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                                                     ASK DOC SECTION

In this section, I have attempted to answer the queries which have been asked to me by various visitors to this home page.

Q.    What are the causes of bad breath? What can be done about it?

Q.    What is to be done if gums recede?

Q.    What is the treatment for a canine that is outwardly placed?

Q.    What is the cause and the remedy for tingling sensation in front teeth?

Q.    Which toothpaste and toothbrush are best for teeth?

Q.    Why is there a sharp pain when a silver foil comes in contact with a silver filling in a tooth?

Q.    Do teeth become weak and loose if scaling is performed on them?

Q.    Is there any alternative medicine therapy for bleeding gums?

Q.    What is the best course of treatment for prognathic mandible?

Q.    What is the treatment for out-of-position front teeth which look ugly?

Q.    My 7 year old daughter has 2 sets of teeth in lower jaw. What do I do?

Q.    My mother is having numbness in her lower right teeth and gums since surgery. What can be done?

Q.    I am 25 years old and in depression and am afraid that within 5-6 years, I will have wear dentures. Please advise me.

Q.    Can the non-removal of wisdom teeth affect breathing and lead to death in 5-6 years?

Q.    A 16 year old child wants braces just because his friend has braces. What should we do?
 
 
 
 

If you have any queries, or questions, please DONOT hesitate in e-mailing me your question. I would be glad to help you. My e-mail address is drrchandra@yahoo.com


 
 
 
 

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Q.    What are the causes of bad breath? What can be done about it? - Nitesh, New Delhi, India

A.    Bad Breath ( or Halitosis ) is a very unpleasant and embarrassing condition in which a foul smell enamates from the mouth when speaking. Bad Breath is mainly due to sulfurous gases which are produced in the mouth due to various reasons :-

* Eating onions, garlic and other sulfur-containing compounds is one reason.
* Keeping your mouth dry over an extended period of time is another.
* Not cleaning or brushing your mouth at regular intervals in the proper manner is another reason.

When the bacteria present in the mouth increase substantially in number, they act upon the food particles present between teeth and decompose them, producing foul-smelling gases, which cause the foul odour. Not cleaning the tongue properly while brushing leads to collection of small food particles embedded in the rough texture of the tongue to be acted upon by the bacteria, and cause Bad Breath. Hence, the causes of Bad Breath are predominantly oral.

Bad Breath can be prevented  by:

* restricting the bacterial count in the mouth,
* by not letting any food particles accumulate so that the bacteria can decompose them.
* Also, avoiding onions, garlic at mealtime
* and sipping small amounts of water at regular intervals will help.
* by cleaning your mouth by brushing after every meal
 

                                                                                    

Q.    What is to be done if gums start to recede? - Rick, New York, U.S.

A.    Gum recession i.e. movement of gum line towards the roots of teeth can be categorized as both a physiological ( meaning normal and natural ) and a pathological ( meaning disease-related ) phenomena. Even in the persons having perfectly healthy gums, a slight amount of recession is seen over the years.
In pathological conditions, the speed of recession is much faster. Various factors which cause recession include vigorous and injurious tooth brushing, traumatic occlusion, periodontal diseases.
As soon as you notice that your gums have started receding, you must consult a periodontist, who will ascertain the cause of the recession and advise you accordingly.

Q.    I have a canine which is outwardly placed and appears very unaesthetic when I smile. What is the treatment for a canine that is outwardly placed? - Bharat, Noida, India

A.    An outwardly placed ( or Buccally placed ) Canine is caused due to lack of space for it to erupt in its normal position. The treatment for this depends on :-
*    how much space ( in mm ) is present between the lateral incisor and the first premolar ( which are the teeth adjacent to the canine ),
*    and the width of the canine.

A discrepancy of 1 mm or so can be taken care of by conservative means, but a discrepancy of 3-4 mm or more needs the extraction of the premolar to make space for the canine to erupt. Note here that the canine itself will never be extracted as it is essential to the integrity and acceptability of the dental arch, as it gives fullness and support to the lips.
The canine may be brought into place by orthodontic means.

Q.    I have noticed slight tingling in my front teeth. What is the cause and remedy for tingling sensation in the front teeth? - Rick, New York, U.S.

A.    Tingling sensation ( better known as Sensitivity or Hypersensitivity ) in the front teeth occurs when the Dentine of the tooth is exposed. Normally, the Dentine is covered by the Enamel ( in upper part of tooth ) and the Cementum ( in lower part of tooth), and thus protected. When the protective shell around the teeth ( called Enamel in upper part of tooth, and Cementum in lower part of tooth ) is eroded, the Dentine is exposed causing sensitivity. Dentine is permeable in nature, as it has millions of microscopic tubules connecting its outer surface to the Pulp of the tooth. Any thermal stimuli, especially cold, like when drinking cold beverages causes irritation of the nerve fibers in the Pulp, through the Dentine, thus causing sensitivity.

The remedy is to use a "Desensitizing Toothpaste". Use of such toothpaste over a period of time, reduces the tingling
sensation. Other methods include using a desensitizing mouthwash, and getting desensitization done professionally by a dentist. All these desensitizing procedures involve the blocking of the tubules present in the Dentine, thus isolating and protecting the pulp from these thermal stimuli.

Q.    Which toothpaste and toothbrush are best for teeth? Which should I buy for myself? - Vikram, New Delhi, India

A.    Although there are a variety of tooth pastes with different formulations presently available in the market, in different countries around the world, no one toothpaste has been scientifically proven to be miles ahead of the others. But in general, if possible, buy a toothpaste which doesn't have a high abrasive factor and contains fluoride ions in the concentration of 1000 ppm ( in areas where the water is not fluoridated ).

As for toothbrushes, there are again, a number of toothbrushes of various shapes and sizes and grips, all proclaiming superiority over others but, again, there is no one brush which can be called the ideal toothbrush.

Here, I would like to emphasize that more important than the toothbrush is the technique of brushing. A poor brushing technique, using a "good" brush is more harmful than a good technique using a "poor" brush. While buying a toothbrush look for a toothbrush with even, finely cut bristles, of "Medium" bristle hardness. Always remember to replace your old toothbrush once its bristles are hopelessly out of shape.

Q.    Why is there a sharp pain when a silver foil comes in contact with a silver filling in a tooth? - Tapesh, Bareilly, India

A.    There occurs a sharp pain when silver foil ( or any other metallic object ) comes in contact with a silver filling, or any other metallic restoration in the mouth because all metals possess different Electromotive Potentials. So when they come in contact with each other, there exists a potential difference between the 2 metallic surfaces causing a very weak current to flow between the silver foil and the metallic restoration, thus a pain occurs. This phenomena is known as Galvanism.

Q.    Do teeth become loose and weak if scaling is performed on them? - Chetan, San Jose, U.S.

A.    Scaling, either hand, or ultrasonic is a procedure which removes the calculus from the teeth. This Calculus is inhabited by many bacteria, most of which are harmful in nature. These bacteria secrete chemicals ( called "toxins" ) which are harmful for the teeth, gums and the bone which holds the teeth in place. These toxins damage the gums and erode the bone which holds the teeth in place, thus robbing the teeth of their support and thus the teeth become weak and mobile.

If this condition is left unchecked, it can lead to loss of the tooth, by eroding all the bone support of the tooth. But, calculus, being mineral in nature supports the tooth ( while eroding its bone support). When scaling is done, this calculus support is lost, causing a slight mobility to be present in the tooth.

But, it is important to realize that although the teeth may loosen a bit, their bone-eroding process is stopped. It is imperative to understand the fact that once a certain amount of bone support has been lost due to calculus, it is very difficult to restore the lost bone. Only surgery can help gain back some of the lost bone support.

Q.    Is there any alternative medicine therapy for bleeding gums? - Rick, New York, U.S.

A.    I am passing on to you a home-made remedy for bleeding gums which was used in the olden days.Take mustard oil ( 1 teaspoon ) and add 2 pinches of salt to it, then massage your gums with this solution twice a day. Although I haven't tried it out professionally, but you could try it. It might help you.

Q.    I have prognathic mandible (underbite) and require corrective surgery. The problem is not very acute and mostly aesthetic. The lower jaw has to be corrected (pushed back) 4-5mm. I'm 27 male. I need following information to decide. 1. duration of surgery; 2. Cost involved; 3. duration of post-op stay in hospital; 4. Side effects. What is the best course of treatment for prognathic mandible? 5. How can one manage with jaw wired shut for two months? is it the only possible surgery? - Ashu, Lucknow, India

A.    It seems that you are very well-informed about your dental condition. What you are suffering from is a bony abnormality and it requires surgical correction. The surgery involved is called Osteotomy, which is a type of Orthognathic Surgery. Although
there are several types of Osteotomies, the one which is suitable in your case can only be decided on a complete clinical and
radiological examination.
As this surgery is a complicated procedure, also requiring General Anaesthesia, it cannot be done in a private dental clinic, but
only in a hospital, and that too by a skilled Oral & Maxillofacial Surgeon. Now, the accessibility of such a facility depends on
your city of residence. If you are a residing in or near Delhi, Bombay or Bangalore, then you are in luck as both these cities have such infrastructure and skilled surgeons.

*    Duration of Surgery - approx. 3 to 4 hours
*    Cost involved - depends : Rs 5000/- in Govt. facility to Rs. 50,000/- in Pvt. Setup.
*    Post-op stay in Hospital - 3 to 7 days
*    Side-effects - none whatsoever

The jaws are wired shut for a period of 4-6 weeks as time is required by the cut jaw-bone ends to fuse with each other and
gain strength. Till such time, the patient is kept on a liquid and semi-solid diet, comprising of soups, juices, curd, milk, khichdi
etc.


 

Q. My fiancee has all upper four front teeth out-of-position and her smile is ugly. I was told that these teeth will have to be taken out and Porcelain Veneers put in place. Is it true? Also, please tell me if Porcelain Veneers will correct the problem ? - Rajeev, Nottingham, U.K.

A.    No, you have been misinformed.
Firstly, there is no need for the teeth to be taken out for Porcelain Veneers. The term " Veneer " literally means a sheath or a thin covering. A Veneer is thus a covering which is used on the facial surfaces of teeth ( that is, those tooth surfaces which are visible while speaking or eating ). In this treatment, a microfilm of tooth surface is reduced and then a veneer is prepared to cover that tooth surface. So, teeth are not taken out for giving Porcelain Veneers.
Secondly, Porcelain Veneers can be used for cosmetically improving the appearance of the front teeth, but this is true in a very few cases. Conventionally, and might I add, ideally, the correct treatment will be orthodontic in nature, i.e. use of braces, to bring the teeth in proper position.

Q. My daughter is 7 years old and her only 1 milk teeth has fallen till now, and her permanent teeth have already started growing in the lower jaw behind the milk teeth.  So now she has 2 set of teeth in the lower jaw. Should I give her treatment now, or should I wait till her milk teeth fall out ? - Hina, Mumbai, India

A. You must get her milk teeth removed immediately, atleast the ones which have permanent teeth behind them, as the milk teeth are obstructing the path of normal eruption of the permanent teeth. Otherwise the permanent teeth will erupt in abnormal positions and will stay in those abnormal positions even after the milk teeth fall off.

Q. My mother got her wisdom teeth pulled out in August 1998  by surgery in Canada. Since then, her right side of her gums and teeth are numb. Its been over a year now, and the sensation haven't returned. She can't eat spicy, hot and cold stuff. She feels some sort of itchiness and pain. The doctors in Canada said there is no cure for this. Please help us and advise us. - Miratta, Canada

A. It seems to me that while the dental surgery was being performed on her, her 2 major nerves, which are located near the wisdom tooth, have been damaged.
    The 1st nerve, which seems to have suffered greater damage is the Inferior Alveolar Nerve, which receives the sensation from the lower teeth and gums. Thus, your mother does not feel anything on the teeth and gums of the right side.
    The 2nd nerve, which seems to have suffered damage, although to lesser extent, is the Lingual Nerve, which receives the taste sensation from the tongue. Thus, your mother is feeling altered taste sensations like itchiness, tingling etc.
    The damaged nerves will repair themselves, but the progress is slow and can take months, as is happening with your mother. As treatment, I suggest you yo put her on multivitamin pills ( at normal doses and 1 pill daily ) for a period of 6 months.

Q. I am a 25 year old recently married female. 2 years back, I met with an accident and 4 of my teeth got damaged ( 2 incisors in the upper jaw and 2 1st molars on the upper jaw, 1 on each side ). The 'root canal' treatment was done for all the teeth and they were 'capped'. I am in a depression. I always feel that I am going to have to wear dentures in 5-6 years. My self-confidence is really low. I am not able to concentrate on my studies. I am not able to sleep at night. Please advise me. - Mrs. Kajal, New Jersey, U.S.

A. Please rest assured, nothing bad is going to happen to your teeth. You are not going to lose any teeth, either the ones which were damaged 2 years ago, or any other teeth. As the damaged teeth have been treated with 'root canal therapy' and 'capped' with crowns, there is absolutely nothing to worry about. Teeth treated with 'root canal therapy' and then 'capped', have a very long life-span.
    Please do not be depressed for such an inconsequential thing, which is not going to happen. You will have your teeth for many more years to come. Just take proper care of them, like brushing your teeth twice daily, once in the morning and once at bedtime.
    Please take your mind off your teeth, concentrate on your studies and have faith in God.

Q. My fiancee is having pain in her wisdom teeth. I'm told that the 2 wisdom teeth in the lower jaw are causing a lot of tooth decay to the adjacent teeth. I'm also told that if the wisdom teeth are not removed, they will affect the breathing and can lead to death in 5-6 years. Is this true? Please tell me if the wisdom teeth can be removed safely? Why can't we leave them as they are? - Rajeev, Nottingham, U.K.

A.  Yes, wisdom teeth can be removed safely, but their removal is only necessary if need be, i.e. if they are causing any trouble. If they are not causing any problems, it would be prudent not to disturb them.     Wisdom teeth are not needed by the human body and are useless and serve no function and purpose.
As our dietary habits are changing to softer, easily chewable foods, the size of our jaws is decreasing and space available for the wisdom teeth to erupt is getting decreased leading to such problems.
    If the wisdom teeth are closely located to the nearby teeth, they can cause decay in those teeth. If the wisdom teeth are causing tooth decay on the adjacent teeth, then they should be removed.
But in no way, can the wisdom teeth affect breathing and lead to death in 5-6 years.

Q. If a child, male aged 15 years is having the upper front teeth ( 2 in number ) very fractionally big, I mean they appear to be so. Then in that case, should we allow the child to undertake surgery and get the teeth removed and planted again and then have braces. A friend of the child concerned has braces on his teeth for cosmetic reasons. Please advise - Ajay, Noida, India

A. In the child's case, if the 2 front teeth are "fractionally" large, then rest assured, no need for any treatment is there. At an age of 15 years, till the age of 22 years, the teeth and the jaw bones are growing slowly, sop slight changes are taking place in the thooth size and the jaw size. Most probably, by the time the growth is over, the teeth will appear normal. Braces are not at all indicated, from what information you have given me.  It seems to me that peer pressure is catching up on the young teenager.