Himachal Dental

Treatment Of Sleep Apnea

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. The blockage may cause shallow breathing or breathing pauses.When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea happens more often in people who are overweight, but it can affect anyone.

Untreated sleep apnea can:

* Increase the risk for high blood pressure, heart attack, stroke, obesity, and diabetes
* Increase the risk for or worsen heart failure
* Make irregular heartbeats more likely
* Increase the chance of having work-related or driving accidents

Major Signs and Symptoms

One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.The snoring usually is loudest when you sleep on your back

Others signs and symptoms of sleep apnea may include:

* Morning headaches
* Memory or learning problems and not being able to concentrate
* Feeling irritable, depressed, or having mood swings or personality changes
* Urination at night
* A dry throat when you wake up

Treatment Of Sleep Apnea

* Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
* Lose weight if you’re overweight or obese. Even a little weight loss can improve your symptoms.
* Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
* Keep your nasal passages open at night with nose sprays or allergy medicines, if needed. Talk to your doctor about whether these treatments might help you.
* Stop smoking.
* A mouthpiece, sometimes called an oral appliance
* Breathing Devices-Continuous positive airway pressure (CPAP)
* Surgery

Sleep apnea often goes undiagnosed. Doctors usually can’t detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don’t know they have it because it only occurs during sleep.Lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people. Treatment can improve your overall health and happiness as well as your quality of sleep.Consult your doctor today for more information.

Dental Implants – Excellent Tooth Replacement Option

One of the most exciting advancements in cosmetic dentistry in the past decade has been the introduction of dental implants. Dental implants are an excellent aesthetic option for the replacement of missing or lost teeth. This mode of treatment is indeed more expensive than a conventional denture, but if sufficient bone is present into which the implant can be placed, then dental implants are often the most ideal way to fill a space left by the loss of a tooth/teeth.

In the past, when you lost a tooth you would only be able to have a denture or bridge fitted. Luckily, with the developments in modern dentistry and with the use of dental implants, you can now have stronger, fully restored teeth that look and feel completely natural.Our dental implants are titanium, screw shaped attachments which are used as an artificial substitute for the root of your natural tooth. The titanium implant is inserted into the jaw and left to integrate with your bone.This titanium dental implant can be placed immediately after removing a tooth that has been electively extracted. This method often means less swelling and can minimize post operative sensitivity. In the event that a space/gap is being filled years after a tooth has been lost then this titanium rod acts as a substitute tooth root.

There are two stages to dental implants. At first the dental implant post is placed into the jaw by a specialist implant dentist (Periodontist or Oral Surgeon). When the jaw has healed over and the sutures have been removed, then it is possible to attach the man made dental crowns to the implant. These replacement teeth are attached to the dental implant, and are positioned just above the gum like real teeth which gives a beautiful aesthetic natural appearance. Not all patients are suitable for implants. A consultation with a DermaDental dentist along with specialist x-rays will determine a patient’s suitability for dental implants.

A dental implant affords the new man made tooth the much needed strength to remain in-situ within the mouth, for a very long time. Dental implants allow patients to live a completely normal life with absolutely no need to worry about dentures falling out of the mouth during eating or talking. Dental implants can also be successfully placed in order to support fixed bridges or dentures, ensuring a very stable result with minimal risk of movement during normal daily function.

Dental implants are as close to real teeth as are available. Because the root of the implant is secured to the jawbone like a real tooth, it acts and feels like a real tooth. If you have a missing tooth or are looking to replace an earlier dental substitute, make an appointment to see a dentist.For more information call Goma Dental at 177-645-0704.

Republic Day Wishes

Posted in Uncategorized by UK Dental Tourism on January 26, 2010

Salutations To The World’s Largest Democracy..

Lichen Planus – Chronic Inflammatory Disease

Lichen planus is a chronic mucocutaneous disease that affects the skin and the oral mucosa, and presents itself in the form of papules, lesions or rashes. Lichen planus doesn’t involve lichens; the name refers to the appearance of affected skin.The name of condition was provided by British physician Erasmus Wilson ,who first described it in 1869.Lichens are the primitive plants composed of symbiotic algae and fungi.The term planus is latin for flat.Even though the term lichen planus suggests a flat ,fungal condition ,current evidence indicates that this is an immunologically mediated mucocutaneous disorder.

The cause of lichen planus is not known. It is not contagious and does not involve any known pathogen. Some lichen planus-type rashes (known as lichenoid reactions) occur as allergic reactions to medications for high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-versus-host disease of the skin. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease. Lichen planus affects women more than men (at a ratio of 3:2), and occurs most often in middle-aged adults. Lichen planus in children is rare. In unpublished clinical observation, lichen planus appears to be associated with hypothyroidism in 3 young females.Allergic reactions to amalgam fillings may contribute to the oral lesions very similar to lichen planus, and a systematic review found that many of the lesions resolved after the fillings were replaced.


The typical rash of lichen planus is well-described by the “4 P’s”: well-defined pruritic, planar, purple, polygonal papules. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur. The presence of cutaneous lesions is not constant and may wax and wane over time. Oral lesions tend to last far longer than cutaneous lichen planus lesions.

Oral lichen planus (OLP) may present in one of three forms.

* The reticular form is the most common presentation and manifests as white lacy streaks on the mucosa (known as Wickham’s striae) or as smaller papules (small raised area). The lesions tend to be bilateral and are asymptomatic. The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips.
* The bullous form presents as fluid-filled vesicles which project from the surface.
* The erosive form presents with erythematous (red) areas that are ulcerated and uncomfortable. The erosion of the thin epithelium may occur in multiple areas of the mouth, or in one area, such as the gums, where they resemble desquamative gingivitis. Wickham’s striae may also be seen near these ulcerated areas. This form may undergo malignant transformation.

The microscopic appearance of lichen planus is pathognomonic for the condition

* Hyperparakeratosis with thickening of the granular cell layer
* Development of a “saw-tooth” appearance of the rete pegs
* Degeneration of the basal cell layer
* Infiltration of inflammatory cells into the subepithelial layer of connective tissue

Oral Lichen Planus Typical Featutes

* Females account for atr 65% of patients
* Patients usually over 40 years
* Untreated disease persists for 10 or more years
* Lesions in combination or isolation comprise Striae,Atropic areas and Erosion Plaques
* Common Sites are buccal mucosa,Dorsum of tongue and Gingiva
* Lesions usually occur bilaterally ansd symmetrically
* Cutaneous lesion only ocassionlly associates .
* Usually good responce to corticosteroids

Lichen planus may also affect the genital mucosa – vulvovaginal-gingival lichen planus. It can resemble other skin conditions such as atopic dermatitis and psoriasis.Rarely, lichen planus shows esophageal involvement, where it can present with erosive esophagitis and stricturing. It has also been hypothesized that it is a precursor to squamous cell carcinoma of the esophagus.


Care of OLP is within the scope of Oral medicine speciality. Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

Some Drugs Capable Of causing Lichenoid Reactions
* Colloidal Gold
* Beta-Blockers
* Oral Hypoglycemics
* Allopurinol
* Non steroidal anti inflammatory drugs
* Anti malarials
* Methyl Dopa
* Penicillamine
* Some tricyclic anti depressants
* Thiazide diuretics
* Captopril

Features suggesting a lichenoid reactions
* Onset associated with starting drug
* Unusual severity
* Unilateral lesions or unusual distributions
* Widespread skin lesions
* Localised lesion in contact with restoration
* Lichenoid reaction are treated in same way as lichen planus with withdrawl of dtrugs if possible

Medicines used to treat lichen planus include:

* Oral and topical steroids.
* Oral retinoids
* immunosuppressant medications
* hydroxychloroquine
* tacrolimus
* dapsone
* Aloe vera

Non-drug treatments:

* UVB NarrowBand Phototherapy

Management Of Oral LP

Patients are sometimes concerned that lichen planus is infectious and should be reassured that tis is not so.Although oral lichen planus cannot be cured completely ,some drugs can provide symtomatic relief and satisfactory control.Corticosteroids are single most useful group of drugs in the management of lichen planus.The rationale of their use is their ability to modulate inflammation and the immune responce.Corticosteroids such as Beclomethasone from aerosol inhalers used for asthma can be used effectively -approx six puffs from inhaler is enough for the lesion.Triamcinole applied to the lesion is an alternative form of the treatment.Gingival lichen planus is most difficult to treat.It is essential to maintain rigourous oral hygiene .In erosive LP ,one of the stronger topical corticosteroids like Fluticasone nasal spray ,Fluocinolone,Betamathasone,Clobetasol gel applied several times per day to the most symtomatic areas is usually sufficient to induce healing within 1-2 months.The patient should be warned that he condition will undoubtedly flare up again in which case the corticosteroids should be reapplied.In addition the possibility of iatrogenic candidiasis associated with corticosteroids use should be monitored .Nystatin or Amphotericin-B suspension /Miconazole can be given in conjugation with the above.

* Always check for drugs like NSAIDS which might cause a lichenoid reaction
* Tobacco an alcohol need to be dicontinued
* Allergens need to be eliminated eg change of diet
* Infections associed with Oral Lp need to be terated eg Thrush,Hep C
* Sharp teeth and broken restorations taht cause trauma should be repaired
* Stress management ca be opted

In some cases where topical therapy fails systemic corticosteroids are effective.Antioxidants OD for Six months help improve condition.In exceptionally unresponsive cases ,tacrolimus/pimecrolimus moth rinses may be effective which must be given under strict medical supervision.Immunoregulators like levamisol have found to improve the condition of patient chronically on corticosteroids.

Ankylos Implant System In Shimla

The Ankylos system was developed in 1985 and has been in clinical use since 1987. Some of its significant design features include (1) a progressive thread structure of the endosseous implant body for targeted load distribution to the apically positioned spongy bone; and (2) the gap-free subgingival tapered connection to the abutments.Ankylos Implant System meets both the patients’ and the dentists’ standards of success and is suitable for use as single tooth replacements, bridge abutments, and retention elements for all regions and prosthetic indications.The implants were considered successful if the following criteria were met:

* clinical stability and function;
* no inflammation of the peri-implant hard and soft tissue;
* no progressive loss of the peri-implant bone;
* no progressive loss of the peri-implant mucosa;
* satisfaction of the patient.

The Ankylos implants are made of biologically neutral pure titanium. As the human body tolerates it, the possibility of rejection is excluded thanks to the characteristics of the material. In order to keep them touch proof, the implants are packed in sterile glass: the supporting screw is put inside the superstructure and can only be removed right before the insertion of the implant. The rough surface of the implants enhances the perfect fit and healing of the “new root”. The special shape of ankylos implants ensures ideal fixing directly after the placement of the implant and protects the jawbone during mastication since the implant perfectly adjusts to its physiological characteristics. Four year clinical experience shows that thanks to the special form of the ankylos implant screw, the introduction of the occlusal force is carried out without overloading the bone substance. The ankylos implants are available in four different diameters and length that provide a solution for all implant problems.
The advantages of the Ankylos:

* high level of security
* long term aesthetic stability
* cemented replacements
* it ensures an optimal condition for immediate load
* minimal risk of infections
* low risk of the loss of the amount of bone
* short therapy time
* high quality and affordable

Dental implants are as close to real teeth as are available. Because the root of the implant is secured to the jawbone like a real tooth, it acts and feels like a real tooth. If you have a missing tooth or are looking to replace an earlier dental substitute, make an appointment to see a Implant dentist at Goma Dental or Call 177-645-0704.

Dental Implants – New Solution For Missing Teeth

Despite advances in dental care and a greater awareness of dental problems such as tooth decay and gum disease, millions of people lose teeth each year due to decay or head trauma. In the past, patients wishing to replace a missing tooth had a choice between a partial denture or a dental bridge. These were, at best, only satisfactory substitutes for real teeth and always involved a significant adjustment of lifestyle for the patient. Certain foods became off limits because of the dangers of breaking parts of the prosthetic and patients were frequently worried about the embarrassment of dentures falling out at inopportune moments. All of that changed with the introduction of the dental implant.

A dental implant is a relatively new solution to missing teeth that involves drilling a small screw into the jawbone itself to act as an anchor for an artificial tooth. Because the implant is attached to the jawbone, it creates a similar feeling of stability to a real tooth, which is secured by a root.This procedure according to the experts is ideal for one or more individual teeth that have been knocked out, putting an implant in also improves the chances of not getting jaw bone decay due to a missing tooth. A damaged tooth such as a discoloured, chipped or misshaped one is a good candidate for being replaced by an implant.

The implant is usually made from titanium or other lightweight but strong metal. Once placed into the jaw at the initial appointment it is left for several weeks or months to fuse with the bone and tissue in a process called osseointegration.  When the implant has fully fused, the dentist will replace the temporary crown with a permanent one and it will look and feel exactly like a real tooth. Solid, comfortable and able to endure any food that you care to eat, a dental implant really is the closet thing to a real tooth and can put an end to any anxieties experienced with other dental substitutes. Dental implants are as close to real teeth as are available. Because the root of the implant is secured to the jawbone like a real tooth, it acts and feels like a real tooth. If you have a missing tooth or are looking to replace an earlier dental substitute, make an appointment to see a dentist.For more information call Goma Dental At 177-645-0704.

Tips To Overcome Dental Phobia

Over 90 per cent of patients admit to having some kind of fear of the dentist. There is something about the iconic image of the dentist and the drill that causes real fear in people. The reality today of course is slightly different. With the advances in dental technology over the last twenty years, dental surgeries are more like health spas than hospitals and many treatments are now relatively painless.

This is little consolation to many patients who still have a very real fear of the dentist. Many of their fears are rooted deep in previous traumatic experiences at the dentist, often during childhood. For most patients, it is possible to overcome the fear because they realise the health of their teeth is more important than the fear. This kind of fear is commonly known as dental anxiety. However. for a small number of patients the fear is too great to even contemplate a visit to the dentist. This more severe aversion is known as a dental phobia.

Dental phobics are unable to rationalise the need for dental treatment against their fear. The irony of this is of course that by prolonging dental treatment they often end up needing the very treatment they fear the most. If they had visited the dentist in the first place they may have been able to avoid future dental problems. This then is the aim of treating dental phobias. Dentists are specially trained to deal with anxious patients and many find that just talking through their fears with the dentist is enough to allay them. There is also the option to use self-hypnosis techniques which can help patients overcome their fear by putting them into a trance like state.

Recent studies have also find that by using aromatherapy patients are able to reduce their levels of anxiety. Lavender oil was found to be especially useful in reducing anxiety in patients before treatment.Today, many nervous patients make use of sedatives, anaesthesia, and nitrous oxide to help reduce the stress associated with oral surgeries, extractions, and fillings. That said, before you can have these medications, you will need to let your dentist know about any medications that you are already taking. You will also need to provide a list of all medical conditions.

In coming to terms with any phobia the first and most important step is to confront it. Just by talking with a dentist you may realise that there is actually little to fear. Remember, the dentist is trained to help you deal with our anxieties and is in your interest to have your teeth seen to before any problems have time to develop.

CEREC technology revolutionises dental restorations

Posted in Cosmetic Dentistry by UK Dental Tourism on January 20, 2010
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CEREC is a state-of-the-art dental restoration product that has allowed dentists to use computer-aided technology to produce ceramic inlays and crowns. Utilising new technologies such as 3D imaging, digital x-rays and CAD/CAM, CEREC has allowed teeth restorations to be carried out in only a single visit to a dentist rather than taking several appointments.

CEREC works by creating a digital three-dimensional image of the patient’s mouth that can be stored on a computer. This image can then be used to design a computer-generated approximation of the ceramic tooth or inlay. When satisfied with the approximation, the dentist can sculpt the restoration from a single piece of porcelain using a diamond head cutter under computer control.

This new technology has several distinct advantages. First and foremost is the time and effort saved by both patient and dentist as fewer appointments and less manufacturing is needed to fit the restoration. CEREC technology also limits the need for enamel removal because of the increased degrees of accuracy involved using computer-guided technology. Also, because the crown or inlay can be milled from a single piece of porcelain it preserves a greater degree of strength than layered or pressed ceramics.The ability to store any design and manufacturing information on a computer means that any subsequent alterations or replacements can be easily manufactured without further imaging.

Teeth Whitening For Shining Smile

Our teeth lose their colour because of staining from food and drink we ingest. This happens to some people more than others and also depends on lifestyle choices we make. Certain liquids like red wine and coffee can stain teeth, and using any form of tobacco product can also result in widespread yellowing of the teeth, as well as leaving isolated brown stains.

Teeth whitening procedures involve using bleaching gels to break down stains to make the teeth appear whiter. This is a relatively simple and common cosmetic procedure that most dentists will practice in-surgery. Some dentists may offer pre-prepared take home treatments in trays that patients can wear for longer.

The bleaching ingredient in the gel is called hydrogen peroxide. The strength of the peroxide in the gel varies from three per cent to thirty per cent depending on the severity of discolouration. Take home kits are often lower strength as high strength gels can cause damage to the soft tissue, like gums and lips. It is always wise to consult a dentist before using any whitening products as certain products available for purchase from the internet can be too strong to use without professional safety equipment. Dentists will often use stronger gels when performing the whitening themselves as they have the necessary safety equipment and training.

The procedure, if carried out by a dentist, is perfectly safe but some patients do complain of suffering pain in the teeth after the treatment. This is usually similar to the pain experienced by sensitive teeth and usually fades after a few days.

Teeth whitening can have different effects on different patients. Some find that their teeth are whitened after just one session whereas other patients can have several treatments before there is any noticeable alteration. A  dentist can talk you through the various whitening treatments available at your next six-monthly appointment.

Extranodal Non Hodgkin Lymphoma

Posted in Oral Surgery by UK Dental Tourism on January 14, 2010

Non-Hodgkin lymphoma (NHL) is uncommon. It is the second most common group of malignancies, behind only squamous cell carcinoma.It accounts for 3.5% of intraoral malignancies but rarely arises on gingiva.Most of these are high grade diffuse large B -Cell lymphomas. Diagnosis of an NHL of the oralcavity is often diifficult bacause it may resemble other conditions such as dental abcesses or can mimic other pathological conditions  eg. fibroma ,periodontal disease.

The radigraphic aspect of NHL is also not chracteristic. Frequently,NHL presents as a local ,painless swelling without ulceration andaccompnied by pain or discomfort in the throat .These local symtoms can also be associated with systemic symtoms called  B -Symtoms.Lymphoma should be considered in he presence of a gingival swelling accompnied by tooth mobility, ulceration and unexplained dental pain or numbness.Histologic and immunophenotypic studies are therefore important in establshing the diagnosis.Most patiets with NHL of the head and neck have , at presentation , a stage 1 or 2 high grade diffuse large B-Cell Lymphoma.

According to Ann Arbor Staging Classification , the lymphomas can be classified as :

The principal stage is determined by location of the tumor:

* Stage I indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.
* Stage II indicates that the cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm – that is, both are above the diaphragm, or both are below the diaphragm.
* Stage III indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.
* Stage IV indicates diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

Modifiers.These letters can be appended to some stages:

* A or B: the absence of constitutional (B-type) symptoms is denoted by adding an “A” to the stage; the presence is denoted by adding a “B” to the stage.
* E: is used if the disease is “extranodal” (not in the lymph nodes) or has spread from lymph nodes to adjacent tissue.
* X: is used if the largest deposit is >10 cm large (“bulky disease”), or whether the mediastinum is wider than 1/3 of the chest on a chest X-ray.
* S: is used if the disease has spread to the spleen.

Type of staging

The nature of the staging is (occasionally) expressed with:

* CS – clinical stage as obtained by doctor’s examinations and tests.
* PS – pathological stage as obtained by exploratory laparotomy (surgery performed through an abdominal incision) with splenectomy (surgical removal of the spleen). Note: exploratory laparotomy has fallen out of favor for lymphoma staging.

Treatment of  extranodal NHL includes surgical excision followed by chemotherapy sometimes with associateds radiotherapy.Primary NHL of gingiva can mimic other lesions.It is therefore necessary to perform a histologic examination in cases where signs and symtoms persist,despite treatment . An yearly biopsy will provide an approprite diagnosis and avoid disease progression ,thus improving the pronosis.

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