How to get rid of Toothache ?

Toothache is a lifetime experience for someone who has experienced the pain of acute pulpitis. Be it sharp, acute, transient pain for seconds or some dull aching, continuous vauge pain in the facial region, tooth pain is really intolerable to ignore. Getting rid of the toothache is the only  thing the sufferer thinks of at the time because, foods look painful, all parties are meaningless if you cannot eat anything, even water !

The type of pain you have is very important to know the condition you might be suffering with. For example, continuous pain that lasts for minutes to hours even after removal of an offending stimulus ( cold, heat, air or some acidic foods) or spontaneous pain without any stimulus often represents irreversible pulpitis, which mandates that you should have a root canal treatment rather than a simple tooth filling. The tooth may seem perfectly fine from outside but there may be a large decay between two teeth which can be seen only on radiographs. Or, your teeth may be without any decay but the pain may be from some periodontal problems (problems arising from gums and other supporting structures of tooth)  The decision of treatment plan whether you should get a root canal treatment or a simple restoration will be okay must be done by your dentist after listening to your history of illness, clinical examination and radiographic evaluation. There's no point asking a dentist over the phone about whether you need an RCT or not.

There is no any medication to reverse your tooth decay once a clinically visible cavitated lesion is formed, the only treatment is to remove the caries and then restore it. But for the immediate pain relief, you can avoid the stimulus causing pain. Warm water can be helpful to relieve pain in some tooth sensitivity cases. Lying down or sleeping aggravates the pain in irreversible pulpitis due to increased blood pressure in the pulpal tissues while sleeping or lying down, so, upright positioning provides relief relatively. Avoid taking too cold or too hot foods and acidic foods and beverages like carbonated soda drinks, citric fruits, sweets, ice cream, etc.

 If you cannot tolerate the dental pain, you may take over the counter medications such as Paracetamol 500mg or Ibuprofen 400mg for immediate pain relief. But that does not mean you can defer the dental treatment any further. You do not feel the pain doesn't mean that the underlying problem is cured, the bacteria doesn't die itself. You wouldn't want the disease progress further and come back again larger and stronger which causes more pain, loss of time and loss of money.

A stitch in time saves nine is very much applicable in the field of dentistry.

# MCQ 7 - Which of the following tests for tooth vitality assessment has the highest diagnostic accuracy?

# MCQ 7
# Which of the following tests for tooth vitality assessment has the highest diagnostic accuracy?
A. Electric Pulp Test
B. Heat Test
C. Cold Test
D. Anesthetic Test

Answer: C. Cold Test
The diagnostic accuracy of cold test is 86%, the heat test is 71 % and Electric pulp test is 81%.
So, a combination of cold test followed by Electric Pulp Test (EPT) is recommended in a clinical setting. Anesthetic test is done only in patients who are in pain at the time of the test and other tests have failed to identify the tooth causing pain.

Reference: Grossman's Endodontic Practice, 13th Edition, Page 72

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# MCQ 6 - Maximum use of Computers in the field of Dentistry is in the field of:

# Maximum use of Computers in the field of Dentistry is in the field of:
A. Periodontology
B. Prosthodontics
C. Community Dentistry
D. Operative Dentistry

Answer:
C. Community Dentistry
Other branches of dentistry may optionally use computers, but Community Dentistry uses computers extensively for data analysis, storage, transfer and presentation.

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#MCQ 5 - First Water Fluoridation was done in:

# First Water Fluoridation was done in:

A. Sweden
B. Canada
C. Michigan (USA)
D. California

Answer:
C. Michigan (USA)

To test the hypothesis that adding fluoride would prevent cavities, Dean and his colleagues conducted a controlled experiment by fluoridating the water in Grand Rapids, Michigan, starting 25 January 1945. The results, published in 1950, showed significant reduction of cavities.

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PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS - Oral and Maxillofacial Surgery

According to Contemporary Oral and Maxillofacial Surgery, 6th Edition, the PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS are:

Principle 1: Determine Severity of Infection
Principle 2: Evaluate State of Patient’s Host Defense Mechanisms

Compromised Host Defense States:

Uncontrolled Metabolic Diseases
• Poorly controlled diabetes
• Alcoholism
• Malnutrition
• End-stage renal disease

Immune System–Suppressing Diseases
• Human immunodeficiency virus/acquired immunodeficiency
syndrome
• Lymphomas and leukemias
• Other malignancies
• Congenital and acquired immunologic diseases

Immunosuppressive Therapies
• Cancer chemotherapy
• Corticosteroids
• Organ transplantation

Principle 3: Determine Whether Patient Should Be Treated by General Dentist or Oral-Maxillofacial Surgeon

Criteria for Referral to an Oral-Maxillofacial Surgeon

• Difficulty breathing
• Difficulty swallowing
• Dehydration
• Moderate to severe trismus (interincisal opening less than 20 mm)
• Swelling extending beyond the alveolar process
• Elevated temperature (greater than 101°F)
• Severe malaise and toxic appearance
• Compromised host defenses
• Need for general anesthesia
• Failed prior treatment

Principle 4: Treat Infection Surgically

Principle 5: Support Patient Medically

Principle 6: Choose and Prescribe Appropriate Antibiotic

Guidelines for consideration when choosing a specific antibiotic:

- Determine the need for antibiotic administration.

- Use empirical therapy routinely.

- Use the narrowest-spectrum antibiotic.

- Use the antibiotic with the lowest incidence of toxicity and

side effects.

- Use a bactericidal antibiotic, if possible. 

- Be aware of the cost of antibiotics.

Principle 7: Administer Antibiotic Properly

Principle 8: Evaluate Patient Frequently

Most Common Causes of Some Conditions : Contemporary Oral and Maxillofacial Surgery, 6th Edition, Mosby

Most Common Causes of Some Conditions:

1. The most common cause of adrenal insufficiency is chronic therapeutic corticosteroid administration (secondary adrenal insufficiency).

2. The most common cause of a transient loss of consciousness in the dental office is vasovagal syncope.

3. During normal development, the lower third molar begins in a horizontal angulation, and as the tooth develops and the jaw grows, the angulation changes from horizontal to mesioangular to vertical. Failure of rotation from the mesioangular to the vertical direction is the most common cause of lower third molars becoming impacted.

4. A complication that every dentist believes can never happen—but happens surprisingly often—is extraction of the wrong tooth. This is usually the most common cause of malpractice lawsuits against dentists.

5. The most common cause of delayed wound healing is infection. Infections are a rare complication after routine dental extraction and are primarily seen after oral surgery that involves the reflection of soft tissue flaps and bone removal.

6. The most common cause of treatment failure of odontogenic infections is inadequate surgery. Atooth  may have to be re-evaluated for extraction, or an extension of the infection into an area not detected during the first treatment may have to be incised and drained.

7. The most common cause of Ludwig’s angina is an odontogenic infection.

8. Oral Candidiasis: Candida rarely causes disease unless the patient’s health becomes compromised. The two most common causes of compromise are:
- administration of antibiotics, especially penicillin, for prolonged periods,  and
-  immune system compromise, as occurs with acquired immunodeficiency syndrome (AIDS) or chemotherapy for leukemias and other forms of cancer.

9. One of the most common causes of true mucoceles is surgery on the sinus that results in separation of a portion of the sinus lining from the main portion of the sinus. This area can then become filled with mucus and walled off, forming a separate cystic lesion. These lesions are termed surgical ciliated cysts or postoperative maxillary cysts.

10. The most common causes of temporomandibular disorders (TMDs) are muscular disorders, which are commonly referred to as myofascial pain and dysfunction. These muscular disorders are generally managed with a variety of reversible nonsurgical treatment methods.

11. The most common cause of TMJ ankylosis involves macro-trauma, most frequently associated with condylar fractures. Other causes of ankylosis include previous surgical treatment that resulted in scarring and, in rare cases, infections.

# MCQ 4: Which of the following materials cannot be used as a base under composite restorations?

# Which of the following materials cannot be used as a base under composite restorations?
A. Zinc Phosphate
B. Zinc Polycarboxylate
C. Zinc Oxide Eugenol
D. Glass Ionomer Cement


Answer: C. Zinc Oxide Eugenol.
Reason: Residual free eugenol interferes with the proper setting of resin-based composites or resin cements. Therefore, various types of carboxylic acids have been used to replace eugenol and produce a ZOE-like material. These products are called zinc oxide-non eugenol cements.

Reference: Phillip's Science of Dental Materials, 12th Edition, Page No. 331

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