This blog gives you some information on the Corona Virus or Covid19 pandemic, what the guidelines for us dentists are and what patients must remember to do during the time of Corona Virus or Covid19 when you come for treatment in the current scenario.

Dentists are responsible for adopting prevention and infection control measures during or Corona Virus or Covid19 to avoid or reduce as much as possible the transmission of microorganisms during any procedure in their practice. WHO has recently declared a pandemic, caused by the SARS-CoV-2 virus, known as coronavirus disease (COVID-19).

SARS-CoV-2, the virus that causes COVID-19, is thought to be spread primarily through respiratory droplets when an infected person coughs, sneezes, droplet inhalation or indirect contact with nasal, oral, and eye mucosa. Dental workers play a crucial role in the prevention of this viral infection, because aerosol and droplets are the main transmission vectors. Airborne transmission from person-to-person over long distances is unlikely. There are also indications that patients may be able to spread the virus while pre-symptomatic or asymptomatic. The virus has been shown to survive in aerosols for hours and on some surfaces for days. Many dental procedures produce aerosols and droplets (high speed hand pieces, triple syringes, ultrasound, etc) that may be contaminated with the virus. These droplets and aerosols are small enough to remain suspended in air for a long period of time before falling into environment surfaces or entering the respiratory tract of other individuals. Therefore, dentists or dental care workers or providers may enforce even more stringent prevention and control measures, taking into account their individual and specific realities.

The Occupational Safety and Health Administration places DHCP (Dental Health care professionals) in the very high exposure risk category, as their jobs are those with high potential for exposure to known or suspected sources of the virus that causes COVID-19 during specific procedures.

Centres for disease control and prevention has given recommendations:

• Postpone elective procedures, surgeries, and non-urgent dental visits.
• Proactively communicate to both staff and patients the need for them to stay at home if sick
• Contact Patients Prior to Emergency Dental Treatment

Provision of Emergency Care to Dental Patients with COVID-19 During the COVID-19 Pandemic

Assess the patient’s dental condition and determine whether the patient needs to be seen in the dental clinic. If a patient arrives at your facility and is suspected or confirmed to have COVID-19, take the following actions:

• Defer dental treatment
• Give the patient a mask to cover his or her nose and mouth.
• If not acutely sick, send the patient home and instruct the patient to call a medical provider.
• If acutely sick (for example, has trouble breathing) refer the patient to a medical facility.

Dental treatment should be provided in a hospital or other facility that can treat the patient using the appropriate precautions.

Provision of Emergency Care to Patients Without COVID-19 in a Dental Clinic like ours on Shivajinagar and Nigdi Pradhikaran near Wakad Pune during the COVID-19 Pandemic

If the patient is afebrile (temperature < 100.4?F) and otherwise without symptoms consistent with COVID-19, then emergency dental care may be provided using appropriate engineering controls, work practices, and infection control practices.

Engineering Controls and Work Practices

• Avoid aerosol generating procedures whenever possible.
• If aerosol generating procedures are necessary for emergency care, use four-handed dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols.

Infection Control Considerations

• DHCP should wear a facemask at all times while they are in the dental setting. Surgical masks are generally preferred over cloth face coverings for DHCP because surgical masks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others

The PPE is recommended for DHCP when providing emergency dental care to patients without Corona Virus or COVID-19.

Dental care to patients with acute viral symptoms

There is high risk of virus transmission in dental care, due to the high viral load present in high airways and due to likelihood of exposure to biological material in aerosols generated by procedures. Especially during the COVID-19 outbreaks, it is recommended that dental procedures be restricted to emergency or urgent cases.

General precautions patients should take when arriving at a dental clinic like Dr Kheur Dental Clinics on Shivajinagar and Nigdi Pradhikaran near Wakad in Pune:

Instruct patients that if they have flu-like symptoms or a cough, they should wear a face mask before leaving their homes and follow the following breathing etiquette:

• Whenever you cough or sneeze, cover your nose and mouth with your elbow or a tissue;
• Use a disposable tissue to clean your nose (dispose of it immediately after using, then wash your hands);
• Avoid touching their eyes, nose, and oral mucosa;
• Wash their hands (Washing your hands and face: hands and face should be washed with water and soap for 20 seconds).

Hand hygiene technique with alcohol-based formulation

If necessary, sanitize the hands with alcohol-based sanitizer.

• Do not touch your face.
• Thermometer: request someone to check your body temperature.
• Tie your hair and avoid wearing earrings, rings, and wristbands.
• Bags: If you decide to enter the clinic with your bag, it is recommended that you sanitize it with 70% alcohol spray.
  Wear shoe covers.

General precautions for patients and those accompanying them when arriving at a dental clinic like Dr Kheur Dental Clinics on Shivajinagar and Nigdi Pradhikaran near Wakad in Pune:

Patients and those accompanying them should be instructed to immediately inform the reception whether they have had any flu-like symptoms (such as coughing, a running nose, fever, difficult breathing), and should take appropriate preventive measures like wearing surgical masks as soon as they enter the clinic (surgical masks should be available at the entrance, otherwise, a patient with flu must request them). Practice social distancing;

Wash your hands with water and soap for 20 seconds, dry them with disposable tissues, and sanitize the hands with 70% alcohol-based sanitizer. Let them dry naturally. After sanitizing, do not touch anything else, including your mobile.

As soon as the patient enters the dental clinic, an attendant should check their body temperature with a digital infrared thermometer and update their medical history (even if it is a return patient, always ask about corona virus or Covid19 symptoms or if any relative, friend, or acquaintance has had any symptoms). If the patient’s temperature is above 37.8 degrees Celsius, they should be provided with a face mask and instructed about possible symptoms, then they should return home, rest, and seek medical care.

When entering the clinic, remove rings, wristbands, and other accessories. Turn off mobile phones and place them away, sanitize bags with 70% alcohol spray.

Wear shoe covers.

As the virus is sensitive to oxidation, it is recommended to do a pre-procedure antiseptic rinses in order to reduce viral loads. Pre-procedure rinses (15mL of the solution for 30 seconds) with 1.5% hydrogen peroxide or 0.2% povidine iodine mouthwash for 1 minute. Do not use a spittoon. Use the same sink that had been used for washing the hands and face.

Give the patient a head cap and instruct them to fully cover their hair and ears.

When leaving the clinic, they should return to the restroom to wash their hands with water and liquid soap, dry them with disposable tissues and sanitize the hands with 70% alcohol-based sanitizer. They should wait for their hands to dry before going home safely.

Instruct patients to follow these procedures when arriving home:

Video Links:
1.Hand wash WHO:

2. Hand Rub WHO:

The post Dentistry in the times of COVID-19 – Corona virus and dentistry appeared first on Dr Kheur Dental Clinic.

You can imagine our surprise and joy when this awaited us in our inbox yesterday!!

The Journal of Prosthodontics is a popular journal of dental articles for reading latest developments in the field of Prosthodontics, best dental implants and dental materials.

We published our research on “Assessment of antagonistic enamel wear and clinical performance of monolithic zirconia crowns” – one of the first clinical studies on this exciting new material then – Monolithic zirconia crowns.

It was a delightful to have our research published in what is staple reading for most dentists across the world; but getting this award for having our research as the most downloaded and most read piece of publication was simply a matter of immense joy.

The post Some Joy Amidst The Corona Virus Gloom appeared first on Dr Kheur Dental Clinic.

The month of March 2020 brought in two pleasant surprises in the first week. We saw our old patients – Sanjeev and Babloo for their yearly follow-ups who underwent one of the best dental implants in our clinics on F.C. Road, Shivajinagar and Nigdi Pradhikaran near Wakad in Pune. 

For any patient there can probably be nothing more psychologically shattering than the loss of a front tooth. 

We often see such patients who come in in an emergency situation after loosing one or more front teeth following a road accident or biting on something excessively hard and breaking a previously weak tooth. 

Ask any dentist – The most difficult job in dentistry is replacing a missing front tooth! 

Sanjeev lost a tooth (his central incisor) while playing cricket (August 2017), while Babloo was more unfortunate- he was involved in a motorcycle crash that left him without all his front teeth (June 2016).  Both patients presented different challenges.   

We got an excellent result after treating them. But what gave us great joy this March was to see them after 4 years also, looking just the way they were when we gave them their new teeth. 

Such beautiful long lasting results come through a combination of good technique, good materials (we used premier best dental implants in both the cases from F.C. Road, Shivajinagar and Nigdi Pradhikaran near Wakad in Pune, premium bone graft materials, and of course we used the best materials for making their artificial teeth). 

Here are their stories in very brief: 

Sanjeev : This is how he was when he showed up covering his mouth with a handkerchief in December 2017.

Sanjeev went through 3 surgeries to have the best dental implant placed where he was missing his tooth. 

We used Straumann Dental Implants https://www.straumann.com/group/en/patients.html 

These are premium implants, one of the most widely used dental implants across the world, with an unmatched pedigree of research behind them. 

Sanjeev received full ceramic crowns made of a material, which is acknowledged as the world leader in cosmetic materials – Emax crowns. This is a lithium disilicate based material and is known to have life like, long lasting esthetics. 

https://www.ivoclarvivadent.com

This is how Sanjeev looked when he got his front tooth in January 2018.

It was a delight to see him in March 2020 with a smile on his face, looking exactly the same as he was when we fixed him up. He deserved to be complimented for maintaining hygiene and taking good care of his new tooth.

Babloo – Babloo was involved in an accident and lost his front teeth. This is how he entered our practice. He was not only missing his teeth, he was also missing his confidence.

From a technical standpoint he was also missing a lot of jawbone after his accident, so we had less foundation to put in his best dental implants. 

He underwent 2 surgeries 3 months apart in order to receive his dental implants. The front region of his mouth received artificial bone graft using a material called Bio – Oss. 

https://www.geistlich-pharma.com/en/dental/bone-substitutes/bio-oss/user-benefits/

Babloo received a premium brand of dental implants called Biohorizons tapered internal implants. https://www.biohorizons.com/Products/DentalImplants 

He received 4 fixed front teeth on these implants. The material for his teeth was one of the best-known, most popular material used for front teeth replacements on implants- Zirconia.  3M Lava Premium

https://www.lava-elite.com/lava-premium-zirconia-crowns.shtml

Babloo was thrilled beyond words when we showed him his teeth in a mirror. He left us with a promise and a beautiful smile on his face – to maintain his teeth well (and also be a more careful driver !)

When we saw him again in March 2020, after 4 years, we were delighted to see the long-term stable results we achieved with this very complex situation.

The post March Begins With A Pleasant Surprise! appeared first on Dr Kheur Dental Clinic.

The primary (milk) teeth have an important role in guiding the eruption of the permanent teeth. Early loss of primary teeth can lead to undesirable tooth movements resulting in space loss for the permanent teeth to erupt. This can have detrimental effects on developing occlusion (bite) of the child including crowding, impaction or midline discrepancies.

Children may require space maintainers if they lose a tooth early or have a primary (milk) tooth removed due to dental decay. If either is the case, it is important to know the benefits of using a space maintainer for babies and how it can help support the child’s dental health.

If a space is not maintained, then teeth can shift into the open space and orthodontic treatment may be required. Not every child who loses a primary tooth early or to dental decay needs a space maintainer; however, a specialized consultation with the dentist or orthodontist should be conducted to determine if using a space maintainer is needed.

Types of Space Maintainers for children and babies
There are two types of space maintainers for children or babies, removable and fixed at Dr Kheur Dental Clinics on F.C. Road, Shivajinagar and Nigdi Pradhikaran near Wakad in Pune

1. Removable – removable space maintainers are similar to orthodontic appliances and are usually made of acrylic. Indicated when there is multiple loss of primary teeth.
2. Fixed – there are different kinds of fixed space maintainers: band and loop, crown and loop, distal shoe and lingual arch.

It is important to try and maintain the primary dentition in the arch until exfoliation where possible, however, where early loss is unavoidable this should be managed to minimise the unwanted effects on the developing occlusion. Space maintainers for children and babies can be used for this purpose. In order to be able to consider space maintenance, patients must be dentally fit, have caries removed and motivated to maintain adequate oral hygiene and follow non-cariogenic diet advice.

While there are ways to manage the difficulties associated with space loss through careful orthodontic treatment planning and mechanics. Space maintenance can be especially important in managing and guiding developing dentitions in patients where lengthy orthodontic treatment may not ever be appropriate.

When to space maintain?

Early loss of second primary molars

Preservation of the primary second molar space is key for guiding the eruption of the first permanent molar, otherwise it will shift in the space available leading to space loss and reduction in arch length.

The first permanent teeth to grow are typically the maxillary and mandibular first molars. These molars will erupt behind the primary second molars. Permanent premolars (bicuspids) develop in the place of primary molars.

Generally, second primary molar space should be maintained when the first permanent molars are erupted so they can be included in the space maintainer appliance. When the first permanent molars are unerupted, it would be advantageous to be able to maintain the second primary molar space in order to guide the path of eruption of the first permanent molar into an ideal position.

Wearing the Space Maintainer by children or babies

Once the space maintainer is made by the dentist or orthodontist, it may take the child a few days to get accustomed to wearing the appliance whether it is removable or fixed.

The dentist should review with the child and parent the proper ways to clean the space maintainer thoroughly in order to keep the gum tissue healthy and free of dental plaque. Proper instruction for tooth brushing and flossing should be considered for improved oral hygiene.

Review and removal of space maintainers for children and babies

Once the space maintainer is attached, they should be followed up regularly – initially for oral hygiene reasons as there is an increases risk of plaque accumulation until the patient is able to clean the appliance. This is especially important during the first few weeks. Patients should then be reviewed after a month to ensure the appliance is intact and there are no major problems with wear of the appliance.

Patients should inspect their own appliances, attend review appointments regularly and return as soon as any breakages, loss or slippage occurs. It is advisable to change the method of space maintenance if repeated failures occur.

Generally, the patient should be reviewed at a six-monthly review appointment to ensure the appliance is intact and to monitor the eruption and development of the permanent dentition. Once the permanent successors begin to erupt the space maintainer can be removed.

Maintaining the space may reduce the need for further, lengthy and more complex orthodontic treatment.

How a space maintainer will look in your child’s mouth?

Video Links :

Kids Dentistry

Space Maintaner

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CAD/CAM dentistry was introduced in dentistry during the 1980s. When creating a chairside CAD/CAM filling, the dentist at our Clinics on F.C. Road, Shivajinagar and Nigdi Pradhikaran near Wakad in Pune makes a digital picture of the prepared tooth with a small intraoral camera. This digital image contains 3D information about the tooth size and morphology, defect to be restored, about adjacent teeth anatomy and relation with tooth. According to this digital image, the dentist designs the adequate restoration directly on a computer screen using CAD/CAM software.

The advantages of chairside CAD/CAM dentistry technique are one-visit fixed restorative procedure, less chances for error compared to traditional technique, aids in preparation visualization, no need of impression making, no need of temporary restoration, reduced potential for tooth sensitization, no laboratory costs as no model or die pouring required, and projects as a state-of-the-art image. Disadvantages of chairside CAD/CAM technique are soft tissue management more critical than with conventional technique, depending on the material and patient, customization may be required.

Procera was introduced as a non-chairside CAD/CAM device. Esthetic inlays, onlays, veneers, copings, full-coverage crowns, partial and complete dentures, surgical stent for implant placement, and maxillofacial prosthesis all can be fabricated using current techniques.
The benefits of chairside laboratory-integrated technique are precision, focus on artistic ceramics, scanned image transferred directly from the office to the laboratory, reduced chairside time, and team approach. Only disadvantage of this technique over chairside CAD/CAM technique is two visits are required for delivering of prosthesis.

All CAD/CAM systems exhibit three computer-linked functional components although the degree of sophistication may differ.

• Data acquisition – equivalent to traditional impression-making
• Restoration design
• Restorative production.

CAD/CAM was initially based on “subtractive method,” but the recent CAD/CAM dentistry at our Clinics on F.C. Road, Shivajinagar and Nigdi Pradhikaran near Wakad in Pune processes involve “additive” approaches such as rapid prototyping and selective laser sintering technologies.

The available advanced CAD/CAM systems can be divided into the following three groups based on their production methods:

• In office system: Where a dentist digitally scans the prepared tooth, creates restorations chairside, and then seats it within a single appointment
• In laboratory system: Where laboratories could scan models made from physical impressions and use CAD/CAM to produce restorations
• Centralized production: Where a dentist captures chairside digital impressions and then send data via the internet to the laboratory.

Digitalization in dentistry has made dentistry easier, faster and better. It shows:

1. Improved efficiency – both cost and time
2. Improved accuracy in comparison to earlier methods
3. A high level of predictability of outcomes

Development in dental technology has helped patients to avail modern solutions for conventional dental problems. Prosthodontists has included digital technology into their practices to increase their workflow efficiency and ease of collaboration with laboratories. Digital technologies that are available for prosthetic dentistry are digital radiography, computerized case presentations, virtual articulator and facebow, computer-aided design/computer-aided manufacturing restorations, digital impressions, and shade selection. Although conventional techniques in dental care have worked excellently for decades, for a simpler, faster, more accurate, and more efficient workflow, there is shift towards digital dentistry at our Clinics on F.C. Road, Shivajinagar and Nigdi Pradhikaran near Wakad in Pune.

3 D Printing by Glidewell

Intra Oral Scan by 3Shape Trios

Milling of Crown

Milling of Bridge

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