Tuesday, 24 June 2014

Brushing Technique

TOOTH BRUSHING TECHNIQUES:- One of the major cause of tooth abrasion is the wrong brushing technique that many of the people use daily.some techniques are mentioned here to make people aware of the common techniques one should use.
The best technique is the "ROLL TECHNIQUE" TECHNIQUES for Children up to 9 years:Scrub technique advised .Normally the Scrubbing technique is advised for very young children; brush for at least 2 minutes; always use tooth brush with soft bristles and fluoridated, flavoured toothpaste. A tooth brush with hard bristles can cause gum recession(i.e. they will recede and move backward) and if used with an abrasive toothpaste, can cause tooth abrasion(loss of tooth substance)

Children 10-15 years: Bass Technique is advised-Directly push the filaments toward roots of teeth at 45 degree angle, press lightly but not enough to bend filaments of brush and gently, brush forward and backward in short vibratory movement, attempting to press into gums margin ; brush for at least 3 minutes; use soft toothbrush with fluoridated toothpaste Adults: Soft or medium toothbrush & fluoridated paste.

Several techniques can be used :
 Modified bass technique: add circular movement which will cover gum as well as tooth surface. It massages the gums .
Roll technique: Position your tooth brush as in bass technique , then roll downwards over tooth surface, away from gum margins. Lift the brush, position it and repeat.it is the most commonly used method, it is an easy method but it neglects the gum margins.
Stillman technique: Position your tooth brush as in bass technique, press the filaments of your tooth brush till the gum blanches, turn your wrist through an angle of 45 degree and proceed to vibrate and roll against each tooth. Wrist movement is required; it is an unpopular technique because it is difficult. Also the gum margin is often ignored.
Fones technique (circular method): Brush is placed perpendicular to teeth. Large circular motion of brush over clenched teeth to simultaneously cover both upper and lower teeth.A soft tooth brush is used.it was Previously popular but is not advised nowadays as it has proven to cause tooth abrasion Charter’s method: Brush is angled 45 degree downwards, with half the bristles of the brush over the gum and half over the crown. Vibratory movement along with a circular motion is done.
Modified Charter’s method: Modification is to include occlusal surfaces(i.e bitting surfaces). Both these are difficult to learn, hence unpopular

Extraction Socket Healing

Tissue taken from a socket 3 days after tooth extraction was comprised of a fibrin clot
partially infiltrated with inflammatory cells, which were loosely organized and very
fragile. In another sample, tissue taken from a 1-week-old extraction socket
was found to be composed of degenerating fibrin and early granulation tissue

fibrin clot----Granulation tissue----organize into----collagen plug[1 month]----plug increase in density---replaced from the apex and the periphery---by bone deposition

After the development of a fibrin clot, the tissue becomes granulation tissue, which
contains blood vessels, fibroblasts, and chronic inflammatory cells. The granulation
tissue eventually matures into a collagen plug. For example, the authors found that, after
1 month, tissue removed from the center of the extraction site was composed of fibrous
connective tissue and fibroblasts with some remaining inflammatory cells.The
buccal wall and alveolar crest was resorbing with associated gingival collapse and loss of
interdental papilla. The socket enlarged to the buccal, and bone on the buccal alveolar
surface, and alveolar crest resorbed in the area of the extraction site. In this
patient, tooth extraction precipitated a generalized resorptive response in the alveolar

In tissue samples of the periphery of the soft tissue removed from extraction sockets, new 
bone formation occurred on the old necrotic bone of the original socket wall. 
However, in the same socket, necrotic bone was set free from the underlying vital bone 
and was sloughed into the socket to be expelled as bone sequestra . The  bone of the original socket wall dies and is undermined by osteoclastic resorption. This necrotic bone can form a nidus for new bone growth, or the necrotic bone can be expelled from the socket as bone sequestra. A portion of the old socket wall will form new bone on its surfaces and will become incorporated into bone forming in the extraction socket. However, a significant portion of the old socket wall will be undermined, become 
necrotic, and be sloughed into the oral cavity through the extraction socket orifice.

If the first stage of extraction-socket healing is resorption and disposal of necrotic bone,
then this would explain why tooth extraction in patients on bisphosphonates occasionally
leads to osteonecrosis. The bisphosphonates prevent osteoclastic undermining and disposal of necrotic bone lining the socket wall. The inability of the alveolus to dispose of the necrotic bone lining the socket wall could then lead to progressive osteonecrosis

Even with modern antibiotics, osteomyelitis and osteonecrosis are major medical
challenges. To prevent osteomyelitis and osteonecrosis, bone mounts an inflammatory
response to protect the host.After extraction, a significant amount of bone is sacrificed
by the body, but the host survives.However, with proper treatment, our findings
indicate the resorptive, clotting, granulation, and collagen phases of healing can be
skipped, and the extraction socket can proceed directly from extraction to regeneration.

To skip the negative phases of extraction-socket healing, a biocompatible material must
be placed in the socket after extraction. However, to avoid the resorptive phase of
healing, the graft material should not require resorption before bone formation. The graft
material should be biocompatible, inhibit bone resorption, and stimulate osteogenesis.
Also, to limit bone resorption on the buccal, lingual, and crestal bone surfaces, gingival
flaps that expose this bone should not be raised during placement of the graft material.

The drug component in Socket Graft stimulates osteoblasts and inhibits osteoclasts and
phagocytes. As the calcium phosphate based component of the bone graft is replaced by
bone, the drug component enters the osteoblasts, stimulating osteogenesis. The drug
component is retained by the osteoblast and continues to stimulate osteogenesis after the
calcium phosphate portion of the graft material has been converted into bone

Monday, 20 January 2014

Diagnosis Of Pulpal Disease

Classification of pulpal diseases
1) Within normal limit_asymptomatic or mild to moderate transient pain subside after the stimulus is removed.tooth is not tender on percussion.

2) Reversible pulpitis_quick, sharp, hypersensitive response to the stimulus.that subside after the removal of the stimulus.

3) Irreversible pulpitis_
a) asymptomatic- hyper plastic pulpit is /pulp polyp or internal resorption.

b) symptomatic- spontaneous, unprovoked, intermittent or continuous pain, lingering pain to thermal stimulus.
Radiographs can help in identifying the tooth involved or widening of PDL space in advance stages.

4) Pulpal  Necrosis-
a) partial necrosis-one or two canal is undergoing necrosis in a tooth with more than one canal. It can be symptomatic.
b) total necrosis- no symptoms , negative pulp vitality
It is a stage before it affects the periodontal ligament.

Tuesday, 25 June 2013

Preferred Periodontal Flaps

·        For accessibility in anterior teeth segments
·        For reconstructive osseous surgery
Papillary preservation flap
·        For accessibility in non – esthetic zone
Modified widman flap
·        For osseous defect closure by bone recontouring
·        Decreased width of attached gingiva with thick pocket wall
Apically displaced flap
·        Long narrow gingival defect on single tooth
Laterally displaced flap
·        Absence of attached gingival with friable pocket wall or no pocket
Free gingival graft
·        Isolated recession on upper teeth
Tarnow’s semilunar coronally displaced flap

Monday, 10 September 2012

3D Tooth Atlas- Beyond Visualization

''Few things can be learn by actually seeing it''. The credit goes to who created it and who shared it on you tube.I am sharing this for educational purposes.

Dental Anatomy: Maxillary Molars

We must understand anatomy of tooth first then  invade those structures.

Saturday, 1 September 2012


Wow! very precise way of taking alginate impression. You can take really good impression with alginate provided you follow the guidelines appropriately.

About Me

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Welcome to my blog....I am Dr Pratibha Singh and I am trying to create awareness in people so that people can have healthy and beautiful smile.Smile improves our face value and giving that wonderful smile is our[dental] profession.So keep reading and updated.


endodontics RCT Root Canal Treatment necrosis tooth paste Anesthetized area BMP Criteria for obturation Dr Shotwell Endodontic treatment Extraction GIC Impacted upper premolar Inferior Alveolar Block Nerve anesthetized OPG Pain history Pulpal disease Removable partial denture Salman Khan Treatment options for dentin hypersensitivity Trigeminal Neuralgia abrasion access opening anaesthesia antibiotic antiinflammatory apex apical periodontitis apically displaced apico coronal filing balanced force bass bone brushing technique buccal walls canals case presentation causes cementodentinal junction charter chief complaint circular classification components of prescription crown debridement dental dental pain dental problem dentist diagnosis duration electrolysis erosion etiology exudate file x ray files flaps fones free gingival graft growth and development healing instrumentation irreversible pulpitis laterally displlaced ledges light cure local anaesthesia major connector medicament minor connector molar RCT mouthrinses movement of files in RCT multirooted teeth nature oral ulcers oral; surgery orthodontics osteoblast osteoclast pain pulpal pain patient's education periodontics primary teeth eruption principles of RCT procedural accidents pulp pulp vitality pulpal floor pulpitis purulent discharge reamers restoration retreatment reversible rolls root rubber dam scrub method. site spread stamp stem winding steps in root canal TREATMENT tibiotics stillman supporting structures surgery symptoms teeth brushing technique demontration thermal test tooth tooth brushing technique treatment treatment follow up treatment of oral ulcers treatments type of pain wound you tube

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