to cellulitis( inflammation of the connective tissue) in severe conditions.

2. Grossly decayed impacted tooth should also be removed because it can cause periapical abscess formation.

3. Tooth in line of fracture.

4. Tooth involved with cyst and tumour.

5. For prosthodontic reasons where there is need for a complete denture of if patients requires implant for aesthetic purpose.

6. For orthodontic reason, where space is needed distally for the movement of teeth brought about by orthodontic appliance.

7. In cases where impacted tooth causes impingement of soft tissues, chronic pain and discomfort.


Fluoride toothpaste

Does your dentist always remind you to use fluoride toothpaste? Many of us are aware of the  importance   of using an appropriate toothpaste but little do we know about the ingredients in the  toothpaste which protects our tooth from dental decay. There are several components in a  toothpaste which help in protecting the tooth: Continue reading

Tooth whitening

Tooth whitening, also  known as dental bleaching is a common procedure in dentistry in which chemical agent such as carbamide peroxide is used to lighten the shade of the tooth. Dental bleaching is usually done to get rid of unsightly stains on the teeth.  There are several factors which can cause tooth staining: Continue reading

What is a dental bridge?

What is a dental bridge? Post-insertion of a bridge

A dental bridge is also known as a fixed partial denture. It is used to replace a single missing      tooth or a short span of missing teeth. It is a permanent prosthesis, which is joined to the tooth      or implant adjacent to the space created by the missing tooth. Before the bridge is fabricated, the    adjacent tooth on both sides of the missing space is prepared (a cantilever bridge requires only    one adjacent tooth to be prepared). The tooth is reduced to the appropriate size, depending on the   material used to fabricate the bridge. The reduced tooth will serve as the anchor unit, holding the   bridge in place. A dental bridge can be fabricated using all metal, all porcelain, porcelain fused to   metal or gold. Continue reading

Understanding Tooth Abscess

What is a tooth abscess?

Abscess is a collection of pus in a cavity formed by the tissue due to bacterial infection or trauma by foreign objects. The pus is formed by dead inflammatory cells and bacteria. It is a defensive reaction of the tissue to prevent the spread of infection to the other parts of the body. A tooth abscess is pus enclosed in the tissues of the jaw bone at the apex of the root. There are three types of tooth abscess: Continue reading

Dental filling-What are the different options?

What is a dental filling?

A dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material.

Dental fillings can be divided into three broad types: Continue reading

Root Canal Treatment- How is it performed?

The Anatomy of a ToothWhat is root canal therapy?

A tooth consists of enamel, dentine, cementum and pulp. The pulp is a living tissue, inhabitated by nerve tissues, blood vessels and cells responsible for tooth formation and repair. Root canal therapy /treatment (endodontic therapy) involves removal of these structure which have been contaminated by bacteria and damaged permanently. The subsequent hollow space is cleaned, shaped and decontaminated using files and irrigants. The decontaminated space is then filled with inert filling material. After root canal therapy, the tooth will be ‘dead’ or non vital because it contains no living tissues. Continue reading

Foods you should avoid eating while wearing braces


Braces are fixed orthodontic appliance which is used to straighten your teeth, providing you a better smile and confidence.While wearing the appliance, you should avoid certain types of  foods which will stick between the wires and make it difficult to keep your mouth clean. These foods can also damage the braces. While wearing the orthodontic appliance, you should constantly clean your teeth and braces using the appropriate brushing method and instruments. Continue reading

Composite vs Amalgam

Composite resin and amalgam are the most commonly used filling materials in dentistry. Throughout the years, the content of both materials have been modified to improve the quality of the fillings.

Dental composite resins are types of synthetic resins. A composite material is a product which consists of two distinct phases normally formed by blending together components having different structures and properties.The purpose of this is to produce a material having properties which could not be achieved from any of the individual components alone. The two main components of composite filling materials are resin phase and the reinforcing filler. The resin gives the material the ability to be moulded at ambient temperature and polymerization achieved in a short time.Synthetic resins evolved as restorative materials since they were insoluble, aesthetic, and insensitive to dehydration and were inexpensive. It is easy to manipulate them as well. Composite resins are most commonly composed of Bis-GMA monomers, a filler material such as silica and in most current applications, a photoinitiator. Dimethacrylates are also commonly added to achieve certain physical properties such as flowability. Further modification of its physical properties is achieved by changing the concentrations of each constituent.Unlike amalgam which essentially just fills a hole, composite cavity restorations when used with dentine and enamel bonding techniques restore the tooth back to near its original physical integrity.

The main advantage of dental composite over amalgam is improved aesthetics. Composite is a tooth coloured material and it comes in a wide range of tooth colours allowing near invisible restoration of teeth. Composite is bonded to the tooth with the use of dentine bonding agent. This strengthens the tooth structure. Unlike amalgam, there is no need to create retentive features which destroys healthy tooth structure because composite bonds to tooth chemically. Therefore, using composite material as filling is proven more conservative and less tooth preparation is needed. Continue reading

Does cod liver oil improve dental health?

Cod liver oil is a nutritional supplement derived from liver of cod fish. It has high levels of the omega-3 fatty acids, EPA and DHA, and very high levels of vitamin A and vitamin D. It is widely taken to ease the symptoms of arthritis and for other health benefits. It was once commonly given to children, because the high levels of vitamin D in cod liver oil have been shown to prevent rickets and other symptoms of hypovitaminosis D. Continue reading