Friday, March 30, 2012

Chewing Gum, Aye or Nay..!



Caries is the most common chronic infectious disease in the World. We should do everything to prevent or at least decrease its spread. Sugar increases blood pressure,bad cholesterol and risk of heart disease. On top of that, sugary food adhere to teeth and stimulate plaque growth.
Xylitol is a five carbon sugar alcohol compound. Sugar alcohols are neither sugar nor alcohol. Xylitol is not an artificial sweetener as well. Xylitol is a naturally sugar compound which can be derived from  vegetables and plants. Xylitol has all the benefits of sugar without its many drawbacks.
Bacteria can use the six carbon monosachcharide such as glucose or fructose as food source to produce plaque on teeth which leads to decay but cant use xylitol for this same purpose.

Xylitol has been added to chewing gums as a sweetener instead of sugar.For this reason, it is very important to know all its advantages. Now to get back to our main subject about chewing gums. Chewing gums are very effective in preventing teeth decay for the following reasons:
  1. It increases saliva flow up to 10 times.Saliva helps to wash away food debris and plaque.
  2. Chewing gum mechanically washes away food debris and food trapped on deep areas of back teeth.
  3. The increased saliva flow increases remineralization process. What the plaque acids take out, the extra saliva puts back.
  4. Dry mouth is common for people who take medications such as antidepressants and anti-histamines. More saliva production helps those patients from dry mouth side effect.
  5. Chewing gum  improves memory and increases concentration. We all remember the legend Micheal Jordan and how he used to chew gum during his NBA games. 
  6. Chewing gum helps those who want to quit smoking. 

How to use the chewing gum?

Chew gum immediately after each meal for 20 minutes.When you eat sugary meals, the PH level in your mouth drops rapidly and remains low for some time.The chewing action stimulates far more saliva,which rapidly brings the PH levels back up to its normal limit.

N.B. Be sure to chew  chewing gum with xylitol.Other sweeteners such as mannitol,aspartame or sorbitol can be used by bacteria in the mouth as food sources and they can lead to causing decay. So be sure whenever you buy any product with sugar substitute,that xylitol is the main and only ingredient.

Saturday, March 24, 2012

Fluoride treatment

Fluoride treatment can reduce caries in children and adults.
There are many Types of fluoride treatments, we will take about topical method.
Topical fluoride application includes either sodium fluoride NaF or Acidulated phosphate fluoride APF.
Sodium fluoride comes in a solution, gel or foam forms of 2 % . It is also available in varnish of 5 % . Acidulated phosphate fluoride comes in a solution, gel or foam of 1.23%.
APF is the preferred topical application over NaF, however it is avoided when patient has cosmetic restorations as it may cause some pitting.

Fluoride application techniques:
1- paint-on-method: not for gel or foam forms to avoid fluoride ingestion.
2- tray technique for gel or foam forms; 2 ml for children & 5 ml for adults.
In both techniques, dry teeth before & after with 2*2 gauze.
No drinking or eating for 30 min after procedure.

3- fluoride varnish application: safe and durable. Most effective technique to use on children.

Optimal level of fluoride in drinking water is 0.7mg/ L .

Ingestion of extra fluoride is toxic.
Certainly lethal dose in adults is 5 to 10 grams of sodium fluoride taken at one time. It is between 0.5-1g in children depending on size and weight.
Signs of toxicity begin to appear after 30 min of ingestion.
Emergency treatment : induce vomiting by stimulating back of throat or by Ipecac syrup.
Giving calcium binding agent such as milk.

Friday, March 23, 2012

Drying root canals

While I was drying root canal yesterday for tooth number 4, I noticed a very important thing. Regardless of how copious you try to irrigate the canal with disinfectant, small tissue tags can still resist the force of irrigation.
Very important tip: always while you are drying the canal with paper points at your last step, put three or four paper points together into the canal until they fit tight, then twist them all together against the canal walls. This way, you mechanically remove any tiny small tag holding still on the inner walls.If you find any tags trapped on the paper points, repeat irrigation and drying, before filling the canal with GP.

Friday, March 16, 2012

Sutures -everything you should know

Suture material that retains long term strength for up to 14 days and resorbs in 21 to 28 days is polyglycolic acid (PGA )

Conversely suture to be placed intraorally where tissue heals quickly ; surgical gut or the new rapidly resorbable PGA suture material (PGA -FA) is used.



Degradation of absorbable , biological origin sutures such as surgical gut ( plain & chromic gut) are digested by intra oral enzymes .

Gut suture is from animal protein
Which resorbs in 1 to 2 days. If coated with chromic compound, it extends 7 to 10 days.

Fast absorbing PGA FA suture is made from synthetic polymers and dissolves in 7 to 10 days. It should be used when gut suture is contraindicated .

Thread sutures range in diameter from 0 to 10

The higher the number, the thinner and more delicate the thread.


5-0 diameter is used in plastic perio surgery
4- 0 diameter is used for other perio flaps.

3-0 diameter used in implant surgeries when mattress suturing technique is used. 4-0 is used when interrupted or continuos techniques are used.


Silk is a classical suture used in dentistry . It's nonresorbable inexpensive multifilament material. Dentist should remove it in a week. It's down side is pulling bacteria into the wound site. In this case nonresorbable sutures such as nylon, polyester, polyethylene, polypropylene or expanded polytetrafluoroethylene (e-PTFE) are a better choice.


Polyester sutures are made of multifilaments braided in a single strand. This suture is coated with absorbable compound that makes the knot untie if not secured well by the dentist

e-PTFE is better in this regard . It is nonresorbable monofilament that has high tensile strength but a little more expensive than polyester.

The 3/8and 1/2 are the most used suture needles in dentistry .


The 3/8 passes easily from buccal to lingual in one motion

The 1/2 circle needle is used in more restricted areas such as maxillary molar area and anterior incisal areas.


Generally in dentistry the 3/8 reverse cutting needle with 3-0 or 4-0 thread diameter and the 1/2 reverse cutting needle with the thinner more delicate 5-0 or 6-0 thread diameter are most commonly used.


Wednesday, March 14, 2012

How to manage moderate to sever pain after third molar extraction?

NSIADS such as Ibuprofen or Naproxen could be given immediately before the surgery and continued for 2 to 5 days. A combination of NSAID with Acetaminophen can even give a better analgesic effect.



Opiods such as (vicodin or percodan) are the hallmark drugs used to manage sever pain after third molar extractions; however their side effects are limiting their use. 





Alternative to opoids is ketorolac tromethamine such as sprix. This nonopoid NSAID is equivalent in strength to the opoid drugs without their side effects. 

Thursday, March 1, 2012

Oral Conscious sedation

"Happy pills"! Have you heard about it?? You may or may not. But let me tell you a little about it.

Medically these drugs are named Benzodiazepines or Benzos as they like to  call them in the United  States. These are Anti- Anxiety pills and prescribed for the treatment of anxiety,insomnia, agitation,seizures & muscle spasms.
What is important to me and what I will be talking about is their use in dentistry.
Many people love to have beautiful smiles........who doesn't? but there is a small little problem that comes with it which is that they still feel anxious going to the dentist. Now, do you want a nice white smile without going through the anxiety and stress that come with it??  Oh yeah , you definitely do.
Here is the solution and it is very simple. Benzo pills are excellent to use and implement before dental appointments.
There are several dental sedative protocols that can give many patients the chance to go through their  dental treatments without feeling anxious or stressed.
Even if you don't feel stressed going to your dental appointment, you can still benefit from benzo pills and feel more calm and relaxed during the procedure.

Let us talk about some of these drugs:


Valium: this is the trade name of the drug. The generic is diazepam . Valium  has been in the market since the 1960's.It has long duration of effectiveness.It stays in your body for like 20-100 hours until it goes out totally.Dose ranges from 5-10mg.
This drug is used for insomnia in first place but it has its role in dentistry and I will come back to this later.

Halcion: this is the trade name of triazolam. This drug is very popular in the United States.It is used commonly before dental appointments; very safe drug. The popularity of this drug comes from its amnesic properties (memory loss).So after finishing your dental appointment, you  can barely remember anything.This drug is used for short appointments ranging from 1to 2 hours.The drug's half life (duration of staying in your body) is 1.5-5 hours. It can be mixed with Vistaril; an anti-histamine drug to get more extended effect.

Ativan:This is the trade name of the generic lorazepam. It is used to treat anxiety in first place. It has high level of amnesic effect.You barely remember anything after your dental treatment. Dosage ranges from 2 to 3 mg. It kicks in after about one hour.Duration of action is 6 to 8 hours and it stays up to 14 hours in your body.

Versed: The generic is midazolam.It is a short acting benzo drug.Excellent  for short appointments.It still has the same level of effectiveness as other benzos. Half life is about 1 to 3 hours. Lasts for as little as 1 hour.  Kicks in after 10 to 20 minutes. Excellent to use in dentistry. Dormicum is the alternative brand known in Lebanon .

There are two other drugs that have anti-anxiety effect without being benzos. These drugs are Vistaril and Sonata.

Vistaril: The generic is hydroxyzine; it is an antihistamine drug .It has anti-anxiety effect without amnesic properties. Can be mixed with benzo drug. Duration of action is 3-6 hours. Half life time is 3-7 hours.

Sonata is the trade name for Zaleplon. Used for insomnia. Duration of effectiveness is 1 to 2 hours. It quickly gets out of your body in an hour or two.

It is very important to mention that all benzo drugs are only given by prescription meaning that you can not get them from the pharmacy as an OTC(over-the counter) drugs.

Now you should know that you can not take benzo drug with other CNS depressants.You should not drink alcohol while taking benzo pills as well.

 Going back to Valium. The best protocol for oral sedation  to be used in dentistry  is as follows: Valium( diazepam) can be given to patients the night before the appointment while Triazolam can be given one hour before the treatment.
This is the best protocol for benzo drugs when used before dental appointments.
Valium is not always necessary to take the night before. Most of the time, it is more than enough to take one pill of triazolam one hour before the treatment.