Dr. Pramod Raj

Teeth are one of the most precious parts of the human body.  By playing a significant functional and structural role in aesthetics, facial appearance, and food habits, digestion and chewing, all efforts at maintaining them should be undertaken. As we all know, we have two sets of teeth, primary or deciduous and the permanent set. Let us discuss tooth removal in these two sets separately.

Primary Teeth
In the primary teeth, the main indication would be dental decay.  If the tooth is severely damaged beyond repair with fillings, then removal could be an option, with two things considered. The primary successor will erupt within the next 6 months; if not, a space maintainer would be put in place.

Another reason would be if the tooth is beyond its lifecycle and is blocking the eruption of the successor, then it requires removal.

The permanent teeth, however, are a set that are meant to last for a lifetime and removal should be considered only as a last resort. With advances in dental treatment methods, gone are the days when removal would be an option for severe decay. 

Some of the absolute indications for removal would be:

1. Wisdom teeth: if it is erupting in abnormal position (flattened or crooked), then removing them to avoid infection and impingement on other teeth needs to be considered. Wisdom teeth infection is one of the most common causes requiring tooth removal. 
2. Recurrent infections: If a tooth has been root canal treated, but continues to have ongoing chronic infection, it could be a case for removal.
3. Malformed or supernumerary teeth: These may also block eruption of other teeth into the mouth. 
4. Orthodontic treatment: In cases where the jaw size is really not sufficient to realign the mal-positioned or crooked teeth, the first premolar is often sacrificed, and this space is used to align the other teeth. 
5. Injuries: In case of accidents or injuries with jaw fractures, teeth in the line of fracture may need to be removed. 
6. Preparation for dentures: In cases of severe periodontal disease, where the mobility of the teeth is high and complete dentures are being considered as an option, teeth removal may be planned.  Also, if there are teeth which are in the line of fixed partial dentures, again removal might be planned
7. Radiation therapy: For head and neck cancer patients, if there are teeth in the line of radiation, then removal might be planned.

Unlike in the earlier years, the absolute indications for removing tooth have changed.  A thorough examination, both oral and radiological, should be done before zeroing on extraction.

Getting braces is the best thing you can do for your teeth. Yes, the process is painful. And maintenance of braces can get too much, but it is not undoable!

When you have braces on teeth, those teeth need extra attention to protect them from decay, staining and gum disease. You should also take precautions to avoid damaging the braces. For example, activities to avoid include eating chewy or sticky sweets, eating hard or crunchy foods, biting your lip, breathing excessively through your mouth and pushing your tongue against your teeth,

So if you got braces for the first time, here are some helpful tips you can swear by. Read on.

1. Listen to your orthodontist: This is kind of obvious, but seriously, listen to what your orthodontists says. You may wonder if you really need to do this or that, but not paying attention to your doctor’s advice can actually prolong your treatment, and extend the time you need to keep your braces on.

2. Brush every time you eat: Although brushing twice a day is the standard oral care recommendation, when you wear braces, you should brush after every time you eat — even after that mid-afternoon vending machine snack or some late-night munchies. That's because food particles easily become trapped in the braces, and the longer those particles stay trapped, the greater risk you have of developing dental problems. Use a soft toothbrush with round bristles, or an electric toothbrush if you prefer.

3. Rubber Bands: If you have been asked to use rubber bands, it is always recommended to carry rubber bands with you all the time, so if one breaks it can be replaced promptly. Rubber bands wear down and lose their elasticity, so they should be replaced often, definitely after every meal. Wearing the rubber bands all the time will keep the treatment progressing at an optimum pace.

4. Use your back teeth to chew: Don’t bite into that burger with your front teeth like you are accustomed to doing. This actually gets the food to stick on to your braces. So eat food that you can cut into bite size pieces and chew easily with your back teeth.

5. Drink plenty of water: Skip that soda, which will only erode your teeth, and drink water after meals. This not only keeps you healthy, but with water, you can swish it around your mouth to rinse out any big chunks of food.

6. Stay away from crunchy food: Crunchy foods are dangerous, not only do they get stuck in your braces, they also can get quite painful to remove. Plus, crunchy foods can be bad news for the shiny braces you just got for yourself.

7. Speak up: If during an appointment you have any query, no matter how silly, ask your orthodontist. Your doctor is there to help and guide you, so don’t shy away from asking questions and discussing your problems. Or if some part of the brace is hurting mildly, get it checked at once. Air your troubles, that is what your doctor is here for.

After The Braces Are Off-

Whitening products, including whitening toothpaste and mouthwash, should not be used until after braces are removed. After braces come off, some discoloration of the teeth will likely be present, so this is a good time for a child to use whitening strips.