Camphor Mono-Chlorophenol (CMCP)

Solution for Root Canal Disinfection

- Composition:p-Chlorophenol 35%, Camphor 65%

- Properties:PD Camphor Mono-Chlorophenol, also known as CMCP, is an active disinfectant for the treatment of infected root canals & periapical infections.

- Indication:- Disinfection after pulpectomy.
- Treatment of post-traumatic inflammation.
- Pulp dressing.

- How to use:- Dry the root-canal thoroughly.
- Complete the pulpectomy.
- Insert 1 or 2 drops of preparation into the root canal & allow few minutes for it to take effect.
- Remove any excess solution with a cotton pellet or an absorbent paper point.
- Remove gangrenous pulp tissue.
- Use CMCP as a dressing by inserting it into the root canal with a smooth broach.
- Obturate canals temporarily.
- Leave it ‘in situ’ for at least 3 days.
- Make sure the canal is completely disinfected after the period.
- If this is not the case, repeat the dressing before the final obturation.

- Storage:Store at room temperature between 5°C & 30°C, protected from direct light.

- Packaging:Bottle of 15 ml.

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Gingival Hyperplasia

- Enlargement of gums or gingiva is called gingival hyperplasia in the dental terms.

- This occurs due to abnormal multiplication of gingival tissues due to various factors. 

- When an individual is diseased with gingival hyperplasia then the gums become swollen and enlarged. 

- If you are suffering from gingivitis there will be bleeding in the gums as well as tenderness. 

- The teeth get covered with the gums if the infection is too intense. 

- The patient is examined by a dentist and then the patient is sent for further examination if any further complications are seen.

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Causes:

There are several causes of gingival hyperplasia:

- Inflammatory and granulomatous disorders "like Hand-Schuller-Christian syndrome"

- Auto-immune disorders "like plasma cell gingivitis which is associated with allergic and collagenous nature"

- Neoplastic disorders "like acute leukemia and monocytic leukemia"

- Metabolic and storage disorders "like aspartylglycosaminuria, genetic disorders like Cross syndrome"

- Toxicity of drugs.

- Excess of deposition of drugs given to a patient. It is also called as Drug-Induced Gingival Overgrowth (DIGO).

- Immunosuppressant like Cyclosporin, anticonvulsants like valproate, phenytoin, phenobarbital, primidone and calcium channel blockers like nifedipine, verapamil and amlodipine.

Note: Cyclosporin and phenytoin toxicity are the important toxicities caused in a patient especially in case of dental plaque where these drugs get deposited on the tooth.

Causes of Gingival Enlargement is divided into five groups:
- Inflammatory Enlargement
- Enlargement due to systemic /genetic diseases
- Neoplastic enlargement
- False enlargement
- Drug induced enlargement
- Gingival Hyperplasia differential diagnosis

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Diagnosis:

- Mainly done by differential diagnosis.

- IFN-gamma-stimulated gene expression which is important to determine the presence of gingival hyperplasia in the body.

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Treatment:

The treatment of gingival hyperplasia is based on the type and cause of the gingival hyperplasia.

- Improving oral hygiene is the most important factor which will determine the cure rate of the disease.

- Maintain oral hygiene regularly to prevent any further spread of infection.

- Gingivectomy, a surgical procedure to remove the excess of gingival tissue is carried out to manage the condition.

- The drugs which cause toxicities and affect the gingival tissues can be replaced with alternative drug therapies. For instance, in case of immunosupression, cyclosporine can be replaced by tacrolimus which is has less affect in gingival hyperplasia. Nefedipine can be replaced by isradipine as it does not increase the conditions of gingival hyperplasia.

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Dental preparations before Head and Neck Radiotherapy

- The status of the dentition has a significant effect on post-treatment quality of life among patients with head and neck cancer that will undergo radiation.

- A dentition in poor repair will increase the risk of post-radiation complications, particularly dentoalveolar infections that could lead to osteoradionecrosis.

- All patients who will be treated with RT for oral/head and neck cancer should undergo a comprehensive dental evaluation prior to treatment.

- Carious teeth, teeth with deep restorations or in poor periodontal health, along with partial bony impacted third molars should be extracted prior to RT if in an area that is expected to receive a dose of at least 50 Gy.

- Teeth that are out of the radiation treatment field, but have a hopeless prognosis or is symptomatic should also be extracted.

- Extraction of healthy teeth does not appear to prevent the development of osteoradionecrosis.

- All indicated extractions should be completed prior to RT and primary closure over the extraction sites is preferred if possible.

- An adequate alveoloplasty should be performed to eliminated the possibility of bone edges ulcerating the mucosa as well as to make the mandible/maxilla ready for dentures.

- Ideally, all extractions should be completed approximately two weeks before the commencement of RT to permit proper healing.

- If the extracted teeth are outside of the treatment areas, however, radiation may be started sooner.

- The oral surgeon should attempt to do all the extractions within the portals of radiation at one sitting so as not to delay the cancer treatment.

- Postponing needed extractions of teeth that will be within the treatment area until after radiation is associated with an increased risk of non-healing and osteoradionecrosis.

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Unusual Breath Odors and What They Mean

The most common causes of Malodor (Halitosis) In children:

1- Most often the result of mouth-breathing, which dries out the mouth and allows the bacteria to grow.

2- Children who consistently breathe through their mouths might have colds, sinus infections, allergies, or enlarged tonsils or adenoids blocking the nasal passages, so a visit to the pediatrician is in order.

3- Thumb sucking or sucking on a blanket can also dry out the mouth.

To check other causes of Halitosis

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Here is a list of some very uncommon, but telltale, odors Take a whiff:

● Acetone – diabetes or acetone, alcohol, phenol, or salicylate ingestion
● Ammonia – some types of urinary tract infections, or kidney failure
● Asparagus – eating asparagus (very unusual in children;>))
● Bitter almonds – cyanide poisoning
● Cat’s urine – odor of cats syndrome (beta-methyl-crotonyl-CoA-carboxylase deficiency)
● Celery – Oasthouse urine disease
● Dead fish – stale fish syndrome (trimethylamine oxidase deficiency)
● Fresh-baked bread – typhoid fever
● Foul – tonsillitis, sinusitis, gingivitis, lung abscess, or dental cavities (some of these are actually quite common)
● Garlic – arsenic, phosphorus, organic phosphate insecticides, or thallium poisoning
● Horse-like (also described as mouse-like or musty) – phenylketonuria
● Rancid butter – odor of rancid butter syndrome (hypermethionemia and hypertyrosinemia)
● Raw liver – liver failure
● Sweaty socks – odor of sweaty feet syndrome (Isovalryl CoA dehydrogenase deficiency)
● Sweaty socks – odor of sweaty feet syndrome II (Green acyldehydrogenase deficiency)Violets – turpentine poisoning

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Toothache After Restoration

- Toothache after dental filling is common for most cases and dentists.
- Filling helps prevent further tooth decay and brings the tooth back to its normal function and shape.
- Most people experience mild to severe toothache after a filling treatment.
- The affected tooth may experience sensitivity to air, pressure, sweet foods, cold foods, or temperature after the procedure.

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Remedies for Toothache:

1- Try to avoid things that can cause sensitivity in your tooth.
2- Follow the instructions given by your dentist.
3- It is better to stay away from very hot or very cold beverages.
4- You should avoid eating candy and any type of sticky items after such a dental treatment.
5- After a filling, it is best to eat soft foods for some days as specified by your dentist.
6- Avoid using the tooth that has been filled for chewing.
7- It is extremely important to follow a proper dental care routine ex."Extra brushing or mouth rinsing"
8- Clove oil is one of the most popular and effective toothache remedies.
9- Saltwater mouthwash is a quick remedy for toothache relief.

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Types of Toothache After Filling:

Pain around your fillings:
If you experience pain around the filling, you must consult your dentist again. This can be because the cavity was not filled properly.

Pain when you bite:
You will start feeling pain after the anesthesia wears off and it might continue for some time. If you experience immediate pain when you bite down, it could be because the filling was not shaped properly. When you bite, you put pressure on it. This usually happens when the filling is interfering with your bite, i.e. the filling is above your tooth level and touching the upper or lower teeth while you try to bite something. You must contact your dentist and have the filling reshaped.

Pain when your teeth touch each other:
This is a distinct pain that occurs when your teeth touch each other. The pain is caused because two different metal surfaces such as the silver amalgam in a newly filled tooth and a silver crown on another tooth touch each other. This pain usually resolves on its own within a short period, but if it's persistent, you must visit a dentist.

Referred toothache:
In this case, you will experience pain or sensitivity in teeth, besides the one that has been filled. If you have this type of pain, then probably there is nothing wrong with the treated tooth and the pain should go away on its own.

Constant toothache:
If the decay was very deep to the pulp of the tooth, then you might have constant toothache, especially while eating, that will last for some weeks even after the filling. This constant toothache indicates that the tissue is no longer healthy and you might have to get a root canal treatment for curing it.

Allergic symptoms after filling:
There might be an allergic reaction to the silver amalgam used in the filling. You will experience itching, skin rashes and other allergy symptoms in this case and the silver filling would have to be replaced with a composite filling. Allergic reactions to silver fillings are rare. The symptoms of amalgam allergy are much similar to those experienced in a skin allergy. These include skin rashes and itching. Getting the filling replaced with composite type of filling is the best solution in this case.

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Toothache after a filling usually subsides after a week or two. Mild toothache is common and you don't even need to opt for an over-the-counter painkiller. However, it is best to avoid eating whatever that causes pain. If toothache doesn't subside within two weeks after the filling or if your teeth have become extremely sensitive, you need to contact your dentist. Most probably your dentist will first recommend a toothpaste for sensitivity or apply a desensitizing agent to the tooth for pain relief. If this does not work, then a root canal treatment might be the solution to eliminate severe toothache.

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Cariosolv - Chemo-mechanical Caries Removal

1- CARIDEX

The chemo-mechanical system for caries removal was published in 1975 by HABIB et al.
It is marketed under the trade name of Caridex.
Chemo-mechanical caries removal uses sodium hypochlorite (NaOCl), a non-specific proteolytic
agent (monoaminobutyric acid) removing organic components at room temperature

2- CARISOLV

Carisolv consists of a red gel and transperant fluid.

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Composition:

- Red gel
glutamic acid,
leucin,
lysine,
sodium chloride,
erythrosine,
water and sodium hydroxide

- Transparent fluid
0.5% sodium hypochlorite

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The chemical action of Carisolv is similar to that of Caridex in softening the carious dentin but leaving the healthy dentin unaffected

In caridex it was shown that, NaOCl was dissolving not only necrotic tissue but also sound dentin.

Instruments:
Special instruments designed to scrape in two or in several directions, which reduce the friction during caries excavation

Mechanical Action:
While mixing amino acids react with sodium hypochloride and forms chloromines.
Chloromines seems to involve the chlorination of partially degraded collagen and the conversion of hydroxyproline to pyrrole-2-carboxylic acid, which initiates disruption of altered collagen fibres in carious dentin.

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Denture Reline and Rebase

Introduction:

A reline is a procedure used to re-fit the surface of a denture to the tissues of the mouth.
This is done by placing a new acrylic base into the denture, duplicating the new form of the oral structures in the mouth.
A reline will bring back comfort to the patient, stability to the denture and discourage food from going underneath it.
Relines are required for many reasons with the most common reason being gum resorption (shrinking of the oral tissues).
Gum resorption is caused by the normal process of aging or after natural teeth have been extracted.
A general rule of thumb is that dentures should be relined once every 2 to 3 years.
Relines are a normal part of denture maintenance and important to the health of the oral tissues and bone support of a denture wearer.
A reline is not always recommended for a denture, If a denture has lost some retention and the "bite" or occlusion has changed considerably, a reline will not be satisfactory in correcting the retention of this denture.

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Types of Relines:

A- Temporary Reline:
A temporary reline (tissue conditioner) is a silicone gel designed to last 1 to 4 months.
It is normally used in dentures of people who have had their natural teeth extracted or to improve the health of their tissues before new dentures are made.

B- Direct Reline:
A direct reline is also called a chair side reline.
The direct reline material is inserted in the denture and sets in the mouth as the patient waits in the dental chair.
The direct reline is offered in a hard or soft base, and are not meant as a long term solution to fit issues.

C- Processed Reline:
A processed reline is completed by taking an impression inside of the patient's existing denture duplicating the new form of the oral structures in the mouth.
This impression is then processed in our in-house laboratory for approximately 7 hours.
This is considered a permanent reline due to the high quality of material used and the precision of the fit achieved.

D- Soft Reline:
A soft liner is used mainly in full lower dentures and allows for more protection and comfort for people who have sensitive gums with little or no bone support.
The soft base is a liner that is bonded into your denture.
Your denture will adhere better to what remains of your gum, be less irritating to your tissues and give your denture more stability.
When constructing a denture, the Prosthodontist will take an impression for the soft base and process it into the inside of the denture.
The Soft liner material is a bonded medical grade rubberized base.
Soft liners will last approximately 2 years.
Remember: relines do not change the color or shape of the teeth or make them sharper for chewing, A reline replaces the fitting surface of the denture to make it fit better.

E- Rebase
A rebase is the process of refitting a denture by replacing the entire denture base.
This procedure is done by taking a new impression inside the denture, completely removing the old acrylic and adding a new acrylic base around the existing teeth.
This service is recommended for dentures that have had multiple repairs, discoloration or are very thin.

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