Dental Insurance in India: Tooth Matters

Dental Insurance in India: Tooth MattersDental Insurance in India: Tooth Matters

Oral health is probably still most neglected areas in Indian health. Cost of dental treatment is cited as one of the main reasons for its negligence and the expenses not being covered under most of the medical health insurances. There is just a lack of dental treatment insurance policies. However, there are some insurance companies who have started covering dental treatment expenses but to a limit. Dental insurance is insurance designed to pay the costs associated with dental care.

Dental and oral health in India

Fifty percent of school going children suffer from dental caries. Ninety percent of the adult population suffer from periodontitis and gingivitis. Tooth loss rate is greater due to periodontitis as compared to dental caries. Increased consumption of tobacco has increased prevalence of oral pre-cancer conditions and oral cancers. Oral cancer is a life-threatening condition and the available treatment modalities are expensive and are way beyond the reach of the common citizen. These can be prevented and controlled by public education and motivation to a significant level. Private fee for service is the only mechanism of payment for dental care in India and government hospitals and facilities providing treatment and care lack infrastructure, manpower, funds and hygiene. The major disadvantage of this type of payment structure is that many patients are unable to receive any care. Many NGO’s are also working but they also lack infrastructure, materials and funds. Government funds on medical healthcare in India is only 2% and out of this very few get for dental healthcare, as a result private dental care clinics are increasing.

Day by day dental graduates and specialists in India are increasing. Government has failed to provide job opportunities to them, resulting in private dental clinics mushrooming, and such facilities are beyond reach for a common man. To run a private practice also needs finance which cannot be maintained by keeping charges low; which means in India manpower is not less only cost of the treatment is the only issue regarding oral health care. Hence dental insurances can remove these barriers for oral health cares.

Why dental insurance is not common in India?

Our policy makers have given oral health last priority during National Oral Health Care Program. They are not aware of dental oral problems and its association with systemic health, that if not treated can be life threatening. Indian Dental Association (IDA) has failed to bring dental insurances policies in India, instead focussing on other off track work. Some private insurance companies have started covering dental expenses, but all these are not up to the mark and contain some serious shortcomings.

Also some private sector companies have started giving dental expenses to their employees with direct reimbursement plans. Under such schemes employees as a patient have the freedom to go any dentist they wish and present the bills of treatment done and employee will get some expenses reimbursed by the company. Companies are funding all these expenses because they know if small dental problems keep their employee home, companies lose their productivity. This however, is for a small percentage of the population. For the rest of the population, they still need proper planning and policies.

Types of dental insurances

In India

Stand-alone dental insurance plans

This type of plan covers the expenses related to general dental problems such as periodontitis and extraction of permanent teeth due caries. The amount of expense to be reimbursed as well as the period of such cover is fixed. Such insurances are provided by manufacturers like Pepsodent after buying their products.

Dental insurance cover as part of general health insurance plan

These are basically general medical insurances which cover some amount of dental expenses but not separate dental insurances. Some are shown in table with the types of coverage they provide.

In other countries

Indemnity plans

This type of dental plan pays the dental office on a traditional fee-for-service basis. A monthly premium is paid by the client and/or the employer to the insurance company, which then reimburses the dental office (dentist) for the services rendered. An insurance company usually pays from 50 to 80% of the dental office fees for a covered procedure; the remaining 20–50% is paid by the client.

Dental health maintenance organisations

They provide a comprehensive dental care to enrolled patients through their own fixed dentist. The dentist is paid on a per capita (per person) basis rather than for actual treatment provided.

Preferred provider organisations

If a patient takes a policy from a group of dentists, they get a discount as long as patient receives treatment from the particular group. If they wish to go out of the network dentists, they have to pay some extra fees.

Dental discount

The managing organizations negotiate with local dental offices to establish a set price for a particular dental procedure and offer deep discounts off the regular pricing code.

Benefits of dental insurances
  1. Oral health care can be available to every person from all socioeconomic levels and locations.
  2. Dental insurances can promote positive attitude in patients regarding oral health.
  3. Patients will visit their dentist regularly and preventive measures can be undertaken in the early stages. Patients will become aware of available treatment option to treat them. Ultimately dentistry is not expensive, neglect is.
  4. Basic preventive and few cosmetic treatments can be covered.
  5. Affordability and access will give everyone a good reason to smile.

Conclusion

There is great initiative still required from the government to initiate such policies. Private policy companies need to modify their schemes by thinking from a patient perspective and dentist perspective. They need to come up with separate dental insurances covering most of the expenses.

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DISCLAIMER : “Views expressed above are the author’s own.”

Obesity and Dental Caries in Children: Markers and indicators for Future Non-Communicable Diseases

Obesity and Dental Caries in Children: Markers and indicators for Future Non-Communicable DiseasesObesity and Dental Caries in Children: Markers and indicators for Future Non-Communicable Diseases

Globalization is bi-directional and has asymmetric manifestations in terms of health and wealth (Labonte and Schrecker, 2007). The health impacts of globalization include the rising levels of non-communicable diseases. (Huynen et al, 2005). The global epidemic of non-communicable diseases is responsible for significant mortality and morbidity; NCDs will be responsible to cause 73% of all deaths globally and 70% of all deaths in developing countries by 2020 (Gwatkin et al, 1999; Habib and Saha 2010). The major causes of deaths include ischaemic heart, cerebrovascular, respiratory, obstructive lung, cancer and diabetes diseases (Habib and Saha, 2010). The public health impact of NCDs is widespread and on the rise in developing countries. Majority of NCDs may start early in life, continue into adulthood and their consequences aggravate with ageing (Habib and Saha, 2010). ‘WHO Guideline for Sugars intake for adults and children’ reported that “Noncommunicable diseases (NCDs) are the leading causes of death and were responsible for 38 million (68%) of the world’s 56 million deaths in 2012. More than 40% of those deaths (16 million) were premature (i.e. under the age of 70 years). Almost three-quarters of all NCD deaths (28 million) and the majority of premature deaths (82%) occurred in low and middle-income countries. Modifiable risk factors such as poor diet and physical inactivity are some of the most common causes of NCDs; they are also risk factors for obesity – an independent risk factor for many NCDs – which is also rapidly increasing globally”. (2015)

Increasing prevalence of dental caries and other oral diseases parallels the trend of NCDs in developing countries. Inequalities in oral health continue to exist globally with rich countries witnessing a marked reduction in the experience of dental caries in children and young adults during 1970 and 2000 (Fejereskov and Kidd, 2008). However, in the developing countries, owing to the westernized diets, the consumption of sugar and as a result, dental caries increased during the same period (Watt, 2005). Oral health is affected by the same factors as those for general health (Hobdell et al, 2002). Oral health, similar to general health, depends on the conditions in which people live and the choices they make (Petersen, 2003). Oral diseases and other chronic diseases have “common risk factors” (Sheiham and Watt, 2000; Sheiham, 2005).

The rising levels of obesity and dental caries in children and the recent emphasis on life course perspective in the prevention of diseases underline the fact that comprehensive primordial prevention must begin in early childhood. Both obesity and dental caries are growing concerns in the developing world and can be regarded as markers for NCDs as they can manifest in early childhood (Hujoel, 2009). Furthermore, both fulfil the criteria stated for a condition to be identified as a public health concern (Daly et al, 2002).

Prevalence and severity of the condition

Both the conditions are widely prevalent. In India, one of every two 5 year old children (rural as well as urban) suffers from dental caries (National Oral Health Survey and Fluoride Mapping, 2004; Bagramian et al, 2009) and one out of ten children belonging to middle class parents (urban) is obese or overweight (Bhave et al, 2004). Dental caries may lead to severe pain and infections (Sheiham, 2005); whereas obesity may well be a determinant of life-threatening non-communicable diseases such as diabetes, CHD and a few cancers, which account for a majority of deaths (WHO, 2003).

Impact of the condition on Individual level

Dental caries in children affects children physically, socially and psychologically (Sheiham, 2006). Tooth decay also affects the quality of life: pain, impaired aesthetics, recurrent infections, eating and sleeping difficulties, emergency visits to dentists and hospitals, poor ability to learn, insufficient nutrition, and improper growth and development (Sheiham, 2005). Treating is expensive due to the direct and the indirect costs, e.g. time taken off by the parents (Sheiham, 2006).

The extreme levels of obesity may affect systemic functions and make an individual prone to a variety of health conditions apart from the psychosocial stigmatization the individual may face (Bhave et al, 2004).

Impact on wider society

The costs of treating non-communicable diseases including dental caries are enormous. Oral diseases are the commonest chronic diseases and are amongst the most expensive diseases to treat (Sheiham, 2005). Restoring decayed teeth remains well out of the reach of most countries due to the budgetary constraints; more than 90% of caries remains untreated (Petersen, 2005). Obesity and related NCDs burden economies, too. Diabetes alone may account for 2.5% and 15% of the total healthcare expenditure. For the age category 20–79, the global annual direct cost is likely to be over $153 billion and anticipated to double in 2025 (Habib and Saha, 2010).

Condition is preventable and effective treatments are available

Rich countries witnessed a marked reduction in caries in children during 1970-2000 (Fejerskov and Kidd, 2008); however, dental caries is increasing in developing countries due to increased sugar consumption and inadequate fluoride exposure (Petersen 2005).

Although there have been limited published reports of successful programmes pertaining to obesity prevention and management; obesity and related dietary causes have become a major focus of health policies in the Western World. Since 1998, the WHO has prioritized the prevention of NCDs and has developed strategies for monitoring, preventing and managing major NCDs with special emphasis on four major disease groups that share the same determinants and risk factors, such as the cardiovascular diseases, cancer, diabetes and chronic obstructive lung disease (Habib and Saha 2010).

Relationship between Obesity and Dental Caries in Children and Rationale for an Integrated Approach for Prevention

A systematic review of published literature between 1980 and 2010 addressing childhood obesity and dental caries with a random effects model meta-analysis reported a significant relationship between childhood obesity and dental caries (effect size = 0.104, P = 0.049) (Hayden et al, 2012). Another systematic review of published literature between 2005 and January 2012 did not find sufficient evidence regarding the association between obesity and dental caries; however, the review included studies on children as well as adults (Silva et al, 2013). Yet another recent systematic review of published literature between 2004 and 2011 pertaining to the body mass index and dental caries in children and adolescents reported that dental caries is associated with both high and low BMI; with socio-economic strata modifying the association. The authors advocated combined strategies to target both dental caries and obesity simultaneously (Hooley et al, 2012).

Evidence is emerging from the USA in terms of effective campaigns for wide-scale initiatives targeting environments in schools and beyond. Healthy study using a cluster design in 42 schools throughout the United States, School Nutrition Policy Initiative, a school-based obesity prevention program in Philadelphia, and Healthy Corner Store Initiative are a few examples (AHA, 2010). In the USA, the CATCH study (Child and adolescent trial for cardiovascular health) and the ‘Go Girls’ in African American girls have demonstrated that the eating behaviour of children can be influenced and they can be trained to be more physically active (Bhave et al, 2004). In Singapore; an 8-year school based initiative targeted at obese children was successful in reducing the prevalence of obesity (from a high of 16.6% in early 90s to less than 14.6%. In Brazil, a programme started in Sau Paulo, and because of its impact, now adopted throughout the country, ‘AgitaBrasil’, has demonstrated psychosocial, educational and physical benefits to children (Bhave et al, 2004).

It must be kept in mind that oral health is an integral aspect of systemic health and its isolation from the larger goal of achieving health can seldom meet success. Often oral health does not remain a priority of many health authorities, particularly of poor economies, as other health concerns need preferred attention (Yee and Sheiham, 2002). Furthermore, health messages in isolation may involve unnecessary duplication of efforts and may even create conflicts (Watt, 2005). The Common Risk Factor Approach identifies diet, alcohol, tobacco, physical activity, hygiene as the determinants of health; working on most of them is essential for oral health, too. Nevertheless, often the risk behaviours are clustered within the deprived communities and this could mean an opportunity to address various concerns together (Sheiham and Watt, 2000). This approach makes possible promotion of health with respect to those conditions that are perceived as higher threats (e.g. obesity, coronary heart diseases, cancer) while also covering the promotional aspects related to those oral conditions usually regarded as lesser threats (such as dental caries and periodontal diseases) by people.

So far, there has not been a national programme for the prevention and management of obesity in children. In different parts of the world, the concern is attracting recognition and a few public health campaigns have been run successfully.

Dietary Sugars and Body Weight: Systematic Review and Meta-Analyses of Randomised Controlled Trials and Cohort Studies reported that in adults, reduced intake of dietary sugars was associated with a decrease in body weight [0.80 kg, 95% (0.39 to 1.21); P<0.001]; increased sugars intake was associated with increased [0.75 kg, 0.30 to 1.19; P=0.001]; whereas in children, prospective studies on sugar-containing beverages, the odds ratio for being overweight was 1.55 (1.32 to 1.82) consuming higher quantities compared to those with the lowest. In a recent systematic review by Moynihan and Kelly (2014), Effect on Caries of Restricting Sugars Intake, 42 out of 50 studies on children and 5 out of 5 studies on adults demonstrated lower dental caries experience with free-sugars intake < 10% for energy (based on evidence of moderate quality), and significantly lower dental caries experience with free-sugar intake < 5% for energy (based on evidence of very low quality). An interventional study providing nutritional guidelines to preschools in Racife, Brazil reported that not adopting the guidelines on sugar-reduction was associated with a significantly high caries risk in children (OR: 3.6) compared to those in preschools adopting the guidelines (Rodrigues and Sheiham, 2000). Thus, there exists a potential for an integrated approach based on the provision of dietary guidelines to prevent obesity and dental caries in children. Reduced intake of dietary sugars was associated with a decrease in body weight [0.80 kg, 95% (0.39 to 1.21); P<0.001]; increased sugars intake was associated with increased [0.75 kg, 0.30 to 1.19; P=0.001]; whereas in children, prospective studies on sugar-containing beverages, the odds ratio for being overweight was 1.55 (1.32 to 1.82) consuming higher quantities compared to those with the lowest (Morenga et al, 2013).

Current Recommendations on Free Sugars and NCDs

The WHO, since 2002, recommended that sugars should make up less than 10% of total energy intake per day (WHO, 2003). In the “Sugar Guidelines” published in 2015, the WHO has proposed following recommendations:

“WHO recommends a reduced intake of free sugars throughout the life course (strong recommendation). • In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake (strong recommendation). • WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation). • Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. • For countries with a low intake of free sugars, levels should not be increased. Higher intakes of free sugars threaten the nutrient quality of diets by providing significant energy without specific nutrients (3). • These recommendations were based on the totality of evidence reviewed regarding the relationship between free sugars intake and body weight (low and moderate quality evidence) and dental caries (very low and moderate-quality evidence). • Increasing or decreasing free sugars is associated with parallel changes in body weight, and the relationship is present regardless of the level of intake of free sugars. The excess body weight associated with free sugars intake results from excess energy intake. • The recommendation to limit free sugars intake to less than 10% of total energy intake is based on moderate quality evidence from observational studies of dental caries. • The recommendation to further limit free sugars intake to less than 5% of total energy intake is based on very low quality evidence from ecological studies in which a positive dose–response relationship between free sugars intake and dental caries was observed at free sugars intake of less than 5% of total energy intake. ”

The American Heart Association (2013) recommended “reductions in added sugars with an upper limit of half of the discretionary calorie allowance, which for most American women is no more than 100 calories per day and for most American men is no more than 150 calories per day from added sugars, or about 6 teaspoons of added sugars a day for women and 9 teaspoons a day for men. As a reference, one 12-ounce can of regular soda contains 140 calories (about 9 teaspoons) from added sugars, one 16-ounce bottle of sugar-sweetened iced tea contains 184 calories (about 11.5 teaspoons) from added sugars, and one regular-sized chocolate candy bar contains 120 calories (about 7.5 teaspoons) from added sugars”.

In a paper published in Nature: The Toxic Truth About Sugar, the authors Lustig et al (2012) claim that excessive sugar consumption results in all the diseases associated with metabolic syndrome; which include diabetes, hypertension, ageing, liver toxicity (similar to alcohol), etc. Following is quoted from the paper:

“A growing body of epidemiological and mechanistic evidence argues that excessive sugar consumption affects human health beyond simply adding calories. Importantly, sugar induces all of the diseases associated with metabolic syndrome. This includes: hypertension(fructose increases uric acid, which raises blood pressure); high triglycerides and insulin resistance through synthesis of fat in the liver; diabetes from increased liver glucose production combined with insulin resistance; and the ageing process, caused by damage to lipids, proteins and DNA through non-enzymatic binding of fructose to these molecules. It can also be argued that fructose exerts toxic effects on the liver that are similar to those of alcohol. This is no surprise because alcohol is derived from the fermentation of sugar. Some early studies have also linked sugar consumption to human cancer and cognitive decline. Sugar also has clear potential for abuse. Like tobacco and alcohol, it acts on the brain to encourage subsequent intake. There are now numerous studies examining the dependence-producing properties of sugar in humans. Specifically, sugar dampens the suppression of the hormone ghrelin, which signals hunger to the brain. It also interferes with the normal transport and signalling of the hormone leptin, which helps to produce the feeling of satiety. And it reduces dopamine signalling in the brain’s reward centre, thereby decreasing the pleasure derived from food and compelling the individual to consume more”.

The “Carbohydrate Hypothesis” has caught attention recently after the acclaimed publication: Good Calories, Bad Calories by Gary Taubes (2008). Two hypotheses “Carbohydrate Hypothesis” and “Lipid Hypothesis” were reported in 1970s explaining the causality of NCDs. The “Carbohydrate Hypothesis” proposed by Cleave and Yudkin, the fermentable carbohydrate intake was cited as the cause of coronary heart diseases and other NCDs. The dental diseases namely dental caries and periodontal diseases were considered to be related to the excessive fermentable carbohydrate consumption. In a contrary view, Keys postulated the “Lipid Hypothesis” stating that excessive dietary fat intake led to systemic diseases. The lipid hypothesis recommended a diet high in fermentable carbohydrate for overall good health, and dental diseases were considered as mere local side effects.

The lipid hypothesis attracted more popularity and the policy makers and the food industry responded positively to it. Several recommendations to regulate the intake of dietary fats over the last few decades of the 20th century, however, failed to make a significant impact in terms of reduction of NCDs (Hujoel, 2009).

The recent published work of Robert Lustig, Gary Taubes, Philip Hujoel and the revision in the dietary guidelines of WHO and AHA are the examples of increased acceptance to the “Carbohydrate Hypothesis”.

Conclusion

A bad diet for dental health is usually a bad diet for general health. Dental diseases can prove to be markers for unhealthy diets and NCDs that appear later in life (Hujoel, 2009). Thus, regulating the intake of free/ added sugars can be an integrated approach to improve health which may first manifest in reduction in dental diseases (particularly, dental caries) and obesity; and later the NCDs (Hujoel, 2009).

References

American Heart Association (2013) The American Heart Association’s Diet and Lifestyle Recommendations http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp

Bagramian RA, Garcia-Godoy F and Volpe AR (2009) The global increase in dental caries: a pending public health crisis. American Journal of Dentistry 22:3-8.

Bhave S, Bavdekar A and Otiv M (2004) IAP National TaskForce for Prevention of Adult Diseases in Childhood: Obesity. Indian Pediatrics 41:559-575.

Daly B, Watt R, Batchelor P and Treasure E (2002) Essential Dental Public Health. Oxford University Press.

Fejerskov O and Kidd E (2008) Dental Caries- The Disease and Its Management. Blackwell Munksgaard Second Edition.

Gwatkin DR, Guillot M and Heuveline P (1999) The burden of disease among the global poor. Lancet 354: 586–89.

Habib, S H and Saha, S (2010) Burden of non-communicable disease: Global overview. Diabetes and Metabolic Syndrome: Clinical Research and Reviews 4: 41-47.

Hayden C, Bowler JO, Chambers S, Freeman R, Humphris G, Richards D and  Cecil JE (2012) Obesity and dental caries in children: a systematic review and meta-analysis. Community Dentistry and Oral Epidemiology 41 (4); 289-308. DOI: 10.1111/cdoe.12014

Hobdell, M H, Oliveira, E R, Bautista, R, Myburgh, N G, Lalloo, R, Narendran, S and Johnson, N W (2003). Oral diseases and socio-economic status (SES). British Dental Journal 194:91-96.

Hooley M, Skouteris H, Boganin C, Satur J and Kilpatrick N (2012) Body mass index and dental caries in children and adolescents: a systematic review of literature published 2004 to 2011: Systematic Reviews 1:57 http://www.systematicreviewsjournal.com/content/1/1/57

Hujoel P (2009) Dietary Carbohydrates and Dental-Systemic Diseases. Journal of Dental Research 2009 88: 490Hujoel P (2009) Dietary Carbohydrates and Dental-Systemic Diseases. Journal of Dental Research 2009 88: 490

Huynen, M T E, Martens, P and Hilderink, H B M (2005) The health impacts of globalisation: a conceptual framework. Globalization and Health 1(14): 1-12.

Labonte, R and Schrecker, T (2007) Globalization and social determinants of health: Introduction and methodological background (part 1 of 3).Globalization and Health 3(5): 1-10.

Ministry of Health and Family affairs, Government of India (2004). National oral Health survey and fluoride mapping (2002 -03).

Lustig R, Schmidt LA and Brindis CD (2012): The Toxic Truth about Sugar. Nature 482; 27-29.

Morenga LT, Mallard S, Mann J (2013) Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.e7492 (Published 15 January 2013)

Moynihan P and Kelly SAM (2014) Effect on Caries of Restricting Sugars Intake: Systematic Review to Inform WHO Guidelines J Dent Res 93(1):8-18.

Petersen, P E, Bourgeois, D, Ogawa, H, Estupinan-Day, S and Ndiaye, C (2005) The global burden of oral diseases and risks to oral health. Bulletin of World Health Organization 83(9): 661-669.

Rodrigues and Sheham A (2000) The relationships between dietary guidelines, sugar intake and caries in primary teeth in low income Brazilian 3-year-olds: a longitudinal study. International Journal of Paediatric Dentistry. 10 (1) 47–55.

Silva AER, Menezes AMB, Demarco FF, Vargas-Ferreira F and Peres MA (2013) Revista de SaúdePública 47(4) http://dx.doi.org/10.1590/S0034-8910.2013047004608

Sheiham A and Watt R G (2000) The common risk factor approach: a rational basis for promoting oral health. Community Dentistry and Oral Epidemiology 28:399-406.

Sheiham (2005) Oral health, general health and quality of life. Bulletin of the World Health Organization 83 (9): 644-645.

Sheiham A (2006) Dental caries affects body weight, growth and quality of life in pre-school children. British Dental Journal 201: 625-626.

Taubes G (2008) Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease. Knopf. 2007.

Watt R (2005) Strategies and approaches in oral disease prevention and health promotion. Bulletin of the World Health Organization 2005;83:711-718.

World Health Organization (2015) Guideline for Sugars intake for adults and children.

World Health Organization (2003) World Health Organization Global Strategy on Diet, Physical Activity and Health- Obesity And Overweight

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DISCLAIMER : “Views expressed above are the author’s own.”

Alternatives to Rubber Dam Isolation technique

Alternatives to Rubber Dam Isolation techniqueAlternatives to Rubber Dam Isolation technique

Adhesive techniques are comparatively more sensitive than conventional ones. Here we will focus on atraumatic technique of restoring cervical abrasion-erosion and carious lesions. It is absolutely mandatory to isolate the operatory field to use an alternative placement of sequence in the dental rubber dam. The environment should be suitable enough to be visible, adequate space for instrumentation, easily accessible, moisture controllable for insertion as well as manipulation of dental restorative materials. It should be isolated from soft tissue and moisture including tongue, gingiva, lips and cheeks, blood, saliva and gingival crevicular fluid.

The aim of isolation

Control of moisture

During the operation, control of moisture is required to prevent debris restorative and hand piece spray from being aspirated by the patient. It refers in the operating field excluding saliva, gingival bleeding and sulcular fluid. The operative dentistry cannot be applied unless the moisture in the oral cavity is controlled properly for execution. Absorbents, suction devices and rubber dam help in controlling the moisture.

Access and retraction

This provides maximal exposure during the operation which includes maintaining an open mouth and retracting or depressing tongue, gingival tissue, cheeks and lips. Retraction cord, absorbents, rubber dam, mouth prop, high volume evacuator are useful for access and retraction. The restorative procedure cannot be managed with ease in case of improper access and retraction.

Prevention of harm

An important aspect to be considered is to prevent the patient from being harmed and members of health professions. The axiom taught is “DO NO HARM”, it is basically an awareness to prevent the patients from being protected from harm. The main aspect of prevention of harm along with retraction and moisture control are mouth props (occasional use), absorbents, suction devices and rubber dams.

Classification

Moisture isolation

Direct method

Rubber dam, cotton roll and holder, pieces of gauze, absorbent wafers, suction devices and gingival retraction devices.

Indirect method

Comfortable position and relaxed surrounding for the patient, local anaesthesia, muscle relaxants, antisialagogue and anti-anxiety medication.

Rubber dam

It has good visibility and adequate access to the operating field, patient protection and management.

History: On 15th March 1864, Dr Sanford Christine Barnum Connecticut valley, dental society.

Dr JF Hadson 1870, seven types of clamps, no forceps used.

Dr Tees 1870, festooned clamps

Dr Elliot 1878, designed clamp forceps

Ainsworth 1879, rubber dam punch

Dr Hickmans 1880, lipped clamps

In 1890, clamps with holes.

Rubber dam frame introduced a metal Fernald’s frame in early 20th century.

Advantages

  • Access and visibility
  • Clean and dry operating field
  • Protects operator and patient
  • Psychologically more relaxing
  • Reduces risk of cross-contamination and objection by the patient

Disadvantages

  • Minor changes in cervical cementum and marginal gingiva during clamp removal
  • Time consuming and patient willingness
  • Ceramic crowns may fracture in case of clamps, gripped to the margins
  • Metal crown margins show defects at a microscopic level following removal of the clamp

Indications

Bleaching, endodontic treatment and caustic chemicals.

Contraindications

In fixed orthodontic appliances, a newly erupted tooth has been found where the clamp does not retain due to physiological resistance and allergies.

Cotton rolls and holders

When rubber dam application is impractical, absorbent in case of moisture helps in minimally retracting soft tissues.

Manually rolled as well as prefabricated with smooth and woven maybe be employed.

Fluid absorbing materials:

Cotton rolls are used in association with anaesthesia will provide acceptable dryness for procedures such as examination, topical fluoride application, sealant placement, impression taking, cementation.

Cotton roll holders in which cotton rolls can be placed into position and with commercial devices stabilised withholding it.

Advantages

Visibility and accessibility improvements in the working area and it provides more retraction.

Disadvantages 

It is time-consuming as it has to be constantly changed.

Techniques used for application

  • Maxillary anterior area isolation
  • Labial frenum on either side, a small sized roll is placed
  • Mandibular anterior area isolation
  • Mandibular labial frenum along with a lingual sulcus on either side small sized rolls

Absorbent Pads/Cellulose wafers

Dry aid/parotid shield

Silver dri aid: It reflects light for improved visibility in which laminated side prevents soak through it.

Gauze pieces

2” * 2” (5*5 cm)

The functionality is same as cotton rolls and also delicate tissue is better tolerated by it.

Evacuation system

There are two types of Evacuation system

  • High vacuum evacuation system
  • Low vacuum evacuation system

Debris and fluid evacuation equipment

High volume evacuation: Metallic autoclavable tips and disposable plastic.

Approximately 150 ml of water per second, it is also more efficient.

Advantages

In the working site it removes shavings of the tooth and restorative material as well as other debris to remove the toxic material. Washing is avoided with intermittent rinsing and decreases the time of treatment.

Saliva Ejector

  • Metallic autoclavable tips
  • Disposable plastic

Placement

It is not directly in contact with tissues; saliva ejectors should be placed with their tips on the floor of the mouth.

Sweflex Saliva ejector

It is curved, flexible, efficient and comfortable as well as reduces aerosols with superior suction capability.

Indirect methods

Local anaesthesia reduces discomfort and makes the patient less anxious. It reduces sensitivity to stimuli and less salivary secretion is also observed.

Prescription Drugs

Though rarely indicated it, used for controlling bleeding of gingival with pain control medication.

Anti-anxiety drugs like valium – 5 to 10 mg, 30 min before.

Atropine (antisialogogues) – 5 mg, 30 min before procedure to reduce salivation.

Muscle relaxants.

Soft tissue isolation

  • Tongue retractors
  • Svedopter
  • Hygoformic saliva ejectors
  • Cheek and lip retractor

Lip retractor

  • Wire lip retractor
  • Oringer lip retractor
  • Simple lip retractor
  • Plastic lip retractor

Cheek and tongue retractor

Disposable spend ezz expanders: sizes small (green), medium (blue), large (red).

Dry field system: Red–pedo, white in colour adult, it is autoclavable at 280 degrees F, it is high heat plastic and silicone construction, it is for posterior restorations, sealants and ortho bandings.

Fast dam: It is used when applying sealants and 17 suction holes along the perimeter.

Mirror-vac saliva ejector mirrors: Ideal for sealants, bonding, air abrasion and other dry field procedures.

Mouth prop: It is used for relief of muscle pain, muscle fatigue and also for the relief of responsibility for adequate mouth opening. The prop ensures adequate constant opening of the mouth which permits multiple extended operations.

Gingival retraction aids: Retraction cords and gingival retractor collars.

Collars: Margins fully visible especially sub-gingivally, reduces chance of recession, better tissue control and helpful for physical retraction.

Gingiva retraction:

  • Physico-chemical means
  • Chemical-mechanical means
  • Electro-chemical means
  • Surgical means

Types of retraction cords:

  • Cotton, synthetic
  • Braided, twisted, woven
  • Coarse and fine
  • Impregnated and non-impregnated

Isolating materials are used for various reasons in the field of operative dentistry for better isolation during the treatment procedure. The rubber dam is one of the isolation techniques in endodontic cases, it is ideal for the treatment procedure of root canal system as well as restorative dentistry. It is considered as a boon and best isolating technique to use with comfort for all involved for better outcomes.

References:

  1. Restorative techniques in paediatric dentistry – M.S Duggal
  2. Paediatric dental medicine – Donald Forrester
  3. Sturdevant’s art and science of operative dentistry – 7th edition
  4. Textbook of pedodontics – Shobha Tandon

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DISCLAIMER : “Views expressed above are the author’s own.”

Be A Super dentist: Understanding your patients

Be A Super dentist: Understanding your patientsBe A Super dentist: Understanding your patients

We live in an evolving world where life is all about change. This is no different for a dental practitioner. If practitioners run their practices in the same manner day after day, year after year; without inculcating a habit of constant up gradation, it’s going to take a toll on them in the long run. In this technological era, we need diverse set of skills to run a smooth practice.

A good dentist is well-versed, rather than well-trained to handle patients with zeal and passion. He works on intuition and looks at the practice in a new light each and every day.  In the 21st century, the dental practice is all about promotions, marketing, scoring high with patient conversions, swift ethical treatment along with fetching positive patient reviews. Besides expertise in dentistry one requires to have keen interest to analyze patient needs by stepping into their shoes.

 

To achieve this understanding one needs to have a growth mindset. When I say growth mindset it means ‘To be able to accept new ideas from people of the same domain and give out practical solutions to people who come to you for treatment, instead of following what you think is the safer conventional method’.

Our education system has a long way to go before we can analyze things in a broader light. Dealing with misunderstandings, delayed deliveries from dental labs, coordination with patients over the phone, scheduling appointments, creating scope for continuous professional development, how to build a good clientele. All these require an exceptional behavior and patience from the dentist.

When I started my practice in Mumbai eight years ago, I was an amateur and expected thing to work my way. But with time I realized the importance of working smart, rather than working hard. Maintaining a balance between my household responsibilities and the dental practice requires time management, support from family members and patients. But of all the skills that I had, I wish I had a good understanding about growth mindset.

dentalreach

During my struggling days, I met some great people on my way to self-improvement. I realized that I need to change my perception to ameliorate my career. Initially, I was struggling with life and working in a team was a giant task for me.

Our education system does not teach us the importance of teamwork and solely revolves around ‘me’ rather than ‘we’. The conventional education system did not teach us how to create a win win situation in our practices. However, these days we can see a change in pattern. The dental education system has started emphasizing on practice management as a serious subject of concern. With the use of smart technology, where students can discuss their ideas in the open forum the present generation are well equipped to market themselves well.

So what is growth mindset?

dentalcare

Enhancing your handskills skills regularly and working in a team are required to be a successful entrepreneur. To stay in your cocoon and never be a part of self-development is a fixed mindset. The transformation must happen from within. If we change this fixed to a growth mindset, the possibilities are endless that allow us to excel in our business.

There are many instances in practice where an open mindset or growth mindset can help you. The behavior of dentist with growth mindset is entirely different from that of a person with closed or fixed mindset. Attitude of a dentist with growth mindset is similar to fearless trader. These kinds of individuals can easily step into patient’s shoes and read their minds. Dentists with growth mindset are keen to learn, ready to evolve everyday and this makes a practitioner happier, interesting and appealing to the public. A dentist with a growth mindset can never settle with being a mediocre.

The aura, ambience, method of practice in a clinic solely depends on how happy you are and how confident you sound to your patients. If you encourage all your clinic staff to build a growth mindset it’s going to help everybody around you grow. To accept, adapt and evolve is what we call growth mindset.

Having a growth mindset is crucial to be a good marketer and helps you in marketing yourself well.

What is marketing? How is it useful for a dental practitioner in the 21st century?

Various actions taken to promote or sell products and services along with research and advertising is called Marketing.

Advantages of marketing for dentists:

  • Helps increase number of patients as you become more popular.
  • Improves your visibility among people with little knowledge on the subject.
  • Makes dentistry interesting and economically viable profession.
  • Gains are realized within a brief period of time.

There are four pivotal parameters we take in consideration when we talk about marketing. In short, we call them the marketing mix. This applies in dentistry to the core.

1. Product

Here dentist should clearly define the services available and his/her strengths to the patients(audience). This will help to gain clarity when they speak in public about their practice. Gives more confidence to the practitioners during consultations, dental camps, online marketing or webinars. Since they are sure about their  products and services.

2. Price

The price of treatment services should always be at par with market prices. For example, if a root canal in your vicinity costs about Rs 3500 for manual RCTs and Rs 5000 for rotary endodontics. However, you wish to charge Rs 5500 for manual RCTs and Rs 7000 for rotary endodontics as you claim your work is better than other dental practitioners; it will not help you gain popularity in patients. Prices should be more or less in par with the dental practices in your locality.

3. Place

Being at the right place at the right time to promote your practice is essential to grow your patient flow and the brand name of your practice. As a practitioner, I have recommended my boss to sponsor certain events at a very low budget in the area, to get noticed. The place where we market will solely determine the kind of patients we attract in the future.

4. Promotion

There are many ways we can come up with packages for various age groups to improve walk-ins. Tracking reward points in the software, giving out loyalty coupons, advertising group packages for treatment and giving offers all come under this marketing sector of dentistry. Use of banners, coupons, flex boards in various locations around your practice can help you sustain the competition.

What is Holistic Marketing?

The word holistic stands for ‘whole’. Though the responsibility of running a business comes under the hands of one proprietor the task of running the practice should be divided into various departments. It’s for this reason, using strategies from marketing gurus like Philip Kotler and Kevin Lane Keller is very important to become a super dentist in today’s world.

Holistic marketing constitutes of

  • Internal marketing
  • Relationship marketing
  • Integrated marketing
  • Performance marketing

What is internal marketing?

dentistrytoday

Internal marketing literally means training and development of your staff. Teaching them to effectively communicate with patients and making them familiar with the dental business. It involves training them to actively involve in your practice toward creating a brand image. Internal marketing is simple but vital for the sustenance of a dental practice.

Some examples of internal marketing in dental office are:

  • Training them to engage patients in conversations which helps them cooperate. Especially on days when you have bulk appointments placed for specialists.
  • Interacting with your staff in friendly manner create a feeling of self-belonging. Help them to improvise their work from time to time.
  • Provide some assistance in educating receptionist and other dental staffs.
  • Maintain a peaceful clinic ambience on a daily basis and never losing a patient..
  • Giving timely incentives and appraisals for their extra efforts.

There could be many ways you want to improvise your practice and all these methods are a part of internal marketing. If your own team is on your side, success is guaranteed.

2)  What is Relationship marketing?

dentkart

Relationship marketing stands for creating a long-term relationship between the practitioner and patient in the dental practice.  It involves building mutual satisfaction with patients to get more leads or new patients. This helps in retaining the patients successfully.

Loyalty coupons, premium memberships and reward points can be given to existing patients to build long-term relationship.

3)  What is Integrated marketing?

The mode of developing new products and communication. Creating new channels to develop brand awareness in public is termed as integrated marketing. Making your clinic linked with the top brands in the country.

Example of integrated marketing would be to have a tie-up with businesses like insurance companies which provide the loan to patients to avail treatments. Example Bajaj Finserv, Capital Float and Religare.

There could also be tie-ups with oral healthcare care product manufacturers like Colgate, Oral B etc. Display products in clinics and sales promotion could attract a lot of patients to walk into your practice. This benefits the dentist too when we sell products for a good margin, as well as the companies benefit from the brand promotion. Creates a win win situation.

4)  Performance marketing

This is an extremely innovative method used by brand marketers to reach number of people who can be useful to dentists to advertise their practices and sell products. Gives one the ability to measure everything from brand reach to tracking conversion rate in a single advertisement. It’s easy to track with minimal risk when it comes to advertising via social media.

This also includes knowing your competitors in your area of practice. Tracking their success and information for survival in dental market.

I shall be discussing this in detail, in my upcoming articles for DentalReach.

Marketing opens means to generate more patients apart from mouth to mouth publicity which dentists have been relying on since ages.

Tips to improve your marketing skills as a practitioner:

1)  Gauge your market value in today’s competitive world:

google scholar

The new era is for multi-talent and there are always multiple ways to learn new skills in dentistry. For instance, if a general practitioner would like to learn about rotary files and use of endomotor in his practice, nothing should stop him.

There are many practitioners who are making good amount of revenue based on the maximum number of skills they can use in their day to day practice.

Unfortunately, when a dentist passes out of MDS from a reputed colleges they are fed with the fact that they can just handle a certain type of cases. The stereotypical nature of the college staff gets into their blood for years together. It takes a while for them to come to reality. For example, a surgical case is supposed to be handled only by an oral and maxilla facial surgeon. A root canal can be performed only by an endodontist.

This in turn, brings down your demand in the market of dentistry. Is this what you want to happen to you?

Jobs get scarce and you again need to plan to get another degree to specialize in each one of these skills. The cycle never ends. Unless you decide to take the risk and start learning new skills. Being an all-rounder is all that it takes to win a number of patients into your practice.

2)  Have a look at your career graph:

journal of dentistry

What you did yesterday, shouldn’t be what you are today? Improve in all aspects like the salary you draw, standard practice you work in, number of complicated cases you handle in your career, way you engage your dental supporting staff, all these enhance your career.

dental news India

 

The career graph can vary for every single individual. But the pointer should always move up with every year we approach in our practice. For instance, this year I have learnt to take in patients for flap surgery confidently and after six months I’m going to place implants myself.

I have a Facebook page for my clinic, coming years I need to have my own website. This kind of approach at a very early stage of establishing a practice can take you to heights very soon.

 

3)  Make sure your patients love your services:

dental treatment videos

This is crucial in the competitive world of dentistry. It’s also a part of internal marketing as I discussed earlier. In the current scenario, patients have wider options ahead of them at the click of a finger. But the dentists with the highest number of stars and honest reviews from patients get the benefit. When I say ‘love’ it literally means loving to come to you for every appointment. The goal of every dentist should be to be able to win the patients mind when it comes to comfort, approachability and enjoying the ambience of the clinic. A small investment on a music system, or a fish tank with multiple things in it, a good library in the reception area, having a well-trained staff can go a long way to help them engage themselves in your practice.

4)  Understanding patient psychology

This is a wide area of discussion and has many aspects to it. However, I can bring it down to one simple concept, that is a chart from Maslow’s hierarchy of needs which stands true for any business.

dental treatment videos

To convert your patients into a treatment in the first meeting, categorize the patients into the following sections. Psychological, Security, Social, Ego, Self-actualization. The fact that different people have diverse needs, and you realizing it before they even say it, this is what will help you escalate your practice to another level.

Now based on their needs they can be divided into 5 categories. Here I can take you through the lowest to the highest for dental patients.

Psychological:

They can nowhere afford a day’s meal or pay for their child’s school. Et they want help from you as a dentist as they are in pain. Here it makes no sense to explain all kinds of options of treatments and come out with your catalogue. However, if the patients are interested to know we should explain all the treatments with due respect.

Security:

These set of patients do have some means to fulfil their basic requirements and have planned ways to get treatments done through insurance or pension schemes. All options should be provided for such patients since they take time to decide what treatment can be done now and what can be planned for some months later. However, these set of individuals shouldn’t be over burdened with the heavy dental treatment. Instead, talking to them about the treatments one by one will benefit them a lot.

Social:

These set of patients have all the money and resources but are very cautious and knowledgeable people. They can ask you a multiple number of questions and will still never do the treatment. Yet they do return if they are fully gratified with your suggestions in comparison to the next dentist they just visited to cross check what you said stands true or not.

Ego:

These set of patients come to you just because they were referred from other patients who had already taken treatment from you. They may just be convinced even before you try convincing them. But you need to make sure you charge uniformly for all these set of patients. Time is a big factor for these patients to be kept under consideration.

Self-actualization:

These set of patients according to me are the best suited to understand any kind of treatment planning and will go to any extent to know what problems they have. Finance should never be a problem for these set of patients. They are knowledgeable and undoubtedly the loyal kind of patients who will turn up for the treatment and yes, they need that VIP call for their appointment scheduling since they have many things on their priority list.

5. Prove your worth in the first meeting

The old saying ‘first impression is the best impression’ has a lot to do with building a good clientele. The body language of the dentist, the persona and the management skills go hand in hand to build a comforting feeling in the patients.

6. Respect one’s time

One should keep a watch on the time allocated for a treatment to get to the next patient who is equally important and needs attention in the peak hours. If in case there must be a delay, the dentist is always advised to take a quick walk around his reception to greet the patients in person and let them know you will be calling them in any minute. This reduces patient anxiety in the waiting area and patients respect it if you care for their time. Unlike, cardiac or general medicine, dentistry is a field that is taken for granted by people. Until the dentist starts the treatments on day 1 the patients are never inclined to the dentist.

Remember the saying from the great orator Shiv Khera-‘Winners don’t do different things, they do things differently’.

This is just what we need to understand in our practices worth crores of rupees today. These ideas and principles in my practice have always lead to success and I’m sure it will help you too.

Practice management is a major topic of discussion in many forums today and deserves your undivided attention. DentalReach is going to bring forth many such articles which will help you improvise your practices and help you enjoy being a dental practitioner for the next few decades.

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DISCLAIMER : “Views expressed above are the author’s own.”

Top 10 Dental Movies

Top 10 Dental MoviesTop 10 Dental Movies

Looking for binge-watching some great dental movies or movies with dentist characters? Allow me! Here is the list of the top 10 dental movies of all time.

1) The Great Moment, 1944

It is a biography of Dr William Thomas Green Morton, a 19th century Boston based dentist who tried to get accepted as a surgical anaesthetic. The movie shows fear of dental pain among public and the quest of Dr WTG Morton to provide painless dental extractions to his patients. On September 30 1846, Morton successfully performed a painless tooth extraction. This was followed by a demonstration of operating theatre at Massachusetts General Hospital on October 16, 1846. Dr John Collins Warren painlessly removed tumour from the neck of a patient. This movie will instil a sense of gratitude for the current era of painless surgeries effortlessly done by pioneer dentist like him.

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2) Eversmile, New Jersey, 1989

It depicts the story of a travelling dentist, Dr Fergus O’Connell who works for a foundation based in New Jersey. He offers his services free of charge to rural population of Patagonia, South America. The movie shows the ignorance towards dental health and its barriers faced by dentist to spread oral hygiene. Dr Fergus’s glowering expressions on seeing someone eat candy is certainly enough for him to quit candy forever. It was quite impressive that they managed to convert a bar into a dental clinic to perform an auto transplantation of a wisdom tooth into an edentulous space of recently extracted missing molar. The bike being repurposed into a makeshift dental chair setup reminded me of mobident that provides door to door dental services.

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3) The Dentist, 1932

This slapstick comedy movie deals with an unsociable and forgetful dentist, who deals with his patients unconventionally, runs his clinic in the house and share memories with his disobedient daughter. Various patients with unusual physical traits such as a tall “horse” faced woman, a tiny, heavily-bearded man arrive at the office and he attempts to use his dental drill on them without any apparent painkiller. With one of his patients, he engages in an intimate wrestling match. A lighthearted movie that will teach you the things NOT to do in your dental practice.

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4) Charlie and the Chocolate Factory, 2005

It is the second adaptation of Roald Dahl’s classic book. This movie is about Charlie Bucket, a poor boy who lives near Wonka Candy Company. While the movie is about Charlie, star of the movie is Johnny Depp’s supremely weird character Willy Wonka, the candy company’s owner. And the reason for his odd behaviour? You guessed it right, an overbearing dentist father, Dr Wilbur Wonka denying his young son candy because of the potential risk to his teeth. Don’t be harsh with your kids or they will run away and consider family a hindrance in pursuing their dreams. This is the message conveyed by the movie.

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5) The Hangover, 2009

When four friends travel to Las Vegas for a bachelor party of their friend Doug’s upcoming marriage, things quickly go out of control. Doug’s hilariously strange future brother-in-law, Alan played by Zach Galifianakis gave them drugs in hopes of a better night. Dr Stuart “Stu” Price, played by Ed Helms is a dentist, the normal one among his group of insane friends. Being a dentist does not ensure safety from dental injuries. Stu performs an extraction on himself to defend his honor as a dentist on being bet that he couldn’t perform an extraction.

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6) Horrible Bosses, 2011

This movie depicts the story of three friends and their delightfully nasty tale of resentment, desperation and amoral revenge against their “horrible bosses”. One of the titular bosses, Dr Julia Harris aka Man-eater played by Jennifer Aniston. She is a dentist and frequently assaults her dental assistant, Dale, played by Charlie Day. Dale and his two friend’s team up to murder their respective abusive bosses and things go horribly wrong. Homicide is probably the worst option to deal with a difficult boss.

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7) Thumbsucker, 2005

The movie focuses on teenager Justin Cobb as he copes with his thumb-sucking habit and low confidence. Justin’s orthodontist, a mystical-hippie person played by Keanu Reeves tries to help him overcome his adverse habit. During his final checkup, Dr Lyman reveals to Justin his discovery that thumb-sucking is not a medically debilitating problem but says that everyone has their own flaws and nobody has all the answers. Good one! Dr Lyman. Wonder if this answer will convince our examiners during viva!

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8) Rudolph the Red-Nosed Reindeer, 1964

It is a television Christmas special released on December 6, 1964 depicting the story of Rudolph, a reindeer who is bullied because of his red nose. Meanwhile, Hermey one of Santa’s elves dislikes making toys and wishes to be a dentist instead of a toy maker. This outrages the elf foreman and other elves chastise him for his interest in dentistry. Despite this Hermey continues his studies. This movie gives a rare glimpse of dentistry as a positive profession. As dentists, we acquire skills to pull out teeth, which can always be used to defeat the bad guys and save the day!

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9) Finding Nemo, 2003

A Sydney based dentist Dr Philip Sherman captures Nemo and adds him to the collection in his dental office fish tank. He is supposedly going to gift Nemo as a pet fish to his nasty niece who terrifies the fishes. Nemo along with the Tank Gang devise an escape plan. The dental expertise shown by the aquarium inhabitants while watching the dentist performing RCT is amazing! This movie shows another psychotically weird child related to a dentist, reinforcing the point that dentists apparently pass on cruelty to their progeny?? A food for thought…

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10) Talvar, 2015

The story revolves around the mysterious murder cases of a teenager and the domestic help, who worked at her place. The film is based on the real life 2008 Noida Double Murder Case, in which 14 year old Aarushi Talwar was found, murdered at her home. The family’s missing 45-year-old servant Hemraj was initially sought for the murder, until his dead body was discovered in another part of the building on the following day. The parents, a dentist couple were convicted for the crime. The film showcases three perspectives to the case which emerge as the investigation moves forward, portraying the parents as guilty or innocent. The movie depicts how office politics and grudges held by a dental assistant can prove to be dangerous. Beware! Treat them right.

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DISCLAIMER : “Views expressed above are the author’s own.”

Chemotherapy agents and dentistry

Chemotherapy agents and dentistryChemotherapy agents and dentistry

Chemotherapy is a type of treatment given to cancer patients who are under medication in order to overcome a particular ailment. This treatment involves chemical substances like cytotoxic and other drugs may be used. Chemotherapy is given to alleviate the symptoms and control cancer that has spread. Patients should be aware of the dental treatment after chemotherapy to avoid any major problems. Dentists should be careful about the dental treatment after chemotherapy for the cancer patient.

Classifications

Chemotherapy agents are divided into many groups depending on several factors such as:

  • Mechanism of action
  • Cell-specific types
  • Formulation
  • Relationship to the different drug

Chemotherapeutic agents consist of five classes:

Mitotic Inhibitors: It is derived from compounds and plants in phase of cell cycle by stopping mitosis as it can damage cells for reproduction. Some of the mitotic inhibitors are vincristine, vinblastine (vinca alkaloids), taxotere, taxol (taxanes) and ixempra (epothilones).

Anti-tumour antibiotics: It is used to treat infections and cells of DNA. Group of anti-tumour antibiotics agents are daunorubicin, idarubicin, epirubicin, adriamycin. There are some other types of anti-tumour antibiotics drugs such as bleomycin, actinomycin- D, mitomycin, mitoxantrone.

Topoisomerase Inhibitors: Specific type of enzyme interfered by drugs known as topoisomerases. During S phase, it helps for strands of DNA to separate cancer cell propagation enzymes inhibitors which prevent DNA replication. Topoisomerase inhibitors consist of irinotecan, topotecan and topoisomerase ii inhibitors which consist of teniposide and etoposide. The risk of acute myelogenous leukaemia has topoisomerase ii inhibitors after 2 to 3 years.

Antimetabolite: The normal building blocks of DNA and RNA in which antimetabolites interfere. During S phase antimetabolite damage cells and use to treat ovary, breast and gastrointestinal tract cancer. Some antimetabolite are is hydroxyurea, methotrexate, floxuridine and fludarabine.

Alkylating agents: It is used to treat cancers like leukaemia, sarcoma, lung cancer, lymphoma, Hodgkin disease as it damages DNA directly and in all phases of cycle. Alkylating agents are triazines, nitrosoureas, nitrogen-mustard, ethylenimines and alkylating sulfonates.

There are other agents like cytokines, corticosteroids, monoclonal antibodies and biologic medications. Corticosteroids help to avoid hypersensitivity reactions, nausea and vomiting for treatment with radiation and chemotherapy. Biologic therapy involves some substance which is extracted from living organisms. It has developed for disease like cancer in order to target specific types of cells. Some vaccines or bacteria are used to trigger immune system, these are also known as biologic response modifier therapy. There are other therapies of biological type like genetic material DNA, RNA and antibodies.

Chemotherapy side effects

The side effects of chemotherapy are mucositis/stomatitis, mucosal ulcerations, xerostomia, fungal and bacterial infections. Patients who undergo chemotherapy may also suffer from oral complications from the ailment and the treatment. It mainly affects oral mucosa and bone marrow. It is used individually or with another aspect of antineoplastic treatment with palliative combination. The combination may arise with immunosuppressed state of patients and ulcers may occur in a span of 2 weeks after chemotherapy. Patients with advanced cancer are commonly used as the stimulant and it may help in relieving pain. Severity of mucositis is caused by alkylating agents and antimetabolites suffering from advanced stage of cancer.

During the treatment, dividing cells are affected and normal cells are also involved. (Technically not making sense) Chemotherapy depends on location, type and dosage of treatment which varies from person to person. These also include nausea, loss of appetite and hair, sexual dysfunction, diarrhoea, pain, fatigue and constipation. It affects both peripheral and central nervous system, which could linger and last for long durations. Sometimes these side effects could be permanent.

Healing of lesions takes nearly 2 to 4 weeks after the last chemotherapy dose. Status of oral mucosa and changing peripheral blood counts have a direct relation, as it appears to be affected by chemotherapy. Neutropenic ulcers are seen in the case of severe neutropenia. When there is a chemotherapy treatment undergoing by agents secondary to xerostomia, it leads to rampant decay and affects teeth cementoenamel junction (CEJ). Patients with low white blood cells are more prone to fungal and bacterial infections. There is strong relationship between oral cavity, sepsis and bacteremia for myelosuppressed patients.

Chemotherapy management: Patients with dental problems undergoing chemotherapy prerequisites (Unable to understand) a focus on medical history prior to treatment initiation. During treatment, patient’s age has a strong influence on overall health fighting against cancer. The psychological impact upon them has to be recognised in suffering patients as it relates to perception and attitude.

Acute infection must be first considered by dental practitioners. Patient who is under chemotherapy medication or about to begin must be addressed to practitioner since there are areas of potential spread of infection.

Maintenance therapy must be monitored by a dentist and recalled frequently not only to those who have better healthy dentition, and also for acute diseases. Oral prophylaxis and root planning must be taken, good initiative care in the maintenance therapy stage. Patients whose system are recovered from the effects of chemotherapy must delay undergoing elective and cosmetic services. Radiation therapy of head and neck for the patients suffer from cervical caries, so the use of customised fluoride trays helps reduce the degree of impact in the oral cavity.

The chemotherapy agents have a great influence and closely related to the field of dentistry. Every dental practitioner during the course practice will come across patients with one or more who are suffering from cancer. Chemotherapy is included in the combination of treatment presently available for the disease treatment in the course of a lifetime. These agents are complex and also targets with the sophisticated mechanism of action when they are directed. In the field of dentistry is advancing through research to render for better service by enhancing the knowledge with experience and skills by the dental practitioner.

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DISCLAIMER : “Views expressed above are the author’s own.”

Magic of Orthodontics

Magic of OrthodonticsMagic of Orthodontics

Orthodontics is the advanced training in a sphere of dentistry mainly concerned with the study as well as treatment of malocclusion, irregular positioning and disproportionate relationship of jaws. The word orthodontics is derived from the Greek language Ortho, meaning straight and Odont, meaning tooth. Orthodontic treatment has mainly two aims; pragmatic – to improve irregular positioning of teeth causing various issues like bite problems, occlusion, etc. and cosmetic – to design a healthy and beautiful smile over a period of time thereby the appearance of the face.

Orthodontics

Orthodontists should be fully aware how the teeth work and its affects and effects an oral wellbeing.

Orthodontists base their understanding of mechanics of tooth movement on three principles:

1.       Development and growth of jaws and teeth.

2.      Teeth alignment within dental arch.

3.      Occlusion of teeth and its functions. 

Smile design in a unique way through Orthodontics

Through orthodontic treatment, proper positioning and teeth alignment is one of the prerequisite methods to design a beautiful smile. 

Diagnosis by orthodontist

Orthodontists will evaluate and determine the recommended age for orthodontic treatment. This plays a crucial role in the plan and assessment of the treatment. All medical, dental history of a client is required prior to undergoing orthodontic treatment. 

First step would be taking an impression with which moulds of the teeth will be made. Articulator is a study model placed in an articulator to study and replicate jaw movement of the patient. Next, jaw and teeth x-ray with specialized radiograph are captured through a computer. Records are extremely important for images and it also helps an orthodontist determine the treatment plan. Details of records are also necessary for teeth stabilization and also to prevent the relapse of teeth after orthodontic treatment. The main motive is to give them a healthy smile for life.

Teeth movement

Orthodontist uses appliances with small brackets placed on the teeth through which flexible wire is threaded within the braces. Flexible wire tends to place light forces on the teeth and tends to move their teeth in order to straighten without any distortion. Movement of teeth is due to the characteristics of periodontal ligament which is elastic and attaches to the bone of the teeth. The living tissues in our mouth are remodelling and changing constantly. When mild force is applied in a controlled way on the tooth due to tension cementum, ligament and bone are formed. Tension is mainly due to pulling side whereas on the pressure side, in order to allow tooth to move, even cell will remove ligament and bone. Overall, the outcome of orthodontic treatment is taken into consideration that is to aim for function, stability and aesthetics. The discrepancies in the position of tooth and bite problems are considered to be basic modality. It is equally important to determine where the position of teeth must be, the methodology used for moving the teeth, stabilisation and retention as the treatment is completed. So, orthodontic experience is found to be vital in determining the orthodontic treatment plan.

Orthodontic appliances

There are several options to select appliances whilst undergoing orthodontic treatment. In fixed appliances, the patient cannot remove the braces on their own. The primary one is such that for posterior teeth, orthodontic band and anterior teeth, bonded bracket and it is known as a traditional bracket. An individual who intends to have aesthetic appliances may go for clear brackets which are less visible. During the course of treatment, it is highly recommended to avoid hard foods. Fixed appliances are used in comprehensive and complex cases. A clear aligner is a choice of treatment for reposition of teeth and it is known as removable appliances. It gives the teeth a better alignment since each one is different from preceding one. Removable appliances are used in cases which are milder and for tipping movements of the tooth. Simple movements of teeth may take at the most few months whereas complex movements may take 18 to 24 months or more, depending on severity and depth of the case. The diagnosis and careful assessment are considered to be the important factor in choosing an appropriate choice of appliance used for the treatment procedure.

Dental Surgery

Dental surgery is a type of dental treatment combined with surgery done to correct jaw and face, concerned with growth, structure, skeletal discrepancies and TMJ disorders. Orthodontist, combined with oral and Maxillofacial Surgeon focuses on treating craniofacial complexes related to skull, face, jaw and mouth. It is essentially needed when the jaws align improperly and proper bite results cannot be achieved by orthodontics alone. Orthodontic surgery can be done only when the jaw growth is complete; in females at 16 years and in males at 18 years. So, orthodontic surgery aligns the jaws and braces by the treatment which is used to move the teeth into proper position.

This treatment is one of the most important scientific discovery in the field of dentistry since it impacts all of oral health. It also enables your teeth to move into proper position which has a great influence psychologically.

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DISCLAIMER : “Views expressed above are the author’s own.”

Seven deadliest medical conditions related to oral health

Seven deadliest medical conditions related to oral healthSeven deadliest medical conditions related to oral health

In the modern era there have been lot of aspects associated with oral health, especially chronic and acute medical conditions. A lot of studies have been conducted regarding scariest medical conditions related to poor oral habits. The dentists can focus mainly on preventive measures in different ways. The dentists are now dealing with some of the scariest medical conditions including stroke, chronic kidney disease, lung cancer, respiratory infections, Alzheimer’s, breast cancer, oesophageal cancer.

Stroke

Stroke is an obstruction of total blood flow to the brain and may be acute. Oral bacteria may cause diseases which affect the brain.

Types and symptoms

  • Haemorrhagic stroke
  • Transient ischemic attack
  • Ischemic stroke

Symptoms of stroke

Nausea, vomiting, numbness of face, unstable mind, headache, loss of balance, paralysis on one side of the body, blurred vision, drooping face and dizziness.

Effects on oral health

The effects on oral health include inability to brush teeth, slurred speech, inability to rinse mouth, dry mouth, inability to swallow, loss of teeth and abscess formation.

If it is untreated, the adverse effects are gingivitis, dental caries and periodontal disease. If patients do not take proper care of their oral health, it leads to denture stomatitis, inflammation of the mouth and ulcers.

Chronic kidney disease

The individuals with kidney disease have other health-related issues since their immune systems are compromised, so they are more affected by various infections.

Symptoms

Vomiting, sleep disturbances, swelling of ankles and feet, feeling of itching, weakness, cramps and loss of appetite.

Effects on oral health

The oral health is affected since the kidneys are unable to remove urea from blood and the urea breaks down in order to form ammonia. The changes in the bone density also occur since calcium is not absorbed by body properly. Therefore, people with kidney problems are high-risk. Bleeding gums, halitosis (bad breath), xerostomia, sensitive teeth, salivary gland infection, inflammation of the mouth, tooth loss are the symptoms of gum disease. If it is not monitored periodically, the adverse effects lead to dental caries, abscess formation and periodontal diseases. The other symptoms affecting general health are heart disease, anaemia and eating disorder known as anorexia blood disorder.

Lung cancer

It is the growth of abnormal cells in an uncontrolled way that may happen in the lungs and lead to tumours.

Symptoms

Fatigue, loss of appetite, difficulty in breathing, recurring infections, coughing are the symptoms of lung cancer. Some other symptoms are jaundice, lumps in collarbone or neck region, swelling of the face neck and arms, pain in the bone, limbs become numb or weak. In advance stage of lung cancer, the effects spread to the body mainly affects the brain, liver and bones.

Effects of oral health

It plays an important role in affecting oral health.  Chemotherapy affects the white blood cells, red blood cells and platelets which affects the lining of gums and mouth. The radiation therapy causes stiffness. It would result in dry mouth, gum diseases like gingivitis, sore mouth and more sensitivity. The taste of the food changes.

Respiratory infections

The reservoir has potentially been considered in the oral cavity which is specifically respiratory pathogens. The mechanism of infection of the lungs such as pneumonia, dental plaque colonization by pathogens of the respiratory tract is through aspiration. Along with pathogens of the periodontal region, facilitating dental plaque colonization in the pulmonary tract is also seen.

In the elderly people, the dental plaque colonization due to pulmonary pathogens is more frequent. The reaction leads to variable inflammatory process and connective tissue destruction which is present in emphysema and periodontal disease. There is also strong relation and association between COPD (chronic obstructive pulmonary disease) and periodontal disease. The acute condition such as pneumonia is a gradual onset with little or no fever with a cough.

Symptoms of acute respiratory infection

Runny nose, sore throat, fatigue, cough, loss of consciousness, dizziness and congestion.

Effects on oral health

Oral health is impaired in a great way and it leads to periodontal disease, poor oral hygiene, difficulty in swallowing, problems in feeding, poor functional status and dental caries.

Alzheimer’s

Is a mental deterioration occurring progressively in middle and old aged people due to degeneration of brain.

Symptoms

  • Difficulty in remembering things due memory loss
  • Unable to cope with challenges of life
  • Difficulty in completing a task
  • Confused state of mind  with time and place
  • Vision problems especially in identifying visual images
  • Mood and personality change
  • Poor judgement capability
  • Avoid associating in social environment

Effects on oral health

Alzheimer leads to tooth decay and gum diseases like gingivitis, gum bleeding, halitosis, periodontal diseases in old aged people. Denture wearing results in denture stomatitis, sore mouth and chronic atrophic candidiasis.

Breast cancer

Is when cells in the breast begin to grow out of control. The cells ultimately form a tumour which may turn out to be malignant and spreads to surrounding tissues and distant areas of the body and often felt as a lump.

Symptoms

  • Pain in the breast and nipple
  • A discharge from the nipple other than breast milk
  • Irritation in breast skin
  • Thickening of the nipple
  • Redness and scaliness

Effects on oral health

The effects on oral health are inflammation of mouth, difficulty in swallowing, tastelessness, dry mouth, burning sensation in the mouth and dental infections.

Esophageal cancer

The growth of abnormal cells in the food pipe in an uncontrolled manner is also known as cancer of gullet. There is a strong association between poor oral hygiene and esophageal cancer.

Symptoms

  • Weight loss
  • Difficulty in swallowing
  • A persistent cough and indigestion
  • Throat pain
  • Heartburn

Effects on oral health

The association of oral hygiene with oesophageal cancer results in gum disease like gingivitis, halitosis, gum bleeding, periodontal disease, tooth erosion, sensitive teeth, dry mouth and dental caries.

Summary

The awareness of symptoms and regular check-ups by medical practitioners can bring a change in the society. If the symptoms are diagnosed in the initial stage, doctors can help the patients to cure. Otherwise, they won’t be able to help them and their life may come under risk. There are different educative programmes and campaigns to aware individuals about different scariest medical conditions.

References

  1. Gopal1Strokeand oral health, Vital 5, 40 – 42 (2008)
  1. Amir Azarpazhooh* and James L. Leake*  Systematic Review of the Association Between Respiratory Diseases and Oral Health DOI:10.1902/jop.2006.060010
  2. N A Dar,1,2,* F Islami,2,3 G A Bhat,1 I A Shah,1 M A Makhdoomi,1 B Iqbal,1 R Rafiq,1 M M Lone,4 C C Abnet,5 and P Boffetta2,6Poor oral hygiene and risk of esophageal squamous cell carcinoma in Kashmir Br J Cancer. 2013 Sep 3; 109(5): 1367–1372.

 

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DISCLAIMER : “Views expressed above are the author’s own.”

Here’s what Orthodontists have to say on World Orthodontic Health Day

Here's what Orthodontists have to say on World Orthodontic Health DayHere's what Orthodontists have to say on World Orthodontic Health Day

May 15, 2017 was the first World Orthodontic Health Day, and the WFO created a special logo and posters that established the brand identity of this annual celebration. The logo, available in a variety of formats, is available for download (see below). WFO members should use this logo in all promotional materials for this celebration going forward. Read more.

  1. DR NITIN V MURALIDHAR
    READER
    DEPT OF ORTHODONTICS
    JSSDC&H

Malocclusion which means teeth which are out of their normal positions in both upper and lowers jaws of an individual.  Malocclusion is associated with adverse Psychological & social effects including the longevity of the dentition & oral health overall & therefore adversely affecting the quality of life.

Malocclusion can manifest in a wide range & variations of malpositioning of teeth in the dental arch like – spacing/crowding/protrusion/retrusion /rotation and so forth.

Adverse consequences of Malocclusion

A person’s malocclusion can have a direct effect on his/her dental & facial aesthetics leading to poor social image & psychological disturbances. A person’s quality of life can be affected due to compromised functions of the oral cavity: chewing, breathing & speech.

Consequences of Malocclusion:

  1. Poor facial aesthetics

Negative body image

Psychological disturbances

  1. Compromised function of the oral cavity

Poor masticatory performance

Difficulty in articulation & lack of clarity of certain words

  1. Loss of tooth substance & attrition

Hypersensitivity of teeth

  1. Increased susceptibility to trauma
  2. More prone to dental diseases
  3. Obstructive sleep apnea

Benefits of Orthodontic Treatment:

  1. Improved smile/facial aesthetics
  2. Improved oral functions
  3. Positive psychological outlook
  4. Improved body image
  5. Reduction of Obstructive sleep apnea

The WFO Executive Committee chose May 15 for World Orthodontic Health Day as it marks the signing of the WFO’s charter in 1995 during the 4th International Orthodontic Congress in San Francisco. The main aim of celebrating this day – May 15th every year as the “World Orthodontist Day” is to promote the awareness of ill effects of malocclusion and promoting the science of Orthodontics to solve this problem.

  • The various treatment options available to the patients are:
  • Removable corrective appliances/plates
  • Preventive removable trainers
  • Functional jaw orthopaedic appliances

Fixed braces

Usually fixed orthodontic treatment commences at the age of 12-13yrs , i.e when all the permanent teeth have emerged in the mouth. But there are instances when the preliminary treatment has commenced as early as 8-9yrs due to the severity of the problem like severely displaced upper anterior teeth or any other jaw deformity or even a thumb sucking habit.

Habits such as thumb sucking have to be curtailed as early as possible. It is considered normal if a child sucks his/her thumb until the age of 4 yrs. But thereafter it poses a threat of deforming the dental arches by flaring up the upper front teeth and pushing back the lower front teeth.

To control this habit a Tongue crib is advised which has to be worn by the child for at least 6-8months depending on the severity of the problem.

Fixed braces treatment can commence after the full set of permanent teeth have emerged into the mouth.

The types of fixed braces are

  • Metal braces
  • Ceramic braces- Usually for adults who are more conscious about their appearance.
  • Lingual braces- which are invisible as they are placed on the inner aspect of the teeth
  • Invisalign/ Aligners – which involves a series of removable soft trays which the patient has to wear sequentially.

Usual duration of fixed braces lasts around one & half yr to two years depending upon the severity of the condition.

2. DR. AKSHAY RATHI

ORTHODONTIST

NAIR HOSPITAL DENTAL COLLEGE, MUMBAI

What are the first three most important patient factors for the
successful outcome of Orthodontic Result ?

Humans are complex and multiple patient, doctor, and appliance factors
are in play to give the resultant smile.

Three important patient factors which are mandatory to give best results
are:-

1. Maintenance of good oral hygiene.

2. Observing the appointment schedule.

3. Following dietary instructions to reduce appliance breakages.

3.  DR. BIJU ABRAHAM – BRACES FOR HEALTHY LIFESTYLE

ORTHODONTIST & DENTOFACIAL ORTHOPAEDICIAN

FULL MOUTH REHABILITATION SPECIALIST

DENTAL IMPLANTOLOGIST

EDITOR, IOS TIMES – THE OFFICIAL NEWSLETTER OF THE INDIAN ORTHODONTIC
SOCIETY (IOS)

CHAIRMAN, PUBLIC AWARENESS COMMITTEE, IOS

Braces . . . a road map for a healthy lifestyle !

“What’s dental braces got to do with health ?!”

A lot ! Trust you are aware that your mouth is the gateway to your health. i.e. Whatever you put in your mouth has a big role to play in your overall health. Things put in the mouth, unless liquid, cannot be gulped down. It needs to be broken down in small pieces, so that the juices in the stomach may easily digest it. That job is delegated to your teeth, jaws and the muscles around your mouth.

“What difference does it make, if teeth are not ‘straight’ ?!”

If the teeth are not in the correct place, you think breaking down of food will happen evenly. In an attempt to break it down evenly, individual teeth undergo more than necessary strain. In the long run, teeth end up wobbly. One dial, of the many in a watch, if out of place, the time is never set right. Same with the teeth set.

“Really?!”

If the upper and lower teeth are not in the correct place, the muscles around the mouth and jaws may shift the lower jaw such that it gets the teeth, as nearly in the correct place, as possible, to break down the food evenly. This shift can cause uneven wear of one or many teeth. It may weaken the teeth, cause pain in the gums around the teeth, pain in the jaw, pain in the jaw joint, pain in the head and neck, or, a combination of these.

“It’s alright doc. I brush my teeth twice a day. I wont have any such issues!”

If the teeth are not in the correct place, it becomes difficult to clean the teeth and gums thoroughly. Teeth and gums, dirty in some nook and corner of the mouth, not only gives a bad smell to those around you, but you end up having cavities on your teeth and gum infection around it. In the long run, you may end up losing few, or, many of your teeth.

“What, doc !! I have crooked teeth, but I have nothing, what you mentioned!”

If you don’t, thank your genes, and/or, your body’s capacity to deal with the situation. However, be aware, things will surface, given time. Meanwhile, in your best interests, do let a qualified orthodontist examine your pearly whites.

Orthodontic associations around the world, celebrate May 15, as WORLD ORTHODONTIC HEALTH DAY, to create awareness about the various possibilities with orthodontic treatment.

4. DR. DEEP GARG

BDS,MScD (Phil.), MDS

GARG DENTAL CLINIC

Www.bracesinmumbai.com

As braces is not just for good looks

Let us raise awareness on this World orthodontist Day about the
increasing importance of teeth that are in line and bite properly.

Studies suggest. A single teeth that is not in its correct position can
cause interference in biting which can lead to temporomandibular joint
disorders and frequent headaches. Such cases are most commonly left
undiagnosed leading to patients taking painkillers for prolonged
periods.  These pain can be similar to migraines. Severe patients with
Migraine should go for a dental evaluation by an Orthodontist!!!

Maybe it was never a Migraine!!

5. DR. MONA PRABHAKAR

An Orthodontist’s Message for World Orthodontic Day- 15th May 2018

 A confident smile can work wonders; it can inspire, motivate, exude charm and even give comfort and assurance.  It has the power of a thousand unspoken words. Such an uninhibited and radiant smile generally stems from good oral health.  Healthy teeth are often referred to as our “32 pearls” because of the immense esthetic value they add to the face when they are well aligned, correctly positioned in the jaws and disease free. The importance of celebrating 15th May as the “World Orthodontic Day” is aimed at creating awareness that orthodontic checkups beginning as early as 7 years of age can help create healthy, beautiful smiles with improved self esteem enhancing the psychosocial component of an improved quality of life.

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World Day for Safety and Health at Work – Infection control and safety in the dental practice

World Day for Safety and Health at Work - Infection control and safety in the dental practiceWorld Day for Safety and Health at Work - Infection control and safety in the dental practice

World Day for Safety and Health at Work is a campaign held on 28 April internationally and annually to promote healthy, safe and decent workplace. It has been observed since 2003 by an International Labour Organisation (ILO). This campaign is for the benefit of workers like trade unions, representatives of government, organization employer’s as well as for the next generation. Its main aim is to achieve and accelerate action for sustainable development and make workers feel secure in their working environments. It also highlights the importance of focussing on challenges related to work aspects, thereby improving the safety and health of workers, and also combats the efforts through awareness.

About International Labour Organization (ILO):

ILO is a United Nations (UN) agency brings together workers, employers and governments of near state of members of 187 countries to develop policies and set standards of labour, promote and programmes devices to work decently for all men and women worldwide. The ILO, with the celebration of World Day for Safety and Health at Work, promotes globally the creation of preventative health and safety culture involving its constituents and its key stakeholders.

History Of ILO

The ILO began with the United States in the year 1919, as part of the treaty of Versailles that reflected on the universal way and based on social justice with the belief of lasting peace. The labour commission by the constitution was set up by peace conference, it was held primarily in Paris and later in Versailles. The head of an American Federation labour, commission chaired by Samuel Gompers of United States was together held with many representatives from nine countries; namely Italy, Belgium, Japan, Cuba, France, Poland, Czechoslovakia, United States and the United Kingdom. The outcome resulted in an organisation of Tripartite, with including executive bodies, representatives of government and employees. The constitution of the ILO permeable speaks the parties of high contracting were moved by the desire of justice and also to secure the peace permanently in the world. Due to increasing understanding aspects of the world’s economic interdependence and also to obtain the cooperation of working conditions in competing countries, reflecting on these aspects it states as

  1. Based upon the social justice lasting peace can be established universally.
  2. Improvement on working conditions is essentially required for labour where harmony and peace never waver.
  3. If in case of adopting conditions of human labour since obstacle was on the way of other nations the desire to improve the conditions exist for their own countries.

Goals Of ILO

Aim for living conditions and labour alleviating

  1. Conditions of labour and living of people must be improved
  2. Unemployment must be prevented
  3. Duration of hours of working on any day of youth, women and children all must be protected, and also care for disabled and elderly provision must be created

The overall purpose of these aspects is to be accepted globally with social standards and also in international trade in divided participants will be prevented from creating advantages over by decreasing the rights of employees.

Functions Of ILO

  1. International labour standards to be established
  2. Information on labour and conditions of industrial related is distributed and also collected
  3. Assistance of technology to be provided

Infection control and safety in the dental practice

In the life of a person, most people will visit a dentist in order to get to know about their oral health; therefore, dental professionals are held responsible for ensuring a safe and infection control environment practice.

Infection control

Asepsis concept and its primary role in the infection control was put forward two centuries ago, by Ignaz Semmelweis in Europe and Olive Holmes in USA. After the Joseph Lister’s studies, the principles were accepted on prevention of wound infection. Though it is very much well known in surgery and general medicine it has been considered as late coming to dentistry.

In the field of dentistry, there are 4 possible routes where the disease may be transmitted.

  1. Direct Contact
  2. Indirect Contact
  3. Airborne route
  4. Droplet Transmission

Planning for Infection Control

  1. Always assess upon return and prepare before

It is the basis for assessing the effectiveness at the end, there follows to improve the process as future aids.

  1. Basic Setup

Choosing a best operating area where exactly the position of patient’s heads placed with regard to artificial or natural light.

  1. Site Setting

The positioning of a patient, access to supplies, adequate lighting, excessive noise and dirt. There are factors must be considered in selecting a setup for treatment of patients.

Principles of Infection Control for Safety practice

  1. Take appropriate action to stay healthy
  2. The spread of contamination has to be limited
  3. Always avoid contacting body fluids or blood
  4. Make objects safe for use

Safety Measures for dental care delivery

Hand Hygiene

Always wash hands before gloving and after removing the gloves. Use alcohol-based sanitizer on hands.

Personal barriers

Using gloves, gowns, masks and eye protection is the safest measure during dental care delivery.

Other Safety Measures

  1. Instead of using fingers to retract tissue use retractor or mirror
  2. Maintaining a container for sharp used instruments in order to allow disposal of blades or needles after using immediately
  3. While processing dental procedures carefully handling instruments
  4. While transferring instruments between operator and assistant have to be done carefully.

It is always safe and best to treat everyone as if they are infected with pathogenic microorganisms and also it is safe to handle every contaminated item as if carrying an infectious blood-borne agent. The effort and focus are to eliminate or decrease in the spread of infection from all types of microorganisms. Eliminating and breaking the cycle of infection is the core objective of a dental professional. The clinician holds a responsibility for implementing effective infection control and also for safe practice.

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