Author: sajith varghese

Author: sajith varghese

Space Maintainers And Their Types

Space Maintainers And Their Types

In the last post, we learnt about the need for space “maintainers”. There are different designs of space maintainers and the decision to choose a particular design is based on:

  1. the number of teeth missing,
  2. the number of teeth present in the mouth and
  3. the number of years remaining for the permanent teeth to erupt.

If only a single tooth is missing, we can go for a fairly simple design called a “band and loop”. This is very stable and easy to maintain.

If multiple teeth from both sides are missing, we may have to give a slightly sturdier design so that space in both sides of the mouth may be maintained

Generally constructed with stainless steel wire, these space maintainers may be made of acrylic also. Teeth can be set in the base so that your child may be able to chew properly. Removable varieties are available, although majority parents and practitioners prefer fixed type. Children are very unpredictable, right?

Space maintainers can also transform your child’s smile and boost their confidence! If there is no other option but to extract, space maintenance is MANDATORY. After all, a stitch in time saves nine..

Space Regaining

Space Regaining

Space maintenance is pretty straightforward. But what can be done in case it has been many years since extraction of milk teeth and space “loss” has already occurred?

That is when we “regain the space”. Why? Because we do not want the permanent teeth to erupt crookedly!

“If braces are anyway needed, why should we go through all this earlier? Can’t we correct it in one go?”..This is another question normally asked by parents. You have to understand, the main aim is to reduce the severity and duration of orthodontic treatment later. Also, we are trying to bypass crowding and avoid extraction of permanent teeth while fixing braces, which may otherwise be required.

The designs are similar to space maintainers, except a spring or screw may be inserted to open up space

How much time should these be worn? Depends on amount of space needed to “regain”. Your dentist will generally start fixed treatment with braces soon after this step.

Contact your nearest clinic today for more information!

Space “Maintainers”- What, Why, How, When?

Space “Maintainers”- What, Why, How, When?

Earlier, dentistry used to be synonymous with “extraction” of badly decayed teeth. Especially in children. The idea was that milk teeth are going to be replaced anyway, so why not just remove it. But what if I told you that the thinking has changed now? The permanent teeth especially in the back of the mouth do not erupt till 10-12 years of age and keeping an empty space in those areas till that age is not good.

So, what happens if the milk tooth has to be removed pretty early on?

  1. The permanent tooth developing underneath is not ready to come out… So, the back teeth may “tilt” into this space
  2. Once the back teeth tilt, space available for the other teeth reduces
  3. At age 10, the permanent teeth are crowded/ stuck and arranged wherever there is a little space- Braces will definitely be required to align

What can be done, then?

  1. Space maintainers are given immediately after extraction of the milk teeth.
  2. These will be in place till the permanent teeth are ready to erupt and prevent loss of space.
  3. The probability/ duration of orthodontic treatment reduces at a later age.

Medium for Re-implanting tooth

Medium for Re-implanting tooth

When a tooth completely comes out of socket it is called AVULSION of tooth. In this scenario the golden time to reach a nearby dentist is 60 minutes.

Never clean the tooth or root with a scrubber or tooth brush

Never carry the tooth dry or in a box wrapped of paper

Preferable mode of carrying the tooth are regular milk (not hot), tender coconut water, patients saliva, HBSS, cotton, lens solution, in patients own mouth saliva, placing it back in the tooth socket etc.

If these above instructions are followed then success rate for re-implanting the dislodged tooth is very high.

For more details visit

How safe are the full mouth X-Rays?

How safe are the full mouth X-Rays?

In the last post, we had seen the uses of full mouth X ray called Orthopantomogram (OPG).

The benefits are more, agreed, but what about the safety? So let us go back to basic mathematics here:

Imagine a child is having cavities at 4 different places in the mouth. With a basic intra oral film, we can see a maximum of two /three teeth properly in a particular area. That means if cavities are there in four completely different places, we have to take 4 separate films. Meaning 4 times we have to expose the child to X Rays.

Instead is it not better to take a single large film with single dose to see all the areas in the mouth?

That being said, dental Xrays make up just 1/10th of the environmental radiation a person is exposed to on a daily basis..

In addition, the child is draped with a lead apron and collar for extra protection.

In conclusion, an OPG is completely safe. And completely required, if the full mouth is to be seen at one go.

Kidz ‘N’ Teenz introduces the world’s smallest OPG machine to address the patient’s time and travel issues. We are upgrading to provide all treatment in house!

What are the uses of a full mouth X-ray?

Often, we advise the parent to take a full mouth X-Ray called an OPG or Orthopantomogram.

More often, we get this question in return- “Doctor, but why this? Why can’t we go for the small film?”

So let us have a look at the innumerable uses of OPG:

1. OPGs are extremely useful, especially in children. This is because we can see the status of both the milk teeth and permanent teeth in the child’s mouth. So, we can see if all the teeth are erupting in the right track or there is some delay.

2. If there is some delay in development, we can easily see the cause for it. It may be some infection or tooth may be rotated or there might be some obstruction blocking it.

3.In a child who is very anxious, these are the best because the film is outside the mouth unlike the other type where we have to hold film inside the poor child’s mouth!

4. Not just the teeth, it is possible to see the status of the bones of the jaw and the nose also. Basically any fracture/ breathing problems can be evaluated.

5. Lastly, and the most common reason- cavities! If your child has multiple teeth with “holes”, it is better to take a full mouth X-Ray and see all the teeth in one single film.

For further clarifications, contact your Dentist today.

Management of immature roots (roots with open apex in children)

In children aged 6-9 years, it is very critical when it comes to trauma in the front teeth especially, to know outcome of their problem at later date.

Reason cited is that front teeth erupt at age of 6-7 years or 7-8 years, but root completion of teeth happens after 3 years, that is 9-10 years.

In this window period of 6-10 years if any trauma occurs to pulp of tooth or any trauma occurring without breakage of pulp, it can be managed by a 2 stage process called Apexification or Apexogenesis.

First followed by root canal treatment and later is an intermediate process usually done with help of MTA at the level where fracture has happened.

The advantage of MTA is that it aids in helping roots to grow so that the root canal can be carried out effectively.

To know more about tooth trauma visit

How useful are X-rays to see a fractured tooth?

We always get this question. “Aren’t X-rays harmful?” or “Does it have any side effects on the brain?”

Well, to answer this question, it is important to know what “natural background radiation” is. This is basically the radiation we receive on a daily basis from the environment.

And the doses from intraoral and full mouth radiographs are lower, less than one day of natural background radiation.

Does that answer the question?

Also, consider the benefits of taking a small X-Ray especially when there is a broken tooth involved. We can:

1. Give emergency treatment :

  1. Visualize the extent of fracture, and that helps us in planning the treatment.
  2. If the tooth pieces are loose, we can also use X ray to confirm we have repositioned the tooth in the correct manner

2. Monitor the tooth:

  1.  See if there is any developing infection
  2. Check if the tooth root is formed nicely or not. In young children with newly erupted teeth, the root may not be formed completely. In such a case, we use a calcium rich material called MTA to seal the root.

3. Monitor the treatment:

Monitor the treatment given to see if the filling is in the correct place and the body is accepting the treatment.

Clearly there are more benefits and is a must, especially in cases of traumatic injuries!

Sequelae of tooth trauma

Sequelae of tooth trauma    

Sequelae in layman term mean the after effects of the incident. In our scenario, it implies the after effects of dental trauma of teeth. What happens after incident of trauma has occurred. After effects of fall immediately would be some blunt injury to tooth or broken part for which we do splinting or replace broken part by means of a filling. Point to be noted by the public is that the problem is not rectified immediately, but only momentary treatment is done at that point of time e.g. chipping of tooth.


There is a process which can be initiated after this trauma, which is nerve damage or pulpal damage or blood vessel damage to a particular tooth


Each tooth internally has a chamber called PULP which actually provides life for tooth. It is like heart to the body. When the trauma or fall occurs this pulp also can get injured. This injury is not seen immediately in most of the situations. It happens in due course of time. For some people it takes days, for some it takes months, for many situations it takes many years. The only visible change that a common man sees is change in color of the tooth.

Color can change either to dark yellow or grayish white, blackish grey etc.

Most important point to be noted is that even though color change happens, the tooth doesn’t cause pain immediately. May be over a period of time it can provide a small low grade discomfort to the person which is ignored most often. When a person comes for a dental consultation a good dentist will elicit and provide needed solution for this problem.

Most of the time considering there is no symptoms or signs of the problem, the person having this issue will ignore the treatment getting done, sitting lack of time, no pain or not believing the dentist.

There will be a moment in his life, when the immune levels come down due to some viral infection. At that point of time this problem will also get activated causing localized swelling, severe pain, discomfort etc.

At this moment when we take an x-ray or elicit the vitality (life of tooth), we are able to assess the root canal and it is severely damaged due to fall or a hit at his/her earlier age. So the dentist gives option of multiple visit for root canal treatment, periapical enucleation (episiotomy).

Sometimes even extraction (removal of tooth) is an option.

So never take trauma to permanent tooth very lightly.

For more details about tooth trauma check out –

Fractured teeth? Can be managed naturally! Here’s how:

Imagine this, summer vacation, football or some other “outdoorsy” sport, a fall and the result, a badly broken tooth.

A very common scenario in most of our households. Worried parents come to us, clutching the broken fragment and ask, “Can it be re-attached?” Our answer is, Yes.

  • In the case of a simple fracture of the tooth’s crown (the portion that is seen outside), we can attempt to attach the same tooth fragment.
  • If the fracture is very deep and has involved the nerves, a root canal therapy may be required. Still, the same fragment can be used to give more a natural, aesthetically pleasing appearance.

But what if the fracture involves the root (the portion inside the gum) as well?

In that case, it is termed as a complicated crown-root fracture. This too, may or may not involve the nerves.

  • Taking an X-ray is a must to see the extent of fracture because, it cannot be predicted.
  • Emergency treatment involves fixing a splint to reduce the mobility of the affected tooth- in the same way a general fracture is fixed.
  • We can attempt to expose the fractured area by slightly cutting the gum and giving a crown after root canal treatment
  • If the child is very young and there is no sufficient amount of root, we may have to modify the root canal treatment slightly and give a calcium rich material called MTA to seal the root.
  • Maximum attempt is made to save the tooth. If the fracture is really very deep and most of the root is gone too, we may have to consider extraction. Of course, an artificial tooth will be given in place.

For more details, refer