Indications and Contraindications of a Dental Crown


Crown and bridges are being served to dental patients routinely as its manufacturing has become fast, readily available. It is a dependable option. 

Although, the crown & bridge is generally considered very safe and it is associated with a low incidence of complications, there are some precautions that need to be considered. 

Indications of a Dental Crown

  1. Damage of crown beyond repair
  2. Large filling needing replacement
  3. Fractured tooth
  4. Esthetic enhancement
  5. Dental implant coverage
  6. To fix dental bridges or dentures
  7. Erosion of teeth

Code of conduct for Australian Dentists

  



The shared Code of conduct

The shared Code of conduct (the code) applies to registered health practitioners in 12 professions including dentistry. The code sets out National Boards’ expectations of ethical and professional conduct for the health practitioners they regulate. It is governed by AHPRA.
The code outlines 11 principles which include information about how to apply the code in practice.

Fluoride Modalities in Caries Prevention




Use of fluoride for caries prevention 



Fluoride has been widely used for caries prevention for several decades, and it is considered to be one of the most effective measures in reducing the incidence of dental caries. There are different ways to apply fluoride for caries prevention, including:

  1. Topical fluoride: This involves applying fluoride directly to the teeth in the form of a gel, foam, varnish, or mouth rinse. Topical fluoride works by strengthening the tooth enamel and making it more resistant to acid attacks. 
  1. Systemic fluoride: This involves ingesting fluoride in the form of fluoridated water, dietary supplements, or fluoride-containing toothpaste. Systemic fluoride works by strengthening the teeth from the inside out as the fluoride is incorporated into the developing tooth structure. 

Fluoride helps to prevent caries by: 

Teeth Whitening




Introduction


Tooth whitening is done to correct the discoloration of a tooth. When we talk about discoloration of a tooth, we mean to say that the colour of a tooth has become from its normal white colour to light, light brown to dark brown or from light Gray to dark Gray or to complete black. The discoloration may be of one tooth, or all the teeth.

Fluoride as Anti-Caries

Clinical context

Water fluoridation is a safe, effective and ethical way to help reduce tooth decay across the population and has long standing support of peak public health and dental authorities.

Water fluoridation

Water fluoridation is a proven method for reducing the prevalence of tooth decay in communities.

Surveys of tooth decay and dental fluorosis must be undertaken regularly, taking into account all fluoride sources and patterns of consumption in a community, in order to confirm the most appropriate water fluoridation concentration for that community or region.

Introduction to Third Molar Surgery: Part 3-Classification of Impaction

Classification of third molar impaction is done to facilitate the communication between clinicians, for record keeping that may be used for audit research purposes.    

Introduction to Third Molar Surgery-Part 1

The third molars are the most common teeth that are found to be impacted. This article will provide and introduction to this topic. The difference between simple and surgical extraction along with the aetiologies and frequency of third molar impaction are explained in a simple way.

Introduction to Third Molar Surgery: Part-2 Indications and Contraindication

Mandibular Third Molars  

According to George Dimitroulis, there are common and uncommon reasons for the removal of the mandibular third molar.   

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Oral Hygiene



Regular oral hygiene by mechanical brushing and cleaning between the teeth removes soft dental plaque. When dental plaque becomes mineralised (calculus), it must be removed by a dental practitioner. Dental plaque and calculus can cause periodontal disease (eg gingivitis) and dental caries.

Frequent exposure to dietary sugar and carbohydrates leads to an increase in the risk of dental caries. Avoid sucrose in sticky forms and limit other sugars (eg acidic drinks) and carbohydrates as snacks between meals.

Avoid drinks other than water at bedtime after brushing teeth (including milk, formula and expressed breastmilk)—saliva flow diminishes during sleep and the sugar from the drink remains on the teeth overnight. This is a common cause of dental caries in children and the elderly.

Interdental cleaning

Interdental cleaning using floss or interdental brushes is recommended once each day before brushing the teeth. Brushing teeth with a toothbrush does not remove plaque from between the teeth or below the gum line.

Dental floss can be used to wipe the interdental tooth surface to remove plaque (back and forth, then up and down several times on each tooth surface). Manual dental floss, floss-holding devices or automated flossing devices are available—the choice is based on personal preference or level of dexterity.

Interdental brushes areas effective as dental floss in plaque removal, and often more effective for debris removal. They require less dexterity than dental floss. Interdental brushes are particularly useful in patients with gum recession or disease, where the spaces between the teeth are larger.

Interdental wood sticks can remove food particles, but do not effectively remove plaque.

Water jets do not effectively remove plaque.

Tooth and tongue cleaning

Soft-bristle toothbrushes are recommended; hard-bristle toothbrushes are not more effective and can damage the gums and the softer root surface. Children younger than 6 years should use a children’s toothbrush. Powered toothbrushes with a rotation oscillation action are slightly more effective at plaque removal than manual brushes. Powered toothbrushes are useful for people with dexterity or disability problems, and for carers. Toothbrushes should be replaced once damaged or when the bristles become deformed.

Advise patients to use a fluoride-containing toothpaste; for recommended concentrations of fluoride in toothpaste. Toothpastes that do not contain fluoride provide little protection against dental caries. Toothpastes also contain other additives (eg abrasives, detergents, antibacterial, bleaches, remineralising agents).

Toothpastes that do not contain fluoride provide little protection against dental caries.

Advise patients to brush teeth for 2 minutes, twice each day with fluoride toothpaste. Toothpaste should be spat out and not swallowed to minimise fluoride ingestion; the mouth should not be rinsed to allow increased uptake of fluoride from the saliva.

Advise patients to brush or gently scrape the tongue, but not to brush or massage the gums.

Mouthwash

Mouthwash is usually not required as part of a standard oral hygiene routine, provided mechanical cleaning (toothbrushing, interdental cleaning) is performed properly. Mouthwash should not be used as substitute for proper mechanical teeth cleaning.

Fluoride-containing mouthwashes can be used as an additional source of fluoride for people at high risk of dental caries on the recommendation of a dentist.

Mouthwash that inhibits plaque formation (eg chlorhexidine) can be used for a short duration in addition to mechanical tooth cleaning, usually when pain associated with periodontal disease restricts mechanical cleaning (see Management of necrotising gingivitis and Gingivitis).

Alcohol-containing mouthwashes may be associated with oral cancer and are not recommended. See here for further information on mouthwashes.

Specialised oral hygiene

People with dental implants, bridges, crowns that are joined together, and orthodontic brackets should follow the oral hygiene advice from their dentist.

Denture hygiene

Dentures should be regularly cleaned twice a day to remove food particles and plaque. Advise patients to remove dentures from the mouth and clean them with warm water, mild soap and a toothbrush, denture brush or soft nail brush. Avoid cleaning dentures with hot water, toothpaste, kitchen detergents, laundry bleaches, methylated spirits, antiseptics or abrasives (unless instructed to by a dental practitioner). Patients should clean their gums and remaining teeth with a soft toothbrush and toothpaste.

Advise patients to place dentures in a dry environment overnight after cleaning them. Traditionally, it was recommended that dentures were kept in liquid overnight. However, allowing the cleaned denture to dry out at night is more effective for reducing yeast colonisation and plaque accumulation, compared with both denture cleansers and water. Although repeated cycles of hydration and dehydration can change the shape of the denture, these changes are small and not clinically significant.

Dentures should be cleaned then placed in a dry environment at night. If there is a build-up of hard deposits (tartar, calculus), dentures can be soaked overnight in a solution of white vinegar (diluted 1:4), then cleaned as usual. Advise patients to see their dentist for professional cleaning if hard deposits cannot be removed.

Denture-associated erythematous stomatitis is prevented by regular cleaning of the dentures and storing them in a dry environment overnight. Advise patients with denture-associated erythematous stomatitis to optimise denture hygiene—it can take 1 month for symptoms to improve; see Oral candidiasis and Candida-associated lesions for further information.








Ref: Therapeutic Guidelines Limited 2019 (www.tg.org.au)

Radiation Protection of Pregnant Women

Is there a safe level of radiation exposure for a patient during pregnancy?

Dose boundaries do not apply for radiation exposure of patients, since the decision to use radiation is reasonable depending upon the individual patient situation. When it has been decided that a medical procedure is justified, the procedure should be optimized. This means that the conditions should achieve the clinical purpose with the appropriate dose. Dose limits are determined only for the staff and not for patients.

Dental Amalgam: SAQs for Viva Voce

SAQ 1. A patient arrives at your office and expresses concern about mercury from dental amalgam causing her harm. What will you tell this patient to reassure her about the safety of amalgam? 

ANSWER: 

You will explain three facts of dental amalgam fillings:

(1) The mercury present in amalgam is not free. It is always tied up chemically in the dental amalgam matrix. It is never released into the body. The majority of bound mercury never leaves the dental amalgam mass.