Lefort fractures, named after the French surgeon René Lefort, encompass a spectrum of severe facial injuries resulting from high-impact trauma. These fractures, classified into three primary types, necessitate a thorough understanding due to their complex anatomical involvement and varied clinical presentations.

How important is sinus in dentistry?

A toothache is one of the worst pain one can experience. This toothache can be confined to that particular region, or it can be a throbbing pain that can radiate to the head and jaw regions. This tooth pain as such is caused by main reasons, and some may be not even due to the tooth itself!! One of these can be due to a blocked sinus. If you suffer from chronic nasal congestion as well as toothaches, the two might be related, and this is a two-way relationship.

In a study conducted over a 5-year period, 198 patients with 244 affected sinuses fulfilled the proposed criteria. The incidence of chronic maxillary sinusitis in the population was 0.02%. A dental pain manifestation was found in 40.6% of the sinusitis cases. [1]

Like how a blocked sinus can cause tooth pain, so can an infected tooth cause sinusitis.10-12% of maxillary sinusitis are of odontogenic origin. [2]

How does it affect tooth pain?

A sinus is an air-filled cavity, which is located in the skull. It plays a very important role in conditioning the air that we breathe in before it reaches the lungs. The sinus is lined by a membrane, which acts as a hub of both healthy and harmful microorganisms.

There are 4 sinuses seen in the skull namely the frontal, ethmoidal, sphenoidal and maxillary air sinuses. When dentistry is concerned, the important relationship is seen with the maxillary air sinus. This is to the discrete placement of the sinus in the upper jaw and the roots of the upper molar teeth being related to this sinus.

The sinus is lined by a membrane. This membrane can become inflamed and infected. If this happens, it can block the nasal passage, and the passage can become packed with mucous. The bacteria which is now trapped in the sinus will multiply and cause an infection. Pain and bad taste in the mouth is the sequel to this.

If you have an infection in your maxillary sinus, pressure starts to build and then it presses down on your jaw bones.

Since the upper back teeth are the ones close to the sinus, they are the ones usually affected and cause a sinus toothache.

The cause of the pain? It is the roots of the upper first molar teeth and since they lie to close the sinus floor, or sometimes even extending inside them. The nerves of the roots will be affected by the swelling and pressure. Even though our teeth might be in good health, we will experience sensitive teeth. This is a sinus toothache, and it can be very painful. The longer the sinus block is left untreated, greater the pain.

Symptoms and Management of sinusitis :

One of the classical symptoms to recognize sinus infection causing toothache is pain that is experienced in the tooth when you bend down. This occurs due to shifting of pressure in the sinus. The sinus, jaw and nasal area tend to feel sore and painful too. A headache too can be usually associated with sinusitis and tooth pain. Typically a sinus caused a toothache disappears once the sinusitis is treated and a tooth disease-causing sinusitis disappears once the offending tooth is treated.

There are certain home remedies that one can attempt to do, to manage the symptoms. Flush your nasal passages, take multiple steam inhalation sessions in a day to reduce the soreness and heaviness in the face. Keeping the body hydrated is also of uttermost importance and stick to a hot meal plan through the period of sickness.

If the home care management fails to subsidize your symptoms, visits the Dentist and the ENT to rule out potential complications. Management would include starting on a first line management of antibiotics such as Amoxicillin or Augmentin. Once the underlying pathology has been treated, the other manifestations tend to subside.

OROANTRAL FISTULA

As the name suggests  [ORO-Oral cavity, ANTRUM-Sinus, FISTULA-]

An epithelium-lined pathologic tract] an oroantral fistula is an abnormal communication between the sinus and the oral cavity. 

It can be due to various reasons. One of the main reasons for such fistula formation is an infection near the end region of the root, especially the upper first and second molars. The infection proceeds onto form a communication between the teeth and sinus.

The oro-antral fistula can be detected using various methods. A thorough examination intraorally using the mouth mirror is usually carried out to detect the fistula. Treatment would be that when the doctors would prescribe a mouth rinse and a course of antibiotics. Surgery will be indicated in the later stages to remove the fistula.

IMPORTANCE OF  MAXILLARY SINUS IN DENTAL IMPLANTOLOGY:

The success of fixed prosthetics like dental implants mainly relies on the quality and quantity of bone at the implant site. So when implants are planned in the upper back tooth, especially the upper molar region, the maxillary sinus plays a pivotal role. 

This is mainly due to the position of the maxillary sinus near the roots of the upper molar teeth. When the level of the sinus comes down due to various reasons such as prolonged nonreplacement of teeth, aging etc, the height of the available bone for implant placement becomes less viz., less than 10 mm. Hence comes the need for a procedure called   

 ‘SINUS LIFT SURGERY’

TYPES OF SINUS LIFT SURGERY- Performing a sinus life surgery is as important as placing a dental implant. Following a thorough diagnostic examination and various confirmatory tests, a conclusion will be drawn as to which method of sinus lift is to be performed. Each of the techniques has its indications and contraindications and must be performed strictly in accordance with them.

There are mainly two types of sinus lift surgeries

· -Direct

·- Indirect

I)  Direct sinus lift- Direct sinus lift is mainly indicated when the bone height is very less. It involves making a small window in the wall of the sinus and packing the sinus with a bone graft material. This usually has a longer healing period and immediate placement of implant would be difficult. Since the height of the bone is minimal, it requires from 4 to 6 months for healing and bone regeneration after the sinus lift procedure

II)  Indirect sinus lift- This procedure can be indicated in cases where there is a moderate level of bone present (7-8mm). The sinus is approached from the crest of the alveolar ridge and an osteotome is used. This is a less invasive procedure and has a shorter healing time and waiting period. This is usually a ‘one step procedure’ were implant can be placed on the same day as the sinus lift.

If implants are placed simultaneously with the sinus lift procedure and the process of loading should be increased gradually. It will allow the bone to recover and regenerate after grafting. The patient should be under regular medical supervision in the postoperative period.

Sinus lift surgery proves to be a very important aid for successful implant placement. A study was done to evaluate the success rate of sinus lift assisted implant surgery. A success rate for dental implants in the sinus lifts reached 95.2% after a period of 24 months of evaluation. [3]

COMPLICATIONS OF SINUS LIFT SURGERY:

Success and failure are two sides of the same coin. Complications are possible, regardless of the technique. A study was conducted were a group of 45 patients in whom a sinus lift procedure had been performed was evaluated for sinus pathology 12 to 60 months after bone transplantation and implant insertion, using a questionnaire, conventional radiographic examination, and nasoendoscopy and postoperative maxillary sinusitis was detected in two of five patients with a predisposition for sinusitis, but in none of the other 40 patients. The occurrence of iatrogenic sinus membrane perforations during surgery was not related to the development of postoperative sinusitis in patients with healthy sinuses. [4]

 But these complications can only arise as a result of poor dental implant hygiene or non-observance of certain restrictions given by the doctor after the sinus lift procedure.

REFERENCES

1.  Melén I, Lindahl L, Andréasson L, Rundcrantz H. Chronic maxillary sinusitis: definition, diagnosis, and relation to dental infections and nasal polyposis. Acta oto-laryngologica. 1986 Jan 1;101(3-4):320-7.

2.  Brook I. Sinusitis of odontogenic origin. Otolaryngology—Head and Neck Surgery. 2006 Sep;135(3):349-55.

3.  Bortoluzzi, M. C., Manfro, R., Fabris, V., Cecconello, R., & Derech, E. D. (2014). Comparative study of immediately inserted dental implants in sinus lift: 24 months of follow-up. Annals of Maxillofacial Surgery, 4(1), 30–33. http://doi.org/10.4103/2231-0746.133071

4.  Timmenga NM, Raghoebar GM, Boering G, van Weissenbruch R. Maxillary sinus function after sinus lifts for the insertion of dental implants. Journal of Oral and Maxillofacial Surgery. 1997 Sep 1; 55(9):936-9

Teething is a necessary, albeit painful, rite of passage for your baby. Sprouting her new teeth is hard work, and can leave her irritable, feverish and with difficulty sleeping as those teeth cut through her delicate little gums and break the surface.

Because so many parents today are hesitant to use any over-the-counter medications unless they’re absolutely necessary, there’s quite an interest in more natural, chemical-free ways of soothing the screams and the pain that accompany teething.

While each baby is different and will respond to each solution with varying degrees of relief, here are some of the ways that you might be able to cut the pain of cutting teeth without reaching for medication.

• Keep Gums Cool – One of the most cost-effective methods of drug-free relief of teething symptoms is wring a wet washcloth out very well, leaving it only damp, then place it in the freezer. Letting Baby chew on the frozen (or very chilled) cloth not only helps to reduce swelling, pain and inflammation; it also satisfies their innate need to chew, in order to speed the process of the teeth surfacing. The softness of the washcloth versus the sometimes rigid and uncomfortable plastic of a frozen teething aid might be just what your little one needs; remember, all babies are different and will like and dislike different things. Be careful that you supervise her at all times to prevent any chance of choking, and let her gnaw to her heart’s content.

• Choose Teething Rings Carefully – Older teething rings may freeze into very hard and uncomfortable rings, contain the potentially dangerous chemical Bisphenol A, also known as BPA and may not be compliant with all modern safety standards. Teething rings that are hand-me-downs might save money, but they could present a hazard. The problem of freezing teething rings to boost Baby’s level of relief has been addressed in recent years, with newer offerings hitting the market every day that are designed to be placed in the freezer without losing their pliability.
• Rub Her Gums – The first-ever teething aid was Mom’s finger, and things haven’t changed so much that they can’t be used in a pinch to massage a teething baby’s sensitive, inflamed gums. Be sure to wash your hands, however; using gel hand sanitizers can expose your baby to chemicals, dyes and fragrances that should never been ingested. Good, old-fashioned soap and water is best.
• Soothing and Comforting – Sometimes a baby that’s irritable and uncomfortable from the effects of teething just needs to be held, cuddled and soothed to sleep. During particularly rough bouts of teething, it may be necessary to spend more time than usual loving on your little one to get her calmed and feeling secure enough to sleep despite her discomfort.
• Clove Oil – Many all-natural moms rave about the soothing power of clove oil for teething gums, but it’s important to remember that, in its pure form, clove oil is very strong and can increase Baby’s discomfort. Dilute the oil with food-grade carrier oil and test it out yourself before applying it to her gums via massage, and keep in mind that her gums are far more sensitive than your own. If the mixture feels uncomfortable, is accompanied by a very strong taste or is otherwise unpleasant for you, it’s a safe bet that the same will hold true for your baby a few times over. It’s always a good idea to speak with your child’s healthcare provider before using homeopathic remedies.
• Teething Biscuits – Traditional teething biscuits tend to be laden with sugars and preservatives that you probably don’t want your little one ingesting, but there are a wide variety of low sugar or sugar-free, organic offerings on the market as well.
• Cold Spoons – The American Dental Association recommends that teething babies be given a chilled spoon to suck on, to ease their discomfort without presenting a serious choking risk. It’s still important, however, that you supervise her at all times as she gnaws away on the flatware.

Benzocaine and other numbing agents sold over-the-counter and marketed as teething relief ointments do numb your baby’s gums and reduce her pain, but they can also numb the rest of her mouth and her throat. That numbness can greatly increase her chances of gagging or choking, another reason why these remedies should be avoided whenever possible. Also, the drooling that often accompanies teething can cause your baby’s skin to become irritated, so be sure to keep her face, neck and torso as clean, dry and saliva-free as possible to prevent a rash that increases her discomfort even further.

original article from www.newborncare.com

The Holy month of Ramadan is a time for fasting and self-discipline for Muslims. It is also the time for purifying the mind and the body and empathizing with the less fortunate.

Fasting has numerous therapeutic benefits including improvement in blood sugar levels, blood pressure and cholesterol levels.

SEE ALSO: Ramadan and Oral Health: What You Need to Know

To help you ensure good oral hygiene practices during the fasting period. Here’s some insight from Dr Major Pravin Prathip J 

What causes bad breath?

• Poor oral hygiene - Bacterial plaque build-ups are a known cause of bad breath, tooth decay and gum disease.
• Improper cleaning of dentures - Like teeth, dentures can retain bacteria, tartar and cause bad breath when they are not cleaned properly.
• Smoking – including cigarettes, cigars and shisha
• Nutrition - Some food may aggravate the bad smell, such as onion, garlic and some kind of spices.
• Dry mouth – Also known as xerostomia, dry mouth is one of the major causes of bad breath. It is caused by an insufficient flow of saliva and is a common side effect of certain medications and a symptom of some medical conditions.
• Other non-oral conditions – including nose, sinus, throat or digestive disorders

How does bad breath occur during the fasting period?

Saliva plays an important role in protecting your mouth and decreasing bacterial growth. The reduction of salivary flow while fasting is the main reason for bad breath. After Iftar, the salivary glands are soon stimulated and the production of saliva becomes normal.

Is there a way to prevent bad breath while fasting?

Here are some important tips to prevent bad breath while fasting.

• Practice excellent oral hygiene to efficiently eliminate plaque.
• Eat fruits and vegetables and avoid salty, fried and sticky food.
• Cut down on diuretics like coffee, tea, soda and all other caffeinated drinks.
• Do not smoke.
• Drink plenty of water during Iftar, rinse your mouth with water during the fasting hours without swallowing it.

What are your top tips for maintaining a healthy oral hygiene routine during Ramadan?

Oral hygiene during the holy month of Ramadan does not differ from your routine dental hygiene.

• Brush thoroughly before sleeping at night and I recommend brushing after Suhoor (pre-dawn meal) for at least 2 minutes.
• Floss at least once a day.
• Clean your tongue using tongue scrapers or separate toothbrush.
• Use alcohol-free mouthwash.

Can Crooked teeth correct on its own?

Crooked teeth are caused due to an imbalance between the jaw size and the tooth size. Let's say , for example if your jaw sizes are smaller and your teeth size are bigger then the teeth and the jaw have to accommodate itself in the jaw somehow, so it causes crookedness.

It is merely like three people who are bigger traveling in a small car , then each one has to adjust by either sitting front and back or one above the other to go comfortably. This is the same situation with the mouth also , either the teeth has to accomodate or it has to overlap each other or get arranged either front and back.

The correction for this problem could be one person has to leave the car so that others to sit comfortably. Vice versa  few teeth also have to be removed to get accommodated to each other. That is why your dentist will ask you to remove your few good teeth to correct the malocclusion or the crookedness.

Will there be a gap if my tooth extracted for orthodontic treatment?

It is the most common question asked by almost all the patients when they are told to remove the teeth for orthodontic corrections. Once your premolar teeth are removed which are the most commonly removed teeth for orthodontic corrections, the front tooth is brought into position into that extracted space, so you don't have to worry that there won't be any space after the treatment completion. 

The stability of the orthodontic treatment can be achieved by giving light forces on the teeth movements and giving permanent retention in most of the cases. The most common cases where there is permanent retention would be generalized spacing, midline diastema, and severely rotated teeth.

Do braces hurt or pains? 

The answer for this question could be explained from an example whenever we buy new shoes it hurts our legs for a moment because there will be some elasticity of the shoe over a period for a couple of weeks. Later the shoe gets adopted to our leg causing no pain afterward.

Vice versa your new braces could hurt you due to the friction of your mouth tissues over the brackets causing pain and ulcerations during the initial stage of your treatment. 

What should you do when your braces hurt or pains? 

At what age should one schedule an orthodontic treatment? 

What is the interceptive Orthodontic treatment method?  Why is Interceptive orthodontic treatment procedures are important?

What are the common interceptive treatment methods in orthodontics? 

2. The second most common solution to the interceptive problem would be correcting the mouth breathing.Children tend to have mouth breathing because of three main reasons when there is some blockage in the nose this obstructs the nasal airflow of the child causing the child to open the mouth and breath. This mouth breathing habit then becomes the typical pattern for the child. So when the child starts breathing through the mouth, there is an excess pressure from the cheek onto the tooth surface causing the face to become long and narrow because the pressure could cause the excess vertical growth of the face. 

3. Mouth breathing could cause dryness of the mouth during night time causing gum infections in the front tooth which has signs of bleeding gums bad breath and also decay starts in the front tooth first. 

The correction for this starts by referring the child to an ENT surgeon who specializes in the ear nose and throat. 

The ENT surgeon will do the following tests :

1. He will refer to take  a PA view of sinus x-ray 

2. He will ask for nasal endoscopy if the problem is severe to assess the intranasal polyps and any lesion and conditions causing nasal obstruction. 

3. He might ask for an MRI test also for determining the Nasal pathway and oral pathway and even the pharyngeal path. 

4. When there are conditions of nasal polyps and tonsils, the ENT surgeon might ask the patient to go for tonsillectomy or polypectomy using lasers or conventional surgical methods to clear the obstruction of the nose.

 

5. Once the nasal obstruction is clear the child will be referred back to the suffering dental surgeon or the orthodontist. 

6. Then the orthodontist or the dental surgeon will give an appliance called oral screen. 

  

7. An oral screen is a custom-made device which looks like a thick plate of acrylic which is kept on the buccal surface of the tooth or of the outer surface of the tooth. 

8. There will be four holes in the Oral screen which helps the child to breathe through the mouth itself during the initial phase of treatment. 

9. Every two months the patient has to be evaluated, and the holes will be closed one by one week by the doctor generally and slowly improving the patient to breathe through the nose and to solve the patient's problem by interceptive orthodontics measures. 

10. The oral screen has to be worn throughout the night and 2 to 3 hours of conscious wearing during the daytime once the child comes back from the school. 

11. The child has to do an active exercise called oral screen exercise where the 'O'ring or the handle of the oral screen will be pulled manually by the child, and the child has to suck the oral screen with the lips. This causes lip elongation or lip growth for the child. This will help the child to have a proper lip when there is a problem of very small lips, and also it helps the child to close the mouth passively. 

12. When the patient is having problems with jaw growth, there are many appliances which are given in this age group of 7 to 11 or 12 years. These are all called activators bionator and frankels appliances. These appliances are provided when the patient has got the problem which is mostly muscle oriented.

13. But when the tooth is being affected by the jaw growth, then it becomes an Orthopaedic problem. Orthopedic problems are corrected by using headgears, chin cups, face masks. 

Corrective Orthodontics :

When a child reaches an age group of 12 to 13 if it is a girl child, then we can start orthodontic treatment which are the regular and conventional treatment methods like using stainless steel brackets, ceramic brackets and all the bracket based treatment therapies for orthodontics. 

There are many types of braces colors which come. Braces colors come from the modules which we are applying to hold the wire into the brackets. But these days kids are very conscious, and they never prefer to go for color braces they prefer to go for braces which are normal in color.

 There are many many types of braces available based on the material we can classify it as standard Steel brackets and ceramic orthodontic brackets. Based on the ligation methodology brackets are classified as self-ligating brackets or regular modular brackets. 

 

  

The difference between self-ligating brackets and modular brackets would be self-ligating brackets use an automated door Technology where the wire is retained with the bracket with the help of a small sliding stainless steel door. In the conventional Technology, the wires and the braces are connected using wire module or elastic modules. 

Based on the visibility of the braces there are aligners which are called clear aligners. Clear aligners are those acrylic aligners which are made up of clear acrylic sheets printed using 3D printing Technology. These are the most sought-after treatment for orthodontics over the last 2 to 3 years for correcting orthodontic problems.

Adult braces are not very appealing to adults because of social concerns. People who are very conscious about their treatment appearance seek clear aligners. These are little expensive by way of its cost of aligners. But the number of advantages are very vast. 

 

 

The benefits of clear aligners would be 

1. They are very very clear and not visible, so it is very convenient to wear during office time and also patients till functions like wedding and any other ceremonies. 

2. Clear braces are very comfortable to remove and place it back there is no restriction on any food. 

3. In regular braces chances of dislodgement of brackets are more causing more time to fix it back and tooth movements etc., 

4. In clear aligners, this kind of problems never happens, so treatment time is considerable shorter with clear aligners. 

5. Chances of relapse are very less because of light forces applied. 

6. Very predictable treatment outcome can be seen before the treatment is completed using software for 3D aligner Technology. 

7. The chances of tooth damage in conventional orthodontic treatment caused by using adhesives, sealants and acid etching in traditional braces are not there in clear aligners.Clear aligners keeps  the tooth to be as virgin as possible without altering the nature of the tooth in the mouth. 

8. Clear aligners don't cause any secondary caries because of no damage to the tooth structure. 

These are some of the preventive interceptive and corrective methodologies of orthodontic treatment. 

Surgical Orthodontics :

Any adult patient after 18 years of age has to undergo only surgical orthodontics the most commonly solved using surgical orthodontics are 

1. Prognathic maxilla where the upper jaw is proclined forward. 

2. The retrognathic mandible was causing jaw deficiency. 

3. Prognathic mandible and retrognathic maxilla. 

4. Chin corrections, malar bone corrections can be done using surgical orthodontics. 

The advantage of surgical orthodontics are 

1. Very very quick correction of orthodontic problems, suitable for people who are seeking orthodontic treatment for the wedding and marital problems in a short span of time.

2. People who are traveling abroad and wants to get their problems corrected in their native town with the help of a specialist. 

3. The complete transformation of the person happens during surgical orthodontics where the whole face changed in 3 hours or 4 hours.

 

4. Surgical orthodontics is highly predictable these days using 3D Technology where we can visualize the face appearance before it is getting done. 

5. Surgical orthodontics is performed by the team of oral and maxillofacial surgeons and orthodontist under general anesthesia in hospital setup, not in clinics. 

6. Surgical orthodontics cost in Chennai would be roughly from 100000 to 1.5lakhs. 

Finally, in this blog, I have explained you very openly about all the four modalities of orthodontic treatment preventive interceptive surgical and corrective. I have also explicitly explained about the treatment timings the appliances used; the problems addressed and the cost.

if you would like to consult personally with me kindly 

book your appointment here

What is sensitivity?

It is a sharp shooting pain felt on a particular tooth or teeth causing discomfort

while taking hot/cold foods.

Causes include

1.Tooth decay

2.Wearing of enamel in case of fractured teeth

3.Worn fillings

4.Wearing of cementum and exposed tooth roo5.Acidic foods and beverages

6. Incorrect brushing techniques

7.Clenching/grinding the teeth

Bacterial acid destroys the outer surface of the teeth exposing the inner layers 

leading to sensitivity

various factors govern tooth sensitivity

How will I find that I have tooth sensitivity?

If hot/cold foods, sweet, acidic foods/drinks, breathing in cold air makes the

 tooth sensitive/ painful then it is indicative of tooth sensitivity

Treatments for sensitive teeth:

There are variety of treatments depending on the cause for sensitivity

1.Desensitizing toothpaste

2.Fluoride gel application

3.Surgical grafting techniques

4.Filling / Root canal treatment

Daily care for a sensitive teeth:

1.Brush and floss regularly

2.Don’t brush too hard/too often

horizontal way of brushing causes wearing of tooth enamel in the neck region. Condition called abrasion, causes sensitivity

3.Use a softer tooth brush

4.Use desensitizing toothpaste twice a day

5.Change your tooth brush once in three months

How to prevent tooth sensitivity?

1.Brush twice daily not exceeding 2 mins

2.Use tooth paste that does not have high abrasive content

3.Floss once a day

4.Diet low in acidic foods and drinks

Where to go for tooth sensitivity?

Which hospital is best for tooth sensitivity?

Malligai dental hospital located in West mambalam, ashok nagar, 

with all the state of facilities. It is headed by Major Dr.Pravin Prathip.J, 

an Ex army dental corps officer with more than 16 years experience.

 He specializes in Implantology, Root canal treatment, Orthodontics. 

His value is based on compassionate patient care. He brings the world class 

Dental care to all the people in a very affordable pricing. 

Our Malligai Dental Hospital has been ranked in 9th position in 

All India Times of India survey. We also have in house OPG (xray facilities) blood lab facilities.Both the clinics are well located in ground floor convenient for elderly patients.

Book your appointments here

What is Bad breath ? 

Bad breath also called as halitosis ( in dental terms) is a persistent, unpleasant odor in exhaled breath, usually not severe sometimes it may be a symptom of the underlying health situation. Bad breath is often is due to result of poor dental hygiene, particular food that the patient eats and also due to other life style habits.

The story begins here..