Dental Caries is an irreversible microbial disease of the calcified tissues of the teeth, characterized by de-mineralization of the inorganic portion and destruction of the organic substance of the tooth.

GV Black Classified Carious Lesions into 6 types based on their location:

• Class I: Carious lesions on the Occlusal areas or Buccal areas or Lingual Pits on the tooth surface.
• Class II: Carious Lesions on the Posterior occlusal and inter-proximal surfaces of the tooth.
• Class III: Carious Lesions on the Anterior inter-proximal surfaces of the tooth.
• Class IV: Carious Lesions on the Anterior inter-proximal surfaces of the tooth including the Incisal corners.
• Class V: Carious Lesion on the Gingival third of the crown on Facial or lingual Surfaces of the Tooth.
• Class VI: Carious Lesion on Tip of The Cusp of Posterior Teeth

Class I: Carious lesions on the Occlusal areas or Buccal areas or Lingual Pits on the tooth surface.

Class I Carious Lesion

Class II: Carious Lesions on the Posterior occlusal and inter-proximal surfaces of the tooth.

Class III: Carious Lesions on the Anterior inter-proximal surfaces of the tooth.

Class IV: Carious Lesions on the Anterior inter-proximal surfaces of the tooth including the Incisal corners.

Class V: Carious Lesion on the Gingival third of the crown on Facial or lingual Surfaces of the Tooth.

Class VI: Carious Lesion on Tip of The Cusp of Posterior Teeth

Some Facts about Avulsion:

• Ranges from 0.5 -16% of injuries in the permanent dentition
• 7-13% in the primary dentition
• Occurs most often in 7-9 yrs of age.

Etiology:

•  Fights
• Sports injuries
• Falls against hard objects
• Accidents

Most Frequently Affected areas:

• Max. CI – Most affected.
• Lower jaw – seldom affected.
• Usually involves single tooth.
• Associated with lip lacerations and fracture of alveolar socket wall.

Treatment:

This is a true dental emergency because the treatment and prognosis are extremely time dependent.

The main Aim of Treatment Plan is Reimplantation.

Success of Reimplantation depends on:

• The success of reimplantation is inversely related to the storage material and the time the tooth is out of the mouth.
• Teeth reimplanted within 30 min have a good chance of surviving, whereas those reimplanted after 2 or more hours have a more limited survival.

The goals of reimplanting teeth:

• To maintain the viability of periodontal ligament cells
• The avulsed tooth should be without periodontal problems.
• To return the cells as close to normal condition as possible.
• Impede resorption of the tooth.
• Alveolar socket should be reasonably intact
• Extra-alveolar period should be considered.

Time within which the teeth should be Reimplanted:

• After avulsion, the pdl cells are cut off from their blood supply and their stored cell metabolites are depleted.
• So should be replanted within 60-120 mins.   (Blanoff ,1981)
• After this time, pdl cells undergo necrosis & root resorption begins.
• Since teeth are rarely replanted within this time, biologic storage and protection from crushing of pdl cells is of paramount importance.

Save a Tooth - Emergency tooth preserving system

Storage Media (For Storing Avusled tooth before reimplantation )

1. Saline
2. Milk – Low fat milk preserved pdl cells better than whole milk.
3. Saliva
4. Oral vestibule
5. Hank’s balanced salt solution
6. Viaspan
7. Propolis
8. Tender coconut water
9. Contact lens solution

Note: Storage of avulsed teeth in water and saliva has been shown to be damaging to the periodontal ligament cells, thus causing increased root resorption. (Andreason. Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors. Int J Oral Surg,1981)

Steps to Follow before Reimplantation of Tooth into socket:

1. If dirty, the tooth should be grasped by the crown and rinsed gently in saline, tap water or milk at the scene of the injury.
2. Do not scrub off, brush the tooth or handle the root.
3. Immediately place the tooth back in the socket and hold in place with light pressure en route to the treating facility.
4. There is no need to physically debride the socket prior to replacement.
5. Gentle saline irrigation will remove debris.
6. If the tooth cannot be replaced at the scene, it should be stored in the buccal vestibule or floor of the mouth for transport.
7. If this is not possible, the tooth should be stored in a cup with the Hanks Balanced Salt Solution (HBSS), the patient’s saliva, milk, saline or water. Do not wrap tooth in tissue, towel or foil or allowed to dry out.

Reimplantation n splinting - delayed reimplantation

Steps for Immediate Reimplantation Procedure:

1. Preservation of the avulsed tooth.
2. Cleansing of the avulsed tooth
3. Cleansing of the alveolus
4. Replantation & Splinting
5. Endodontic treatment
6. Splinting removal and final RCT
7. Bleaching or Restorative treatment

Post Reimplantation measures to be taken:

• Once the tooth is reimplanted in a gently saline-irrigated socket, splint it to the adjacent teeth with a non-rigid or semi-rigid splint for 7–10 days.
• If a concomitant alveolar fracture is present, maintain the splint for 2–8 weeks.
• Longer splinting periods are required for more extensive fractures.

In a permanent tooth with an open apex that has been replanted 2hrs after avulsion:

• Radiographs and clinical exam should be performed in 3–4 weeks to look for evidence of pulpal pathology versus revitalization.If pathosis is noted, root canal therapy should be instituted immediately.
• The canal should be cleaned and filled with CaOH2 until apexification has occurred (usually 6–24 months).
• Then obturation with gutta percha is indicated.

For a permanent tooth with a partially to completely closed apex and less than 2 h dry time:

• The pulp should be removed in 7–14 days.
• The canal is cleaned and CaOH2 is placed.
• The new American Association of Endodontics guidelines recommend only 7–14 days of CaOH2 treatment and immediate obturation of the canal with gutta percha and sealer.

For permanent teeth with partially to completely closed apices and greater than 2 h extraoral time:

• Root canal therapy can be performed immediately.
• These teeth will eventually be lost to resorption but may be retained short term and are likely to ankylose.
• The tooth, once the canal has been extirpated extra-orally can be soaked in sodium fluoride solution to discourage resorption once reimplanted.

Do not replant primary teeth.

Antibiotic Prpphylaxis:

Consider tetanus prophylaxis and antibiotics (penicillin VK 500 mg QID, clindamycin 150–300 mg QID or erythromycin 250 mg QID) for 7–10 days and place the patient on a soft diet.

In Case of Delayed Reimplantation:

1. Cleansing  & conditioning of the avulsed tooth

Cleaning n conditioning of Avulsed tooth in delayed reimplantation

2. Extraoral  endodontic treatment

Extraoral RCT for delayed Reimplantation

3. Cleansing of the alveolar socket

4. Replantation and splinting

Reimplantation n splinting - delayed reimplantation

5. Treatment of resorbed replanted tooth

I think this kinda setup will surely fix the problems.

I think this a good dental joke to have a good laugh at.

Gingiva shows stiplling, which is its typical appearance and is known as stippled gingiva as seen in the above picture.

The gingiva is a type of Masticatory mucosa.

Gingiva is the soft tissue around the teeth which is continous with the Mucosa of the Oral cavity, this junction is called the mucogingival junction.

It is Differentiated by the line seen in the image which demarcates it due the dark color of the mucosa (due to high vasculature) and the light color of the gingiva (due to presence of more fibers) comparitively.

Gingival Sulcus: It extends from the gingival marging apically to the cemento-enamel junction, which acts as aseal against the tooth and acts as a barrier against the sub-gingival plaque, bacteria and prevents fluid loss from underlying tissue.

Types:

The Gingiva is divided into:

• Attached Gingiva: The thick pink tissue that hugs the bone and is tightly attached to the underlying Bone and mucosa.
• Free Gingiva: The soft thin movable tissue that makes u the inside of the lips and cheeks.

Based on epithelium:

Oral Epithelium: It is a stratified squamous keratinizing epithelium, that lines the vestibular and oral surfaces of the gingiva it extends from the mucogingival junction to the gingival epithelium except for the palatal epithelium where it blends with the palatal epithelium.

Sulcular Epithelium: This is the epithelium which covers the gingiva present in the sulcus depths.

Junctional Epithelium: The portion of the gingival tissue that is attached the gingival connective tissue on one side and the tooth surface on the other. And its coronal end lines the end of gingival sulcus.

Histology: The gingiva is covered with Keratinized Stratified squamous epithelium the outer most layer of gingiva. This epithelial layer shows projections into the underlying Connective tissue which are known as “Rete Pegs”.

The outer layers of the epithelium are keratinized and are stratified so the size of the cells increases as we go into the gingiva.

The epithelium has 4 layers:

SC: Stratum Corneum-The cells are flattened, outermost layer.

SG: Stratum Granulosum-The cells contain granules and are relatively bigger in size

SS: Stratum Spinosum-The cells are spinous in appearance.

SB: Stratum Basale-The cells are rounded and these are the proliferative cells which give rise to new cells.

There is the connective tissue underneath the Epithelium which contains fibers, Blood vessels etc.

Cells: The different types of cells which are present in the Gingiva apart from the normal epithelial cells are

Melanocytes: They are the cells which give the darkish color of gingiva in some individuals which are dark skinned.

Langerhan Cell: These are the modified macrophages which help in producing antigens.

Merkel cell: these are present in the deep layers and act as tactile proprioceptive cells.

Fibers: The fibers are mainly

Collagen Fibers:

• Type VII collagen fibers are predominant which are present in intimate contact with basal lamina.
• Type IV collagen fibers present in basal linings of epithelial walls and blood vessels.

Elastin Fibers: Rare in lamina propria and common in lining mucosa, the elastic fibers are made up of

• Elastin: provide elastic nature
• Fibrillin:

Oxytalin Fibers: These resemble immature elastic fibers.

Gingival Diseases:

The gingival deiseases are mainly the inflamation of Gingiva which is known as Gingivitis, which is of 2 types

• ACUTE: It can be due to acute infections or due to poor oral hygiene and accumulation of plaque and calculus.
• CHRONIC: It is mainly caused due to Hormaonal imbalance, Poor Oral hygiene, Vitamin deficiency.

Pedodontics or pediatric dentistry is the branch of dentistry which deals with the Prevention, Diagnosis, and Treatment of teeth in children and adolescent patient, who are under the age of 16.

Pediatric dentistry: The specialty of dentistry concerned with the care of children and adolescent teeth.

According to wikipedia: Pedodontics is a branch of dentistry dealing with child’s teeth from birth to childhood the branch give facilities to people study this branch to can understand nature of children’s teeth which are called primary teeth, or deciduous teeth in scientific language, and also the permanent teeth of children and adolescents. Also, most pedodontists learn to take care of the dental needs of physically or mentally handicapped people, such as people with cerebral palsy or mental retardation.