Autumn Update

Dear all followers of Kai Dentistry! It’s been a long while since I last blogged, so here is a recap of what I have been up to for the past few months.

Final year has begun

It all comes down to this. After all the blood and sweat of the previous 4 years, the final hurdle is finally here.

This year we work mainly in the Total Patient Care (TPC) clinic. It combines the practice of restorative dentistry, endodontics, periodontics and prosthodontics under one roof. Before this we used to go to separate clinics to carry out different kinds of treatment. For example, we used to go to the periodontal clinic for gum treatment and prosthodontic clinic for denture treatment. Now that we have a combined clinic, it feels more like an actual dental practice. We have to think more clearly of treatment plans in handling complex treatment cases.

Summer research project

As you may know, I didn’t go back to Malaysia for my summer holidays. Instead, I spent the whole summer working on a summer research project with the university.

The topic of the project was “quality of root canal treatments undertaken by undergraduate students”. It’s a retrospective study looking at X-rays of completed root canal treatments done by students in the school of dentistry, and grading them according to strict criteria. I’ll not divulge into the results of the findings, because it is unpublished research data I’m not allowed to share. The image above shows me posing during the early stage of the research, where I was collecting patient data from the patient records.

Of course, I wasn’t alone. I was working with my research partner Omid, who was a ball of fun (and noise!).

 

And this is how the majority of the research was carried out. We were mainly working on clinic in the school of dentistry, looking at digital X-rays and patient notes, and inputting all the data into a Microsoft Excel sheet.

Root canal selfie!

For the last few weeks of the research, we were writing a paper on the research findings. It hasn’t yet been finalised as we need to consult with consultants over some minor details. Hopefully something good will come out of it!

Your Toothache Could Kill You! Here’s How

Not many people out there relate dentistry to anything lethal. I’m here to convince you that a dental infection could actually lead to your demise – and that you need to keep your teeth clean to stop that from actually happening!

As explained in an earlier post about tooth decay, a decay that persists and spreads into the tooth nerve (pulp) will eventually result in an irreversible infection of the pulp. This is called an irreversible pulpitis (-itis means inflammation) and results in a “dead tooth” and will require either root canal treatment or a surgical extraction.

But why though? Why treat it or remove it when it’s already dead? If the nerve is dead, so that means there should be no pain sensation, right? Just leave it be!

WRONG! This will kill you!

LUDWIG’S ANGINA

Ludwig’s angina is the result of a dental infection that goes untreated/unextracted. Ludwig is the name of the German doctor who first described this disease. Angina stems from the Greek word ankhon which refers to the feeling of being strangled.

Whoa! That escalated quickly. From a mere toothache to being strangled? Here’s how it works:

1. A dental infection causes pus formation in the pulp and the area surrounding the roots. Pus is a collection of dead white blood cells and bacterial cells after a drawn-out battle. Think of pus as the body count after a war. This pus collected inside your tooth causes toothache – and this is the part where you NEED to seek help from a dentist to prevent it from getting any worse.

Image source

Look at the left side of the above diagram. Looks terrible, yes? Abscess is the collection of pus.

2. The infection remains active, bacteria multiply and further destroy your tissues surrounding the tooth. From the pulp, the infection spreads to other parts of your face and neck.

3. As the region around your mouth and face are so widely interconnected, the infection spreads rapidly from the tooth to the muscle, fat, blood vessels and soft tissues. Pus formation and inflammation causes your neck and face to swell up.

4. If the infected tooth is an upper tooth, Ludwig’s angina is highly unlikely. However the spreading infection will affect your sinuses and your nose. However, infection spreading from a lower tooth may result in Ludwig’s angina and will proceed to kill you if left untreated! This spreading infection will cause swelling of the tissues around your airway – constricting it and causing the “strangling” effect described by angina.

5. The constricted airway obstructs your breathing. And you’re dead.

NOT ALL DOOM AND GLOOM

By today’s standard of medicine (in the developed world), we can save lives much more easily. Antibiotics such as penicillin be used to stop the infection spreading and kill the bacteria. If hospitalised, the doctors can insert a tube down your throat to keep the airway open so that you can continue breathing. The culprit tooth causing all the damage must be extracted. Incisions must be made to drain the pus out of your face – and the swelling will diminish after some time.

Prior to the introduction of antibiotics, mortality (death) rates of Ludwig’s angina was more than 50%. [1] I suppose it was thought of as an incurable disease. As of 2010, the mortality rate is around 5%. [2] Yay to the advancement of science!

Remember to keep your teeth clean, people!

 

References

[1] Evidence-Based Diagnosis and Management of ENT Emergencies

[2] Newlands C, Kerawala C (2010). Oral and maxillofacial surgery. Oxford: Oxford University Press. pp. 374–375. ISBN 9780199204830.

I am ROOT!

This post is about root canal treatment. Read on to find out about what’s it all about!

So one of the new skills we learned in third year was this: endodontics, which is basically root canal treatment. Surprisingly I enjoyed this subject even though the content was rather dry, and I attribute my interest in the subject to the dental school staff who did a marvellous job in teaching. Okay, time to get to the root of it (pun intended).

Below is a picture of a plastic incisor (front tooth) block with a single root dyed red in colour. Our job in root canal treatment is to, under local anaesthesia of course, cut open a hole in the tooth to gain access, in which the primary goal is to get the red stuff (simulated tooth nerve) out of the block. Following that, we have to fill it up with a suitable filling material and then do a temporary filling to seal the access hole.

The work involved in root canal is extremely long-winded and repetitive. I’ve personally heard complaints from fellow peers who were struggling to go through all the steps to finish a root canal. I’m not gonna mention it all here, but if you’ve ever had root canal done on you, you’d surely know how tedious and intricate the process is. In short, it’s all about placing endodontic files (little needle-like sticks) into the canals, do multiple in-out-in-out movements, and rinse and repeat.

Filling up the root canal is a bit trickier. This step is called obturation – where we use a rubber stick called Gutta Percha, coat it with a sealer material called Tubliseal, and place it into the canal. A hot instrument is then used to slice off the top of the Gutta Percha stick. Another temporary filling material is then used to close up the access hole and voila! The first stage of root canal treatment is done.

Root canal treatment is done when there is an irreversible infection of the pulp (tooth nerve) i.e. the nerve cannot recover back to its normal function. The nerve needs to be taken out of the tooth so that it does not give the patient any pain, and removes the risk of a spreading infection. The alternative is to extract the tooth. Note that root canal does not guarantee a 100% success rate, I’ve seen cases where the infection still persists even after root canal.

Root canal treatment is not for everyone. Some older patients who may not care so much for the looks of their teeth may wish infected teeth to be extracted instead – which they then proceed to get dentures done. Some patients feel that the molar teeth at the back may not be worth doing root canal on, and because it does not affect their looks, might also want them extracted.

Fun fact! The tooth nerve (pulp) carries only pain receptors. Its evolutionary function is to stop people from biting/grinding hard things like rocks. Removing the nerve from the tooth does not cause any nervous system damage. The tactile sensation of the tooth remains and your tooth will still function properly after root canal.

This is just a simple explanation of the story of root canal treatment. There is a lot of detail covered in the lectures and practice sessions in our course. Drop a comment or email me if you have any burning questions regarding root canal treatments!