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Sterilization

We at Gulati Dental Clinic, follow all the sterilization and disinfection procedures required for infection control. These are used for each and every patient to prevent the transmission of the dreaded HIV/AIDS virus, Hepatitis virus and other infectious diseases. All our staff involved in patient care share a very concerned attitude in this regard. We follow a stringent Four- tier sterilization process for our instruments. Needless to say , disposables like needles, syringes, glasses, etc. are all discarded after being used once. Appropriate protective garb such as disposable gloves and masks are used. Infection control is one of our utmost priorities. The Four steps sterilization protocol used for our instruments. Step One : All the instruments are scrubbed with spirit swabs to remove any attached debris. Step Two: The instruments are then immersed in 5% korsolex sterilizing solution for 45 minutes for standard disinfection.
Korsolex Sterilizing Solution ( Korsolex Offers) (a). Complete viricidal action (including hepatitis B, HIV). (b). Total bactericidal, fungicidal, tuberculosidal and sporisidal activity. (c). Complete protection against corrosion, has inbuilt rust inhibitors. (d). Lethal action against microbes, highly suitable for emergency disinfection.

Sterilization Chamber
Step Three: After cold sterilization, instruments are packed in individualized sterile packs that contain instruments, gauze, cotton rolls and suction devices. Patients feel reassured when a new pack is opened in front of them prior to commencement of treatment. AUTOCLAVING (Steam under pressure) is the standardized sterilization method used in our dental office. These measures are carried out rigorously and consistently to make sure patient’s safety. Step Four: After autoclaving, dental instruments in sterilized packs are stored in UV chamber to maintain the sterilization.	Autoclaved Sterilized Instruments in Indvidualised surgical packs

Crown / Laminates and Fixed Teeth Prosthesis

Crown/ Laminates Crown is an artificial covering of a tooth-like structure called porcelain, which restores damaged tooth, replaces the missing tooth wall, thereby protecting and strengthening the tooth and preventing further deterioration. Situations when it may be necessary to place a crown are: (a). Large decay If a tooth has developed a decay so deep and large, that it weakens the tooth structure, a crown must be placed on the tooth to save it. (b). Crack / Fractured Tooth The teeth which are fractured or cracked because of large and deep decays are usually too weak to hold the filling. A crown will replace the missing tooth wall, strengthen it and thus restore the damaged tooth.
FIXED TEETH PROSTHESIS / REPLACEMENT / BRIDGE ixed teeth prosthesis is a procedure which helps to replace missing tooth/teeth and hence prevent unwanted drifting of teeth or any jaw or gum problems thereafter, thus harmonizing the balance of dentition. Each tooth of our dentition is beautifully carved and shaped by nature and has been prescribed specific task to perform so that even if a single tooth is missing/ damaged, the total balance of the dentition is jeopardized. It will be difficult for us to chew if the molar teeth behind are damaged or smile confidently if front teeth are damaged. These problems can also multiply, may lead to bite problems, tooth decay, jaw pain or gum disease. Missing Teeth are replaced with fixed teeth by taking the support from immediate adjoining teeth by covering them. If the adjoining/ supporting teeth are decayed/ damaged, this procedure not only replaces missing tooth with fixed tooth but also protect the supporting teeth by treating them, re-structuring them timely ( In case of structure loss due to decay ) and eventually not only taking their support but also saving them for life by covering them with Crown/ Laminates.	Missing Tooth Before
Step Three: After cold sterilization, instruments are packed in individualized sterile packs that contain instruments, gauze, cotton rolls and suction devices. Patients feel reassured when a new pack is opened in front of them prior to commencement of treatment. AUTOCLAVING (Steam under pressure) is the standardized sterilization method used in our dental office. These measures are carried out rigorously and consistently to make sure patient’s safety. Step Four: After autoclaving, dental instruments in sterilized packs are stored in UV chamber to maintain the sterilization. “When You See It First, Get It Fixed Right Then.” The earlier we get our damaged tooth protected by a crown or missing teeth replaced by fixed teeth prosthesis, the more predictably can the dentist count on a successful outcome.	Replaced fixed Tooth After

Root Canal Treatment ( Endodontics )

Sudden pain/ acute pain/ sensitivity to hot or cold/ pain on biting Time to be Alert Your tooth may be damaged enough such that simple restoration (filling) treatment alone may not suffice. To get immediate relief, you need to meet a dentist . Your teeth maybe cracked, have loose restoration (filling) or simple cavity which can lead to passive destruction of tooth.
Your dentist will take X-rays to know the internal structure of the tooth and surrounding bone and estimate the extent of damage. If the vital part of tooth called pulp (which is responsible for painful sensation) is involved, it has to be removed, cleaned and replaced with an artificial nerve. This can take one to three sittings depending upon the infection inside the tooth. With delicate instruments called the Root Canal Instruments or files, infection is removed, flushed out with irrigants. Tooth canals are cleaned and then filled with artificial nerve. The tooth is now non-responsive to hot, cold or any painful stimulus. This whole procedure is known as Root Canal Treatment (R. C. T.). R.C.T. is the only treatment which can save the tooth that has been badly damaged due to decay/injury and has reached almost extraction stage.
Good success rate is achieved if R.C.T. is started as soon as possible after problem is identified. If treated early and with the use of local anaesthesia, it causes almost "No Discomfort" to the patient and is totally painless. The success rate of R.C.T. is as high as 95% provided certain criteria / factors are taken care of: Long standing infection or abscess can affect the periodontium, thus decreasing the success rate. Early diagnosis followed by immediate treatment planning is very important for achieving good success rate. After Root Canal Treatment, in order to make the tooth fully functional again, the tooth should be restored with either a dental crown or, a dental crown in combination with a dental post. Dental crown provides a seal protecting the interior of the tooth. This barrier helps to prevent seepage of bacteria and contaminates from the oral cavity into the interior aspects of the tooth. A dental crown improves the appearance of the tooth, restoring tooth to its original shape and adding strength to the tooth. Additionally and very importantly dental crowns create an excellent seal over a tooth. Crown cemented in place provides a barrier that is helpful in preventing bacteria and contaminates from seeping back into those inner aspects of a tooth where the root canal treatment has been performed.
Placing a Post in a tooth that has had root canal treatment. A "Post" is like a pillar rod which provides retention and allows building up of the fragile tooth. Posts are usually placed in those teeth which have extensive portions of their natural tooth structure missing. The greater the amounts of the build up tooth over the post , the more stable the crown will be. In those cases where a great deal of tooth structure is missing a dentist will "build up" the height of the tooth using dental filling material. A dental Post provides a way for the dentist to securely anchor this filling material into the core of the tooth.

Dental Implants

A Dental Implant is an artificial tooth root placed into the jaw to hold an artificial tooth (replacing missing tooth). Dental implants are an excellent option for people who, otherwise in good oral health have lost a tooth due to periodontal disease (gum disease), root canal failure or tooth decay.
Anatomy of Dental Implant A Dental Implant is composed of three parts: The Titanium implant that fuses with the jaw bone. The abutment which fits over the portion of the implant that protrudes above the gums. Crown or artificial tooth created by the dental surgeon to be fitted onto the abutment making it ready for normal tooth functioning.
Indications for Dental Implants Dental Implant, though the best option for the conditions mentioned below, an adequate jaw bone is always required to support the implant. Dental implants are indicated in following cases: Replacing a single missing tooth. Replacing more than one missing teeth. In case of all missing teeth, an implant supported bridge (fixed teeth) or denture are good replacement options. Implants are treatment options in case of all missing teeth or in case where your own teeth are not healthy enough to give support to artificial teeth / bridge. Selection for Implants There are a number of factors a dental surgeon should consider before selecting a patient for implant treatment. Despite the success rate with dental implant treatment, it has got its' own limitations, which may be due to conditions like poor bone quality / bone resorbtion because of periodontal disease, existing medical conditions like diabetes, smoking, bone loss (common with patients who have lost teeth for long and have not gone for any replacement).The most important factor contributing to failure of implant is not keeping good oral hygiene after implant treatment.	Before After

Cosmetic Dentisetry

Cosmetic Dentistry is a branch of dental science which deals with complete smile makeover giving a beautiful smile so that we can smile with confidence. There are techniques in cosmetic dentistry which deal with discoloured, chipped, spaced, crooked and missing teeth.

Dental Bonding

This technique allows build-up of fragile / brittle / Enamel Chipped teeth, thus adding to their strength and beauty. Tooth coloured composites are added /bonded over discoloured, chipped or spaced teeth matching the shade, translucency and texture of existing (adjoining) teeth. Bonding teeth is mostly used in front teeth to fill a gap in between. The stains, chips and discolouration so eliminated beautifies smile, enhances the aesthetics and boosts self-confidence.

Composite Light Cured Bonding to restore enamel chipped tooth.

Before	After	Before	After

2. Smile Designing

Smile designing is done in case of teeth spacing, overlapping, etc. It creates a beautiful smile with minimal changes to existing teeth.

Enamel shaping, veneers (front visible site), laminates, and fixed teeth laminates in place of missing teeth. This is done to add aesthetics to otherwise healthy teeth and gums. Aim is to give natural, beautiful and confident smile. Just because teeth are white does not mean they have cosmetic appearance. Giving natural shade to teeth is more important. This is a procedure which involves proper gum contouring (in case of gummy smile), remodeling of teeth and giving them the most natural shade so that it flows and blends with adjoining teeth and supporting structures.


Before	After

3. Enamel shaping, veneers (front visible site), laminates, and fixed teeth laminates in place of missing teeth.

Veneers / Laminates
These are porcelain facings that are bonded to the front surface of teeth to close spaces, repair chipped or worn-out teeth, and straighten crowded or overlapping teeth.


Before	After	Before	After

4. Tooth Coloured Fillings

These are natural, translucent fillings which match the shade of adjacent teeth. These have high compressive strength, more resistant to fracture, thus having less chances of micro-seepage; and have more conservative approach as less tooth structure is required for giving them retention.

Silver Amalgum Fillings »		Tooth Coloured light cured composite Fillings »

5. Instant / Zoom Whitening


Before	After

6. Dental Implants

A missing tooth can be replaced with dental implant rather than a fixed partial denture. A small titanium screw is fixed into the jaw and the crown or tooth is fitted. In due course of time, the screw becomes fused (osseointegration) with the jaw bone. Thus giving it an appearance and functioning as a natural tooth.


Before	After

Pediatric Dentistry

Pediatric Dentistry deals specifically with the oral care of children. It is very important for a dental surgeon to have training in child psychology, growth and development before treating any child. Primary teeth or milk teeth start appearing in mouth usually between 6-7 months. However, permanent teeth eruption process starts between 6-8 years and all permanent teeth erupt by 12-13 years. Primary teeth are very important as they act as space maintainers for permanent teeth Bottle feeding should be avoided after 18 months age as this will prevent “Baby -Bottle” tooth decay or rampant decay. By the time children are 3 years old, they usually have a full set of 20 primary teeth, however there are 28 – 32 permanent teeth. Primary teeth shed off one by one between the age of 6-12 years and eruption process for permanent teeth takes place during this age ( 6-12 years) period.
Preventive Dentistry This is perhaps the most important role that dentist can play by preventing children teeth from deteriorating. Child should be thoroughly and patiently examined to detect any potential problem areas. Counselling and if necessary, certain steps / procedures should be taken like: 1. Advise / Prevent Preventing bottle-feeding in a child after a certain age, as this habit can lead to pre-mature decay of primary / milk teeth. This is because sweet liquid pools around the child's teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel.
2. Sealants These are resin materials filled in little ridges on the chewing part of the child’s teeth to protect and seal the teeth from food and plaque. Children with newly erupted back teeth benefit the most from sealants as these teeth are at highest risk of developing “Pit and Fissure” caries. Some of the sealants release fluoride as well.
3. Fluoride This is an element which helps teeth to resist cavities. However, too little or excessive fluoride can be harmful to teeth. Little or no fluoride will not strengthen the teeth, to help them resist caries. Excessive fluoride may contribute to dental-fluorosis, which is a chalky-white or even brown discolouration of permanent teeth.
4. Calcium Calcium is very essential for children especially during eruption stage of teeth. It is very important for the growth of strong bones and teeth. Children should meet their calcium needs by eating dairy foods and having well-balanced diet such as milk, cheese, milk-based custards and leafy-green vegetables.

Gum Treatment and Surgeries (Gum Shaping)

Gum is gingival fibers (soft tissue) surrounding neck of the teeth. Inflammation of gums (red and spongy, pain on pressing) / gum disease may lead to loss of bone surrounding the teeth and hence cause tooth-ache.

Causes of Gum Inflammation / Disease

(A). Mainly caused by plaque (bacterial film over soft deposits lodged mostly on inter-dental surfaces). Plaque with course of time gets calcified (tartar) and lacerates gum tissues.

(B). The other causes are-tobacco use, diabetes, certain medications, mal-aligned teeth, pregnancy, defective fillings and poor oral hygiene.

Symptoms of Gum Disease

Early symptoms include bleeding gums while brushing. It maybe without pain. Pain is there in advanced stage when there is bone-loss around the teeth leading to gum (periodontal) pockets. These gum pockets provide room for food lodgment over which the bacteria acts, causing gum inflammation, pain and further loss of supporting bone. With the result, teeth sometimes become shaky (mobile) and can shed-off leading to loss of otherwise healthy teeth.

Treatment

If early symptoms are ignored or left untreated the condition may further deteriorate leading to destruction of tooth supporting tissues, e.g., periodontal ligament. It reaches a condition known as periodontitis. At this stage teeth are unable to take food (masticatory) pressure. Gums start bleeding with sometimes pus formation (pyorrhoea), resulting in bad breath (foul smell) from the mouth.

1. Non-Surgical Treatment

This involves:

(A). Scaling and Polishing of teeth: With this procedure, supra-gingival (above gum margin) plaque / tartar accumulated around the teeth are removed.

(B). Root planning (sub-gingival scaling or deep scaling): After supra-gingival scaling the rough surfaces of the roots are smoothened, allowing gum healing and reattachment to the teeth.

(C). Curettage: Removal of plaque and infected tissue from gum pocket walls.

Preventive Dentistry

This is perhaps the most important role that dentist can play by preventing children teeth from deteriorating. Child should be thoroughly and patiently examined to detect any potential problem areas. Counselling and if necessary, certain steps / procedures should be taken like:

1. Advise / Prevent

Preventing bottle-feeding in a child after a certain age, as this habit can lead to pre-mature decay of primary / milk teeth. This is because sweet liquid pools around the child's teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel.

Surgical Treatment

Flap Surgery

In severe gum inflammation, there will be alveolar bone-loss (on which teeth rests). In Flap surgery, gum is retracted from the teeth to remove the diseased tissue. Bone is contoured, reshaped and allows re-generation of healthy bone and gums.

Latest surgical techniques for the treatment of periodontal pockets and subsequent bone-loss are:

(A). GTR (Guided Tissue Regeneration) and
(B). GBR (Guided Bone Regeneration) Grafts

Prevention

- Proper brushing and flossing.

- Incorrect brushing will miss some spots in mouth leading to bacterial accumulation of high levels which will cause gum inflammation or gum disease.

- One must make a conscious effort to brush every single tooth.

Flossing

It is usually advised to people prone to food lodgment in inter-dental spaces due to crowding of teeth or irregular (mal-aligned) teeth. Brush cannot reach these surfaces, thus these areas are deprived of good cleaning. Inter-dental flossing is recommended to remove soft deposits from such surfaces, thus stopping bacterial accumulation and preventing gum disease.

Bad Breath

Bad Breath (Halitosis)

Bad breath or halitosis may be due to many causes and is an extremely embarassing problem for some people. Halitosis is usually caused by poor oral hygiene or the presence of food that gets stuck in the teeth.

Causes of Bad Breath

1. Gum Disease

Millions of bacteria in the mouth form a film over food lodgement (plaque), one of the main causes contributing to halitosis.

2. Poor Oral Hygiene / Health

Without proper brushing and routine examination by dentists, food remains in the mouth which is a breeding ground for bacteria causing odorous breath.

3. Medical Conditions

Bad breath may be an indicator or symptom of dental or medical condition:
In the absence of Gingivitis (Gum Disease), tooth decay, etc. your dentist may refer you to a physician for diagnosis of gastric disorder (Stomach problem), respiratory infection, chronic bronchitis, chronic sinusitis, etc.

4. Tobacco Products

Tobacco products such as cigarettes, cigars, smokeless tobacco not only cause staining of teeth and put the body at risk for host of diseases, but also are the main cause of bad breath.

Treatment of Bad Breath

Dentist will form specific treatment for halitosis based on:

(A). Oral Hygiene
(B). The cause of the origin of the condition
(C). Extent of the condition

A periodontal cleaning often helps to remove the bacteria and plaque that has accumulated and is causing the recession of gums. Regular dental cares like proper brushing, flossing and anti-bacterial mouth wash maybe recommended by dentist so as to control bacterial proliferation thus preventing halitosis.

Dr. Gulati Dental in India, Dentist in India

Wisdom Teeth / Impacted Teeth

Wisdom teeth are the rear (third) Molars that erupt sometime around late teens or early twenties. Wisdom teeth can cause various dental problems including overcrowding of the existing teeth and impaction. Impacted teeth are unerupted or partially erupted teeth as their eruption process is being obstructed due to :-

(a) Lack of space:
In some cases ,there may not be enough room in the jaw for the erupting wisdom teeth.This can stall their exit at the halfway point,making room for food lodgement.Food and bacteria will build up between the wisdom tooth and its neighbouring molar,so decay and gum infections are more likely.Partially impacted or crowded (tilted) wisdom teeth in the upper jaw have tendency to lean sideways and grate against the cheek causing cheek bite and chewing problems.The pressure from wisdom teeth may also force the other teeth closer together causing crowding,thus interfere with the bite.

(b) Ankylsos:
The roots of the impacted tooth can fuse to the surrounding bone ,creating a tooth stuck in an unerupted or partially erupted state.

(c) Competitive position:
(A tooth has erupted over another tooth’s position). The teeth most likely to become impacted are the third molars also known as the “wisdom teeth”.There is rarely enough space to fit these last teeth into the small space left behind the second molars,thus causing obstruction in their eruption and the wisdom tooth becomes impacted. An average mouth dentition holds 28 teeth.There can be discomfort/pain when 32 teeth try to fit in a space comfortable for only 28 teeth.These four other non-funtional teeth are the wisdom/third molars.the tendency to get impacted is due to the small space available to them.

Using panaromic X-ray,dentist can evaluate the position/angulationof the wisdom teeth and determine the severity of the impaction.This is important for planning the treatment course.If a wisdom tooth is erupted but the clinical visibility is obstructed due to soft tissue flap over it,the dentist may need to snip the soft tissue to avoid food lodgement and hence infection.

The impaction can be subcategorized into four depending on the way they are positioned and their relation with the adjoining tooth or any other bony structures.

1. Vertical impaction :
This may cause cheek-bite or infective abcess inside the jaw bone.

2. Mesio-angular :
This may press on the second molar causing cavity and subsequent infection in connection with the second molar.

3. Horizontal impaction :
This kind of placement can cause trismus (inability to open mouth fully) in addition to symptoms similar to those of mesio-angular impaction.

4. Tissue impaction or partial impaction:
Some portion of wisdom tooth erupts out of the soft tissue, with some tissue portion still overlying the tooth. This provides room for food debris in the pockets leading to gum inflammation and pain. Surgical removal should only be done if the wisdom tooth starts causing persistent discomfort. This highly skillful extraction procedure is performed by a Maxillofacial surgeon in our team. The surgery is performed under appropriate anesthesia to maximize patient comfort. The procedure is performed under conditions of optimum safety, utilizing modern equipment, and by staff thoroughly experienced in the procedure.

Some useful tips for self care after dental extraction:

1. Apply cold compress to avoid swelling.
2. Take appropriate pain relievers as and when required, keeping adequate gap before the next dose.
3. Rinse with lukewarm and prescribed anti-microbials after 24 hours of extraction.
4. Do not brush over the area for two days.
5. Eat cold diet on the day of extraction and soft/easy to chew food for the next few days.

Zoom Whitening

Whiter the teeth, smarter the look and more beautiful the Smile
Everybody wants to have pearly white teeth.
Dental clinic is the best place to seek professional help.
Safety of the procedure and cost are the two main considerations before selecting the procedure.

Before you step in a dental clinic, stand in front of the mirror and analyze:

Are you under-confident about your smile because of your color?
Do you attempt to hide your teeth while smiling?
Ask your friend/ spouse/ relative to tell you about your smile and color of teeth.

Then you frame your mind whether you want to get your teeth whiter.

Milk teeth are generally whiter than permanent teeth. Permanent teeth generally become yellow with age due to extrinsic stain deposits because of tea/ coffee, cigarette, smoking, pan chewing, etc. These stains can be removed by teeth whitening procedures. Though whitening strips are available to be used at home, but it is always advisable to perform procedure under professional supervision. The chair-side whitening system (zoom whitening) is safe, effective and very fast.

In about 45 minutes, teeth would become whiter (lighter in shade) and brighter. Hydrogen peroxide, the active ingredient has been safely used for many years in treatment of gums and teeth. The degree of whiteness will vary from patient to patient depending upon the severity of discoloration/ stains.

Braces (Orthodontic Treatment)

Braces are the most efficient and accurate way of aligning teeth. Braces, also known as brackets, are usually made of stainless steel. Clear or tooth-colored braces are also available.

These are fixed appliances to correct alignment of teeth and their position with regard to bite.

Braces are often used in following conditions:

Mal-occlusion (Improper Bite) such as open bite, cross-bite, etc.
Various other flaws of teeth and jaws- Cosmetic or Structural.
Teeth crowding

Orthodontic braces are often used in conjunction with other orthodontic appliances to widen the palate or jaws, create spaces between crowded/ overlapping teeth. Most orthodontic patients are children or teenagers, however more and more adults now are seeking orthodontic treatment without any inhibitions.

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