Super white teeth, here how you get it.............

 Office chairside tooth whitening

• If you are a smoker, do not smoke for 48 hours.
• Stay away from highly colored foods (red sauce, blueberries, etc.) and beverages (coffee, tea, etc.) for 48 hours.
• Mild sensitivity to hot or cold liquids may occur.  This usually passes within 1-2 days.  If sensitivity is severe or persists, contact us.
• If you experience gum sensitivity do not brush the afflicted area while brushing your teeth.
• Immediate whitening results can be quite dramatic due to minor dehydration of your teeth.  It is normal for the color to tone down somewhat after treatment when your teeth rehydrate to a natural white tone.
• Long term results vary from patient to patient.  This can depend on the original shade of your teeth and include habits such as smoking or drinking colored beverages (red wine, coffee, tea, etc.)
• “Touch-up” treatments may be needed every 6-12 months to retain color.  You can ask us about different “touch-up” options such as home whitening protocol.
• Existing fillings, crowns, bonding, etc. will not whiten.  Therefore, these may need to be changed in order to match your new smile.
• If your family or friends notice your new smile, let them know that  whitening can help improve their smile too!

If you have any question?

email: dental.spa@hotmail.com

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Fusion presenting as gemination;rare case report

Gemination is a developmental anomaly of form ,which is recognized as an attempt by single tooth germ to divide resulting in a large tooth with a bifid crown &usually a common root and root canal in which the teeth count is normal when the anomalous tooth is counted.

Fusion is recognized as union of two separate tooth buds during odontogenesis,therefore one fewer tooth than normal in the dentition if the affected tooth is counted as one.

Case report: An 11 years old boy appeared in my clinic for examination. During intra oral diagnostics, tooth # 8 was not erupted yet. Clinically, it was revealed an abnormal maxillary temporary incisor retained in the mouth;two crowns joined togther. A provisional diagnosis  of gemination was given since the teeth count is normal. Radiographically, two fused  crowns with seperate roots and root canals were seen,along with a supernumerary tooth preventing the central incisor from erupting. A diagnosis of two temporary anomalous teeth fused together conjoined with a peg shaped anomalous supernumerary tooth embedded between the central permanent incisor and the temporary milk tooth.

A decision was made to surgically  extract the temporary tooth along  with the impacted peg shaped supernumerary tooth to give a way to the central permanent incisor to erupt.

**N.B. Normally,Maxillary central incisors begin to erupt at the age of 6. In this case the eruption of maxillary permanent right central incisor was delayed.

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.

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.

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.

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.

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.