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21/May/2012

Dear valued customer,
Starting 1st of June 2012, we open every WEDNESDAY
THEREFORE, We’ll open EVERYDAY
 
OUR Working Hours

  • Monday – Friday                        10.00am – 7.00pm
  • Saturday                                   10.00am – 6.00pm
  • Sunday                                     10.00am – 1.00pm (Please call for an appointment on Sunday)
  • Public Holidays                          Close   


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24/Feb/2011

Prestige Dental Care

Topics

  • Tooth Colour
  • Tooth Discolouration
  • Extrinsic Causes
  • Intrinsic Causes

Tooth Colour

Tooth color is determined by a combination of phenomena associated with optical properties and light. Essentially, tooth color is determined by the color of dentin and by intrinsic and extrinsic colorations. Intrinsic color is determined by the optical properties of enamel and dentin and their interaction with light. Extrinsic color depends on material absorption on the enamel surface. Any change in enamel, dentin, or coronal pulp structure can cause a change of the light-transmitting properties of the tooth – teeth discolouration.

Tooth Discolouration

Tooth discoloration varies in etiology, appearance, location, severity, and affinity to tooth structure. It can be classified as:

  • extrinsic
  • intrinsic
  • or a combination of both

according to its location and etiology.

Extrinsic Causes

Mouthwash (Chlorhexidine) staining

The principal causes are chromogens (colour agent) derived from habitual intake of dietary sources, such as wine, coffee, tea, carrots, oranges, licorice, chocolate, or from tobacco, mouth rinses, or plaque on the tooth surface.
Extrinsic staining caused by tobacco and coffee

The most commonly used procedure to remove discoloration from a tooth surface is by using abrasives (such as prophylactic pastes) or a combination of abrasive and surface active agents such as toothpastes. These methods prevent stain accumulation and to a certain extent remove extrinsic stains; however, satisfactory stain removal depends on the type of discoloration. Unfortunately, the chemical interactions that determine the affinity of different types of materials that cause extrinsic dental stains are not well-understood.

Intrinsic Causes

Unlike extrinsic discolorations that occur on the surface, intrinsic discoloration is due to the presence of chromogenic (coloured) material within enamel or dentin, incorporated either during tooth developing (odontogenesis) or after eruption. This type of stain can be divided into 2 groups, preeruptive and posteruptive. The most common type of pre-eruptive staining is endemic fluorosis caused by excessive fluoride ingestion during tooth development. Post-eruptive stain usually associated with pulp problems such as pulp necrosis, or root canal material. Generally, intrinsic stain can be divided into:
Systemic causes are

  • drug-related (tetracycline), excessive fluoride ingestion;
  • metabolic: dystrophic calcification, fluorosis;
  • genetic: congenital erythropoietic porphyria, cystic fibrosis of the pancreas, hyperbilirubinemia, amelogenesis imperfecta, and dentinogenesis imperfecta

Intrinsic staining: Tetracycline staining

Intrinsic staining: Fluorosis

Local causes are

  • pulp necrosis,
  • intrapulpal hemorrhage,
  • pulp tissue remnants after endodontic therapy (RCT),
  • endodontic/RCT materials,
  • coronal filling materials (eg. Crown, filling material),
  • root resorption,
  • aging

Intrinsic staining: Non-vital tooth

Intrinsic staining: Intrapulpal hemorrhage

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24/Feb/2011

Prestige Dental Care

Topics

  • Internal Bleaching
  • ‘Walking bleach’ technique
  • Complication
  • Limitation

Internal bleaching procedures are performed on devitalized (dead) teeth that have undergone root canal therapy (or RCT) but are discolored due to internal staining of the tooth structure by blood and other fluids that leached in. Unlike external bleaching, which brightens teeth from the outside in, internal bleaching brightens teeth from the inside out.

Yellow-brown discoloration of tooth after RCT treatment and the clinical results after 3 applications of the walking bleach technique.

Bleaching the tooth internally involves drilling a hole to the pulp chamber, cleaning, sealing, and filling the root canal with a rubber-like substance, and placing a peroxide gel into the pulp chamber so the gel can work directly inside the tooth on the dentin layer.In this variation of whitening the peroxide is sealed within the tooth over a period of some days and replaced as needed, the so called “walking bleach” technique.

‘Walking bleach’ technique

  1. Before treatment a radiograph would be made to check the quality of the root filling.
  2. The quality and colour (shade) of any restoration present are assessed.
  3. Tooth colour was evaluated and clinical photographs were taken at the beginning  of and throughout the procedure.
  4. Rubber dam should applied to isolate the treated tooth, to prevent reinfection of the root canal, and to protect the adjacent structures from the bleaching agent.
  5. The restorative and the obutarating material was removed until below gum margin
  6. A layer of cement was applied on top of the obturating material.
  7. Bleaching agent: sodium perborate mixed with 30% hydrogen peroxide into paste form was be loaded into the pulp chamber of the tooth.
  8. Finally, a temporary restoration was used to cover the cavity
  9. The patient was rescheduled approximately 1 month later and the procedure was repeated 2 to three times.

Walking bleach, A, Internal staining of dentin caused by remnants of obturating materials (OM) in the chamber as well as by materials and tissue debris in pulp horns (PH). B, Coronal restoration is removed completely. C, A protective cement base (B) is placed over the gutta-pecha. A paste (P) of sodium perborate and hydrogen peroxide is placed. D, A thick mix of temporay cement (Z) seals access. E, At a subsequent appointment when the desired shade reached, a permanent cement is placed (TS) at the pulp chamber and composite resin (C) to seal of the access

Complication

External resorption – Internal bleaching occasionally induces external cervical root resorption. Chemicals combine with heat are likely cause necrosis of the cementum, inflammation of the periodontal ligament, and root resorption.
Crown (Coronal) fracture – Increased brittleness of the crown part of the tooth, particularly when heat is applied resulting in the tooth is more susceptible to fracture.
Chemical burn – 30% hydrogen peroxide is caustic and will cause chemical burns and sloughing of gingiva. Therefore, rubber dam is needed to protect the gum from chemical burn.

Limitation

Even though internal bleaching can produce satisfactory result in most cases, no all will achieve the desirable result. Therefore,  other options such as full porcelain crown, porcelain veneer will be the alternative to whiten non-vital tooth!!

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Root canal therapy
Full porcelain crown
Porcelain Veneer
Resin Veneer


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21/Feb/2011

Complications of dental extraction

Infection: Although rare, it does occur. The dentist may opt to prescribe antibiotics pre- and/or post-operatively if they determine the patient to be at risk.
Prolonged bleeding: The dentist has a variety of means at their disposal to address bleeding; however, it is important to note that small amounts of blood mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually, however, bleeding will almost completely stop within eight hours of the surgery, with only minuscule amounts of blood mixed with saliva coming from the wound. A gauze compress will significantly reduce bleeding over a period of a few hours.

Swelling: Often dictated by the amount of surgery performed to extract a tooth (e.g. surgical insult to the tissues both hard and soft surrounding a tooth). Generally, when a surgical flap must be elevated (i.e. and the periosteum covering the bone is thus injured), minor to moderate swelling will occur. A poorly-cut soft tissue flap, for instance, where the periosteum is torn off rather than cleanly elevated off the underlying bone, will often increase such swelling. Similarly, when bone must be removed using a drill, more swelling is likely to occur.

Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a “sinus exposed” has occurred. If the membrane is perforated, however, it is a “sinus communication”. These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure—depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called “gelfoam” is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.

Nerve injury: This is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth should the nerve be close to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent.

Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antral lavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the Canine fossa–a procedure referred to as “Caldwell luc”.

Dry socket (Alveolar osteitis) is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It is commonly believed that it occurs because the blood clot within the healing tooth extraction site is disrupted. More likely,alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible (which explains why dry socket is usually not experienced in other parts of the jaws). Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically causes a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone — it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction.

Bone fragments Particularly when extraction of molars is involved, it is not uncommon for the bones which formerly supported the tooth to shift and in some cases to erupt through the gums, presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is distinguished from a similar phenomena where broken fragments of bone or tooth left over from the extraction can also protrude through the gums. In the latter case, the fragments will usually work their way out on their own. In the former case, the protrusions can either be snipped off by the dentist, or eventually the exposed bone will erode away on its own.

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20/Feb/2011

Air polishing is an alternative, non-contact, method of polishing teeth using a polishing cup and paste after teeth scaling. It requires a special ultrasonic unit (e.g. Air Flow from EMS) that allows use of this insert in the handpiece.

Air polishing uses medical-grade sodium bicarbonate and water in a jet of compressed air to “sandblast” the surface of the enamel smooth. Examples include the Prophy-Jet® and Cavitron Jet® (Dentsply Ltd.). The nozzle is held 3 to 5 mm from the tooth, centred on the middle third of the tooth. Use at 60° to the long axis of the root. Do not direct into the gingival sulcus.

Air polishing with EMS Air Flow®

Before air polishing

Afer air polishing

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