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Speech is a complex process involving the tongue, lips, teeth and vocal cords. Some types of speech problems can partly be caused by the tongue. It is often detected in young children just learning to speak, but it can sometimes be missed and carry on into adulthood as well. For some patients, the tongue cannot move normally and cannot even touch the roof of their mouth. The reason for the problem is due to restrictive muscle attachments.

There can be an attachment from the tip of the tongue to the floor of the mouth. Sometimes these muscle attachments can also connect from the lips to the gums that can restrict lip movements. Certain words, for example, “thirsty” or “thoughtful “cannot be pronounced properly. There may even be a lisp. In everyday terms, these conditions are referred to as “tongue-tie”. 

Fortunately, modern dentistry has a permanent remedy for this issue. The dentist can solve the problem by performing a minor surgical procedure to release these attachments that could also be done with a laser. The muscle attachment is partially or totally cut to allow free movement of the tongue. Speech will become much clearer and the words well-articulated. 

The procedure itself is carried out under local anesthetic and typically only takes a few minutes. The healing process after the procedure is also very rapid and provides instant relief to the patient’s symptoms. 

If you’re having concerns with your speech and suspect that you might be having a tongue-tie, make an appointment with the expert team at Acharya Dental to diagnose and resolve your problem today!

The post Tongue Tie: Overview, Treatment and Procedure appeared first on Acharya Dental.

What the Team from overseas could not imagine was the sheer numbers -1500 registered delegates to make the Meet one of its kind.

The overwhelmed Speakers were seen taking a panoramic selfie of their audience to “show the folks back home”. The ITI is a global association of professionals in Implant Dentistry. The ITI’s mission statement is to “serve the dental profession by providing a growing global network for lifelong learning in Implant dentistry through comprehensive quality education and innovative research to the benefit of the patient”.

The ITI Symposium was held in Mumbai at the expansive Hotel Sahara on the 5th October 2019. In an unique move, the far thinking visionary and president of the Indian Dental Association, Dr. Janak Raj Sabharwal along with Dr. Ashok Dhoble bridged the gap to bring on to the Indian stage a galaxy of luminaries renowned in the world of Dental Implants. The Speakers were spearheading the research and concepts in the practice of Implantology. Their Implant Division, Straumann, was just making their entry into the crowded dental Implant Market hopeful of breaking ground and positioning their product in the premium niche. Their USP ? Backed by sound research and unique design with a majority of the world share, Straumann is confident of success in their Indian venture.

The statistics speak for theirself. The realty that was clear was, indeed, Indians needed dental implants, trailing behind the US, China, Korea and many smaller countries in the uptake of dental implants. 

The ITI brings home a message. Learning and education are two different things. Learning is how to do it versus get educated on the logic or reasoning for why we do it. The subjects of the Symposium with Speakers such as Dr. Stephen Chen, Dr. Daniel Buser, Dr. Daniel Thoma and Dr. Christoph Hammerle were rich with new information laced with age old wisdom and many home truths.

All our patients want it done faster, easier and cheaper, but this may not always be possible. While Implant designs are being modified for immediate loading, experience and literature show us that all cases cannot be speeded up. A staged approach or delayed one, immediate loading – all these are choices that have to be weighed carefully by the educated and enlightened Implantologist on behalf of his patient for his good.

The Indian Dental Association lends its ‘desi’ flavor with all its spice and colour to make the event meaningful and fun. ‘Straumann” party was full of ‘Chaat Masala’!

And so it was that the guests from Switzerland who lent ‘cheese’ were given a taste of legendary Indian Hospitality. The Team from IDA that made it possible does indeed deserve a standing ovation. Thank you, Organizing Committee for a sterling meet and memorable event!

– Dr. Vijailakshmi Acharya

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The “art” is to choose wisely and master the one procedure that precedes clinical dentistry which could make or break your practice.

How do patients judge the skills of their dentist? What gives them confidence? 

Their experience, how they feel and most often from the way they get an injection.

Equally, studies have shown that when a painful response to an injection is elicited, the dentist undergoes a great deal of stress. We have seen some of us break into a sweat!

What we need to know:

1. Current products
2. The physiology of pain
3. Patient’s fears
4. Proper selection and proven technique

80% of patients have a dread of the needle. It is advisable to avoid making them wait for a long time before the procedure as this will only increase their anxiety. Prior to starting, a review of history and current medication could prove useful. It is necessary to use a topical anaesthetic before injection. These are available in gel, liquid, ointment or pressurized forms. The most common ones are those containing benzocaine or lidocaine. 

Gels are used for effective pain relief and to alleviate pain at the point of injection of the local anaesthetic.

To apply the topical:  

Retract the tissue, identify the area and wipe dry with gauze to remove saliva. Carry the gel on a cotton bud and rub for 30- 60 seconds. Inject local anaesthetic within 2 minutes, all the time keeping the tissue away from the site and then wash off the gel.

The needle should ideally be a triple bevel design for minimal tear to the tissue. The scalpel bevel is also a good choice.

Injecting Information:

1. Inject in a straight line
2. Do not bend the needle as there is a risk of breakage.
3. Smaller gauges break easily.

          25-27 gauge needles are ideal for infiltrations or nerve blocks.

4. Do not bury the needle to the hub.

      5. Inject slowly, with good control. The rapid injection causes ballooning and stretching of the tissue, causing pain.

6. Pay attention to the direction of the needle. For example, an infiltration for the upper anterior teeth could end up with a swollen lip or a numb nose. A misdirected mandibular block can also benumb the ear lobes. 

During the procedure use ‘The Gate Control’ theory to distract the patient.

The Gate Control theory asserts that a non- painful input (pressure/vibration) closes the nerve gates to a painful input (needle prick) which prevents the pain sensation from travelling to the central nervous system.

Tapping the shoulder or stretching the cheek or jiggling lip tissue are methods commonly used.

For palatal injections, topical anaesthesia does not work so well due to thick, immovable tissue. Always infiltrate on the buccal side first and then move to the palatal.  A sliver of ice can be applied to briefly numb the area, or the back end of a mouth mirror could be used to compress the mucosa and the needle inserted alongside the instrument slowly.

When dealing with an infected site:

1. Ideally, wait for the active infection and accompanying swelling and pain to subside with covering antibiotics and then perform the procedure. 
2. Try infiltrating directly into the periodontal ligament, intraosseously and around the crest surrounding a periodontally compromised mobile tooth needing extraction.
3. Select a more protein-bound anaesthetic with a less acidic pKa value (this value indicates the strength of the acid). Articaine, with a pKa value of 7.8 can work effectively.
4. The STA Wand or any computerised local anaesthesia injection system is worth considering, as it provides visual and audio feedback. It can effectively anaesthetise a section or a single tooth with minimal discomfort using an intraligamentary technique.

When you fail to achieve anaesthesia and are forced to abandon the procedure and reschedule:

1. Consider the anatomy carefully at the site of needle penetration. 
2. Ensure patient is adequately rested from the previous night.
3. Prescribe an anti-anxiolytic an hour before the procedure. 
4. A calm and reassuring manner by the dentist will help the patient relax.
5. Treat the patient under conscious sedation.

In the final analysis, the successful administration of a painless and effective injection is a mixture of the approach, confidence and in-depth knowledge of the drug by the operator. This is a unique skill that can be fine-tuned by the experience gained from every injection given in the course of practice. 

The signal sent to your patient is unmistakable. You are in control, there will be no pain, and it will work!

    -Dr. Vijailakshmi Acharya

The post Painless Local Anaesthesia Technique – A Practice Builder appeared first on Acharya Dental.

Taking care of your teeth is simple until suddenly you have constant sneezing or a blocked nose. Coughing, wheezing or sniffing- all these make oral hygiene very difficult.

Here are some quick care tips during a cold or flu bout:
1. Hydrate yourself – drink plenty of water.
2. Watch your sugar intake. Use sugar-free cough drops.
3. Use a mouthwash to reduce bacteria in the mouth and to feel fresh.
4. Brush and floss your teeth even if you don’t feel like.
5. Change your toothbrush once the cold is gone because it may harbor harmful bacteria.

The post Your mouth when you have a cold appeared first on Acharya Dental.

To start with, select a toothbrush head size that easily fits into your mouth and can brush 1-2 teeth at a time. Any toothbrush you choose should have soft but firm bristles. Hard bristles may cause gum tissue to recede causing sensitivity and discomfort.

Powered electrical brushes are becoming popular. Research shows that they are not superior in action to manual brushing. However, you may be motivated to clean your teeth more often and for the required length of time. For people with uneven teeth or those that need assistance due to limited mobility of their fingers, powered toothbrushes are most useful. At the end of the day, it is your choice. Choose whatever gives you a better result.

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The complex world of dentistry today, whether private, corporate or institutional, poses a challenge to the budding dentist as well as to the seasoned one. The climate has changed and so has the way we need to practice our profession.

Famdent is undoubtedly the most widely read and appreciated dental journal that reaches out across the country to educate and bring together dentists in the pursuit of one simple goal – a better quality of service to patients and better opportunity for dentists via education and sharing of information.

It is through these pages I want to reach out to the profession with snippets of information of value to you. I have, in my decades of practice, found some solutions to the great many questions out there. Some, I have learned the hard way, others the patients themselves have shown me. This page will be a random mix of this evolved experience which I hope will make for some interesting reading.

There are several aspects that we deal with every day. The set-up, the reception, the assisting staff, the team and the equipment. Add to that our speaking skills, our clinical skills, lab support, hygiene standards and maintenance. And to top it all the overwhelming presence of the Internet ruling our lives.

Where do we begin? At the dental chair, of course! Chairs are getting more and more expensive with technological advances and are inevitably costlier. Therefore, you will see chairs ranging from a lakh of rupees to twenty lakhs!

Where do we draw the line? Is it only a matter of budget?

What do we really want from a chair?

I am sure you will agree that ‘trouble-free’ will be the first word and ‘convenience’ the second. Most chairs today fall broadly into hydraulic or electrical types. While both work well, the hydraulic one may develop oil leaks and sometimes have a jerking movement as it goes into a selected position especially when descending. Many chairs boast of multiple chair positions. Ironically, we use just a few of them. We just end up paying for what we never use. It is like the fancy car with automatic everything. Do we need it?

Here is a list of what works practically in my clinic:

• A chair that is not bulky and cumbersome and rust proof
• The spittoon should be ceramic and the spittoon cover over the drain hole for which a spare is readily available
• The seat should not be moulded. If it is so, it will be impossible to re-upholster after some years. We change the chair upholstery every 3 years.
• A reservoir bottle for letting in controlled clean water into the unit, connected to an external compressor to provide high vacuum. Air Venturi systems are not powerful enough and are useful at best for a saliva ejector.
• The nurse’s side should have the high vacuum, the saliva ejector, the 3- way syringe and the light cure unit.
• The operators side should have the 3- way syringe as well.
• The ultrasonic scaler, two hi-torque hand-pieces and an air motor fixed with the contra-angle and straight hand-pieces is ideal.
• The faucet for rinsing should be easily accessible and managed by the patient and the nurse. Control from the operator’s side is not necessary.
• A shadow-less lamp is required that throws sufficient light and is easy to clean. Some newer LED lights cast a blue glow that is most disturbing.
• The foot control should be able to perform chair movements both from the console and the foot control. A push type of control is easier than a step on and press type.
• Operators stool and assistant stool is necessary to facilitate 4 handed dentistry.

Most chairs today are ergonomically designed with an adjustable head rest but none of them are comfortable and give very poor neck support. The patient ends up extending his neck which can be very tiring. I have solved the problem by making a small bolster that is tied around the headrest. A car seat neck pillow also serves very well. Try it…you should see the grateful relieved look on your patients face when you provide this support.

Once a patient sits on the chair it doesn’t matter what model it is. It matters to us, the dentist and the assistant. Choose wisely, not too cheap, not too expensive. Focus on sturdy, functional and efficient after sales service. We protect our chairs with a stitched piece of plastic at the foot end of the chair so that a patient can keep his footwear on and still not damage the chair. The headrest is covered with a shower cap to avoid oil and dye stains. Children are treated on a disposable chair cover that covers the chair entirely.

A maintenance regime includes wipe down of the chair, spittoon and tubing cleaning after every patient and at the end of the day.

A dental chair is a big investment. Let us choose wisely, maintain it well, and it will last for decades.

The post How To Choose The Best Dental Chair? appeared first on Acharya Dental.

These are a suspension of fine solid particles or liquid droplets in air or another gas. They may be natural such as fog or mist or anthropogenic which are particulate air pollutants.

In dentistry, aerosols are everywhere. They are produced from handpieces, three-way syringes and other high-speed instruments. An aerosol cloud of particulate matter and fluid is often clearly visible during dental procedures such as scaling, tooth preparation and polishing. It is important to realize that these aerosols are contaminated with bacteria and blood from the treatment site. These represent a potential source for disease transmission.

The smaller particles of an aerosol have the potential to penetrate and lodge in the lungs and are thought to carry the greatest potential for transmitting infections. Splatter is defined as particles larger than 50microns in diameter. These are airborne only briefly until they contact a surface or fall to the ground. It is the particles less than 50 microns that can stay airborne and enter respiratory passages. Saliva is contaminated with bacteria and viruses. Our focus on aerosols have been sharpened due to the pandemic.

During a procedure, we are covered by aerosol mist on the face, hands and clothes most of the time as well as on two thirds of the mask we wear.

We need to use effective respiratory protection to help combat against infectious diseases such as Influenza, Measles, Corona Virus and its variants to name a few.

The CDC guidelines of May 2021 that states that fully vaccinated people no longer need to wear a mask does not apply to our line of work in health care.

One virus is apparently receding while the Omicron is gaining ground as it is very infectious. All mutant forms are potentially capable of disrupting normal life in so many ways. It is necessary not to let our guard down. The same infection control methods need to be adhered to as well as ventilation in operatories, limiting and spacing patients and placement.

Masks continue to be our best defense. They are measured based on their performance matrix such as

1. Particle Filter Efficiency
2. Bacterial Filter Efficiency
3. Fluid Resistance
4. Breathability -The measure of the mask’s resistance to airflow.
5. Inflammability.

For dentists, Fluid Resistance is of the most importance.

The mask types that we are familiar with are as follows:

1. Face Mask: Used by the general public not meant for medical purposes.
2. Procedure Masks: These have loops instead of ties and are used in many practices.
3. Surgical Masks: These are loose-fitting masks that cover the nose and mouth to provide a physical barrier to particulate materials and fluids. They have ties to enable a tighter closer fit and are worn over surgical hair coverings. They are considered medical devices with a filtration rate of around 80%. They are designed to protect only in one direction that is, from inside out. These do not ensure a good hermetic seal and allow particles to enter around the edges.
4. Respirators: Also called FFRs (Face Filtering Respirators) are classified according to their filtering facepiece (FFP). These could be FFP1, FFP2, and FFP3 with a particle filtration capacity of .3 microns of 80%, 95%, and 99% respectively.

Respiratory masks provide protection in two directions. They can filter both incoming and outgoing air and are resistant to liquid spray or blood splatter. These masks allow adjustments to provide a hermetic seal on contact with the skin.

In conclusion we need to use medical grade N95 respirators without valves.

The use of N95 or FFP2 respirators is part of PPE for dental use during patient care. For a longer useful life for Respirators an outer surgical mask is added. Masks were there and in use by dentists long before the pandemic. They will continue to be there long after.

They are a way of life, a protection, and a true friend of the dentist indeed!

The post Watch Out For That Spray! appeared first on Acharya Dental.

The “art” is to choose wisely and master the one procedure that precedes clinical dentistry which could make or break your practice.

How do patients judge the skills of their dentist? What gives them confidence?

Their experience, how they feel and most often from the way they get an injection.

Equally, studies have shown that when a painful response to an injection is elicited, the dentist undergoes a great deal of stress. We have seen some of us break into a sweat!

What we need to know:

• Current products
• The physiology of pain
• Patient’s fears
• Proper selection and proven technique
• 80% of patients have a dread of the needle.

It is advisable to avoid making them wait for a long time before the procedure as this will only increase their anxiety. Prior to starting, a review of history and current medication could prove useful. It is necessary to use a topical anaesthetic before injection. These are available in gel, liquid, ointment or pressurized forms. The most common ones are those containing benzocaine or lidocaine.
Gels are used for effective pain relief and to alleviate pain at the point of injection of the local anaesthetic.

To apply the topical:

Retract the tissue, identify the area and wipe dry with gauze to remove saliva. Carry the gel on a cotton bud and rub for 30- 60 seconds. Inject local anaesthetic within 2 minutes, all the time keeping the tissue away from the site and then wash off the gel.

The needle should ideally be a triple bevel design for minimal tear to the tissue. The scalpel bevel is also a good choice.

Injecting Information:

1. Inject in a straight line
2. Do not bend the needle as there is a risk of breakage.
3. Smaller gauges break easily. 25-27 gauge needles are ideal for infiltrations or nerve blocks.
4. Do not bury the needle to the hub.
5. Inject slowly, with good control. The rapid injection causes ballooning and stretching of the tissue, causing pain.
6. Pay attention to the direction of the needle. For example, an infiltration for the upper anterior teeth could end up with a swollen lip or a numb nose. A misdirected mandibular block can also benumb the ear lobes.

During the procedure use ‘The Gate Control’ theory to distract the patient.

The Gate Control theory asserts that a non- painful input (pressure/vibration) closes the nerve gates to a painful input (needle prick) which prevents the pain sensation from travelling to the central nervous system.

Tapping the shoulder or stretching the cheek or jiggling lip tissue are methods commonly used.

For palatal injections, topical anaesthesia does not work so well due to thick, immovable tissue. Always infiltrate on the buccal side first and then move to the palatal. A sliver of ice can be applied to briefly numb the area, or the back end of a mouth mirror could be used to compress the mucosa and the needle inserted alongside the instrument slowly.

When dealing with an infected site:

• Ideally, wait for the active infection and accompanying swelling and pain to subside with covering antibiotics and then perform the procedure.
• Try infiltrating directly into the periodontal ligament, intraosseously and around the crest surrounding a periodontally compromised mobile tooth needing extraction.
• Select a more protein-bound anaesthetic with a less acidic pKa value (this value indicates the strength of the acid). Articaine, with a pKa value of 7.8 can work effectively.
• The STA Wand or any computerised local anaesthesia injection system is worth considering, as it provides visual and audio feedback. It can effectively anaesthetise a section or a single tooth with minimal discomfort using an intraligamentary technique.

The post Painless Local Anaesthesia Technique – A Practice Builder appeared first on Acharya Dental.