What should you look for before starting a crown preparation?

So, you are ready to start your crown work for the patient who is eagerly waiting to regain the lost functional ability, phonation and aesthetics. The functional ability, aesthetic value, speech enhancement and self-confidence of the patient will enhance when you look for the following anomalies in the oral cavity and rectify them, before the commencement of the crown preparation. You can make your crown & bridge without giving a dam for these factors, and get the quick bucks. But, it would be a good idea to consider them before you jump on for crown preparation part. And believe me, in long run, you will gain the faith of your patient, converting into your most reliable source of referral and image builder. These factors are given below:

• General overall health of the oral cavity
• Expectations of the patient
• Extremely tilted teeth
• Mobile teeth
• Type of occlusion
• The type of crown you want to fabricate for your patient

When we start examination, we look for the general health of the oral cavity. Is it healthy? Does the oral hygiene acceptable? Does the periodontal status of the tooth concerned adequate? Is the tooth tilted, rotated, supra or infra erupted? Does the patient need oral prophylaxis? What are the other systemic diseases the patient is suffering with; for example, cardiac, endocrine, orthopaedic, and physiological?  If any of the answer is yes, then the dentist needs to take care of them first, before the commencement of the crown preparation. Of course, few chronic diseases cannot be cured but they should be kept under control by the patient’s’ physician.

That preparatory phase, the phase that involve the work done inside the mouth so that the longevity of the prosthesis remains satisfactory, includes the scaling and root planing, the removal of hopeless mobile teeth, orthodontic correction of tilted tooth, and occlusal surface adjustment of the supra erupted tooth. The other decayed teeth should be appropriately restored.

You should also know that what type of crown you plan to provide or what type of crown the patient is wishing for? What are the expectations of the patients from a particular type of crown? Will the patient understand the significance of the particular type of crown? Does patient understand the inherent drawbacks of that particular crown? Does patient know and ready to accept the post insertion maintenance care?

The other consideration is the type of occlusion in a patient. Is it canine protected or group function? Will you be needing to alter it for the betterment of the function and longevity? Does patient has any TMJ issue?

NABH Standards for Dental Healthcare Service Providers: Care of Patients

NABH Accreditation Standards for Dental Healthcare  Service Providers  have been outlined in two parts: (A) patient centered standards & (B) organisation centered standards. Here we shall discussed the second chapter of patient centered standards.

Chapter 2: Care of Patients (COP)

NABH Standards for Dental Healthcare Service Providers: Access Assessment and Continuity of care

NABH Accreditation Standards for Dental Health Care Providers  have been outlined in two parts: (A) & (B). Each part has been divided into 5 chapters.

 

(A) Patient Centered Standards

1. Access, Assessment and Continuity of Care (AAC)
2. Care of Patients (COP)
3. Management of Dental Material and Medication (MOM)
4. Patient Rights and Education (PRE)
5. Hospital Infection Control (HIC)

Accreditation Standards for Dental Healthcare Service Providers by NABH

National Accreditation Board for Hospitals and Health Care Providers (NABH) has laid down Accreditation Standards for Dental Healthcare Service Providers (DHSP). The entities that can apply for are dental teaching institutions, dental hospitals and clinics. The NABH dental standards have been laid down keeping the Indian beliefs and working environment in mind. The board has laid down the standards that focus on

All About Inferior Alveolar Nerve Block

The inferior alveolar nerve is also known as inferior dental nerve.  It gives off a motor branch that supplies to mylohyoid muscle and anterior belly of digastric. Then it enters mandibular foramen and travels through the inferior alveolar canal. From inferior dental canal it supplies to mandibular third molar, second molar, first molar, and second premolar.  

From the level of the second premolar, it moves forward as mental nerve and exits through mental foramen.  The mental nerve supplies sensory nerve fibres to the chin and lower lip of that side. Within the mandible after mental foramen, it moves forward as incisive nerve and gives sensory supply to mandibular incisors and mandibular canines of that side. 

Dental Materials Used In Pulp Protection: Resin Sealants

Resin Sealants

 

Properties

These are light activated unfilled resins. Most are relatively viscous and do not set through loss of solvent. They set either by chemical or light activation.

Maxillary Nerve

Maxillary nerve is the second division of the trigeminal nerve. It divides into several branches. You will read here about those that are related to dentistry below.

Effects of Diabetes Mellitus on Osseointegration and Dental Implants

Effect of Diabetes on Osseointegration and Dental Implants

The tenacious hyperglycaemia in diabetic people, hinder osteoblastic activity and modifies the response of parathyroid hormone that adjusts metabolism of Ca and P, decreases collagen synthesis during callus formation, induces apoptosis in lining cells of bone and increases osteoclastic activity due to untiring inflammatory response. It also stimulates deleterious effect on bone matrix and reduces growth and build-up of extracellular matrix. The subsequent result is reduced bone formation during healing.

Type -1 diabetes (insulin dependent) causes decreased bone formation, as well as reduced bone mineral density and higher bone resorption while Type -2 diabetes (non-insulin dependent) produces normal or greater bone mineral density in some patients. It has been detected that insulin not only diminishes the harmful effect of hyperglycaemia by controlling it but also stimulates osteoblastic activity.

Dental Materials Used In Pulp Protection: Varnishes

The pulp of a tooth lies within its mass. It may be insulted due to various types of injuries and may need to be protected during the treatment. There are varieties of materials available for use. They show different properties and can be used in different conditions with their own advantages and disadvantages. These materials are as follows.

Abrasion Of Teeth and its Consequesces

Abrasion

It is loss of the tooth substance because of the friction with a foreign substance.The area affected by abrasion are smooth and usually in C shape, more wide than deeper.

Clinical Features 

These are usually facio-cervical concavities that are more broad than deep and can be associated with an abrasive diet. They are usually found on prominent surfaces of the teeth in the dental arch such as canines, premolars, and mesio-buccal aspects of first molars. 

They may affect several teeth in a row with a “band” of abrasive damage. Sometime they may cause hypersensitivity which means the tooth or teeth may have pain while drinking hot or cold beverages like hot coffee or a cold drink.

Figure 1. Abrasion: note the concave smooth cavities in the cervical regions of upper and lower teeth.

Causes of Abrasion

The reason may be one or a combination of following factors. Normally in clinical practice, I see a combination of several factors.

• Excessive tooth brushing for a longer period
• Use of hard tooth brush
• Use of tooth paste containing highly abrasive material
• Use of locally prepared tooth cleaning powder or paste like Gul, Gulak or Lal Manjan (red tooth powder)
• Repeatedly putting foreign objects in the mouth like pipe smoking, pen, bobby pins or any other occupational material

 

Prevention of Abrasion

Use of common sense is the best way for the prevention of the abrasion. If the cause is a hard tooth brush or brushing the teeth for a longer duration or use of an excessively abrasive tooth paste. Then correcting the hardness of the tooth brush which means suggesting a patient to use soft brush, limiting the tooth brushing time for two minutes, and changing the tooth paste manufactured by a reputed company will be sufficient. If the cause is abrasive food or any occupational factor, this may be a bit difficult to arrest the lesion but not impossible.

Treatment of Abrasive Lesions

 The treatment of the cavities created by abrasion is the restoration of teeth by Glass Ionomer or tooth coloured composite filling material. These types of fillings or restoration fall under the category of 'Cosmetic' or 'Aesthetic' 'Restorations'. 

Some times, the depth of the abrasive lesion is so deep that it affects the pulp in an adverse way. In this stage, it is better to get the 'Root Canal Treatment' before going for aesthetic restoration. But, if the lesion had been there since long, the involved tooth may need extraction. 

Tooth abrasion का अर्थ "दांत का घर्षण"  होता है | मै इस लेख को हिंदी में लिखने की पूरी कोशिश करूंगा |