DENTAL CAVITY

Dental caries

 Dental caries, also known as tooth decay or Dental cavity is a disease where bacterial processes change carbohydrate like sugar in food left on teeth to acid that demineralises hard tooth structure.
Two groups of bacteria are responsible for initiating caries: Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss and infection. Today, caries remains one of the most common diseases throughout the world. Cariology is the study of dental caries.

Cause

Dental caries is the multifactorial disease.

Listed here are 4 primary criteria required for caries development: the tooth surface (teeth enamel or dentin).There must be carious susceptible tooth structure like the tooth having heavy pits as well as fissures; caries-causing Bacteria such as streptococcus mutants; food particles, fermentable carbohydrates (such as sucrose); as well as time. In  the event that each one of these elements can be found then the teeth will get carious. The microorganisms may ferment the meals contaminants and produce acid. This particular acid will cause the actual dissolution and also the damage to the teeth surface leading to caries. These microorganisms combined with the food particles along with other tissue additionally form the oral plaque buildup which sticks to the tooth surface causing other dental care issues such as gum diseases. It is also the actual causative factor for caries The actual caries process does not have an unavoidable end result, and different people will be susceptible to various levels depending on the shape of their own tooth, dental hygiene routines, and also the buffing capacity of the saliva. Dental caries can occur on any surface area of a tooth that is exposed to the oral cavity, although not the actual structures which are retained within the bone are affected. Just about all caries occurs from acid demineralisation which exceeds saliva and fluoride remineralisation, and just about all acid demineralisation occurs exactly where a meal (containing carb such as sugar) remains on teeth. Though most caught food is remaining in between tooth, more than 80% of cavities occur inside pits and fissures on chewing surfaces where brushing, fluoride, and saliva cannot reach to re mineralise tooth like on easy-to-reach surfaces that develop few cavities. Fissure sealants positioned in chewing surface , block food particles to becoming caught as well as stop the actual caries process. Extracted teeth - where sealants were forced within pits and fissures under eating pressure and then the teeth dissolved in acid-- eaves the actual sealant as an impact associated with how deep food is pressured below eating stress as well as signifies the opportunity of better tooth brush style to force fluoride tooth paste within pits as well as fissures prior to cleaning to remineralise demineralised teeth like on easy to reach areas exactly where few cavities happen.

Sign & symptoms
An individual experiencing caries may not be aware about the condition. The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, suggesting an area of demineralization of tooth enamel. This is referred to as incipient decay.Since the lesion continues to demineralize, it can change brown but will ultimately turn into a "cavity". Before the cavity forms, the process is reversible, but when the cavity forms,the lost tooth structure can not be regenerated.Any lesion that looks brown and also shiny indicates dental caries were once present however that demineralization process has ceased, leaving the stain. The brown spot that is dull in appearance is possibly a sign of active caries.Since the enamel and dentin are destroyed the cavity gets to be more noticeable.The actual affected regions of the tooth alter colour and become soft to touch. When the decay travels through enamel, the dentinal tubules,which have passages to the nerve associated with the tooth,turn out to be exposed and results in pain in the tooth. The pain may worsen with exposure to heat, cold, or even sweet foods and drinks.

Treatment

For the quite small lesions, topical fluoride is usually preferred. For larger lesions, a dental hand piece ("drill") is used to clear away large portions of decayed material from the tooth. A spoon excavator, a dental instrument can be used to remove decay properly and after that filled with a restorative material. Restorative materials include dental amalgam, composite resin, GIC.Now a day’s use of amalgam is definitely reduced because of its colour. Both composite and GIC are tooth coloured restorative material. When the decay is too extensive, there might not adequate tooth structure remaining to allow any restorative material for being placed with in the tooth, then a crown also referred to as cap is used. In some cases, when caries have reached pulp, endodontic treatment may be necessary for the restoration of a tooth. Endodontic therapy, also called as  "root canal". In some cases extraction is recommended if the tooth is far destroyed from the decay process to effectively restoration the tooth.

Prevention

Oral hygiene

1. Personal hygiene care consists of proper brushing and flossing daily. The objective of oral cleanliness is to minimize any etiologic agent associated with disease inside the mouth. The main focus of brushing and flossing is to remove and prevent the formation of plaque. Plaque consists of bacteria. As the quantity of bacterial plaque increases, the tooth is more vulnerable to dental caries when carbohydrate in the food is left on teeth after every meal or snack. A toothbrush enables you to remove plaque on accessible areas, but not between teeth or inside of pits and fissures on chewing surfaces. When used properly, dental floss removes plaque from locations which might otherwise develop proximal caries. Additional adjunct hygiene aids include interdental brushes, water picks, and also mouthwashes.
2. Nibbling Dietary fibres like celery after eating forces saliva inside the trapped food to dilute any kind of carbohydrates such as sugar-neutralise acid and re mineralise demineralize tooth( the teeth which are at higher risk are 1st & 2nd molars). Rinsing the mouth with water after eating anything greatly reduces the risk of caries.
3. Professional hygiene care includes- regular dental examination and cleanings (oral prophylaxis). Occasionally, complete plaque removal becomes tough, and a dentist may be needed. Together with maintenance of oral hygiene sometimes radio graphs may be needed, for identification of dental caries at risk site

Dietary modification

Frequency of sugar consumption is much more significant than the actual amount of sugar eaten. In the presence of sugar and other carbohydrates, bacteria in the mouth generate acids which can demineralize teeth enamel, dentin, as well as cementum. The more frequently teeth are exposed to this particular environment, the much more likely dental caries are to occur. Therefore, reducing snacking is recommended, since snacking creates a continuous supply of nutrition for acid-creating bacteria within the mouth. Furthermore, chewy as well as sticky foods (such as dried fruit or candies, cookies, chocolates)tend to adhere  to teeth longer, and there fore, best eaten as part of a meal or simply prior to meals. Brushing the teeth after meals is actually suggested. For children limiting the frequency of consumption  of drinks with sugar, and not giving baby bottles to infants during sleep is advised. Mothers are also recommended to avoid sharing utensils as well as cups with their babies to prevent transferring germs from the mother's mouth.
It has been discovered that milk and certain kinds of cheese such as Cheddar can help counter tooth decay if consumed soon after the consumption of meals potentially harmful to teeth. chewing gum containing xylitol (a sugar alcohol) is widely used to protect teeth. Xylitol's effect on decreasing plaque is probably because of bacteria's inability to utilize it like other sugars.Chewing and stimulation of flavour receptors on the tongue are also known to increase the production and release of saliva, which contains natural buffers to prevent the lowering of pH in the mouth to the point exactly where enamel may become demineralised.

Other Preventive measures

Dental caries

1. The use of dental sealants is a means of prevention of dental caries . A sealant is a thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents food being trapped inside pits and fissures in grooves.Sealants are usually applied on the teeth of children, shortly after the molars erupt.
2. Calcium found in food such as milk and green vegetables, are often recommended to protect against dental caries. It has been demonstrated that calcium and fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel. The incorporated calcium makes enamel more resistant to demineralization and, thus, resistant to decay.
3. Application of Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions as part of routine visits.
4. Furthermore, recent research shows that low intensity laser radiation of argon ion lasers may prevent the susceptibility for enamel caries and white spot lesions.
5. There is currently research to find a vaccine for dental caries.

Oral Health Problems in Children/pediatric dentistry

Oral health problem in children/pediatric dentistry

There are a number of problems that affect the oral health of children which includes tooth decay, thumb sucking, tongue thrusting, lip sucking, and early tooth loss. Even though milk teeth or baby’s  teeth are replaced with permanent teeth then also keeping baby teeth healthy is important for child's overall health and well-being.Pediatric dentistry/children dentistry

Baby bottle tooth decay
Children Dentistry

Baby bottle tooth decay

Baby bottle tooth decay also called early childhood caries, nursing caries  and nursing bottle syndrome occurs when a baby's is between 18 months and 3 years of age and baby’s teeth are in frequent contact with sugars from liquid carbohydrates, such as fruit juices, milk, formula, fruit juice diluted with water, sugar water or any other sweet drink. Human breast milk can cause tooth decay as well. As these liquids break down in the mouth into simple sugars and are allowed to sit in the mouth, bacteria start feeding on the sugars, causing tooth decay. If this left untreated decayed teeth can cause pain and make it difficult for child to  chew and eat. Baby’s teeth also serve as "space maintainers or saver" for adult teeth. If baby teeth are damaged or destroyed, they can't help guide permanent teeth into their proper position, possibly resulting in crowded or crooked permanent teeth. Badly decayed baby teeth could lead to an abscessed tooth, with the possibility of infection spreading elsewhere. The upper front teeth are most vulnerable to damage from nursing bottle mouth.Pediatric dentistry/children dentistry

Prevention & treatment  of baby bottle tooth decay

Baby left with bottle in mouth during sleep
children dentistry

• At any time, don't dip your baby's pacifier in sugar, honey, or any sugary liquid.
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•  At bedtime, don't put your baby to bed with a bottle filled with sugary liquids watered-down fruit juice or milk. Give plain water.
•   Don't allow your baby to nurse continuously throughout the night while sleeping, since human breast milk can cause decay. Use a pacifier or give a bottle filled with plain water instead.
• Don't add sugar to your child's food
•    Use a wet cloth or gauze to wipe your child's teeth and gums after each feeding. This helps remove any bacteria-forming plaque and excess sugar that have built up on the teeth and gums.
• Teach your baby to drink from a cup by his or her first birthday. Moving to a "sippy cup" reduces the teeth's exposure to sugars

How to clean baby's mouth

Thumb sucking/Pediatric dentistry/children dentistry

Thumb sucking is the placement of thumb or one or more fingers in varying depths in the mouth. Generally, it's normal and healthy for infants to suck their thumbs, fingers, pacifiers or toys. Object sucking gives children a sense of emotional security and comfort. However, if thumb sucking continues beyond the age of 5 ,when the permanent teeth begin to erupt, dental problems may occur. Depending on the frequency, intensity, and duration of the sucking, the teeth can be pushed out of alignment, causing them to protrude and create an overbite. The child may also have difficulty with the correct pronunciation of words. In addition, the upper and lower jaws can become misaligned and the roof of the mouth might become malformed.

Thumb sucking
children dentistry

How to stop child thumb sucking

• First of all you should keep in mind that thumb sucking is normal and should not be a concern of parents unless the habit continues as the permanent teeth begin to emerge. It is usually said that children lacking parental care, love and affection resort to this habit. Thus the parents should be counselled to provide the child with adequate love and affection.
• The child must make the decision on their own to stop sucking their thumb or fingers before the habit will cease. To help toward this goal, parents and family members can offer encouragement and positive reinforcement. Thumb sucking is a security mechanism act such as scolding, nagging, or punishments are generally ineffective. This makes children defensive and driving them back to the habit. Instead, give praise or rewards for time successfully avoiding the habit. Gradually increase the time needed without sucking to achieve the reward. The younger the child, the more frequent the rewards will need to be given.
•  For children who want to stop, cover the finger or thumb with a band-aid as a reminder. Take the thumb or finger out of the mouth after the child falls asleep.some bitter chemicals can also be used such as pepper ,quinine and asafoetida.
• Dunlop put forward a theory called beta hypothesis that states that the best way to break a habit is by its conscious, purposeful repetition. Dunlop suggested that the child should be asked to sit in front of a large mirror and asked to suck his thumb observing himself as he indulges in the habit. The procedure is very effective if the child is asked to do the same at a time when he is involved in an enjoyable activity
• To help older children break the habit, parents should try to determine why their child is doing it -- find out what stresses your child faces and try to correct the situation. Once the problem is gone, the child often finds it is easier to give up sucking. If this doesn't work, you should contact pediatric dentist(children dentist) who will give dental appliances to the child to wear in the mouth to prevent sucking. These appliances can be removable as well as fixed and  are cemented to the upper teeth, sit on the roof of the mouth and make thumb sucking harder and therefore less pleasurable.

Tongue thrusting-pediatric dentistry/children dentistry

Tongue thrust is a condition in which the tongue makes contact with any teeth anterior to the molars during swallowing. Just like thumb sucking, tongue thrusting exerts pressure against the front teeth, pushing them out of alignment, which causes them to protrude, creating an overbite and possibly interfering with proper speech development.

Causes

• Retained infantile swallow.
• Upper respiratory tract infection.
•  Neurological disturbance
•   Macroglossia
•   Retrogonatic mandible
•   As associated with thumb sucking
•   Improper feeding habits

Treatment

• Various muscle exercise of the tongue. Ask the patient to count 60-69
• Yawing
•  Whistling
• Lip exercise
• Trainers-the child is taught correct method of swallowing
•  Habit breakers given by dentist(pediatric dentist,children dentist) such as removable cribs or rakes, oral screen

Mouth Breathing

Mouth breathing can be because of complete or partial obstruction of nasal passage

•  Deviated nasal septum.
• Nasal polyp.
• Obstructive adenoids.
• chronic inflammation of nasal mucosa. 
• Allergic reaction of nasal mucosa
•  Localised benign tumors
• Mouth breathing can also be habitual
• Mouth breating is also common in child whose lip morphology does not permit complete closure of the mouth.

Treatment

•   Removal of nasal obstruction-consult ENT
• Deep breathing exercise
•   Oral screen

Lip sucking/pediatric dentistry/children dentistry

Lip sucking involves repeatedly holding the lower lip beneath the upper front teeth. Sucking of the lower lip may occur by itself or in combination with thumb sucking. This practice results in an overbite and the same kinds of problems as discussed with thumb sucking and tongue thrusting. Stopping the habit involves the same steps as described for stopping thumb sucking.

Early tooth loss/pediatric dentistry/children dentistry

Premature loss of a child's primary teeth typically occurs due to tooth decay, injury, or lack of jaw space.If teeth are lost before the permanent teeth emerge, the nearby teeth can tip or shift into the space now unoccupied. When a permanent tooth tries to emerge into its space, there may not be enough room. The new tooth may emerge tilted. Crooked or misaligned teeth can cause a range of problems from interfering with proper chewing to causing temporomandibular joint problems.If your child loses a tooth prematurely, your dentist(pediatric dentist, children dentist) may recommend a space maintainer. A space maintainer is a plastic or metal device that holds open the space left by the missing tooth. Your dentist(pediatric dentist,children dentist) will remove the device once the permanent teeth begin to erupt.Pediatric dentistry/children dentistry

                                                                                       

Care for a Child's Teeth/pediatric dentistry

children dentistry

When to Start Caring for Your Baby's Teeth               

It's a good idea to get in the habit of cleaning your baby's gums even before teeth emerge.

To clean your baby's mouth:Lay your baby in your lap with his head close to your chest.Gently, but firmly, rub a clean and damp piece of gauze or soft cloth along both the upper and lower gum pads.Clean the gums at least two times a day.Even better clean  baby's gums after every feeding.

What Is Teething?

Teething refers to the time when baby teeth appear. Generally, teething first occurs between 6 months to 24 months of age. While this process is uneventful in some children; for others, it causes quite a bit of discomfort and irritability.

teething ring
/children dentistry

Symptoms of Teething

• Placing objects or fingers in the mouth and biting down on them
• Increased irritability
• Increased saliva or drooling
• Loss of appetite or becoming choosy about foods
• Tender and swollen gums
• Rash on cheeks or redness in the area of the cheeks near the affected gums
• Restlessness
• Ear pulling, which may be a sign of teething or possibly an ear infection (make an appointment to have your child seen by your doctor or pediatrician)
• Teething does not result in fever, vomiting, or diarrhea. If your child experiences these problems, contact your doctor.

Teething Pain:Massage your child's gums with a clean finger or the back of a small cold spoon.Allow your child to bite down teething ring.Try an over-the-counter teething ointment to numb the gums. Ask your dentist or doctor for some product recommendations.

When to  start brushing baby's teeth?

It's a good idea to start cleaning y baby's teeth twice a day as soon as you see a tooth emerging. If you start early, your baby will get used to having his teeth cleaned, and hopefully you'll avoid problems later on.It's best to carry on brushing your child's teeth for him until he's at least seven. By that age, he should be able to do it properly for himself.

cleaning baby's gum with wet muslin or gauze
/children dentistry

Tooth brush for baby:At first, you may find it easier to clean your baby's teeth using a piece of clean gauze or muslin. Wrap it around your finger, put a tiny smear of toothpaste on it, and rub around your baby's teeth.later on   when the baby is 1 1/2 to 2 years old, purchase a child-size toothbrush.pick soft, round-ended bristles of differing lengths, and a small, angled head tooth brush. This will allow you to reach all parts of baby's mouth easily and comfortably. Look at the packaging to see what age range the brush is designed for.At least once a day  preferably before bedtime you should brush your child's teeth. Several other times during the day preferably after meals -let your child try to brush her own teeth; this will consist mainly of her chewing on the toothbrush. At this age, make no attempt to try to teach your child toothbrushing techniques. It is more important to establish a pattern of dental care, and even chewing on a toothbrush helps clean the teeth.Replace your baby's toothbrush after three months, or sooner if the bristles have started to spread out

 Tooth paste for a baby:Fluroride is the active ingredient in toothpaste which helps prevent tooth decay. Too much of it, though, can be harmful. When choosing a toothpaste, check the packaging for fluoride levels:

Under-threes should use a lower-fluoride toothpaste. This is one containing about 1000ppm (parts per million) of fluoride.

Brushinh
/children dentistry

Over-threes can use an ordinary toothpaste, provided it contains no more than between 1350ppm and 1500ppm of fluoride.

Use a pea-sized dab of an ADA-accepted fluoride toothpaste. Take care your child don’t swallow it.

Use the recommended small amounts and encourage spitting out as your baby grows. If you follow these guidelines, lower fluoride and ordinary toothpastes are safe to use even in areas where fluoride has been added to the water.

 Brushing Techniques for Child:

You may want to supervise your children until they get the hang of these simple steps:

• Use a pea-sized dab of an ADA-accepted fluoride toothpaste. Take care that your child does not swallow the toothpaste.
• Using a soft-bristled toothbrush, brush the inside surface of each tooth first, where plaque may accumulate most. Brush gently back and forth.
• Clean the outer surfaces of each tooth. Angle the brush along the outer gumline. Gently brush back and forth.
• Brush the chewing surface of each tooth. Gently brush back and forth.
• Use the tip of the brush to clean behind each front tooth, both top and bottom.
• you should also clean the tounge.

How to protect baby's teeth

Never give your baby a bottle of milk, juice, or a sweetened beverage when you put her to bed, and never put honey, syrup, or another sweetening agent on your baby's pacifier. These practices can cause severe destruction of your baby's teeth. Tooth decay, or nursing decay syndrome, can result from such practices. When your baby sucks on a bottle when she is awake, the liquid is rapidly diluted with saliva and swallowed. However, if your baby falls asleep while nursing and swallows less often, the bacteria normally present in her mouth have time to turn the sugars in these liquids into acids that attack the tooth enamel. Sweetening agents on a pacifier also permit the sugars to remain in the mouth too long. The teeth most severely damaged are the upper incisors, and it has been necessary to remove teeth destroyed by this type of decay in children as young as 18 months old.

children dentistry

Taking a Child to a Dentist

Your child may be initially afraid of the dentist, just as children usually fear strangers.You should begin taking your child to the dentist no later than by the age of two years.Usually all the primary teeth have erupted by the time your child is between two and three years of age. Most children three years of age or younger have no or few dental problems, and the first visit to the dentist can consist primarily of an examination and probably a cleaning.

Importance of baby's teeth/ pediatric dentistry

importance of baby's teeth

Importance of Baby teeth

Baby teeth are important because they allow an infant to eat a good diet.Without healthy, reasonably well-aligned teeth,  child may face difficulty in chewing and may not be able to eat a well-balanced diet. If child's mouth is sore because of cavities, loose teeth, or sore gums, she may refuse to eat or may accept only those foods or liquids she can consume without more pain. Child needs  variety of foods for a balanced diet, and chewing foods of different textures stimulates and exercises the gums and provides a cleansing action for the teeth.The first stage of digestion of some foods takes place in the mouth itself and chewing helps break up of foods to more easily digested sizes. If  child swallows too rapidly and without chewing food properly, child may prolong the digestion process.

Baby's teeth are a vital aid to speech. Without healthy, well-aligned teeth, baby may have difficulty forming words and speaking clearly. 

Like muscles in other parts of the body, baby's face and jaw muscles need exercise to help them develop.without well-developed jaw muscles, baby's jawbones may not develop properly. Sucking provides exercise for your baby's jaw, cheek, and tongue muscles. When your baby is old enough for solid foods, chewing also exercises these muscles. This exercise is necessary for these structures to develop enough for baby's teeth to come in properly.

Baby,s teeth also aid in the normal development of the jaw bones and facial muscles.

Baby’s teeth add to an attractive appearance. Baby's appearance is as important to you now as it will be to her later. Not everyone naturally has sparkling white teeth and a beautiful smile. Your baby may have inherited tendencies (for example, a tendency toward having  Occurrences during the fetal stages, such as a mother having a fever or taking certain medications, may also affect early tooth development. But you can help your child learn good oral hygiene habits early, which helps add to an attractive appearance.

Baby’s teeth reserve space for the permanent teeth and help guide them into position. child's primary teeth must last five or ten years or longer. As a permanent tooth reaches the stage of development when it is ready to erupt (emerge through the gum), the roots of the primary tooth will replace begin to resorb (break down and dissolve). Gradually, the permanent tooth pushes the primary tooth out and takes the place the primary tooth. If a primary tooth is lost too soon, the permanent tooth has no guide to follow. Also, the teeth next to a missing tooth may drift into the space left by the missing tooth. Because these teeth occupy the space meant for another tooth, their permanent replacements will come in in the wrong position. The dentist may provide your child with a space maintainer if a primary tooth is lost too soon. But it is preferable to take early preventive measures so your child can keep all of her primary teeth until they are ready to be shed.

Beneficial food for teeth

There are many foods items that may safeguard against cavities. Fluoride is definitely one of them ! Fluoride makes the surface of teeth more resistant to acids during the process of re mineralisation.we can get fluoride from two  sources either by drinking fluorided water of use of a fluoridated tooth paste. Our teeth is mainly made up of calcium and phosphorus.Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva consists of buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber might also help to increase the flow of saliva and a bolus of fibre can force saliva into trapped food inside pits and fissures on chewing surfaces where over 80% of cavities occurs . Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth

Some beneficial food for teeth are:

1. Green tea contains polyphenol antioxidant plant compounds that reduce plaque and help reduce cavities and gum disease. Tea may help reduce bad breath. Tooth enamel is strengthened because green tea contains fluoride which promotes healthy teeth.
2. Milk and yogurt are good for teeth because they contain low acidity, which means that wearing of teeth is less. They are also low in decay-inducing sugar. Milk is a good source of calcium, the main component of teeth and bones.
3. Cheese contains calcium and phosphate, which helps balance pH in the mouth,preserves (and rebuilds) tooth enamel, produces saliva, and kills bacteria that cause cavities and disease.
4. Fruits such as apples, strawberries and kiwis contain Vitamin C. This vitamin is considered the element that holds cells together. If this vitamin is neglected, gum cells can break down, making gums tender and susceptible to disease and bleeding from gums
5. Vegetables: Vitamin A, found in pumpkins, carrots, sweet potatoes and broccoli, is necessary for the formation of tooth enamel. Crunchy vegetables may also help clean gums.
   Onions contain antibacterial sulfur compounds. Tests show that onions kill various types of bacteria, especially when eaten raw.
6. Celery protects teeth by producing saliva which neutralizes acid that causes demineralisation and cavities. It also massages the teeth and gums.
7. Sesame seeds reduce plaque and help build tooth enamel. They are also very high in calcium.
8. Animal food: beef, chicken, turkey, and eggs contain phosphorus which, with calcium, is one of the two most vital minerals of teeth and bone.
9. Water cleans the mouth and produces saliva that deposits essential minerals into the teeth. It keeps teeth hydrated and washes away particles from the teeth.

post operative complication of teeth extraction

1. Infection: The dentists may opt to prescribe antibiotics pre- and/or post-operatively if they determine the patient to be at risk.
2. Prolonged bleeding:  Small amounts of blood mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually, however, bleeding will almost completely stop within eight hours of the surgery, with only minuscule amounts of blood mixed with saliva coming from the wound. A gauze compress will significantly reduce bleeding over a period of a few hours.if still bleeding persists septics can be used
3. Swelling:  this is the most common complication after tooth extraction.ice packs work very well for swelling after extractions
4. Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure—depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.
5. Nerve injury: This is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth  where the  nerve is  close to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent.
6. Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antral lavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the Canine fossa--a procedure referred to as "Caldwell luc".
7. Dry socket (Alveolar osteitis) is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It is commonly believed that it occurs because the blood clot within the healing tooth extraction site is disrupted. More likely,alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible (which explains why dry socket is usually not experienced in other parts of the jaws). Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically causes a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone — it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction.
8. Bone fragments Particularly when extraction of molars is involved, it is not uncommon for the bones which formerly supported the tooth to shift and in some cases to erupt through the gums, presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is distinguished from a similar phenomenon where broken fragments of bone or tooth left over from the extraction can also protrude through the gums. In the latter case, the fragments will usually work their way out on their own. In the former case, the protrusions can either be snipped off by the dentist, or eventually the exposed bone will erode away on its own.
9. Loss of a tooth: If an extracted tooth slips out of the forceps, it may be swallowed or inhaled. The patient may be aware of swallowing it, or they may cough, which suggests inhalation of the tooth. The patient must be referred to for a chest Xray in hospital if a tooth cannot be found. If it has been swallowed, no action is necessary as it usually passes through the alimentary canal without doing any harm. But if it has been inhaled, an urgent operation is necessary to recover it from the airway or lung before it causes serious complications such as pneumonia or a lung abcess.
10. Precipitation of systemic problems

DRY SOCKET

Dry socket it is also called alveolitis sicca dolorosa, alveolagia or postoperative osteitis.It is basically focal osteomyelitis in which blood clot has disintegrated or is lost.Dry socket is a temporary dental condition that sometimes occurs after extraction of a permanent tooth. The term alveolar refers to the alveolus, which is actually the part of the jawbone which surrounds the teeth, and osteitis means simply "bone inflammation".Dry socket occurs when the blood clot at the site of the tooth extraction is dislodged, exposing underlying bone and nerves and causing increasing pain. Dry socket is the most common complication following tooth extractions. When it occurs, dry socket usually strikes one to three days after a tooth extraction. The most common hallmark of dry socket is significant pain.

DRY SOCKET

Complications of Dry Socket

Complications as well as problems that dry socket may cause or be associated with consist of:

1. pain
2. Postponed healing after tooth extraction
3. Infection
4. grayish slough
5. foul odor
6. Unpleasant taste in your mouth

Causes of Dry Socket

Usually, a blood clot forms at the site of a tooth extraction. This blood clot serves as a protective coating over the underlying bone and nerve endings in the empty tooth socket. The clot provides the foundation for the growth of new tissue and bone. In some cases,either the clot doesn't form properly or is physically dislodged before complete healing. With the clot is dislodged, bone and nerves in the socket are exposed to air, fluids and food. This can cause intense pain, not only in the socket but also along the nerves radiating to the ear and eye on the same side of the face. The precise cause of dry socket is still not known. Some causes, including:

• Bacterial contamination of the socket
• Difficult or traumatic tooth extraction surgery
• Roots or bone fragments remaining in the wound after surgery

Dry socket occurs in about 3 to 5 percent of all tooth extractions. It's much more common after extraction of wisdom teeth and impacted wisdom teeth.

Signs & Symptoms of Dry Socket

1. Severe pain within a few days after  tooth extraction
2. Partial or total loss of the blood clot at the tooth extraction site, which may be noticed as an empty looking  socket.
3. Visible bone in the socket
4. Pain that radiates from the socket to  ear or eye on the same side of  face
5. Bad breath or a foul odour coming from  mouth
6. Unpleasant taste in mouth
7. Swollen lymph nodes around  jaw or neck

Diagnosis of Dry Socket

Severe pain following a tooth extraction is often enough for your dentist to suspect dry socket  dentists checks to see if any blood clot in the tooth socket and whether their is  exposed bone. You may also need to have X-rays taken of your mouth and teeth to rule out other conditions.

Treatments of Dry Socket

• Medicated dressings. This is the main way to treat dry socket. The socket is packed with medicated dressings.The active ingredients in these sedative dressings usually include substances like soluble aspirin, zinc oxide, eugenol, and oil of cloves. It is usually necessary to have this done for two or three consecutive days, although occasionally it can take longer.  The severity of your pain and other symptoms determines how often you need to return for dressing changes or other treatment.
• Flushing out the socket.  the socket is flushed out with betadine  to remove any food particles or other debris that has collected in the socket and that contributes to pain or infection.
• Pain medication. mostly analgesics are prescribed for pain control.
• Self-care. You may be instructed how to flush your socket at home to promote healing and eliminate debris.you are instructed to do  warm salt water rinses  into the socket for atleast 5-6 times in a day. You may need to continue to do this daily for three or four weeks.
• Once treatment is started, you may begin to feel some relief in just a few hours. Pain and other symptoms should continue to improve over the next few days. Complete healing typically goes smoothly and generally takes about 10 to 14 days.

Prevention of Dry Socket

What your dentist  may do

Your dentist or oral surgeon may discuss with you the following medications that may help prevent dry socket:

• Antibacterial mouthwashes or gels immediately before and after surgery
• Oral antibiotics, particularly for people with compromised immune systems
• Antiseptic solutions applied to the wound
• Medicated dressings applied after surgery
• Experiment by placing sulfanilamide
• Oxidase cellulose-inserted for haemostatic purpose, produces retardation of healing similar to that of combined sulfonamide.
• Sulfathiazole in 60% glycerine base reduces the frequency of occurance of dry socket.
• ureomycin-causes significant reduction in decomposition of blood clot. these is decreased incidence of postoperative pain & swelling after 1 week.
• Tetracycline hydrochloride- if tablet is placed in extraction socket, it helps in reduction of dry socket to 0.78 %.
• Trypsin-digest necrotic tissue & debris & restrains bacterial growth.

What you can do before surgery

You can take the following steps to help prevent dry socket:

• Seek a dentist or oral surgeon with experience in tooth extractions.
• If you take oral contraceptives, schedule your extraction, if possible, during days 23 to 28 of your menstrual cycle, when estrogen levels are lower.
• Stop smoking and the use of other tobacco products at least 24 hours before tooth extraction surgery. Consider talking to your doctor or dentist about a program to help you quit permanently.
• Talk to your dentist about any prescription or over-the-counter medications or supplements you're taking, as they may interfere with blood clotting.

What you can do after surgery

• You'll receive instructions about what to expect during the healing process after a tooth extraction and how to care for the wound. These instructions will likely address the following issues that can help prevent dry socket:
• Activity.For at least a week, avoid rigorous exercise and sports that might result in dislodging the blood clot in the socket.
• Beverages. Drink lots of water after the surgery. Don't drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don't drink with a straw for at least a week because the sucking action may dislodge the blood clot in the socket.
• Food. Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
• Cleaning your mouth. Don't brush your teeth, rinse your mouth, spit or use a mouthwash during the first 24 hours after the surgery. After that time, gently rinse your mouth with warm salt water every two hours while awake and after meals for a week after your surgery. After the first 24 hours, resume brushing your teeth, being particularly gentle near the surgical wound.
• Tobacco use. If you smoke, don't do so for at least 24 hours after surgery. If you chew tobacco, don't use it for at least a week. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications.