In general practice the dentist will normally examine you radiographically with 2 bitewing radiographs. These images will show most of the posterior teeth crowns and the bone levels. These images are great for detecting caries and or bone levels.

Some dentists will routinely carry out panorama radiography called panorals, that shows both upper and lower jaws, including the wisdom teeth; but the detail is not good enough to detect caries.

Because of the extra radiation most dentists do not take panoral radiographs as a screening tool.

If one needs more detail about a specific area or 1-3 teeth then a deeper peri-apical radiograph is taken.

All radiographs must be justified to provide a benefit to the patient. The radiograph must serve a useful purpose in aiding diagnosis.

All radiographs by law must be recorded in the notes as justified, graded for quality and also reported on.

It would make no sense for a dentist to take a radiograph and then not look at it. Sadly this happens a few times in general practice.

The dentist may have asked for radiographs to be taken but then forgets to look at them.

In this interesting case a patient attended in pain with the LR6 molar. He had pain under the tooth for a week.

We did a careful examination of the face, neck, soft tissues and the teeth on the left side.

We noted that the LL6 was slightly raised, mobile and tender to the touch.

A per-apical radiograph was requested of the LR6 LR7 region.

The radiograph would be graded 2 in quality because we do not have the whole crowns in view. It may just be that the teeth are very big in any case.

It was noted that the LR6 was heavily filled with a deep filling that may have encroached onto the nerve. At the apex there is some bone loss. This would indicate a non-vital tooth.

The LR7 however seems to have a dark area associated behind it. Now many dentists would not have seen the area, as they are so busy concentrating on the LR6.

So we took another peri-apical further behind to see what that radiolucency was.

The scene becomes much clearer now as we can see an unerupted LR8 or wisdom tooth, lying on its side. There is a large dark coloured radiolucency that surrounds the crown of the LR8. The area also extend to the LR7 and there is some tipping of the LR7.

The most likely diagnosis is of a dentigerous cyst. These are fluid filled sacs that originate from the cell lining over an unerupted tooth. This cell lining usually breaks down when the tooth erupts, but in unerupted teeth the lining may continue to proliferate and then the centre breaks down into a licid sac.

This is an example of a very large unilocular dentigerous cyst associated with an unerupted LR7 or LR8.

Dentigerous cysts are slow growing and usually painless unless another tooth becomes involved.

There can be a lot of bone loss or jaw deformity that can render the bone liable to fracture.

We informed the patient and sent him to the hospital for an emergency second opinion.

Normally a cone beam CT scan is taken to ascertain the extent of the cyst and if it has involved the dental nerve underneath.

The patient underwent a surgical removal of the LR8, LR6 and the cyst. The large hole left was filled with a bone graft.

Had we not had spotted the lesion the patient could have lost more teeth or even broken his jaw.

In conclusion always ensure the dentist lets you know what he or she found on the radiographs. That way you know they have checked.

O post Why you should get your wisdom teeth x-rayed part 1 apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

In an unprecedented move all dental clinics have been asked to close down. This is to stop patients coming into contact with infected patients in the waiting rooms, reception, toilets and more so in the surgery.

Dental clinics have been ordered to stop all check ups, hygiene visits, orthodontic treatment and routine dentistry; they are being asked stop producing aerosols.

Dental clinics are operating a skeleton service or even just a phone service, much like GP practices.

Aerosols

Most dental procedures produce aerosols; from just drying a tooth to cutting teeth. The 3:1 air water syringe can create an aerosol, the high speed drill as you all know produces high volumes of aerosol, but even the suction unit can from its exhaust create an aerosol

Besides the chances of becoming infected by the virus if you venture outside, what else can you do to minimise a trip to the dentist?

If you are in pain, the first thing you should do is contact the clinic; try not to call 111 or the emergency services as they will be very very busy and ill-equipped to give you advice. The best thing is to speak to a dentist. He or she can remotely diagnose what the most likely problem and solutions are.

Tooth pain

Tooth ache can occur from a leaking filling, a broken filling or tooth, or from the nerve itself. A broken filling or tooth or even a leaking filling can be sealed if you are able to buy a tooth repair or temporary filling kit from the chemist, or even Amazon. If you feel that you cannot seal the tooth yourself then please ask your dentist for advice. Unfortunately the Chief Dental Officer is asking all dentists to refer all emergencies to emergency centres; the problem is that most have not been set up yet.

In certain circumstances the dentist may be able to isolate the tooth, dry it with cotton wool and place a temporary filling. There is the danger however that you, the dentist or the staff could be carriers.

When a tooth pain lasts more than a few seconds and is prolonged then the cavity may have involved the nerve. If the pain is excrutiating and long lasting then the chances are that the nerve maybe irreparably damaged/infected. Normally the dentist would remove the nerve or at least dress the nerve chamber with a sedative dressing. If this is not possible by your dentist then you can try tooth tincture. This is the general name for medicaments that contain eugenol oil. The oil can enter the nerve chamber and kill off the nerve. Be warned that the nerve cannot then be resuscitated and you may later need root canal treatment or an extraction.

Gum pain

Gum disease can be a chronic condition with no pain. Gum disease however causes bone loss and sometimes you can develop a gum abscess. This is usually a pain or swelling linked to the gum. Sometimes the gum abscess appears like a boil. Treatment can involve salt water solution rinse, rinsing with corosdyl or listerine, brushing the gum with these liquids, or even lancing the abscess with a sterile needle. The relief can be very immediate once the pressure is released.

Sometimes a tooth can appear loose due to gum disease or an abscess deeper in the root. It is advised that you try to eat soft foods, and avoid eating on that tooth. Analgesics can help relieve pain and also some of the pressure.

The same goes for loose teeth. One learns to avoid eating on a loose tooth, but if it really painful and needs removal then your dentist is best to call about a local emergency centre. He or she may also be able to splint it to an adjacent tooth until more permanent treatment can be carried out.

Please contact us if you have any questions.

O post Coronavirus; how toothache can be treated. apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.