Fine Feather Dental Clinics

Contrary to the popular belief, the Indian subcontinent still lags behind the Western countries when considered in terms of awareness about the oral care of children. Very few people are aware about the speciality in dentistry concerned exclusively for the oral health care for children – Pediatric Dentistry. Just like the Pediatricians who are child specialist doctors, the Pedodontists are Child specialist dentists. The pedodontists acquire the knowledge of child psychology and the skills of treating a child after undergoing a 3 year post graduation course under the guidance of experts.

The incidence of dental caries (tooth decay) amongst children is on the rise due to multiple reasons such as change in the diet patterns as well as negligence towards the oral care and lack of awareness and motivation for the same. On the other hand, dental caries is definitely preventable. A number of preventive as well as treatment strategies are available in the modern times to deal with tooth decay.

Very few parents are aware of the fact that their child’s first dental visit should be no later than his/her first birthday. Unfortunately, most parents approach the dentist only when their child suffers from toothache. Even more disappointing is the wrong belief of majority of the mass that decay in deciduous teeth need not be treated as they are supposed to exfoliate (fall off) sooner or later. Deciduous teeth are very important to be preserved till the permanent teeth erupt. When the deciduous teeth decay or exfoliate earlier than usual, it may result in lack of space in future for eruption of permanent teeth which is to occupy its place. This may lead to malaligned teeth and subsequent need for straightening of teeth (orthodontic treatment). Moresoever, any child who has habits like thumb sucking (beyond a certain age), mouth breathing or tongue thrusting may develop proclined (forwardly placed) front teeth/malaligned teeth and require teeth straightening treatment later. This scenario can be corrected in the making by a pedodontist by intercepting the habit. A pediatric dentist also specializes in treatment of children with special health care needs such as visually impaired child, autistic child, child with speech or hearing impairment and even the mentally challenged child.

The basic reason for the need of a specialist for treating children is the child’s mental set up, that has a fear of unknown as its inherent part. Often the parents are also afraid of the dental visit and they unknowingly instill the same fear in their children. More often than not, dental procedures involve some discomfort on the part of the patient. But when undertaken in a well equipped set up by a well trained dentist, dental treatment can be totally pain free. On the same lines, a pedodontist is trained to modify and manage the behavior of the child to the better by communicating and informing the child about the procedures so that both the parent and the child may experience an easy and a comfortable dental visit. Very young children and those who cannot cooperate despite multiple efforts have the option of undergoing dental treatment under sleepy effects of medications or general anaesthesia.

• Reception area
• Infection control
• Radiation Safety
• Transparent and Ethical treatments

 Reception area

The first thing one should notice when he/she visits a dental clinic is whether the reception area is neat and clean or not. It should not have a cluttered look. The waiting area should give homely and plush feel so as to make one comfortable and allay his/her anxiety. This is important as it might indicate the level of cleanliness, hygiene and care one might experience later on.

Infection control

Infection control is very important when one visits any medical or dental clinic, as no one likes to take home others infections. This is all the more important as some of the communicable diseases like HIV or Hepatitis are life threatening. One should not let the dental surgeon touch him/her without a pair of gloves and a face mask. The instruments to be used should be sterilized i.e. they should be stored in a sterilized pouch & opened only in front of patient. The areas on the dental chair that are frequently touched in between the patients should have disposable barriers to prevent cross-contamination. The patient should observe and immediately comment if the dental surgeon touches the contaminated surfaces & then again without changing gloves, touches the patient. The assistant helping beside the chair should also be wearing gloves & face mask.

Radiation safety

The patient should inquire whether the x-rays are being taken with an A.C X-ray machine or D.C. X-ray machine. This is important as A.C. X-ray machines generate low intensity X-rays requiring more exposure and also the secondary radiation by such low intensity  X-rays can get accumulated in the body and cause harm. The patient should also inquire whether the clinic is using digital X-rays or conventional X-rays, since digital X-rays reduce the exposure time by about 90% causing less harm to the patient.

Transparency in cost and ethical treatments

The patient should demand a written/printed treatment plan with charges up-front, so that he/she is aware about the total cost to be incurred by him/her. The patient should also be shown the x-rays & images of the problem on the screen.

The patient should be explained the treatment plan in detail with all possible complications if any. The patient should ask for videos/images of similar cases to assess whether he/she is being given a realistic post-treatment outcome.

The most important element one should look for is the trust that the doctor generates. Transparent charges and ethical treatment is what is difficult to get. These are some of the few consideration kept in mind while a visiting a clinic or hospital.

Wisdom teeth are the last teeth to erupt in the oral cavity usually when the individual is in his/her teens i.e. between 18-24 years. However, depending on the space available and the position of the teeth they might erupt only partially or stay un-erupted and embedded in the bone. This in the dental terminology is called as Impaction of wisdom tooth.

The impacted wisdom tooth/teeth might cause many problems like infection, pain of head and neck, foodlodgement & cavity of impacted tooth or preceding tooth & so-on. Therefore they have to be removed by a surgical procedure called Dis-impaction.

However, there are many potential complications and risks. One such complication is paraesthesia. It refers to a situation where post-operatively there is temporary or permanent numbness of the lip/tongue due to damage to the nerve during removal procedure. This is especially seen in cases where the impacted teeth is in very close proximity to the mandibular nerve or lingual nerve.

One such patient aged 42 years visited Fine Feather dental clinic at Nehrunagar centre, with a chief complain of persistent pain in lower left back teeth. An OPG x-ray revealed a partially erupted wisdom tooth, the roots of which were completely encircling the mandibular nerve, as was observed by subsequent CT-scan investigation.

The patient was advised removal under general anaesthesia by an oral surgeon with a very high risk of potential complication of paraesthesia. The risk was very high due to the location as well as the age of the patient, since the paraesthesia in this age group is normally permanent in nature. The patient was thus reluctant to carry out the treatment and came to Fine Feather Dental Clinic for second opinion. The team at Fine Feather comprising of Dr. Keval Shah, Dr. Anish Tiwari and D.r Partho Mukherji discussed the case and thrashed out an alternative treatment plan for the same. Dr Anish felt that Coronectomy whereby the crown is removed  and the roots/root are/is left submerged might be the solution.

Based on this an inter-disciplinary treatment plan was decided. The crown that was causing the problem would be removed surgically and the roots which had the potential to cause complication during/after removal would be left in situ after carrying outpulpectomy.

At Fine Feather, the pulpectomy was performed by Root Canal specialist Dr Partho Mukherjee & the coronectomy followed by sutures was done by Dr Anish Tiwari. Care was taken to see that the roots were completely embedded 2 mm. beneath the bone by the flap. The patient was recalled after six weeks and an X-ray was taken. There was complete cessation of pain and the X-ray also showed signs of healing. The patient has been advised regular recall visits every six weeks to monitor the condition and rule out any pathology.

Dr Keval Shah feels that such conservative approach like, “intentional coronectomy with pulpectomy” may be a good treatment alternative for this kind of high risk patients as regards  potential complications like permanent Paraesthesia, provided the roots that are left in situ do not undergo any pathologic changes like transformation into cyst/tumour later on. Another advantage to the patient is that the procedure can be done under local anaesthesia thus obviating the need for General Anaesthesia and its potential complications and cost escalation.