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Only 62% of adults visited a dentist in 2009. It doesn’t take a psychology degree to know that patients aren’t avoiding your office because they love tooth decay. Many times, the fear of dentists is based on traumatic dental experiences. A successful dentist is not only good at cleaning teeth, filling cavities, and restoring smiles, but also at putting patients at ease so that they will keep returning. Here are a few tips to help reduce your patients’ dental fears and anxieties so that you can best treat them and send them home smiling:

• Communicate clearly: Talking through the steps of the treatment with patients can significantly reduce their fear. When a patient comes to your office, sit down with them and talk through what you will be doing, even if it is only a cleaning. 

• Soothe with music: According to a study by the American Dental Association, music is a great tool for distracting patients and reducing their dental anxiety. Have soothing music playing in the examination room, or better yet, encourage your patients to bring an iPod or MP3 player with their favorite song to listen to throughout their appointment. 

• Try a relaxation technique: One of the most effective ways to reduce fear in particularly anxious patients is to have them do a short relaxation exercise prior to their treatment. Consider getting a relaxation DVD or written instructions for a relaxation exercise and encourage anxious patients to listen to it through headphones or read it quietly while in the waiting room before their appointment.

• Distract, Distract, Distract: Some dental offices are beginning to set up television screens above the dental chairs, and allowing patients to choose from a DVD collection or set of television stations prior to their procedure. This is particularly helpful for longer procedures, and can offer a distraction from their fear and anxiety.

As a dentist, you know that dental work does not have to be scary. By communicating clearly with your patients, creating a relaxing and welcoming environment, and offering them distractions such as music and television, you can help your patients to reduce their anxiety and keep fear at bay. Even for patients that do not have obviously high levels of dental anxiety, these tips can help make them feel more relaxed and create a welcoming atmosphere that gives patients positive associations with the dentist.

Allison Gamble has been a curious student of psychology since high school. She brings her understanding of the mind to work in the weird world of internet marketing with psychologydegree.net.

So much more than than a pair of upturned lips, the smile is the most scientifically studied human facial expression. In her new book, Lip Service, Yale psychology professor Marianne LaFrance, PhD, draws on the latest research—in fields from biology to anthropology to computer science—in an effort to shed some light on the happy face. Here, six facts that may make you, well, you know.

People with big grins live longer. In a study published last year, researchers pored over an old issue of the Baseball Register, analyzing photos of 230 players. They found that on average, the guys with bright, bigmouthed beams lived 4.9 years longer than the players with partial smiles, and 7 years longer than the players who showed no grin at all. We can’t credit wide smiles for long life spans, of course, but smiles reveal positive feelings, and positive feelings are linked to well-being.

Smiles exert subliminal powers. When study subjects are shown an image of a smiling face for just four milliseconds—a flash so quick, the viewers don’t consciously register the image—they experience a mini emotional high. Compared with control groups, the smile-viewers perceive the world in a better light: To them, boring material is more interesting, neutral images look more positive, even bland drinks seem tastier.

There are three degrees of happiness… An article in the British Medical Journal reported that it is indeed possible to spread the love: Within social networks, when one person is happy, the feeling migrates to two people beyond her. So if you smile, a friend of a friend is more likely to smile, too.

…and two types of smiles. Genuine smiles and fake smiles are governed by two separate neural pathways. We know this is true because people with damage to a certain part of the brain can still break into a spontaneous grin even though they’re unable to smile at will. Scientists speculate that our ancestors evolved the neural circuitry to force smiles because it was evolutionarily advantageous to mask their fear and fury.

To spot a faker, check the eyes. When someone smiles out of genuine delight, a facial muscle called the orbicularis oculi involuntarily contracts, crinkling the skin around the eyes. Most of us are incapable of deliberately moving this muscle, which means that when a person fakes a smile, her orbicularis oculi likely won’t budge.

Smiles have accents. When reading facial expressions, different cultures home in on different parts of the face. In the United States, we focus on mouths; the Japanese, by contrast, search for feeling in the eyes.

These emoticons say it all:

HappySadU.S.:):(JAPAN(^_^)(;_;)

Source:  Oprah.com

Leading dental and pharmacy organizations are teaming up to promote oral health and raise public awareness of dry mouth, a side effect commonly caused by taking prescription and over-the-counter medications. More than 500 medications can contribute to oral dryness, including antihistamines (for allergy or asthma), antihypertensive medications (for blood pressure), decongestants, pain medications, diuretics and antidepressants. In its most severe form, dry mouth can lead to extensive tooth decay, mouth sores and oral infections, particularly among the elderly.

Nearly half of all Americans regularly take at least one prescription medication daily, including many that produce dry mouth, and more than 90 percent of adults over age 65 do the same. Because older adults frequently use one or more of these medications, they are considered at significantly higher risk of experiencing dry mouth. 

The American Dental Association (ADA), Academy of General Dentistry (AGD), American Academy of Periodontology (AAP) and the American Pharmacists Association (APhA) are collaborating to expand awareness of the impact of medications on dry mouth, a condition known to health professionals as xerostomia.

With regular saliva production, your teeth are constantly bathed in a mineral-rich solution that helps keep your teeth strong and resistant to decay. While saliva is essential for maintaining oral health and quality of life, at least 25 million Americans have inadequate salivary flow or composition, and lack the cleansing and protective functions provided by this important fluid. 

“Each day, a healthy adult normally produces around one-and-a-half liters of saliva, making it easier to talk, swallow, taste, digest food and perform other important functions that often go unnoticed,” notes Dr. Fares Elias, immediate past president, Academy of General Dentistry. “Those not producing adequate saliva may experience some common symptoms of dry mouth.” 

Signs and symptoms
At some point, most people will experience the short-term sensation of oral dryness because of nervousness, stress or just being upset. This is normal and does not have any long-term consequences. But chronic cases of dry mouth persist for longer periods of time. Common symptoms include trouble eating, speaking and chewing, burning sensations or a frequent need to sip water while eating. 

“Dry mouth becomes a problem when symptoms occur all or most of the time and can cause serious problems for your oral health,” explains Dr. Matthew Messina, ADA consumer advisor. “Drying irritates the soft tissues in the mouth, which can make them inflamed and more susceptible to infection.”

According to Dr. Messina, who practices general dentistry in the Cleveland area, without the cleansing and shielding effects of adequate saliva flow, tooth decay and periodontal (gum) disease become much more common. “Constant dryness and the lack of protection provided by saliva may contribute to bad breath. Dry mouth can make full dentures become less comfortable to wear because there is no thin film of saliva to help them adhere properly to oral tissues,” he adds. “Insufficient saliva can also result in painful denture sores, dry and cracked lips and increased risks of oral infection.”

Common causes
Once considered an inevitable part of aging, dry mouth is now commonly associated with certain medications and autoimmune conditions such as Sjogren’s syndrome. Both of these can reduce salivary production or alter its composition, but experts agree that the primary cause of dry mouth is the use of medications.

Radiation treatment for head and neck cancer is also an important cause of severe dry mouth. The treatment can produce significant damage to the salivary glands, resulting in diminished saliva production and extreme dry mouth in many cases. 

“Saliva plays an important role in maintaining oral health,” says Dr. Donald Clem, president of the American Academy of Periodontology. “With decreased saliva flow, we can see an increase in plaque accumulation and the incidence and severity of periodontal diseases.”

How to relieve dry mouth
Individuals with dry mouth should have regular dental checkups for evaluation and treatment. “Be sure to carry an up-to-date medication list at all times, and tell your dentist what medications you are taking and other information about your health at each appointment," advises Mr. Thomas Menighan, executive vice president and Chief Executive Officer, American Pharmacists Association. "In some cases, a different medication can be provided or your dosage modified to alleviate dry mouth symptoms. Talk to your pharmacist if you have any questions regarding your medication.” 

Increasing fluid intake, chewing sugarless gum, taking frequent sips of water or sucking on ice chips can also help relieve dry mouth symptoms. Avoiding tobacco and intake of caffeine, alcohol and carbonated beverages may also help those with the condition. Your dentist may recommend using saliva substitutes or oral moisturizers to keep your mouth wet. Your local pharmacist is also a helpful source for information on products to help you manage dry mouth.

Source: American Academy of Periodontology

 Scientists have discovered the tool that bacteria normally found in our mouths use to invade heart tissue, causing a dangerous and sometimes lethal infection of the heart known as endocarditis. The work raises the possibility of creating a screening tool -- perhaps a swab of the cheek, or a spit test -- to gauge a dental patient's vulnerability to the condition.

The identification of the protein that allows Streptococcus mutans to gain a foothold in heart tissue is reported in the June issue of Infection and Immunity by microbiologists at the University of Rochester Medical Center.  S. mutans is a bacterium best known for causing cavities. The bacteria reside in dental plaque -- an architecturally sophisticated goo composed of an elaborate molecular matrix created by S. mutans that allows the bacteria to inhabit and thrive in our oral cavity. There, they churn out acid that erodes our teeth.

S. mutans invading a human coronary artery endothelial cell.

(Credit: Image courtesy of University of Rochester Medical Center)

Normally, S. mutans confines its mischief to the mouth, but sometimes, particularly after a dental procedure or even after a vigorous bout of flossing, the bacteria enter the bloodstream. There, the immune system usually destroys them, but occasionally -- within just a few seconds -- they travel to the heart and colonize its tissue, especially heart valves. The bacteria can cause endocarditis -- inflammation of heart valves -- which can be deadly. Infection by S. mutans is a leading cause of the condition.

"When I first learned that S. mutans sometimes can live in the heart, I asked myself: Why in the world are these bacteria, which normally live in the mouth, in the heart? I was intrigued. And I began investigating how they get there and survive there," said Jacqueline Abranches, Ph.D., a microbiologist and the corresponding author of the study.

Abranches and her team at the University's Center for Oral Biology discovered that a collagen-binding protein known as CNM gives S. mutans its ability to invade heart tissue. In laboratory experiments, scientists found that strains with CNM are able to invade heart cells, and strains without CNM are not.

When the team knocked out the gene for CNM in strains where it's normally present, the bacteria were unable to invade heart tissue. Without CNM, the bacteria simply couldn't gain a foothold; their ability to adhere was about one-tenth of what it was with CNM.

The team also studied the response of wax worms to the various strains of S. mutans. They found that strains without CNM were rarely lethal to the worms, while strains with the protein were lethal 90 percent of the time. Then, when Abranches' team knocked out CNM in those strains, they were no longer lethal -- those worms thrived.

The work may someday enable doctors to prevent S. mutans from invading heart tissue. Even sooner, though, since some strains of S. mutans have CNM and others do not, the research may enable doctors to gauge a patient's vulnerability to a heart infection caused by the bacteria.

Abranches has identified five specific strains of S. mutans that carry the CNM protein, out of more than three dozen strains examined. CNM is not found in the most common type of S. mutans found in people, type C, but is present in rarer types of S. mutans, including types E and F.

"It may be that CNM can serve as a biomarker of the most virulent strains of S. mutans," said Abranches, a research assistant professor in the Department of Microbiology and Immunology. "When patients with cardiac problems go to the dentist, perhaps those patients will be screened to see if they carry the protein. If they do, the dentist might treat them more aggressively with preventive antibiotics, for example."

Until more research is done and a screening or preventive tool is in place, Abranches says the usual advice for good oral health still stands for everyone.

"No matter what types of bacteria a person has in his or her mouth, they should do the same things to maintain good oral health. They should brush and floss their teeth regularly -- the smaller the number of S. mutans in your mouth, the healthier you'll be. Use a fluoride rinse before you go to bed at night. And eat a healthy diet, keeping sugar to a minimum," added Abranches.

Abranches presented the work at a recent conference on the "oral microbiome" hosted by the University's Center for Oral Biology. The center is part of the Medical Center's Eastman Institute for Oral Health, a world leader in research and post-doctoral education in general and pediatric dentistry, orthodontics, periodontics, prosthodontics, and oral surgery.

Additional authors of the study include laboratory technician James Miller; former technician Alaina Martinez; Patricia Simpson-Haidaris, Ph.D., associate professor of Medicine; Robert Burne, Ph.D., of the University of Florida; and Abranches' husband, Jose Lemos, Ph.D., of the Center for Oral Biology, who is also assistant professor in the Department of Microbiology and Immunology. The work was funded by the American Heart Association.

Source:  University of Rochester Medical Center

Have you thought about chipped teeth, drooling, gum damage, nerve damage, taste loss, tooth loss or infection? The problems that can arise from an oral piercing might surprise you.

Fractured teeth are a common problem for people with tongue piercings. People chip teeth on tongue piercings while eating, sleeping, talking and chewing on the jewelry. The fracture can be confined to the enamel of your tooth and require a filling, or it may go deep into the tooth; in which case, a root canal or tooth extraction may be necessary.

"Every time you swallow, the barbell hits the teeth, causing constant irritation that can result in mouth ulcers," says Academy of General Dentistry spokesperson Manuel A. Cordero DDS, FAGD.

Infections are also common. Dentists are learning that oral infections can be linked to other infections. "The tongue is covered with bacteria," Dr. Cordero said. "The moment the tongue is punctured, bacteria are introduced into the blood. When that happens, bacteria can travel to the heart and cause a variety of serious problems."

If you decide to pierce your tongue, take care of it. Once the tongue has been pierced, it takes four to six weeks to heal. Barring complications, the jewelry can be removed for short periods of time without the hole closing. Always remove the jewelry every time you eat or sleep.

Gum recession is another big problem associated with tongue piercing.  Many people with pierced tongues get into the habit of rubbing the gums on the inside of the bottom teeth with the ball at the end of the pierce.  This causes the gum, and ultimately the bone, to become stripped away from the teeth resulting in gum recession.  This will oftentimes necessitate repair of the damage by a periodontist.

To avoid serious infections such as HIV or hepatitis, make sure the piercer sterilizes everything in an autoclave, which uses extreme heat to sanitize surgical instruments. Ask the piercer questions about after-care, cleanliness, equipment and other concerns.

Clean your piercing with an antiseptic mouthwash after every meal and brush the jewelry the same as your teeth to remove plaque.

CARY FEUERMAN, DMD

PERIODONTAL ASSOCIATES

Source:  AGD

A new study in the Journal of Dental Research finds bone fluoride levels are not associated with osteosarcoma, a rare bone cancer more prevalent in males.

A team of researchers from Harvard University, the Medical College of Georgia and the National Cancer Institute analyzed hundreds of bone samples from nine hospitals over an eight year period from patients with osteosarcoma and a control group to measure fluoride levels in the bone.

Considered the most extensive study to date that examines a potential association between fluoride levels in bone and osteosarcoma, the results indicated no correlation. Three branches of the National Institutes of Health were involved in the study. The National Cancer Institute (NCI) approved the design of the study, and funding for the research was provided by the NCI, the National Institute of Environmental Health Sciences, and the National Institute of Dental and Craniofacial Research. 

The ADA has issued a press statement and ADA News contains more details about the study.

Patients may ask about the findings of this new study. Here are some points that may be helpful:

• This new study adds to an already strong base of scientific evidence that fluoride is safe and effective at preventing cavities.
• An inconclusive animal study conducted twenty years ago first raised the question of an association between fluoride and osteosarcoma. Since that time, other studies have examined the issue.
• This new study is considered by researchers to be the best science to date because a more accurate and reliable scientific method was used to measure exposure from all sources of fluoride.
• Tooth decay rates have declined dramatically over the past several decades, thanks in part to the use of fluoride.
• The AmericanDentalAssociation advises that people should brush twice a day with fluoride toothpaste, floss daily, eat a balanced diet and maintain regular dental appointments to help prevent tooth decay.

CARY FEUERMAN, DMD

PERIODONTAL ASSOCIATES

Source:  American Dental Association

In a study, Identification of Unrecognized Diabetes and Pre-diabetes in a Dental Setting, published in the July 2011 issue of the Journal of Dental Research, researchers at Columbia University College of Dental Medicine found that dental visits represented a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition. The study sought to develop and evaluate an identification protocol for high blood sugar levels in dental patients and was supported by a research grant from Colgate-Palmolive. The authors report no potential financial or other conflicts.

"Periodontal disease is an early complication of diabetes, and about 70 percent of U.S. adults see a dentist at least once a year," says Dr. Ira Lamster, dean of the College of Dental Medicine, and senior author on the paper. "Prior research focused on identification strategies relevant to medical settings. Oral healthcare settings have not been evaluated before, nor have the contributions of oral findings ever been tested prospectively."

For this study, researchers recruited approximately 600 individuals visiting a dental clinic in Northern Manhattan who were 40-years-old or older (if non-Hispanic white) and 30-years-old or older (if Hispanic or non-white), and had never been told they have diabetes or pre-diabetes. 

Approximately 530 patients with at least one additional self-reported diabetes risk factor (family history of diabetes, high cholesterol, hypertension, or overweight/obesity) received a periodontal examination and a fingerstick, point-of-care hemoglobin A1c test. In order for the investigators to assess and compare the performance of several potential identification protocols, patients returned for a fasting plasma glucose test, which indicates whether an individual has diabetes or pre-diabetes.

Researchers found that, in this at-risk dental population, a simple algorithm composed of only two dental parameters (number of missing teeth and percentage of deep periodontal pockets) was effective in identifying patients with unrecognized pre-diabetes or diabetes. The addition of the point-of-care A1c test was of significant value, further improving the performance of this algorithm.

"Early recognition of diabetes has been the focus of efforts from medical and public health colleagues for years, as early treatment of affected individuals can limit the development of many serious complications," says Dr. Evanthia Lalla, an associate professor at the College of Dental Medicine, and the lead author on the paper. "Relatively simple lifestyle changes in pre-diabetic individuals can prevent progression to frank diabetes, so identifying this group of individuals is also important," she adds. "Our findings provide a simple approach that can be easily used in all dental-care settings."

Other authors who contributed are: Dr. Carol Kunzel, associate clinical professor at the College of Dental Medicine and at Columbia's Mailman School of Public Health; Dr. Sandra Burkett, at the College of Dental Medicine; and Dr. Bin Cheng, an assistant professor in the Department of Biostatistics at the Mailman School of Public Health.

According to the Centers for Disease Control and Prevention, one in four people affected with type 2 diabetes in the United States remains undiagnosed. And those with pre-diabetes are at an increased risk for type 2 diabetes and also for heart disease, stroke and other vascular conditions typical of individuals with diabetes.

Your comments are appreciated.

Cary Feuerman, DMD

Periodontal Associates

Source:  Science Daily

INTRODUCTION
Casting is the process by which a wax pattern of a restoration is converted to a replicate in dental alloy. The casting process is used to make dental restorations such as inlays, onlays, crowns, bridges, and removable partial dentures. Because castings must meet stringent dimensional requirements, the casting process is extremely demanding. In dentistry, virtually all casting is done using some form or adaptation of the lost-wax technique. The lost-wax technique has been used for centuries, but its use in dentistry was not common until 1907, when W.H. Taggart introduced his technique with the casting machine.
Casting can be defined as the act of forming an object in a mold .The object thus formed is also called as a casting .
Objectives of casting
1) To heat the alloy as quickly as possible to a completely molten condition.
2) To prevent oxidation by heating the metal with awell adjusted torch .
3) To produce a casting with sharp details by having adequate pressure to the well melted metal to force into the mold.
STEPS IN MAKING A CAST RESTORATION
1 . TOOTH PREPARATION .
2 . IMPRESSION .
3 . DIE PREPARATION .
4 .WAX PATTERN FABRICATION .
- There are 4 methods for making wax patterns for a cast restoration .
5. SPRUING .
a) Sprue Former . (sprue pin ).
-provides channel for the molten metal .
-made of wax , plastic or metal .
-reservoir is attached to the sprue .
-ideally length of sprue is 3/8 th” to ½”
Lost Wax Process
The lost wax casting process is widely used as it offers asymmetrical casting withnvery fine details to be manufactured relatively inexpensively. The process involves producing a metal casting using a refractory mould made from a wax replica pattern.
The steps involved in the process or the lost wax casting are:
1 .Create a wax pattern of the missing tooth / rim
2 .Sprue the wax pattern
3 .Invest the wax pattern
4. Eliminate the wax pattern by burning it (inside the furnace or in hot water). This will create a mould.
5 . Force molten metal into the mould - casting.
6 .Clean the cast.
7 .Remove sprue from the cast
8 . Finish and polish the casting on the die .
The lost-wax technique is so named because a wax pattern of a restoration is invested in a ceramic material, then the pattern is burned out ("lost") to create a space into which molten metal is placed or cast. The entire lost-wax casting process . A wax pattern is first formed on a die of the tooth to berestored or, occasionally, directly on the tooth. All aspects of the final restoration are incorporatedinto the wax pattern, including the occlusion, proximal contacts, and marginal fit. Once the wax pattern is completed, a sprue is attached, which serves as a channel for the molten metal to pass from the crucible into the restoration. Next, the pattern and sprue are invested in a ceramic material, and the invested pattern is heated until all remnants of the wax are burned away. After burnout, molten metal is cast into the void created by the wax pattern and sprue. Once the investment is broken away, the rough casting ispickled to removed oxides. Finally, the sprue is removed and the casting is polished and deliveredto the patient. If all steps have been done well, the final restoration will require minimal modification during cementation into the patient's mouth.
Dimensional Changes in the Lost-Wax Technique
If materials used during the casting process didn't shrink or expand, the size of the final cast restoration would be the same as the original wax pattern. However, dimensional changes occur in most of the steps and, in practice, the final restoration may not be exactly the same size as the pattern. The management of these dimensional changes is complex, but can be summarized by the equation:
wax shrinkage + metal shrinkage = wax expansion + setting expansion + hygroscopic expansion + thermal expansion .This equation balances the shrinkage (left sideof equation) against the expansion (right side ofequation) that occurs during the casting process. If the final restoration is to fit the die, the shrinkage and expansion during the casting process bmust be equal. Shrinkage forces in the casting process come from two sources: wax and metal. Although the die restricts the wax from shrinking to a large degree while the pattern is on the die, residual stresses may be incorporated into the pattern and released during investing, when the pattern isremoved from the die. Furthermore, if the investingis done at a temperature lower than that atwhich the wax pattern was formed, the wax willshrink significantly because of the high coefficientof thermal expansion of waxes. Metal shrinkage occurs when the moltenmetal solidifies, but this shrinkage is compensated by introducing more metal as the casting solidifies. However, once the entire casting has reached the solidus temperature of the alloy, shrinkage will occur as the casting cools to room temperature. As for wax, the metallic shrinkage that occurs below the solidus is caused by the coefficient of thermal expansion for the alloy. Cooling shrinkage may reach 2.5% for an alloy that cools from a high solidus temperature (1300" to 1400' C), depending on the coefficient of thermal expansion of the alloy. A typical shrinkage range for most alloys is 1.25% to 2.5%. Furthermore, because the casting is solid at this point, the only possible compensation mechanismis to start with a void space that is 1.25% to2. 5% too large. Thus, shrinkage of wax and metalmust be compensated with expansion in the investment if the casting is to have the appropriate dimensions.



Accuracy of the Lost-Wax Technique
A casting should be as accurate as possible, although a tolerance of rt0.05% for an inlay casting is acceptable. If the linear dimension of an average dental inlay casting is assumed to be 4 mm, +0.05% of this value is equal to only +2ym, which suggests that if two castings made for the same tooth have a variation of 4 ym, the difference may not be noticeable. To visualize this dimension, recall that the thickness of an average human hair is about 40 ym. Therefore the tolerance limits of a dental casting are approximately one-tenth the thickness of a human hair. To obtain castings with such small tolerancelimits, rigid requirements must be placed not only on the investment material but also on theimpression materials, waxes, and die materials. Naturally, technical procedures and the proper handling of these materials are equally important. The values for the setting, hygroscopic, and thermal expansions of investment materials may vary from one product to another, and slightly different techniques may be used with different investments. In each case, the values obtained for any one property should be reproducible from one batch to another and from one casting to another.
The Sprue :
Definition:
Its a channel through which molten alloy can reach the mold in an invested ring after the wax has been eliminated. Role of a Sprue: Create a channel to allow the molten wax to escape from the mold. Enable the molten alloy to flow into the mold which was previously occupied by the wax pattern.

FUNCTIONS OF SPRUE
1 . Forms a mount for the wax pattern .
2 . Creates a channel for elimination of wax .
3 .Forms a channel for entry of molten metal
4 . Provides a reservoir of molten metal to compensate for the alloy shrinkage .
SELECTION OF SPRUE
1 . DIAMETER :
It should be approximately the same size of the thickest portion of the wax pattern .
Too small sprue diameter suck back porosity results .
2 . SPRUE FORMER ATTACHMENT :
Sprue should be attached to the thickest portion of the wax pattern .
It should be Flared for high density alloys & Restricted for low density alloys .
3 . SPRUE FORMER POSITION
Based on the
1 .Individual judgement .
2 .Shape & form of the wax pattern .
Patterns may be sprued directly or indirectly ..
Indirect method is commonly used
Reservoir prevents localised shrinkage porosity .
Reservoir And Its Location
Reservoir portion of a Spruing system is a round ball or a bar located 1mm away from the wax pattern. Reservoir should be positioned in the heat centre of the ring . This permits the reservoir to remain molten for longer and enables it to furnish alloy to the pattern until they complete solidification process . Round ball reservoir & a bar reservoir also called connector
Significance of Reservoirs:
Reservoir is the largest mass of any part of the Sprue system & it is present in the heat centre of the ring, it is the last part to solidify. These properties allow continuous feeding of the molten alloy to compensate for Solidification shrinkage & avoid Shrinkage porosity
Spruing Technique:
Direct Spruing:
The flow of the molten metal is straight(direct) from the casting crucible to pattern area in the ring. Even with the ball reservoir, the Spruing method is still direct. A basic weakness of direct Spruing is the potential for suck-back porosity at the junction of restoration and the Sprue.
Indirect Spruing:
Molten alloy does not flow directly from the casting crucible into the pattern area, instead the alloy takes a circuitous (indirect) route. The connector (or runner) bar is often used to which the wax pattern Sprue formers area attached. Indirect Spruing offers advantages such as greater reliability & predictability in casting plus enhanced control of solidification shrinkage .The Connector bar is often referred to as a “reservoir .


Armamentarium :
1. Sprue .
2 . Sticky wax .
3 . Rubber crucible former .
4 . Casting ring .
5 . Pattern cleaner .
6 . Scalpel blade & Forceps .
7 . Bunsen burner .
I . Procedure for single casting :
A 2.5 mm sprue former is recommended
for molar crowns 2.0 mm for premolars & partial coverage crowns .
II . Procedure for multiple casting :
Each unit is joined to a runner bar .
A single sprue feeds the runner bar
4 . SPRUE FORMER DIRECTION
Sprue Should be directed away from the delicate parts of the pattern
It should not be at right angles to a flat surface .(leads to turbulance  porosity .)
Ideal angulation is 45 degrees .
5 . SPRUE FORMER LENGTH
Depends on the length of casting ring .. Length of the Sprue former should be such that it keeps the wax pattern about 6 to 8 mm away from the casting ring. Sprue former should be no longer than 2 cm. The pattern should be placed as close to the centre of the ring as possible.
Significance
Short Sprue Length:
The gases cannot be adequately vented to permit the molten alloy to fill the ring completelyleading to Back Pressure Porosity.
Long Sprue Length:
Fracture of investment, as mold will not withstand the impact force of the entering molten alloy.
Top of wax should be adjusted for :
6 mm for gypsum bonded investments .
3 -4 mm for phosphate bonded investments .
TYPES OF SPRUES
I . - Wax . II . Solid
- Plastic . Hollow
- Metal .
VENTING
Small auxilliary sprues or vents improve casting of thin patterns .
Acts as a HEAT SINK .
WAX PATTERN REMOVAL
Pattern should be removed in line with its path of removal
WETTABILITY
To minimise the irregularities on the investment & the casting a wetting agent can be used .

FUNCTIONS OF A WETTING AGENT
1 . Reduce contact angle between liquid & wax surface .
2 .Remove any oily film left on wax pattern .
DISTORTION OF THE PATTERN
Distortion is dependant on temperature &time interval before investing .
To avoid any distortion ,
Invest the pattern as soon as possible .
Proper handling of the pattern .
PREREQUISITES
Wax pattern should be evaluated for smoothness , finish & contour .
Pattern is inspected under magnification & residual flash is removed .
CRUCIBLE FORMER
It serves as a base for the casting ring during investing .Usually convex in shape.
May be metal , plastic or rubber .
Shape depends on casting machine used .
Modern machines use tall crucible to enable the pattern to be positioned near the end of the casting machine .
Casting ring
CASTING RING LINERS
Most common way to provide investment expansion is by using a liner in the casting ring .Traditionally asbestose was used .
Non asbestose ring liner used are :
1) Aluminosilicate ceramic liner .
2) Cellulose paper liner .
The aim of using a resilient liner is to
-. allow different types of investmentbexpansion (act as a cushion)
_. facilitate venting during casting procedure.
_. facilitate the removal of the investment block after casting.&. prevent the distortion by permitting the outward expansion of the mold.
The casting ring holds the investment in place during setting and restricts the expansion of the mold. Normally a resilient liner is placed inside the ring leaving about 2-3 mm from both ends to allow for supporting contact of the investment with the casting ring.
Purpose of Casting Ring Liner
Ringer liner is he most commonly used technique to provide investment expansion. To ensure uniform expansion , liner is cut to fit the inside diameter of the casting ring with no overlap. Thickness of the liner should not be less than approximately 1mm. Place the liner somewhat short of the ends of the ring, 3mm, tends to produce a more uniform expansion, therefore less chance for distortion of the wax pattern & mold .
Traditional material for lining casting rings until it was learned that it posed a potential health risk to dental laboratory technicians . Asbestos fiber bundles were found to produce hazardous-size respirable particles capable of causing lung disease.
Non-asbestos Ring Liners: Ceramic (aluminum silicate) Cellulose (paper) Ceramic-cellulose combination Safety of the ceramic ring liners remains uncertain, because aluminum silicate also appears capable of producing hazardous-size respirable particles
RINGLESS INVESTMENT TECHNIQUE
Used for phosphate bonded investments .
This method uses paper or plastic casting ring .
It is designed to allow urestricted expansion .
Useful for high melting alloys .
Investing Technique
Investing is the process by which the sprued wax pattern is embedded in a material called an investment. The investment must be able to withstand the heat and forces of casting, yet must conform to the pattern in a way such that the size and surface detail are exactly reproduced. In dentistry, gypsum- and phosphate-bonded investment materials are the two types of materials used for this purpose . After spruing, the pattern a casting ring is added to contain the investment while the investment material is poured carefully around the pattern. For the setting and hygroscopic expansion of an investment to take place more uniformly, some allowance must be made for the lateral expansion of the investment. Solid rings do notpermit the investment to expand laterally duringthe setting and hygroscopic expansions of themold.
To overcome this lateral restriction, a ceramic paper liner is placed inside the ring.The ceramic paper liner is cut to fit the inside ofthe metal ring and is held in place with the finger.The ring containing the liner is then dipped intowater until the liner is completely wet and wateris dripping from it. The ring is shaken gently toremove the excess water. After the liner has beensoaked, it should not be touched or adaptedfurther with a finger because this reduces itscushioning effect, which is needed for the lateral expansion of the investment. A liner that is about3 mm short at each end of the ring is preferred.When the liner is equally short at each end of thering, the investment is locked into the ring, and uniform expansion of the cavity form occurs.
During investing, the water-based gypsummaterial must flow around the pattern and captureevery surface detail. However, the wax sur-faces generally are not easily wetted by water.The surface of a wax pattern that is not completelywetted with investment results in surface irregularities in the casting that destroy its accuracy.These irregularities can be minimized byapplying a surface-active wetting agent on thewax. The function of the wetting agent is toreduce the contact angle of a liquid with the waxsurface. Wetting agents also remove any oily filmthat is left on the wax pattern from the separatingmedium. Thecontact angles are 98' for the plain wax surfaceand 61" for the treated wax surface. The lowercontact angle indicates that the treated wax surfacehas an affinity for water, which results in theinvestment being able to spread more easily overthe wax. Because the surface-active agents arequite soluble, rinsing the wax pattern with waterafter the application defeats the purpose of theiruse.
The distortion of the wax pattern after itsremoval from the die is a function of the temperatureand time interval before investing. Thenearer the room temperature approaches the softening point of the wax, the more readilyinternal stresses are released. Also, the longer apattern is allowed to stand before investing, thegreater the deformation that may occur, even atroom temperature. A pattern should therefore beinvested as soon as possible after it is removedfrom the die, and it should not be subjected to awarm environment during this interval. In anycase, a pattern should not stand for more than20 to 30 minutes before being invested. Once itis properly invested and the investment has set,there is no danger of further pattern distortion,even if it remains for some hours before the finalstages of wax elimination (burnout) and casting
Investment Techniques
During investingof the pattern, the correct water powder ratioof the investment mix, a required number ofspatulation turns, and a proper investing techniqueare essential to obtain acceptable castingresults. There are two methods of investing thewax pattern: hand investing and vacuum investing.In both cases, the proper amount of investmentpowder and water should be used, followingthe manufacturer's instructions exactly. Thewater is added first, followed by the slow additionof the powder to encourage the removal ofair from the powder. The powder and liquid aremixed briefly with a plaster spatula until all thepowder is wetted.
In hand investing, the cover of the bowl containingthe investment mix is placed over thebowl . The cover contains a mechanicalmixer, and the mixing is done by hand,usually for 100 turns of the spatulator. The settingrate of an investment depends on the number ofspatulation turns, which also affects the hygroscopicexpansion. The investment, after beingspatulated, is placed on the vibrator to eliminatesome of the air bubbles from the mix and tocollect all of the mix from the sides of the rubber bowl into the center. Thefilled ring is then set aside for the investment toset completely, which usually requires 45 to60 minutes. When a phosphate-bonded investmentis used, the ring is slightly overfilled, the topof the ring is not leveled off, and the investmentis allowed to set. After the investment has set, the excess investment is ground off using a modeltrimmer. This procedure is necessary because anonporous, glassy surface results, which must beground off to improve the permeability of the
investment and allow for gases to readily escape from the mold during casting.
In vacuum investing, special equipment is used to facilitate the investing operation. With this equipment, the powder and water (or special liquid) are mixed under vacuum and the mixed investment is permitted to flow into the ring and around the wax pattern with the vacuum present. Although vacuum investing does not remove all the air from the investment and the ring, the amount of air is usually reduced enough to obtain a smooth adaptation of the investment to the pattern. Vacuum investing often yields castings with improved surfaces when compared with castings produced from hand-invested patterns. The degree of difference between the two procedures depends largely on the care used in hand investing. Whether hand- or vacuum-investing procedures are used in filling the casting ring, the investment should be allowed to harden in air before burnout of the wax.
Single step investing technique:
The investing procedure is carried out in one step either by brush technique or by vacuum technique.
a). Brush technique:
The accurate water-powder ratio is mixedunder vacuum. A brush is then used to paintthe wax pattern with mix then the casting ringis applied over the crucible fromer and thering is filled under vibration until it iscompletely filled.

b). vacuum technique:
• The mix in first hand spatulated, and then withthe crucible former and pattern is place, then ring is attached to the mixing bowl.
• The vacuum hose is then attached to theassembly. The bowel is inverted and the ring isfilled under vacuum and vibration
Two-step investing technigue:
The investing procedure is carried out in twosteps:
• First, the wax pattern is painted with a thick mix andis left till complete setting, the set investment block(first cost) is immersed in water for about tenminutes . the casting ring is then applied over the crucible former and filled with the properly mixedinvestment (second coat) till the ring is completely filled and the mix is left to set.The two-step investing technique is recommendedwhenever greater amount of expansion is required. Thistechnique also minimizes the distortion of the waxpattern and provides castings with smoother surfaces.
• The investment is allowed to set for the recommendedtime (usually one-hour) then the crucible former isremoved. If a metal sprue former is used, it is removedby heating over a flame to loosen it from the waxpattern. Any loose particles of investment should beblown off with compressed air should be placed in ahumidor if stored overnight.
Wax elimination (burnout):
Wax elimination or burnout consists of heating the investment in a thermostatically controlled furnace until all traces of the wax are vaporized in order to obtain an empty mold ready to receive the molten alloy during procedure.

• The ring is placed in the furnace with the sprue hole facing down to allow for the escape of the molten wax out freely by the effect of gravity .
• The temperature reached by the investment determines thethermal expansion. The burnout temperature is slowly increased in order to eliminate the wax and water without cracking the investment.
•For gypsum bonded investment, the mold is heated to650 -6870 c )to cast precious and semiprecious
precious alloys.
• Whereas for phosphate-bonded investment, the mold is heated up to 8340 c to cast nonprecious alloys at high fusing temperature.
The ring should be maintained long enough at the maximum temperature (“heat soak”) to minimize a sudden drop in temperature upon removal from the oven. Such a drop could result in an incomplete casting because of excessively rapid solidification of thealloy as it enters the mold.
• When transferring the casting ring to casting, a quick visual check of the sprue in shaded light is helpful to see whether it is properly heated. It should be a cherry-red color .
CASTING
Melting & Casting Technique Melting & Casting requires Heat source to melt the alloy Casting force, to drive the alloy into the mould

Casting Torch Selection Two type of torch tips: Multi-orifice Single-orifice Multi-orifice tip is widely used for metal ceramic alloys. Main advantage is distribution of heat over wide area for uniform heating of the alloy. Single-orifice tip concentrate more heat in one area.Three fuel sources are used for Casting Torch; Acetylene ,Natural Gas ,Propane
CASTING CRUCIBLES
Four types are available ;
1) Clay .
2) Carbon .
3) Quartz .
4) Zirconia –Alumina .
Casting Machines
It is a device which uses heat source to melt the alloy casting force .
Heat sources can be :
1) Reducing flame of a torch .
( conventional alloys & metal ceramic alloys )
2) Electricity .(Base metal alloys )
Advantages of electric heating :
-heating is evenly controlled .
-minimal undesirable changes in the alloy composition .
- Appropriate for large labs .
Disadv :
Expensive .
Casting machines use :
1) Air pressure .
2) Centrifugal force .
3) Evacuation technique .
Alloys can be melted by :
1) Alloy is melted in a separate crucible by a torch flame & is cast into the mold by centrifugal force .(centrifugal C M )
2) Alloy is melted by resistance heating or by induction furnace & then cast centrifugally by motor or spring action (springwound CM electrical resistance )
3) Alloy is melted by induction heating cast into mold centrifugally by motor or spring action .(Induction CM )
4) Alloy is vacum melted by an argon atmosphere
Torch melting / Centrifugal casting machine
Electrical resistance /Heated casting machine
Melting of the alloy should be done in a graphite or ceramic crucible .
Adv :
-Oxidation of metal ceramic restorations on
overheating is prevented .
-Help in solidification from tip of the casting to the button surface .
Induction casting machine
Commonly used for melting base metal alloys.
Adv :
- Highly efficient .
- Compact machine withlow power consumption
-No pre heating needed ,
- safe & reliable.
Direct current arc melting machine
A direct current arc is produced between two electrodes :
The alloy & the water cooled tungsten electrode .Temp used is 4000 degrees .
Disadv :
High risk of overheating the alloy .
Vacuum or pressure assisted casting machine
Molten alloy is drawn into the evacuated mold by gravity or vacuum & subjected to aditional pressure
For Titanium & its alloys vacuum heated argon pressure casting machines are used .
Accelerated casting method
This method reduces the time of both bench set of the investment & burnout .
Uses phosphate bonded investments which uses 15 mnts for bench set & 15mnts for burnout by placing in a pre – heated furnace to 815 degrees .
Effect of burnout on gypsum bonded investments
Rate of heating has influence on smoothness & on overall dimensions of the investment
Rapid heating causes cracking & flaking which can cause fins or spines .
Avoid heating gypsum bonded investment above 700 degrees .Complete the wax elimination below that temp .
Effect of burnout on phosphate bonded investments
Usual burnout temp is 750 -1030 degrees.
Although they are strong they are brittle too .
Since the entire process takes a long time two stage burnout & plastic ring can be used .CLEANING AND PICKLING ALLOYS
The surface oxidation or other contamination of dental alloys is a troublesome occurrence. The oxidation of base metals in most alloys can be kept to a minimum or avoided by using a properly adjusted method of heating the alloy and a suitable amount of flux when melting the alloy . Despite these precautions, as the hot metal enters the mold, certain alloys tend to become contaminated on the surface by combining with the hot mold gases, reacting with investment ingredients, or physically including mold particles in the metal surface. The surface of most cast, soldered, or otherwise heated metal dental appliances is cleaned by warming the structure in suitable solutions, mechanical polishing, or other treatment of the alloy to restore the normal surface condition.
Surface tarnish or oxidation can be removed by the process of pickling. Castings of noble or high-noble metal may be cleaned in this manner by warming them in a 50% sulfuric acid and water solution . . After casting, the alloy (with sprue attached) is placed into the warmed pickling solution for a few seconds. The pickling solution will reduce oxides that have formed during casting. However, pickling will not eliminate a dark color caused by carbon deposition The effect of the solution can be seen by
comparing the submerged surfaces to those that have still not contacted the solution. the ordinary inorganic acid solutions and do not release poisonous gases on boiling (as sulfuric acid does). In either case, the casting to be cleaned is placed in a suitable porcelain beaker with the pickling solution and warmed gently, but short of the boiling point. After a few moments of heating, the alloy surface normally becomes bright as the oxides are reduced. When the heating is completed, the acid may be poured from the beaker into the original storage container and the casting is thoroughly rinsed with water. Periodically, the pickling solution should be replaced with fresh solution to avoid excessive contamination.
Precautions to be taken while pickling
With the diversity of compositions of casting alloys available today, it is prudent to follow the manufacturer's instructions for pickling precisely, as all pickling solutions may not be compatible with all alloys. Furthermore, the practice of dropping a red-hot casting into the pickling solution should beavoided. This practice may alter the phase structure of the alloy or warp thin castings, and splashing acid may be dangerous to the operator. Finally, steel or stainless steel tweezers should not be used to remove
castings from the pickling solutions. The pickling solution may dissolve the tweezers and plate the component metals onto the casting. Rubber-coated or Teflon tweezers are recommended for this purpose.
FLUXING
To prevent oxidation of gold alloys during melting always use a reducing flux .
Boric acid & borax are used .
Casting of glass or ceramic
A castable ceramic is prepared in a similar manner as metal cast preparation .
Glass is heated to 1360 degrees & then cast.
Phosphate bonded investments are used for this purpose .
CASTING DEFECTS
Classification (combe ):
1) Distortion.
2) Surface roughness .
3) Porosity .
4)Incomplete casting .
5) Oxidation .
6) Sulfur contamination .
Distortion
It is usually due to the distortion of wax pattern.
To avoid this :
Manipulation of the wax at its softening temp
Invest the pattern at the earliest .
If storage is necessary store it in a refrigerator .
Surface roughness
May be due to :
Air bubbles on the wax pattern .
Cracks due to rapid heating of the investment .
High W/P ratio .
Prolonged heating of the mold cavity .
Overheating of the gold alloy .
Too high or too low casting pressure .
Composition of the investment .
Foreign body inclusion.

POROSITY
May be internal or external .
External porosity causes discolouration .
Internal porosity weakens the restoration .
Classification of porosity .
I .Those caused by solidification shrinkage :
a) Localised shrinkage porosity .
b) Suck back porosity .
c) Microporosity .
They are usually irregular in shape .
II ) Those caused by gas :
a) Pin hole porosity .
b) Gas inclusions .
c) Subsurface porosity .
Usually they are spherical in shape .
III ) Those caused by air trapped in the mold :
Back pressure porosity .
Localised shrinkage porosity
Large irregular voids found near sprue casting junction.
Occurs when cooling sequence is incorrect .
If the sprue solidifies before the rest of the casting , no more molten metal is supplied from the sprue which can cause voids or pits
(shrink pot porosity )
This can be avoided by -
- using asprue of correct thickness .
- Attach the sprue to the thickest portion of the pattern .
-Flaring of the sprue at the point of atttachment .
-Placing a reservoir close to the pattern .
Suck back porosity
It is an external void seen in the inside of a crown opposite the sprue .
Hot spot is created which freezes last .
It is avoided by :
Reducing the temp difference between the mold & molten alloy .
Microporosity :
Fine irregular voids within the casting .
Occurs when casting freezes rapidly .
Also when mold or casting temp is too low .
Pin hole porosity :
Upon solidification the dissolved gases are expelled from the metal causing tiny voids .
Pt & Pd absorb Hydrogen .
Cu & Ag absorb oxygen .
Gas inclusion porosities
Larger than pin hole porosities .
May be due to dissolved gases or due to gases Carried in or trapped by molten metal .
Apoorly adjusted blow torech can also occlude gases .
Back pressure porosity
This is caused by inadequate venting of the mold .The sprue pattern length should be adjusted so that there is not more than ¼” thickness of the investmentbetween the bottom of the casting .
This can be prevented by :
- using adequate casting force .
-use investment of adequate porosity .
-place the pattern not more than 6-8 mm away from tne end of the casting .
Casting with gas blow holes
This is due to any wax residue in the mold .
To eliminate this the burnout should be done with the sprue hol facing downwards for the wax pattern to run down.
Incomplete casting
This is due to :
- insufficient alloy .
-Alloy not able to enter thin parts of the mold .
-When the mold is not heated to the casting temp .
-Premature solidification of the alloy .
-sprues blocked with foreign bodies .
-Back pressure of gases .
-low casting pressure .
-Alloy not sufficiently molten .

Too bright & shiny casting with short & rounded margins :
occurs when wax is eliminated completely ,it combines with oxygen or air to form carbon monoxide .
Small casting :
occurs when proper expansion is not obtained & due to the shrinkage of the impression .
Contamination of the casting
1) Due to overheating there is oxidation of metal .
2) Use of oxidising zone of the flame .
3) Failure to use a flux .
4) Due to formation sulfur compounds .
Black casting
It is due to :
1) Overheating of the investment .
2) Incomplete elimination of the wax .
CONCLUSION
Investing and casting , a series of highly technique sensitive steps , converts the wax pattern into metal casting . Accurate and smooth restorations can be obtained if the operator pays special attention to each step in the technique .
When initial attempts in the casting procedure produce errors or defects , appropriate corrective measures must be taken so that they do not recur .

REFERENCES
• Fundamentals of fixed prosthodontics: Shillingburg
• Dental laboratory procedures: Rudd and Morrow.
• Philip’s science of dental ceramics;Anusavice.
• Dental materials: Craig.
• Tylman’s theory of fixed prosthodontics
• * Notes on Dental Materials , E .C . Combe .
• Applied Dental Materials , Mc Cabe .
• Contemporary fixed Prosthodontics; Rosensteil.
JOURNAL REFERENCES
1 . The effect of sprue attachment design on castability and porosity .J Prosthet Dent , 61 :418 -24 , 1989 .Flared & straight sprue attachment optimised castability and minimised porosity
2 . Setting & thermal reactions of Phosphate bonded investments . J of Dentistry rest :1478 -1485 , 1980 .
3) Delayed hygroscopic expansion of phosphate bonded investments . Dental Mater 3 : 165 -7 ,1987 .
Delayed hygroscopic expansion occurs when the investment is immersed in water after setting .
4) Sprue design in RPD casting : J of dentistry ,Nos 1-2 .vol 24 ,99-103 ,1996 .
Correct sprue designs is a major factor in reduction of casting defects .
5)Creating buttonless casting by using preformed wax sprues ; JOP Sept 1996 ; 327 -329 .
This method conserves metal by allowing a minimum of metal for each casting .Smaller button size allows more new metal to be added with subsequent castings .
6) Effect of burnout temp in strength of phosphate bonded investments ,J of Dentistry ,vol 25 ; No :2 , 153 -160 ,1997 .

I have listed a few simple steps to help prevent gingivitis and periodontal disease as a reminder to all of our patients.

STEP 1.  When normally healthy, pink, and firm gums become red, swollen, and spongy, you have a problem -- a problem called gingivitis. If the condition becomes severe enough, it can lead to periodontal disease -- a deterioration of the teeth and bone that anchor the teeth. So the first step in combating gingivitis is to make sure you’re brushing twice a day, flossing once a day, and visiting a dentist at least twice a year for a checkup and cleaning.

STEP 2.  When you brush your teeth, make sure you’re working it for at least two minutes. Most dentists suggest spending 30 seconds on each quadrant of your mouth.

STEP 3.  When it comes to germs, your tongue can be like Velcro, so brushing it along with your gums and teeth will not only help keep your breath fresher, but will reduce the chance that bacteria, viruses, or fungi find harbor in your mouth.

STEP 4.  Next, make the most out of your flossing time. Floss between every tooth, all the way down to the edge of the gum line at least once a day.

STEP 5.  Finally, use an ADA-approved antimicrobial mouth rinse to finish off your routine. If these steps don’t keep gingivitis away, you’ll need to see a dentist right away. He or she may need to perform a more extensive cleaning or provide you with a prescription dental rinse, or both.

Cary Feuerman, DMD

Periodontal Associates

Source:  American Dental Association

Rotting teeth. Diseased lungs. A corpse of a smoker.

Nine new warning labels featuring graphic images that convey the dangers of smoking will be required by the Food and Drug Administration to be on U.S. cigarette packs by 2012. Other images include a man with a tracheotomy smoking and a mother holding a baby with smoke swirling around them. The labels will include phrases like “Smoking can kill you” and “Cigarettes cause cancer.”

The labels, which the FDA released in late June, 2011, are a part of the most significant change to U.S. cigarette packs in 25 years. They’re aimed at curbing tobacco use, which is responsible for about 443,000 deaths in the U.S. a year.

The labels will take up the top half — both front and back — of a pack of cigarettes and each will include a national quit smoking hotline number. Warning labels also must appear in advertisements and constitute 20 percent of an ad. Cigarette makers have until the fall of 2012 to comply.

“These kind of graphic warning labels strengthen the understanding of people about the health risks of smoking,” FDA Commissioner Margaret Hamburg said in an interview with The Associated Press. “We clearly have to renew a national conversation around these issues and enhance awareness.”

Mandates to introduce new graphic warning labels were part of a law passed in 2009 that, for the first time, gave the federal government authority to regulate tobacco, including setting guidelines for marketing and labeling, banning certain products and limiting nicotine. The announcement follows reviews of scientific literature, public comments and results from an FDA-contracted study of 36 labels proposed last November.

The legality of the new labels is part of a pending federal lawsuit filed by Winston-Salem, N.C.-based Reynolds American Inc., parent company of America’s second-largest cigarette maker, R.J. Reynolds; No. 3 cigarette maker, Greensboro, N.C.-based Lorillard Inc.; and others.

Tobacco makers in the lawsuit have argued the warnings would relegate the companies’ brands to the bottom half of the cigarette packaging, making them “difficult, if not impossible, to see.”

A spokesman for Richmond, Va.-based Altria Group Inc., parent company of the nation’s largest cigarette maker, Philip Morris USA, said the company was looking at the final labels but would not comment further.

In recent years, more than 30 countries or jurisdictions have introduced labels similar to those being introduced by the FDA. The U.S. first mandated the use of warning labels stating “Cigarettes may be hazardous to your health” in 1965. Current warning labels — a small box with black and white text — were put on cigarette packs in the mid-1980s.

The FDA says the new labels will “clearly and effectively convey the health risks of smoking” aimed at encouraging current smokers to quit and discouraging nonsmokers and youth from starting to use cigarettes.

“These labels are frank, honest and powerful depictions of the health risks of smoking,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

American Cancer Society CEO John R. Seffrin applauded the new labels in a statement, saying they have the potential to “encourage adults to give up their deadly addiction to cigarettes and deter children from starting in the first place.”

The new labels come as the share of Americans who smoke has fallen dramatically since 1970, from nearly 40 percent to about 20 percent. The rate has stalled since about 2004. About 46 million adults in the U.S. smoke cigarettes.

It’s unclear why declines in smoking have stalled. Some experts have cited tobacco company discount coupons on cigarettes or lack of funding for programs to discourage smoking or to help smokers quit.

While it is impossible to say how many people quit because of the labels, various studies suggest the labels do spur people to quit. The new labels offer the opportunity for a pack-a-day smoker to see graphic warnings on the dangers of cigarettes more than 7,000 times per year.

The FDA estimates the new labels will reduce the number of smokers by 213,000 in 2013, with smaller additional reductions through 2031.

Tobacco use costs the U.S. economy nearly $200 billion annually in medical costs and lost productivity, the FDA said. Tobacco companies spend about $12.5 billion annually on cigarette advertising and promotion, according to the latest data from the Federal Trade Commission.

The World Health Organization said in a survey done in countries with graphic warning labels that a majority of smokers noticed the warnings and more than 25 percent said the warnings led them to consider quitting.

While some have voiced concerns over the hard-hitting nature of some of the labels, those concerns should be trumped by the government’s responsibility to warn people about the dangers of smoking, said David Hammond, a health behavior researcher at the University of Waterloo in Canada, who worked with the firm designing the labels for the FDA.

“This isn’t about doing what’s pleasant for people. It’s about fulfilling the government’s mandate if they’re going to allow these things to be sold,” Hammond said. “What’s bothering people is the risk associated with their behavior, not the warnings themselves.”

In places like Canada, Hammond said smokers offended by some of the images on cigarettes packs there started asking for different packs when they received ones with certain gory images, or used a case to cover them up. But smokers said those warnings still had an effect on them.

Canada introduced similar warning labels in 2000. Since then, its smoking rates have declined from about 26 percent to about 20 percent. How much the warnings contributed to the decline is unclear because the country also implemented other tobacco control efforts.

Your comments are appreciated.

Cary Feuerman, DMD

Periodontal Associates

Source: New Haven Register

If you’re looking for a dentist in Inglewood, browsing through telephone directories or searching on Google are good ways to find some.  However, it’s vital that you zero in on the right person to be your family dentist. There are several dentists in and around Inglewood but before you select one of them for your family, there are several things you should consider:

1.)    Make sure that the dentist you choose is someone everyone in your family is comfortable with. If you have children or aging parents you will need someone who will be patient and gentle with them and at the same time be proficient in the treatment they require.  

2.)    Most dentists in Inglewood are clean and hygienic. They keep their reception areas and surgical rooms sterile and use gloves and sterilized equipment. The best family dentists also ensure that their staff, hygienists and dental assistants maintain high standards of hygiene too.

3.)    The field of dentistry is growing every day. Innovative inventions that improve dental techniques are being made. Make the dentist you select is motivated and keeps in touch with the latest advancements.

4.)    When it comes to choosing a family dentist, look for someone who will not hesitate to give you a complete explanation of what they are doing with your teeth.

5.)    Lastly, most good dentists in Inglewood are known to allow flexible payment options. In case the dental work you require is not covered by insurance, make sure the dentist you have in mind will allow you to pay in installments.

Once you have narrowed on a few family dentists, it would be best to ask your friends if they know them. Most dentists in Inglewood willingly offer trial appointments. Use this as an opportunity to see what kind of treatment you receive in their care.

To make your teeth last a lifetime, don't do these things.

Teeth are tough -- their enamel is the hardest part of the body -- but they're no match for neglect, misuse, or abuse. Here are some surefire ways to find out how vulnerable your teeth are -- trust us, you don't want to do this:

1. Don’t Brush After Every Meal.

The ideal is to brush your teeth three times a day: after breakfast, lunch, and dinner. But if you do it too soon, you can scrub away tooth enamel that becomes softer in the acidic environment created in your mouth when you eat.

“Make sure you wait 30 to 60 minutes after each meal, which gives the acidity time to neutralize and the teeth time to remineralize," says Debra Gray King, DDS, FAACD, of the Atlanta Center for Cosmetic Dentistry.

Brushing too much, too hard, or with a hard-bristle brush can also erode your enamel. Brush gently, using circular strokes and a soft brush.

2. Forget About Flossing.

Flossing stimulates gum health by cleaning between the teeth and under the gum line. Gums bleed when you brush vigorously? That’s a sign of mild gingivitis, or inflammation of the gums, which can lead to tooth loss.

“You need to brush and floss your teeth every time you eat,” says Jeffrey Gross DDS, FAGD, a Cleveland dentist. “The longer food stays in contact with the teeth and the gums, the easier it is to create problems.”

3. Skip checkups.

Dentists recommend every six months, but most patients fail to comply. This allows plaque to form tatar, which attracts more plaque on its surface, carrying the plaque deeper within the gums. This can weaken supporting structures, such as bone.

“The sooner you find issues, the easier and a lot less expensive they will be to address,” King says.

4. Use Your Teeth as Tools.

Chomping ice and hard candy, not to mention popping off bottle caps and ripping open potato chip bags, can crack or break your teeth.

“People tend to do some wild things with their teeth,” King says. She recalls a patient in her 50s who habitually gripped the ropes of her sailboat’s mast between her teeth. 

Over time, the woman’s natural teeth had worn to the point she needed porcelain veneers. Find a bottle opener or pair of scissors. And if you’re sailing, use your hands.

5. Ditch the Mouthguard.

The Academy of General Dentistry (AGD) recommends mouthguards for many athletes. 

“Anytime there is a strong chance for contact with other participants or hard surfaces, it is advisable to wear a mouthguard. Players who participate in basketball, softball, football, wrestling, soccer, lacrosse, rugby, in-line skating, and martial arts, as well as recreational sports such as skateboarding and bicycling, should wear mouthguards while competing,” the AGD’s web site states. 

6. Grind Away.

Some people clench or grind their teeth when bored, lifting something heavy or stressed; others do it while they sleep. Tooth-to-tooth clenching can wear down teeth and “make you look 10 to 20 years older,” King says.

Grinding also paves the way for cavities. “Aside from causing pressure and fractures, grinding wears away the top layer of enamel and the lower levels of enamel beyond the dentin, which can lead to decay,” Gross says. Can’t stop? Get fitted for a mouthguard.

7. Guzzle Soda, Sports Drinks, and Fruit Juices.

Soda and sports drinks often have either too much sugar or, in the case of diet soda, too much acid. Fruit juices often contain sugar but compared to soda and sports drinks, are “a healthier choice” and water is even better yet, Gross says. 

8. Drink Lots of Red Wine, Coffee, or Tea.

The surface of stained teeth is like sandpaper and attracts more bacteria, which can indirectly lead to tooth decay.

As wine editor for Dish magazine, Yvonne Lorkin of Christchurch, New Zealand, tastes thousands of wines each year. At 37, she spends more on dental upkeep than people twice her age.

“The constant onslaught of acid on my enamel is an occupational hazard, I guess, as we're swilling the wines around in our mouths rather than just swallowing,” Lorkin tells WebMD in an email interview. 

Aside from cutting back, Gross recommends using a straw, when possible, so staining liquids bypass your teeth.

9. Whiten Too Often.

Chronic whitening or failing to follow instructions can lead to gum irritation and increased tooth sensitivity. Desensitizing toothpaste can help. 

If you have very sensitive teeth, gum disease, or worn enamel, “your dentist may discourage whitening,” says Charles H. Perle, DMD, FAGD, a dentist in Jersey City, N.J. and a spokesman for the AGD. Check before starting any whitening treatment.

10. Drink Bottled Water.

Most bottled water has little or no fluoride and most home filtration systems filter much of it out. Stick with fluoridated tap water since it’s “the most cost-effective way to prevent cavities and fight tooth decay,” Perle says. If your water isn’t fluoridated, your dentist may prescribe fluoride supplements.

11. Get Your Tongue Pierced.

When you speak, your tongue moves to make certain sounds and consequently “you’re jamming the metal piercing into your teeth,” Gross says. Fractured teeth may require veneers or crowns in a patient who otherwise doesn’t have other issues.

Jason Lazarus, CEO of Gadgets and Gear in Hauppauge, N.Y., got his tongue pierced and admits he played with it “all the time.” Lazarus says he was shocked when X-rays showed his front teeth “dramatically shaved and chipped” and immediately took his tongue ring out.

“I didn’t want my teeth to get worse,” Lazarus says. He has since spent $2,000 on laminates for his two front upper teeth.

12. Be Bulimic.

Bulimia, which is characterized by bingeing and vomiting, can cause significant dental problems because of the stomach acids. 

“The enamel is usually just kind of worn off, mostly on the front teeth, but even going to the back teeth,” King says. If the damage is done, you may need restorations.

13. Abuse Drugs Such as “Meth."

Crystal methamphetamine, an illegal and highly addictive stimulant, can wreak havoc on your mouth. Users often crave sugary foods and drinks, clench their teeth, and have dry mouth. Telltale signs of “meth mouth” are rampant decay with blackened teeth on the verge of falling out.

“People on methamphetamines are notorious for not taking care of themselves,” Gross says. “By the time the patient is 25 or 30, they are looking at a full set of dentures.”

14. Chronically Use Some Legal Medications.

Oral contraceptives change a woman’s hormonal balance and can lead to chronic gum disease.

“Once they get off the medication, the damage is often done,” Gross says. Some over-the-counter cough medications have lots of sugar, and antihistamines can cause dry mouth, which can lead to decay since saliva protects the teeth.

15. Continue Lighting Up.

Smoking is bad for teeth and gums. Stains make teeth more susceptible to bacteria. It’s also a factor in the development of periodontal or gum and bone disease. 

“The smoke impedes the ability of the gum tissue to maintain a healthy state and fight off disease-creating bacteria,” Gross says. “Almost half of the people who are over 60 who wear dentures are smokers.”

Comments are appreciated!

Cary Feuerman, DMD

Periodontal Associates

Source:  WebMD

I came across an interesting article by Laura Landro in the Wall Street Journal.

A sharp rise in a type of throat cancer among men is increasingly being linked to HPV, the sexually transmitted human papillomavirus that can cause cervical cancer in women.  A new study from the National Cancer Institute warns that if recent trends continue, the number of HPV-positive oral cancers among men could rise by nearly 30% by 2020. At that rate, it could surpass that of cervical cancers among women, which are expected to decline as a result of better screening.  The study was recently presented at the annual American Society of Clinical Oncology meeting. 

Between 1988 and 2004, the researchers found, the incidence of HPV-positive oropharynx cancers—those that affect the back of the tongue and tonsil area—increased by 225%. Anil Chaturvedi, a National Cancer Institute investigator who led the research, estimates there were approximately 6,700 cases of HPV-positive oropharynx cancers in 2010, up from 4,000 to 4,500 in 2004, and cases are projected to increase 27% to 8,500 in 2020.

Recent studies show about 25% of mouth and 35% of throat cancers are caused by HPV, according to the Centers for Disease Control and Prevention.

Men account for the majority of cases, and currently the highest prevalence is in men 40 to 55, says Eric Genden, chief of head and neck oncology at Mount Sinai Medical Center in New York. Studies have shown that the cancer can show up 10 years after exposure to HPV, which has become the most common sexually transmitted virus in the U.S.

"We are sitting at the cusp of a pandemic," says Dr. Genden.

Dr. Chaturvedi says more studies are needed to evaluate whether a vaccine now used to prevent HPV for genital warts and genital and anal cancers can prevent oral HPV infections.

The HPV vaccine, Gardasil, made by Merck & Co., was approved in 2006 for girls and young women up to age 26, but while it is routinely recommended, only about 27% of girls have received all three doses needed to confer protection.

The FDA in 2009 approved the vaccine for males ages 9 through 26 to reduce the risk of genital warts, and in 2010 approved it for both sexes for the prevention of anal cancers. However, the CDC has only a "permissive" recommendation for boys, rather than a routine recommendation, meaning doctors generally will only administer it if parents or patients ask for it, says Michael Brady, chairman of the American Academy of Pediatrics infectious disease committee.

Lauri Markowitz, a CDC medical epidemiologist, says the CDC advisory committee that sets vaccine recommendations will review new data related to the issue at a meeting next month. However, at present there aren't any clinical-trial data showing the effectiveness of the vaccine against oral infections, she says.

A Merck spokeswoman says the company has no plans to study the potential of Gardasil to prevent these cancers.

Researchers say it isn't clear why men are at higher risk for HPV-positive oral cancers. But for both men and women a high lifetime number of sex partners is associated with the cancer.

Changes in sexual behaviors that include increased practice of oral sex are associated with the increase, but a 2007 New England Journal of Medicine article also said engagement in casual sex, early age at first intercourse, and infrequent use of condoms each were associated with HPV-positive oropharyngeal cancer. Mouth-to-mouth contact through kissing can't be ruled out as a transmission route.

Most infections don't cause symptoms and go away on their own. But HPV can cause genital warts and warts in the throat, and has been associated with vaginal, vulvar and anal cancers.

Anna Giuliano, chairwoman of the department of cancer epidemiology at the Moffitt Cancer Center in Tampa, Fla., who studies oral HPV infections of men in several countries, says the rise in cancers among men shows it is important for males, as well as girls, to be vaccinated.

Doctors typically don't test for HPV-positive oral cancers. But Jonathan Aviv, director of the voice and swallowing center at New York's ENT and Allergy Associates, says his group looks through a miniature camera inserted through the nose at the back of the throat and tongue, and can biopsy suspicious warts or tumors.

In addition to being asked about symptoms such as hoarseness, difficulty swallowing, a neck mass or mouth sore that won't heal, patients are asked to fill out a risk-assessment sheet that includes the number of lifetime oral-sex partners. "People do get upset sometimes, but if your sexual history puts you at an increased risk for HPV, you should go and see an ear, nose and throat doctor," says Dr. Aviv.

Fortunately, says Mount Sinai's Dr. Genden, those with HPV-positive oral cancers have a disease survival rate of 85% to 90% over five years, higher than those with oral cancers that aren't linked to HPV, but are more commonly linked to alcohol use, tobacco, and radiation exposure.

Source:  WSJ Online

The American obsession with dental hygiene has taken an ironic turn over the past decade. In an attempt to have the bright, white, healthy-looking smile of the stars, many consumers are bleaching their teeth into oblivion.  Dentists call this addiction to whitening "bleachorexia," calling the overbleachers "bleach junkies." Such patients abuse in-office and at home bleaching agents, leaving teeth eroded, prone to sensitivity and extremely unhealthy, despite their pearly white exteriors.

"The media has done a good job of making whitening sound innocuous, but it's not," says Dr. Ira Handschuh, a White Plains, N.Y., dentist. Carbamide peroxide, the whitening agent in most bleaches, can irritate the gums, causing them to recede, making the teeth brittle, chalky and so thin as to be translucent at the edges when the product is overused.

Lyndsey Gurowitz, 28, has been bleaching her teeth for the past decade with a combination of professional bleaching trays tailor made for her teeth, at-home whitening kits and a few sessions at a "bleaching spa."

"Whenever I thought my teeth weren't up to par, I'd do another bleaching. I would use the product for the prescribed amount of time, but then they say to do it only once a month and I would just kind of do it whenever I was unhappy with the color," says Gurowitz, who lives in New York.  "I think it's a level of hygiene. I don't want my teeth to look dirty, or like I don't take care of them. I think I'm being realistic -- I don't want them to look like Chiclets," she says.

After her dentist told her she was losing the enamel on her teeth, she was given a special, more gentle toothbrush and she started using special toothpaste for sensitive teeth, but she continues to bleach regularly. The bleaching trays, designed to fit snugly on her teeth, are now too large, possibly due to the wearing down of her teeth by the bleach, says Dr. Jennifer Jablow, Gurowitz's dentist.  "For some people, their teeth are never white enough, so they'll do anything to brighten," says Jablow, who coined the term "bleachorexic" back in 2005. Ironically, beyond making teeth weak and prone to decay, overbleaching can actually strip away the protective enamel allowing the underbody of the teeth, which is naturally more yellow in color, to show through.

When someone is a bleaching junkie, you can spot it right away, says Dr. Irwin Smigel, founder and current president of the American Society for Dental Aesthetics. "It's not everybody, but we see it often enough that it bothers me. Enamel doesn't grow back. Sometimes we have to put crowns or veneers on when the teeth have become too damaged," he says.

Bleaching in the Time of the Bard

Whitening strips and bleach trays may be an invention of the past 30 years, but techniques for teeth whitening go back centuries. In the 1100s, physicians would recommend scrubbing teeth with elecampane (a yellow flower) or a sage and salt mixture to make "them firm, white and healthy" or "clean, white, and sweet," Trevor Anderson, an osteoarchaeologist, notes in a 2004 paper on medieval dentistry.  Later on, some would use acid washes in an attempt to strip away stains, but unfortunately, these rinses mostly stripped away all the enamel on the teeth, leaving them crumbling, says Dr. Scott Swank, curator of the National Museum of Dentistry in Baltimore.  It wasn't until the advent of Hollywood and Technicolor movies that there was widespread interest in whitening teeth, usually through whitening toothpastes, he says. Enter the 1980s and in-office bleaching treatments, and it only took off from there, Swank says.  "I think it's followed the rise in plastic surgery and other elective cosmetic procedures throughout the 1990s. It's a matter of what people are willing to put their income into."

Bright White or Bust

Today, Americans spend more than a billion dollars a year just on over-the-counter teeth-whitening products, according to the American Academy of Cosmetic Dentistry. While bleaching can be done safely, especially under the guidance of a dentist, the advent of at-home bleaching kits and spa bleaching treatments have made it all too easy for bleaching junkies to double up or triple up on treatments at the expense of their dental health.

"Bleaching is very effective in moderation, and it's safe in moderation," says Dr. Jablow. "It's when you're bleaching all the time, beyond what is recommended -- that's when you run into problems."

Source:  ABC News/Health

Tooth extractions can be defined as the removal of a tooth from its bone socket. The dentist is always trying to save the tooth, but could not be in a situation where a tooth is extracted.

In the early days of the history of many human diseases have been attributed to dental infections. As there were no antibiotics in the days of a tooth extraction was carried out to cure the disease. Different tools were used to extract the tooth at different points in time. The first was invented by Guy de Chauliac in the fourteenth century and was known as the dental pelican. This has been the main tool used to Century 18 in the dental pelican key that replaces a tooth extraction tool. dental key is replaced by modern forceps in the 20th century and is the main tool used today to extract the tooth. Dental extractions are very variable and facilitate different types of extractions from a wide variety of instruments are used.

Reasons for Tooth Extraction

Generally, when a tooth or tooth loss caused by damage to tooth decay dentist trying to fix a tooth by different means-such as the filling, crown repair, etc. However, there are times when a tooth is damaged, so it can not be repaired, and in these circumstances has no choice as distinguished from a tooth. This is the most common cause of tooth extraction. Also, many diseases and medications require the extraction of a tooth, because it weakens the immune system and cause infection of the tooth. These are - anti-cancer agents, tooth decay, gum disease, teeth, in addition, a broken tooth, organ transplantation, orthodontic treatment, radiotherapy, and wisdom teeth.

Types of Extraction

There are two types of tooth extractions - simple and surgical.

simple extractions * - these are performed on teeth that are visible from outside the mouth and can be easily done by general dentists. The dentist gives him an injection of local anesthetic before removing the tooth.

• Surgical Extractions - these are performed on teeth that are not easily accessible, which could occur if the teeth are broken under the gum line or partially erupted teeth. In such cases, the surgeon must cut and remove gum and providing access to remove a piece of bone or tooth. surgical extractions require oral surgeon specialist.

Prefetching considerations

Before tooth extraction dental surgeon or dentist about your medical and dental x-rays can also make the affected area. He may also prescribe antibiotics if you have an infected tooth, a weak immune system or medical problems.

After removal considerations

• For simple extractions to your dentist can prescribe anti-inflammatory drugs like ibuprofen without prescription.

• For surgical extractions, your dentist can prescribe pain medication for a few days to see NSAIDs.

• * Once the tooth is extracted the dentist bite off a piece of gauze to facilitate clotting and should not disturb this clot in the wound.

• You must use ice packs must be swelling after surgery. Use hot compresses when the jaw is rigid.

• * Most items will disappear in a week or two. rinse with warm salt water can dissolve the stitches. remaining items will be removed by your dentist.

• * Do not smoke or spit after surgery, which could remove the clot away from the tooth and increase blood flow and cause dry socket.

Risk factors

Risk factors due to the extraction of teeth - infection, prolonged bleeding, inflammation, alveolitis, nerve damage, damage to the teeth, incomplete removal, jaw broken, and the hole in the sinuses, sore jaw muscles or joints and numbness in his lower lip.

Pune Dentist gives more details about the reasons for Tooth Extractions and risk factors.

When it comes to tooth whitening, there are many ways for you to whiten your teeth. many teeth whitening products are available on the market, such as teeth whitening strips, whitening gel, whitening and bleaching, a dentist with a toothbrush and the recipes at home for whitening teeth. You can always take the help of the general dentist teeth bleaching.

A simple and easy way to whiten teeth is to brush 2-3 times daily. This will undoubtedly enhance the color of your teeth. If you want to go perfect teeth whitening product or procedure put in place, be sure to follow the advice of others or dentists. Most of the population in general, depends on two factors in the choice of tooth whitening products. These two factors are the specifications and budget. An affordable way of teeth bleaching treatment at home, sometimes even provides immediate results.

When it comes to a whitening treatment at home, you should know that this treatment can be done more damage to teeth, in the long term. Often ruin the enamel of the teeth at the same time due to the hypersensitive. Therefore, it is always advisable to speak or consult your dentist before using any whitening treatment at home, such as bleach. In general, whitening strips or contain peroxide, which does not remove the stains of oxidation of it. Teeth Bleeching products contain peroxide generally show immediate results, which demonstrate the cause sensitivity to teeth. It & is so important that you can find teeth whitening product that is right concentration of peroxide, so that no damage to teeth.

One way to whiten teeth is with the help of a dentist. Process of whitening teeth dentist usually involves two steps. First, you will have a treatment in practice and is treated at home. The process in practice of tooth whitening at the dentist begins the examination of the condition of the teeth. Later, the protective materials are placed on the upper lip and gum for the chlorine will not hurt them. After applying the bleaching solution, which is activated by laser light to accelerate the process. This usually takes an hour to see positive results.

Another way to whiten teeth with a dentist whitening kits. In the latter case, the dentist may recommend a bleach solution and on the whole with the appropriate instructions on what to do. In general, the tank should be taken by the patient's teeth so that once applied the gel and put on the shelf, it fits perfectly. This method of Teeth Bleaching will work in 2-3 weeks. Pune Dentist can give you a more better information.

After Tooth Extractions, it is important to form blood clots to stop bleeding and start the healing process. Therefore, your dentist will ask you to bite a piece of gauze for 30 to 45 minutes after extraction. If bleeding or oozing continues after you remove the gauze bandage, gauze, place an area and bite firmly for another 30 minutes. You may need to do this several times.

After the blood clot forms, it is important to protect, in particular for the next 24 hours. It is important not to:

o smoke and chew tobacco

o drinking alcohol

o suck through a straw

o rinse your mouth vigorously

o clean the teeth next to the extraction site

These activities will reap the clot and delay healing.

Limit yourself to calm activities for the first 24 hours. This keeps your blood pressure, reduces bleeding and helps the healing process.

After the tooth is extracted you may feel some pain and swelling. You can use an ice pack (20 minutes, 20 minutes off) to keep this to a minimum. The inflammation usually begins to decline after 48 hours.

To control discomfort, take pain medication as recommended. Do not take medication on an empty stomach or nausea may cause. If antibiotics are prescribed, continue to take for the prescribed time, even if all the signs and symptoms of infection have disappeared. In addition:

o Drink lots of fluids.

o Eat only soft, nutritious foods on the day of the extraction.

o Don't use alcoholic beverages.

o Avoid hot and spicy foods.

You can begin eating normally the next day, or if not before then, as soon as it is comfortable. Rinse your mouth with warm salt water three times a day (put a teaspoon of salt in one cup of warm water, then rinse gently swish and spit). Also, rinse gently after meals. This will keep the food off site.

It is very important to continue with normal dental routine after 24 hours. This should include brushing your teeth and tongue and flossing at least once a day. This will accelerate the healing process and helps keep your breath fresh and mouth. Call the dental office immediately if you have heavy bleeding, severe pain, continued swelling after two or three days, or reactions to medications. After a few days, you will feel good and can continue to function normally.

Dry socket is an infection in your socket after a tooth is extracted. The disease usually develops when a blood clot does not fit, or if the clot breaks off. It is occurs in about 5 percent of all Tooth Extractions.

Normally, promoting blood clot that forms after a tooth is removed from healing, on the basis of new bone growth. When dry socket occurs, the clot of blood lost and the infected, inflamed socket appears empty - hence the name. Nerves are exposed, and sometimes the bone is visible in the empty pedestal.

You may not have symptoms until 3-5 days after extraction. Then, the disease is manifested by pain persists, often accompanied by what looks like an earache. You may also have an unpleasant taste in the mouth and bad breath. Call your dentist immediately if you notice any symptoms of dry socket. Treatment of dry socket typically includes a gentle rinse of making and dressing to take sedatives.

Pune Dentist can give you more better information.

There are so many kinds of products for teeth whitening and systems available on the market today. A person can have various possibilities how he can turn to teeth whitening. He may choose to go to the dental clinic to get various types of courses procedures.Of teeth whitening, we would have to pay a portion of the money for it. A person who desires to have nicer teeth can also choose to use home tooth whitening products and systems. Now, whatever the approach of a person intends to use is an advantage that he knows not proved more effective tips to whiten your teeth at home and avoid new stains and darker .

A person who wants to get whiter teeth is to know more about the concept of teeth whitening and tooth colored. Before the success of bleach or whiten your teeth, it is important that you learn first in a number of factors that lead to tooth staining and color. Some factors influencing this are the person's age, diet, genetics, smoking, alcohol and personal dental hygiene. When a person is in use the teeth whitening system, you stick a good plan until the desired color of the teeth is satisfied.

The first piece of advice essential for achieving whiter teeth are starting to avoid foods and drinks can cause tooth discoloration. We can use all the teeth whitening products out there, but if you do not know how to prevent dental coloring products, then he just looked over future costs with respect to whiten teeth. Some of the biggest causes of tooth discoloration and stains are the nicotine from cigarettes, cola drinks, coffee and tea. It would be better than smoking and drinking dark beverages are arrested. If these things can not be avoided, then the individual must learn to rinse your mouth after every time you drink or smoke colored drinks.

It is also essential that you know that teeth whitening natural elements that can be found at home. For example, if you have strawberries at home, can crush some pieces in place, rub on your teeth and rinse your mouth thoroughly afterwards. strawberry puree or crushed, when rubbed on the surface of the teeth, the teeth can have instant effects of money laundering. Sodium bicarbonate can also be used as the washing of the powerful capabilities. Can be used with pure water or combined with a few drops of lemon juice and salt. Once you create the mixture, the mixture should be rubbed on the teeth and then you get a fresh product instantly without bleaching.

Another important element that can help a person to have whiter teeth is water. Tap water can do a lot for someone who wants whiter teeth one at a time, to prevent staining of teeth. It is important to drink plenty of water, not only after every meal, but also after each meal. If you smoke, be sure to rinse your mouth with water after each smoking session. It is not only help food particles from the mouth, but you can also rinse your mouth colored liquid. With these tips, you can have whiter teeth without buying expensive teeth whitening products.

Are you looking for more information regarding teeth whitening? Visit Teeth Bleaching today!