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When asked about the number of teeth, the immediate response is 32. What most people don’t realize is that this includes that 4 wisdom teeth also, which don’t erupt in 50% of the adults. The revised number is therefore 28. Again, this is what is normal, and there could be variations among people. While some could have lost some tooth and have less than 28, another interesting bunch of people can have more than 28.
This condition of having extra teeth is known as hyperdontia that is hyper for more and dontia for teeth. Also called as supernumerary teeth, they erupt in the same line as other teeth or if there is lack of space, erupt either on the tongue side or on the cheek side of the jaw bone. In severe cases, it could sometimes even give the appearance of a mouthful of teeth.
These vary in shape and size and the following are the common forms of supernumerary teeth.
Mesiodens: The most common form, they erupt between the incisors in the front of the mouth. The extra teeth are usually conical and much smaller than the regular incisors.
Paramolars: These would look like smaller molars and can grow on the cheek or the palatal side.
Distomolars: These are extra-small, additional wisdom teeth and grow beyond the third molars.
Reasons: Not clearly established, but genetics has a key role in their formation. Abnormalities like cleft lip and palate, Ehler-Danlos syndrome, and Gardner syndrome can also lead to supernumerary teeth. It is more common in men than women.
Fixing Hyperdontia: Even if they do not cause any immediate damage, they will be exerting extra pressure on other oral structures and should be removed. The gums and the jaw bones will be under a lot of pressure with the extra load.
Before going ahead with removal, the underlying cause needs to be identified. If there is any anomaly like cleft lip or palate, that needs to be corrected. If Gardner’s syndrome is suspected, then other symptoms also need to be checked for. Once the cause is identified, then removing hyperdontia is just one part of the whole treatment.
A radiograph will help determine, if there are additional teeth present. A removal plan then needs to be drawn up. After removal, the orthodontist will need to be involved to correct any misalignment with braces. The exact duration and type of treatment will depend on the patient condition. If it was just a conical mesiodens that erupted between the two incisors, then it could just be removed and the space closed in a short period of time. However, if there are many of them, then a planned removal and correction is required.
Fluoride is a chemical naturally present in water and in some foods and is essential for healthy bone growth. A few decades ago, fluoride was discovered to have anti-cariogenic (against tooth decay) properties and slowly gained popularity. While most believe that fluoride can do wonders for your teeth and help you get rid of all problems, it is not true. There is only so much that fluoride can do and there are also undesirable effects from it.
Read on to know some myths about fluoride versus the actual facts.
Myth: Drinking fluoridated water can lead to fluorosis, which produces brown, pitted teeth, which are weak and aesthetically unappealing.
Fact: People develop fluorosis only when the water contains excessive amounts of fluorine. The currently defined permissible level is about 0.7 parts per million. At this level, fluoride provides the maximum protection against caries, at the same time not leading to fluorosis. In some cases, mild fluorosis can be seen, which only produces white speckles on the tooth and not brown pits. These teeth have a higher resistance to decay than people drinking non-fluoridated water.
Myth: Fluoride is a forced medication
Fact: Fluoride is a chemical with special benefits to the bones and teeth. In cases where the water does not contain sufficient quantities of fluoride or where the person is prone for decay, adding fluoride will provide the extra level of protection against caries.
Myth: Adding fluoride to the drinking water leads to various other medical conditions (heart disease, cancer, etc.)
Fact: Various studies have shown that this is not true. In fact, fluoride has been endorsed as safe to use and does not contribute to any diseases like heart disease, cancer, autism, or kidney problems.
Myth: Fluoride is not safe for children.
Fact: Children need a good amount of fluoride in their tooth forming years. This produces teeth that are more resistant to decay and are stronger generally. If the regular supply of water does not contain sufficient fluoride, then the child can be given supplements in the form of fluoridated toothpastes and gel applications at the clinic to provide the anti-cariogenic benefit.
Myth: If there is enough water in the fluoride, then there is no worry of tooth decay.
Fact: Fluoride only makes the teeth resistant to easy decay, it does not protect from decay completely. Proper oral hygiene habits (brushing, flossing, rinsing, dental visits) are essential to ensure that there is no plaque accumulation and food deposits to prevent caries. Fluoride is not a replacement for these practices.
Like with anything else, even excessive fluoride is not good for health, therefore the recommended level is 0.7 ppm. Ensure fluoride supplements are used only after a discussion with your dentist.
‘Smoking is injurious to health’, is a caption that is flashed on all cigarette packets. However, what is not told about is their adverse effects on the mouth. The mouth with the lips, teeth, and gums are not just the first points of contact for a cigarette but also one of the majorly affected parts.
Listed below are how smoking affects the teeth and the mouth at large.
Bad breath (halitosis)
Tooth discoloration (brown to black spotting)
Tobacco deposits on the teeth leading to irritation of the gums
Increased formation of plaque and tartar on the teeth, leading to significant gum disease
Gum disease leads to tooth loss
Increased jaw bone loss
Lower success rate of dental implant procedures
Delayed healing after any oral procedure including extraction, periodontal treatment, or oral surgery
Increased risk of leukoplakia, white patches inside the mouth, which is a precursor to oral cancer
Increased risk of developing oral cancer
Reduces blood flow to the gums, thereby affecting healing
The tiny tobacco deposits sit on the tooth surface and with time, produce brownish stains. These are a constant source of irritation for the gums, causing gum disease. Unlike the regular plaque caused by food, this is much harder and more abrasive on the gums. This leads to damage of the periodontal tissue, which are connecting fibers between the teeth and the gums. This leads to gradual tooth mobility and eventually loss.
Correlation: If you are a smoker,
You are at risk for gum disease twice compared to a nonsmoker.
More cigarettes you smoke, greater the risk for gum disease.
More number of years you smoke, greater the risk for gum disease.
Poor response to regular treatment for gum disease.
Management: The gum disease can eventually lead to tooth loss. Therefore, the gums need to be protected at all cost to maintain oral health. Some things to do are listed below, starting from the seemingly innocuous to the severe infections.
Regular cleanings at your dentist's office once in 6 months
Daily brushing and flossing to manage early gum disease
Deep cleaning below the gum line and prescription mouth rinses if there is already existing gum inflammation
Surgery to remove deeply seated plaque and tartar.
Surgery with bone graft to replace the bone lost to periodontitis.
Most important of all, quitting smoking. This will produce remarkable benefits when the above are followed.
However, if the above are done with continued smoking, the effects will not last long.
Cigarette smoking is one habit, which has way too many effects on way too many working’s of the body and therefore kicking the habit is the best way to manage, not just your teeth, but your overall health.
We all love a set of perfectly aligned teeth to show off when we smile. Many get braces done to get this straight set of teeth. However, many people find it mysterious that their teeth have suddenly started to crowd. Somebody could even be in their late 20s, well past their growing years, and suddenly realize that there is crowding setting in for the last few months. It poses a big cosmetic problem and also affects the way teeth bite with each other.
Causes: The sudden appearance of crowding seems very mysterious. However, in most people, there is no exact reason to pinpoint and it seems it is hereditary and genetic. Despite having braces done, there is sudden crowding after the growing years are over. Though an exact correlation has not been established, it is believed that strange habits of people not related to their mouth at all causes tooth crowding. Regular pressure on the mouth by either placing the face on the head or sleeping on the belly puts a constant pressure on the mouth and leads to crowding over a prolonged period of time.
The most logical explanation is however, what is termed as ‘physiologic mesial drift’. By nature, the teeth have a constant, very gradual movement towards the incisors which is the midpoint of the jaw. Given this inherent quality, there is mild constant pressure from the molars towards the incisors and this is what leads to crowding. Stronger jaw bones may slow the process, but it is not yet proven. This physiologic mesial drift is the reason why the lower front teeth are the most common area of crowding.
Management: The earlier the dentist intervenes, the shorter the treatment duration and the quicker the correction. Radiographs and models would be required to identify the problem completely. The bite with the upper teeth needs to be assessed though to make sure it is not very deep. The age of the person also determine the results.
Mild to moderate crowding in this area can be managed with just a lower brace for about 5 to 10 months. In some cases, even an upper brace would be required. In cases of severe crowding, some cases even presenting with two rows of teeth, some teeth definitely have to be removed and the remaining teeth need to be aligned and the extra spaces closed. Severe crowding may also require you to wear a retained for a long period. This could be placed on the inner side (tongue or palatal side) to improve cosmetic effect.
There is no need to panic when you realize the teeth are crowding, there is definitely a way to flash that bright smile again!
Ever wondered how good it would be if a tooth lost can be placed back in place? That is just what the dental implant does. Unlike the dentures, which replace only the crown portion of the tooth, the implant replaces the crown and the root portion of the tooth.
What’s more the chances of decay are less and there is no fear of mobility. The dental implant replaces the natural tooth to the maximum extent possible, both in terms of chewing efficiency and stability of the tooth. It can take almost as much pressure as the natural tooth, with hardly any restrictions on diet.
When properly fabricated, the dental implant can last a lifetime. However, this longevity depends on two sets of factors. The first is the overall oral health of the patient and the second is the post-implant care.
Oral health: Before deciding that a person is to go for an implant, the following are considered:
The person should have very good jaw bone support: The titanium post that will be used as the root portion is placed into the gum ridge and unless the jaw bone is extremely healthy, it will not be able to support this. Also, the post will be in left in place to get integrated into the bone for about 4 to 6 months. During this phase, the oral health should be maintained extremely well.
Placement: The implant should be done by someone qualified to do an implant, not just by any dentist. Good fabrication of the implant is very essential for its longevity.
Good oral hygiene measures: This is a prerequisite for choosing, if a person is a candidate for a dental implant. If the oral hygiene habits are doubtful, then it would not be worth investing the time, effort, and money on an implant.
Post-implant insertion care: Once the post is absorbed into the bone and the crown has been placed, meticulous care should be taken to ensure there is no plaque formation in and around the implant. The gums have to be maintained healthy through regular brushing, flossing, interdental brushing and frequent mouth rinses. This will ensure the gums are healthy and can support the implant for years to come. Regular visits to the dentist every 6 months and scaling in the dental office are also mandatory when you have an implant.
The overall health of the person also ensures success of implants. Chronic uncontrolled conditions like heart disease, stress, diabetes, and smoking adversely affect the oral health and therefore the success of an implant. These are also associated with a greater risk of gum and periodontal disease. Managing these optimally also adds to longevity of dental implants. If you wish to discuss about any specific problem, you can consult a dentist.
A very interesting thing, that most people would have noticed during their visit to the clinic is the white light that is used on the teeth. This is laser light, which is used extensively over the last couple of decades in dentistry for a variety of treatments. The following are some procedures where laser is commonly used.
Whitening teeth: In-office bleaching is done by applying the whitening agent on the tooth and activating it by laser light. This instant result is whiter teeth and a brighter smile.
Caries: In some cases, laser light is used to remove the decayed portion of the tooth and shape the surrounding healthy tooth to receive the restorative material.
Restorations: When composite resins are used to fill the space left by tooth decay, the decayed portion is removed and the enamel etched to improve adhesion. The composite material is then filled in the tooth space to achieve the desired shape and then light-cured.
Veneers: Where a thin layer of the existing tooth is removed to provide a whiter tooth, then laser light is used. These chemicals are inactive and only become activated when exposed to laser light. In cases of both restorations and veneers, one big advantage is it gives sufficient working time for the dentist to shape the material to the desired form and then activate it.
Gingivitis: Laser is also used in gum diseases where bacteria are removed and the gums are reshaped. Using laser on the root surfaces ensures better removal of the hardened calculus and promotes gum reattachment of the gums to the tooth surfaces.
Root canal therapy: In the root spaces, if there was an infection, laser light can help remove the bacteria before filling up the root canal with gutta percha.
Soft tissue biopsy or lesion removal: Biopsies of the lips, gums, and tongue can be done using laser light. If the lesions are too small and require removal, it can be done by laser, thereby avoiding the need for surgery
Results: In all the above procedures, the laser is more effective than the conventional method that it is replacing. Some advantages include:
Anesthesia not required
Avoids tooth drilling in some cases of very minor decay, so patient is at ease
Reduces bleeding and swelling when dealing with soft tissues
Reduces the amount of tooth removal during cavity preparation
Not all situations can be managed with a laser treatment though and conventional biopsies and drills will be required in some cases. As with all other dental situations, a detailed discussion with the dentist on the pros and cons and the patient condition will help make an informed decision.
There is always the constant attempt to look better and more appealing. To this effect, smile designing is one particular specialty of cosmetic dentistry with the sole aim of improving a person's smile.
Photographs of various angles, jaw tracing analysis, and simulation of images on the computer are all used to arrive at an optimal size, shape, contour of the jaw and the teeth that can produce the best smile for a given patient. These changes are then replicated on paper and tooth models if required and detailed discussion happen with the patient. Thorough patient counseling is done before initiating work at smile designing.
Some parameters that are manipulated to produce a good smile designing are as follows - first the tooth per se followed by the soft tissues:
- Tooth color: In most cases, the tooth color is changed using tooth whitening material or laser. Trust the dentist to achieve a balance between whiteness of the tooth and natural look. In some cases, silver amalgam fillings may be replaced with composite restorations to improve the appearance. Bridges with metal backup may be replaced with complete ceramic crowns too.
- Tooth alignment: Crooked or misshaped teeth can be corrected using veneers in minor cases and by orthodontic braces in severe cases. Again, if the patient is very conscious, aesthetic ceramic braces (read more about braces) can be used.
- Tooth length: If too much or too less of a tooth is showing during a smile, that needs to be corrected too. Longer teeth are considered to produce a younger appearance than short teeth, which usually is associated with old age and wear and tear. The gums can be reshaped as a part of crown lengthening.
- Missing teeth: Teeth that are missing produce a very bad smile and need to be replaced at the earliest for a better smile. Depending on various factors including age and bone health, the choice could be a crown or a bridge or an implant.
- Tooth ratio: When a person smiles, the front tooth are the most obvious and should have a ratio of length to width as 4 to 5. This produces a balanced smile.
- Tooth texture: Mottling or rough edges on the tooth surface can be corrected by veneers or small composite restorations. As regards the soft tissues.
- Gum line: The smile is reproduced on tracing and corrections are made to produce a better smile, even if it requires gum corrections.
- Fuller lips and cheeks: Surgical procedures or chemicals may be used to produce fuller lips and cheeks that improve a person's smile.
The next time you are not happy with your smile, visit a dentist. With so many parameters that affect your smile, a little correction could produce a better smile! If you wish to discuss about any specific dental problem, you can consult a specilized dentist and ask a free question.
Cosmetic dentistry primarily involves improving a person's smile and facial appearance. It could involve the teeth, gums, cheeks, lips, or the bite of the patient. Accordingly, a change can be produced in the color, position, size or shape of the teeth, alignment of the teeth, contouring of the smile, etc. The end result is always a better facial appearance and improved confidence level of the patient.
Some common examples of cosmetic dentistry include:
- Teeth whitening: There are very few people who are happy with the color of their teeth. Everybody wants whiter teeth and therefore go for options like bleaching. This can be done either in the dental office or done at home. A word of caution though - go for teeth whitening only after the consultation with a dentist.
- Veneers, crowns: Just as the color of the teeth, the shape of the teeth also leaves a lot to be desired for almost everybody. Veneers are applied on the teeth after removing a thin layer of tooth structure. Minor reshaping and contouring of the tooth can also be done, especially to improve appearance in the front teeth.
- Tooth contouring/shaping: The edges of the teeth can be smoothened by mere shaping or contouring. There is no extra material that is added to the tooth here. In some cases, a thin layer of resin may be bonded to the tooth if required.
- Bridges: In cases the adjacent teeth shape, size, or color mismatch, then bridges can be done to even out the difference and produce a more corrected appearance.
- Braces: Braces are a big hit as they help correct misaligned teeth. However, the next step with invisible braces and ceramic braces is another step towards moving away from the traditional metal braces, which itself was not cosmetically received.
- Onlays and Inlays: Improper tooth shapes can be corrected with parts of the teeth that either replace only a small decayed portion or the entire crown portion to produce a more pleasing effect.
- Implants: Though fixed bridges do a very good job at replacing lost teeth, implants go to the next level in terms of the aesthetic replacement.
- Gingivoplasty: In cases where the gums have black spots, are too short, or are too long, the gums can be shaped to provide a better teeth visibility. The gums can also be sculpted to produce a more appealing gum line that shows off the teeth to give a more harmonious smile.
- Bite correction: In addition to braces, in some cases, bite correction may be required to smoothen out a sharp cusp or reduce the prominence of the canine.
With a number of corrections possible, cosmetic dentistry is here to stay - just as the drive to look good.
Tooth loss is a challenge for both the patient and the dentist. Patient has to deal with reduced chewing efficiency and altered appearance. The dentist, on the contrary, is faced with restoring the lost tooth to the maximum natural extent possible, functionally and structurally.
The fixed dentures came close with their ability to providing fixed teeth that were stable and aesthetically appealing. However, there was one big disadvantage, the adjacent teeth that were being used as abutment were reduced in size and therefore strength though they could be perfectly normal teeth.
In an effort to avoid this, the dental community started looking at options, the result of which was implant. Not just replacing the crown part of the tooth, even the root portion of the tooth is replaced here.
A biocompatible material, titanium, is put into the tooth to serve as the root. Titanium is strong, light, biocompatible (does not cause autoimmune reactions in the surrounding tissues) and most importantly osseointegrated (fuses to the surrounding bone). Once placed as the root, it gets absorbed into the bone after a period of about 2 to 6 months. Then, a crown or a denture is literally built on this root to simulate the natural appearance as close as possible. This provides not just the complete natural tooth structure but also provides support to the surrounding tissues like the gums and the cheeks.
Implant dentistry is a perfect example of teamwork including surgeons to operate and place the bone, prosthodontists to do the crown or the bridge, a periodontist to manage the gums health, and a lab technician who can do the finest job on the crowns or the bridges.
Types of implants:
- Three common types include: Single tooth replacement: In cases where a single tooth is lost, the implant would be one root that is allowed to fuse to the bone and then a crown is placed over it.
- Fixed multiple teeth replacements: If more than one tooth is lost, then bridges are fabricated by placing one or more implants and then custom-made crowns are placed over these implants.
- Removable implant supported complete denture: If all the lower teeth are missing, implants could be placed at pre-identified locations and then a complete denture fabricated over it. This is commonly done in lower jaws as stability is always a cause for concern.
The success of the implant requires good bone health. The most common contraindications would be patients with chronic diseases like poorly controlled diabetes, cancer in the line of jaws, chronic smoking, or poor periodontal health.
However, if managed well, even these patients can have implants after a detailed assessment by the dental team.