22 July 2019

拔牙=一劳永逸吗?

病患: ‘ 医生,我牙齿很痛, 我要马上解决他, 把它拔掉吧,一劳永逸“
检查后。。。
医生:’ 拔掉?您确定吗? 其实我们还有方法帮您解决疼痛然后进行治疗就可以延长牙齿可使用的期限。。。。。。”
病患:’ 这么麻烦呀。。还要来几次,又只是延长期限罢了。。把它拔掉一了百了,不会再让我有什么困扰。。“

这种熟悉的情景时不时会在日常诊间重演。。 

很多老年人认为:牙齿掉了就掉了,人都老了,就别折腾了
提醒:这样不仅会让牙齿越掉越快,还容易引发龋齿、口臭、牙周病等口腔疾病。

是老了掉牙还是掉牙而变老呢?

当一颗牙齿拔了后, 并不是一劳永逸的。
如果缺牙没有替代, 除了美观问题还有一些后续持续性问题。 
1) 临近牙齿会倾斜,间接造成食物残渣卡着,然后提高蛀牙的机率
2) 上牙会往下长,变长。 牙龈受伤, 或者照常咬和干扰, 
       间接造成假牙制 作困难度提高
3) 牙龈萎缩,骨头流失, 接着造成制作义齿复杂性和难度提高
4) 惯性一边咀嚼食物照成脸部肌肉不对称

没错,后牙拔除没有美观问题。
可是后牙是支撑我们的咬合高度和咀嚼食物, 如果缺失会影响消化功能也会影响脸型的美观之外。
门牙区域就会做代偿, 那么门牙会更快损坏或断裂,这些是一个恶性循环结果, 得不偿失。

#K 女士是我们的顾客,从家家第一年开业到现在断断续续都会来找我们帮他解决牙齿的问题。 这样子持续了三十年了。

……去年, 他因为门牙牙桥摇晃而在几年后出现在我们的诊间……
经过一连串的资料收集发现原来`她的牙桥有断裂的历史然后又把它接的更长了。

其实是她的后牙长期缺失没装义齿 而照成咬合高度改变, 然后前牙代偿的结果就是牙桥断裂了。 咬合高度改变也会影响肌肉强度。 
咬合高度变短(后牙缺失), 让下脸部跟着变短。 比较秀气瓜子脸渐渐的变成四方脸。 外形改变了。
这不是几个月内发生的, 它是经过几年的变化才会发现的后果。 如果一开始就装上义齿, 那么问题不就会这么严重。


治疗前~下排牙齿完全覆盖在上排牙齿后( 深咬)



治疗后~下排牙齿冒出来了(咬合高度zen






下脸部较短-四方脸
咬合高度改变-下脸部比较不方




牙齿拔掉后, 可以考虑3种假牙方案代替会拔掉的牙齿。
1) 活动性假牙
2) 固定式牙桥
3) 人工植牙


1) 活动性假牙


  • 活动假牙的费用是最低的。与假牙基托为化学性连接,多选用成品牙,也可特制.
  • 因为咬合力差,咀嚼效率低,吃饭前需要将食物切成小块,或者吃软一些的食物。在吃年糕或口香糖等有粘性的食物时,会十分苦难。咀嚼的时候,牙床的黏膜部分有可能出现疼痛。
  • 活动假牙戴在黏膜上,而黏膜又属于软组织,随着时间的推移黏膜会有变化,于是就需要经常调节假牙与黏膜面接触的一侧,用着非常不舒服的时候还需要重新制作。

2) 固定式牙桥


  • 外观和不适感比较少,如果使用全瓷材料(不含金属)修复会更美观,但费用较高。
  • 如果基牙没有问题,并得到良好的牙体预备(做固定假牙前将两侧牙磨小)、印模(咬牙印)、设计、制作,基本能达到与天然牙一样的效果。
  • 初次制作的时候需要磨掉大部分的牙釉质,也就是人为磨掉了牙齿最坚硬的保护层,导致基牙比天然牙更容易得蛀牙。当任何一侧的基牙被蛀了,都需要重新制作修复体。
  • 固定牙桥的费用一般根据材料而定,临床上用的有金属材料、金属烤塑、贵金属烤瓷、全瓷材料等。

3) 人工植牙

  • 外观基本和自己的牙齿没有区别,近年全瓷材料的普及与发展,不仅在功能上,外观上也能自然再现牙齿的形态。
  • 种植牙的价格根据品牌、生产国家的不同而有所区别,历史比较悠久的种植体比较保障。
  • 一旦种植体与骨结合后,就可以获得非常稳定的状态,但患者需要定期检查、维护,注意牙周病的防治。


其实, 把疼痛的牙齿拔掉就是一劳永逸吗? 就没有后顾之忧了吗?
身为医生有责任让我们的病患知道因果和各个方案的优缺点。然后自己依照自己的条件和考量做决定。 
毕竟没有东西是永久性的。。有什么是永久的吗?

牙齿和牙科治疗也不例外。每一天在使用的牙齿就如每一天在用的汽车这样, 需要定期保养和照顾, 才能延长它们的使用期限呀。

17 April 2019

根管治疗问与答:

1) 什么是根管治疗?
根管治疗是在不拔牙的前提下修复和保护破损或感染牙齿的治疗方法。
“根管治疗”这个词源于牙根内管道清理。 
手术的目标是挽救严重感染的牙齿。正如北京大学口腔医院的介绍,牙医会通过这个手术清除口腔内的细菌和坏死的组织。


2) 根管治疗会痛吗?
美国牙髓病学家协会称,牙根管治疗旨在缓解疼痛,而非引起疼痛。 实际上,依托麻醉和外科手术技术的进步,牙根管治疗期间人们遭受的不适感还不及补牙时痛苦。

相反,牙疼通常是由受到损坏、感染的组织(例如:牙髓)所造成的;牙根管治疗会移除这些带来困扰的组织、清洁患处、遏制感染并缓解疼痛问题。虽然牙齿及其周边部位可能会疼好几天,但是牙医会开具处方药物来减轻病症,使患者几乎立刻就能正常工作。


3) 治疗后牙齿就不会坏吗?

因为根管内细菌、发炎的牙髓神经组织被清除后,牙周膜得以保留为牙齿提供营养。
牙周膜也称牙周韧带,围绕牙根而生,是介于牙根与牙槽骨之间的致密结缔组织,牙周膜主纤维一端埋在牙骨质中,一端埋在牙槽骨,将牙固定在牙槽窝中,对牙齿起到支持作用;牙周膜中有丰富的神经和末梢感受器,有调节和缓冲咀嚼力的功能;牙周膜中含有的血供不仅营养牙周膜本身,也营养牙骨质和牙槽骨。



4) 什么情况下可以做根管治疗?
       
造成牙髓损伤的常见原因有:牙齿破裂、深度蛀牙、多次口腔治疗或者牙齿外伤。 


5)根管治疗的流程 
根管治疗由许多步骤组成,需多次拜访牙医才能完成。
     1 X光片 – 如果牙医觉得患者需要进行根管治疗,首先会拍摄X光片或者查看现有的X光片,以显示哪个位置遭到龋坏。
     2 麻醉 — 对受到影响的牙齿实施局部麻醉。与普遍认识相反,根管治疗并不比补牙疼。
       3牙髓摘除术(消毒) – 开一个开口,摘除患病的牙髓。
       4 清洁及消毒牙髓腔
     5 填充和封闭 – 用马来乳胶材料填补外露的牙根,然后用接合剂封闭。

根管治疗后的疼痛、肿胀是根管治疗最常见的并发症,轻度的会出现不适或轻微的疼痛。
次日将会消失。重度的疼痛、肿胀需抗炎治疗,但并不影响最终疗效。


6) 根管治疗以外有什么替代方案?
拔牙-最常用的替代方法之一,拔牙后使用人工植牙或牙桥、植入体或局部义齿。


7) 术后护理

根管治疗术后的牙齿尽量不要咀嚼过硬的食物以免牙齿折裂。对于牙冠破坏较大或已有
隐裂的病人建议术后两周内冠修复,以免牙冠折裂。牙齿治疗后脆性较大最好行嵌体或

冠修复,防止牙齿折裂,延长牙齿的寿命。

04 November 2018

What will happened after a tooth is extracted?

What will happened after a tooth is extracted?

Bone lose/collapse/ridge resorption


Without socket preservation, the bone quickly resorbs resulting in 30–60% loss in bone volume in the six months after dental extraction. The jaw bone will never revert to its original shape once bone is lost and tissue contour has changed.


What type of treatment can minimise the effect ?
~socket preservation~



A socket or alveolar ridge preservation procedure involves placing a bone graft into the socket, where the tooth once was. This graft can be made of  synthetic materials, bone from other animals (such as cows) or human bone. After putting the graft in the socket, the dentist usually covers it up with a collagen membrane, then sutures the opening to keep it closed.


What is the purpose of socket preservation? 





The goal of socket preservation is to improve the appearance of the remaining teeth and gums and to make the process of getting a dental implant less complicated.
The severity of the healing pattern may pose a problem for the clinician in 2 ways: it creates an esthetic problem in the fabrication of an implant-supported restoration or a conventional prosthesis; and it may make the placement of an implant challenging if not unfeasible.
The placement of an implant at a site with a thin crestal ridge (e.g., postextraction ridge) could result in a significant buccal dehiscence. Thus, it seems prudent to prevent alveolar ridge destruction and make efforts to preserve it during extraction procedures.

However, it is possible to minimize such problems by simply carrying out ridge preservation procedures in extraction sockets using grafting materials with or without barrier membranes. Socket preservation procedures help reduce horizontal or vertical alterations in the alveolar ridge near the site of a tooth extraction.



Is Socket Preservation Necessary?

Bone graft dental work is not done just for fun, not at all. By having your socket preserved, you improve your appearance by protecting your jaw bone both vertical and horizontal alteration are reduced. Additionally, you protect your gums and make it easier to get dental implants in the future should you need them. 

07 September 2018

Does your child have tooth decay?

Tooth decay or cavities are the most damaging, painful and troublesome issue that can happen to anyone especially kids. Some parents think there’s no reason to worry about these baby teeth getting decay. The baby teeth are going to fall out anyway. Unfortunately, many parents do not know that a proper set of baby teeth can help the child to be able to eat and nourishes proper nutrition as well as develop proper speech.


Why does tooth decay occur?

“My child brushes everyday but why does his/her teeth still decay?” claimed some parents. Our mouth contains hundred different types of bacteria found in our gums, teeth, cheeks or even our tongue. These bacteria consume the sugar and starches in our food and produces acid which destroy the protective layer of our teeth over time. When the child goes to sleep with bottle feeding throughout the night, these bacteria joyfully takes up the sugar causing the teeth to decay. This process can cause rampant caries or decay.


How can we spot tooth decay in children?

“Hi Doc, how can I know when my child’s teeth are starting to decay? How can I spot the decay?” asked one of the parent. At the age of 2-3 years old, normally a child has their full set of baby teeth. Tooth decay can be difficult to notice sometimes but there are some signs to help parents identify the issue.
  • White spots lesion near the gum line
  • Yellowish, brown or black bands near the gum line
  • Chipped or ragged edges of the teeth with discoloration- indicates advanced decay
  •  Discomfort or pain when the child eats cold or hot food


What can we do to prevent tooth decay?

“I want to protect my child from all the sufferings caused by tooth decay. How can I do that?” asked an eager parent. Though at such a young age, children are susceptible to tooth decay and other oral problems, there are also measures of prevention.
  • Avoid bottle feeding throughout the night
  • Avoid snacks between meals
  • Reduce sugary intakes especially candies and chocolates
  • Drink plain water instead of sugary drinks
  • Proper brushing at least twice a day. Use fluoridated toothpaste
  • Obtain sufficient fluoride (from water or supplements)

Regular visits to the dentist is crucial to prevent and treat tooth decay. During the visits, examination and cleaning are done by the dentist:
  • Check and identify early tooth decay
  • Thorough cleaning to remove plaque
  • Apply Fluoride varnish if necessary
  • Dental sealants to prevent tooth decay or cavities- normally done on the developing molars (back teeth)
  • Teach the child proper brushing technique
  • Schedule the next visit for follow up and review


Lastly, parents should supervise their kids during brushing, encourage them to eat healthily and make time to bring their kids to visit the dentists. Parents can be a good role model to exercise proper oral habits so that the kids can be motivated to do so to prevent tooth decay.

03 July 2018

PENGAMBILAN ANTIBIOTIK YANG BETUL

AMARAN!

Topik ini agak berat untuk dibaca, tetapi sangat bagus untuk pengetahuan am kita mengenai pengambilan ubat antibiotik. 

***********************************************************************


Pernahkah anda mengalami sakit gigi yang terlalu kuat sehingga tidak boleh tidur atau melakukan kerja harian? Bagi sesetengah kes yang serius, akan terdapat bengkak pada pipi, muka ataupun gusi, sehingga kadang kala terdapat nanah keluar daripada tisu sekeliling gigi.
             



Apakah punca anda mendapat masalah ini?

Dalam kebanyakan kes, masalah seperti ini adalah disebabkan oleh jangkitan kuman di dalam mulut. Lebih spesifik,  jangkitan kuman pada gigi yang berpunca daripada bakteria. 



Di dalam mulut kita, terdapat berbilion bakteria yang tidak merbahaya sebenarnya. Tetapi, jika kita tidak menjaga mulut dan gigi dengan bersih, penjagaan yang tidak betul; maka bakteria akan membiak dan menyebabkan masalah seperti gigi berlubang, gusi bengkak dan merah, mulut berbau busuk dan lain-lain. 



Jika terdapat jangkitan bakteria, doktor akan memberi ubat antibiotik untuk membunuh kuman dan menghilangkan kesan jangkitan. Tetapi, terdapat sesetengah pesakit agak memandang ringan akan kepentingan antibiotik dalam merawat masalah yang mereka hadapi. Sesetengah pesakit tidak mahu memakan antibiotik langsung, atau ada yang ambil tetapi makan tidak mengikut jadual aturan yang betul. Paling teruk adalah ubat diambil atau dibayar, tetapi tidak dimakan, hanya disimpan di dalam peti atau diletak atas meja sahaja. 



Terdapat pesakit tidak mahu mengambil atau memakan antibiotik kerana mereka berfikir antibiotik boleh memudaratkan badan (kerana bahan kimia yang terdapat di dalam ubat). Pendapat ini adalah tidak tepat kerana tiada keburukan mengenai antibiotik, tetapi (keburukan) hanya datang jika seseorang itu tidak habis memakannya.  Jika dos tidak cukup, ia bukan hanya memberi kesan kepada satu orang, tetapi kepada satu komuniti kerana kuman tidak mati, malah semakin kebal, kuat dan tahan lama. Jadi seharusnya ubat antibiotik yang telah dipreskripsi oleh doktor perlu dihabiskan mengikut arahan. 

Yang penting, pesakit jangan memandai-mandai mengambil antibiotik tanpa saranan atau preskripsi doktor. Pesakit perlu tahu yang antibiotik tidak boleh dimakan dan dihabiskan dalam tempoh tiga hari kerana jika ia sekurang-kurangnya memerlukan lima hari untuk dimakan berterusan mengikut waktu dan dos yang ditetapkan ahli farmasi. Apa yang penting, orang ramai perlu fahami dan patuhi konsep 5B dalam pengambilan dan penggunaan ubat yang digariskan persatuan iaitu 'pengguna yang betul, ubat yang betul, dos yang betul, cara pengambilan ubat yang betul dan masa pengambilan ubat yang betul'.





CARA PENGAMBILAN ANTIBIOTIK YANG BETUL 

  1. Baca arahan pada label ubat.
  2. Pastikan dos yang diambil adalah betul.
  3. Ketahui tempoh pengambilan ubat.
  4. Gunakan bekas bersukat atau picagari yang dibekalkan untuk minum ubat. 
  5. Gandaan dos tanpa nasihat doktor atau ahli farmasi akan membahayakan kesihatan manakala pengurangan dos akan mengurangkan kesan ubat.


Penggunaan antibiotik untuk rawatan gigi.

Bagi rawatan pergigian, kadang kala ubat antibiotik akan diberikan kepada pesakit. Hal ini bertujuan untuk mengelakkan jangkitan kuman bertambah semakin teruk, terutama sekali apabila selesai rawatan pembedahan. Contohnya pembedahan implant (tanam skru pada rahang) atau surgeri untuk membuang gigi geraham bongsu. 

Ubat antibiotik yang kerap diberi kepada pesakit adalah Amoxicillin (daripada group Penicllin) ataupun Metronidazole. Jika pesakit allergi terhadap amoxicillin, ubat Erythromycin/clindamycin/tetracycline akan diberikan (bergantung kepada sama ada jangkitan kuman serius ataupun tidak).

Jika ubat yang diberikan diambil ikut waktu yang ditetapkan dan seperti yang telah dinasihatkan oleh doktor, maka kuman dapat dibunuh dan jangkitan kuman pada badan akan hilang cepat. 


06 June 2018

Dental Implant

For many years, the only treatment options available for people with missing teeth were bridges and dentures. But, today, dental implants are available.

Public has wrong perception towards dental implant (People who has no teeth  or wearing full denture is not suitable to put implants.)

Without a doubt, implant dentistry has allowed for more treatment options to replace single and multiple missing teeth with long-term stability and contributes to improved oral health.

However, not everyone is a candidate for implant dentistry. Patients with a history of uncontrolled diabetes,heart disease and bisphosphonate use, or certain blood disease may not be suitable candidates for implant therapies Heavy smokers or patients who have radiation therapy to the head/neck area need to be evaluated on an individual basis. 

Dental implants require the same care as real teeth, including brushing, flossing, rinsing with an antibacterial mouthwash, and regular dental check-ups. Implant survival rate decrease if without proper oral hygiene daily care.


Treatment Options Available:
1. Single implant
2. Implant supported bridge
3. Full arch  -Implant fixed bridge
-Implant supported denture ( removable )

Implant Supported Bridge ( full arch )

Single Implant



3-units Implant Bridge

Implant supportted denture ( LOCATOR)




Another important issue is the amount of bone available for implant placement and stability. A result of edentulism is the deterioration of the alveolar bone. There must be sufficient bone structure to consider implants . Augmentation of the bone and ridge may be accomplished with a variety of methods and grafting mediums.

    




How do I care for my dental implants?
Well-placed and cared for dental implants have the potential to last a lifetime. Caring for teeth restored with dental implants is just like caring for your natural teeth: brush, floss and get regular dental cleanings and check-ups. 


The destructive process affecting the soft and hard tissues surrounding dental implants.The periodontal pathogens found around failing implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.
Post implant placement care and follow up with dentist are equally important to prolong implant lifespan.