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What is Root Canal Treatment? Case Study

Root canal treatment is designed to eradicate germs from the contaminated root canal, thus preventing re-infection of the tooth and saving the natural tooth. When one undergoes a root canal treatment, the swollen or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed.
A young male patient visited us complaining of a fracture in the upper right front tooth. We did a complete oral checkup and took the required x-rays. The tooth was tender on percussion. An x-ray showed mild periapical infection.
The treatment plan finalized was multiple sitting RCT with the placement of intra-canal medicament followed by the crown for upper right central incisor.



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Fast facts on bad breath

Here are some key points about bad breath. More detail and supporting information is in the main article.
• Bad breath is estimated to affect 1 in 4 people globally.
• The most common cause of halitosis is bad oral hygiene.
• If particles of food are left in the mouth, their breakdown by bacteria produces sulfur compounds.
• Keeping the mouth hydrated can reduce mouth odor.
• The best treatment for bad breath is regular brushing, flossing, and hydration.

What is halitosis?



Bad breath is a common problem that can cause significant psychological distress. There are a number of potential causes and treatments available.
Anyone can suffer from bad breath. It is estimated that 1 in 4 people have bad breath on a regular basis.
Halitosis is the third most common reason that people seek dental care, after tooth decay and gum disease.
Simple home remedies and lifestyle changes, such as improved dental hygiene and quitting smoking, can often remove the issue. If bad breath persists, however, it is advisable to visit a doctor to check for underlying causes.


The best method to reduce halitosis is good oral hygiene. This ensures that cavities are avoided and reduces the likelihood of gum disease.
It is recommended that individuals visit the dentist for a check-up and cleaning twice a year.
The dentist may recommend a toothpaste that includes an antibacterial agent or an antibacterial mouthwash.
Alternatively, if gum disease is present, professional cleaning may be necessary to clear out the build-up of bacteria in pockets between the gums and teeth.

Potential causes of bad breath include:

Tobacco: Tobacco products cause their own types of mouth odor. Additionally, they increase the chances of gum disease which can also cause bad breath.
Food: The breakdown of food particles stuck in the teeth can cause odors. Some foods such as onions and garlic can also cause bad breath. After they are digested, their breakdown products are carried in the blood to the lungs where they can affect the breath.
Dry mouth: Saliva naturally cleans the mouth. If the mouth is naturally dry or dry due to a specific disease, such as xerostomia, odors can build up.
Dental hygiene: Brushing and flossing ensure the removal of small particles of food that can build up and slowly break down, producing odor. A film of bacteria called plaque builds up if brushing is not regular. This plaque can irritate the gums and cause inflammation between the teeth and gums called periodontitis. Dentures that are not cleaned regularly or properly can also harbor bacteria that cause halitosis.
Crash diets: Fasting and low-carbohydrate eating programs can produce halitosis. This is due to the breakdown of fats producing chemicals called ketones. These ketones have a strong aroma.
Drugs: Certain medications can reduce saliva and, therefore, increase odors. Other drugs can produce odors as they breakdown and release chemicals in the breath. Examples include nitrates used to treat angina, some chemotherapy chemicals, and some tranquilizers, such as phenothiazines. Individuals who take vitamin supplements in large doses can also be prone to bad breath.
Mouth, nose, and throat conditions: Sometimes, small, bacteria-covered stones can form on the tonsils at the back of the throat and produce odor. Also, infections or inflammation in the nose, throat, or sinuses can cause halitosis.
Foreign body: Bad breath can be caused if they have a foreign body lodged in their nasal cavity, especially in children.
Diseases: Some cancers, liver failure, and other metabolic diseases can cause halitosis, due to the specific mixes of chemicals that they produce. Gastroesophageal reflux disease (GERD) can cause bad breath due to the regular reflux of stomach acids.

Rarer causes of bad breath

As mentioned earlier, the most common reason for bad breath is oral hygiene, but other situations can also be to blame.

Rarer causes of bad breath include:

Ketoacidosis: When the insulin levels of a person with diabetes are very low, their bodies can no longer use sugar and begin to use fat stores instead. When fat is broken down, ketones are produced and build up. Ketones can be poisonous when found in large numbers and produce a distinctive and unpleasant breath odor. Ketoacidosis is a serious and potentially life-threatening condition.
Bowel obstruction: Breath can smell like feces if there has been a prolonged period of vomiting, especially if a bowel obstruction is present.
Bronchiectasis: This is a long-term condition in which airways become wider than normal, allowing for a build-up of mucus that leads to bad breath.
Aspiration pneumonia: A swelling or infection in the lungs or airways due to inhaling vomit, saliva, food, or liquids.

Home remedies

Other lifestyle changes and home remedies for bad breath include:

Brush the teeth: Be sure to brush at least twice a day, preferably after each meal.
Floss: Flossing reduces the build-up of food particles and plaque from between the teeth. Brushing only cleans around 60 percent of the surface of the tooth.
Clean dentures: Anything that goes into your mouth, including dentures, a bridge, or a mouth guard, should be cleaned as recommended on a daily basis. Cleaning prevents the bacteria from building up and being transferred back into the mouth. Changing toothbrush every 2 to 3 months is also important for similar reasons.
Brush tongue: Bacteria, food, and dead cells commonly build up on the tongue, especially in smokers or those with a particularly dry mouth. A tongue scraper can sometimes be useful.
Avoid dry mouth: Drink plenty of water. Avoid alcohol and tobacco, both of which dehydrate the mouth. Chewing gum or sucking a sweet, preferably sugar-free, can help stimulate the production of saliva. If the mouth is chronically dry, a doctor may prescribe medication that stimulates the flow of saliva.
Diet: Avoid onions, garlic, and spicy food. Sugary foods are also linked to bad breath. Reduce coffee and alcohol consumption. Eating a breakfast that includes rough foods can help clean the back of the tongue.


Often, a dentist will simply smell the breath of a person with suspected halitosis and rate the odor on a six-point intensity scale. The dentist may scrape the back of the tongue and smell the scrapings as this area can often be a source of the aroma.

There are a variety of sophisticated detectors that can rate odor more precisely. They include the following:

Halimeter: This detects low levels of sulfur.
Gas chromatography: This test measures three volatile sulfur compounds: Hydrogen sulfide, methyl mercaptan, and dimethyl sulfide.
BANA test: This measures levels of a specific enzyme produced by halitosis-causing bacteria.
Beta-galactosidase test: Levels of the enzyme beta-galactosidase have been found to correlate with mouth odor.

The dentist will then be able to identify the likely cause of the bad breath.


What is periodontitis?

Periodontitis is a serious infection of the gums. It’s caused by bacteria that have been allowed to accumulate on your teeth and gums. As periodontitis progresses, your bones and teeth can be damaged. However, if periodontitis is treated early and proper oral hygiene is maintained, the damage can be stopped.

What are the symptoms of periodontitis?

The symptoms depend on the stage of disease but generally include:

• gums that bleed when you brush your teeth or floss
• bad breath
• changes in the position of your teeth or loose teeth
• receding gums
• red, tender, or swollen gums
• buildup of plaque or tartar on your teeth
• pain when chewing
• tooth loss
• foul taste in your mouth
• inflammatory response throughout your body

Note: Symptoms in the early stages of periodontitis are often not very noticeable. Your dentist will likely be the first to point them out.

What causes periodontitis?

Healthy people normally have hundreds of different types of bacteria in their mouth. Most of them are completely harmless. When you don’t clean your teeth properly each day, the bacteria grow and build up on your teeth. Periodontitis is typically caused by poor dental hygiene. When you don’t brush your teeth and clean in hard-to-reach places in your mouth, the following happens:

The bacteria in your mouth multiply and form a substance known as dental plaque. If you don’t remove the plaque by brushing, the bacteria deposit minerals within the plaque over time. This mineral deposit is known as tartar, which will encourage more bacterial growth toward the root of the tooth. Your body’s immune response to this bacterial growth leads to inflammation in
your gums. The attachment of the gum to the root of a tooth is disrupted over time, and a periodontal pocket (gap) may form between the gum and root. Harmful anaerobic bacteria colonize in the pocket and multiply, releasing toxins that can damage the gums, teeth, and supporting bone structures.

Additionally, certain factors put you at a higher risk of periodontitis, including:
• smoking, which is one of the biggest risk factors for periodontitis
• type 2 diabetes
• obesity
• hormonal changes in women (such as when menstruation, pregnancy, or menopause occurs), which can make the gums more sensitive
• conditions that impact your immune system, like HIV or leukemia
• medications that reduce the flow of saliva in your mouth
• genetics
• poor nutrition, including a deficiency in vitamin C

What are the complications of periodontitis?

If not treated for periodontitis, the supporting structures of your teeth, including the bones of your jaw, can be destroyed. Your teeth loosen and might fall out or require extraction. Other complications of periodontitis include:

• painful abscesses
• migration of your teeth, which may interfere with eating
• receding gums and exposure of the roots of your teeth
• increased risk of complications during pregnancy, including low birth weight and preeclampsia
• increased risk of heart disease, respiratory disease, and diabetes

How is periodontitis treated?

Treatment is aimed at removing plaque and bacterial deposits on your teeth and gums.

Oral hygiene practices

Your dental care team will give you instructions on how to reduce the number of bacteria in your mouth, which involves keeping your teeth and gums clean. Your dentist will give you advice on how to use tooth brushes and dental floss properly, and may recommend other oral hygiene products like a water pick or mouthwash.

Here are a few tips for keeping your teeth healthy:
• Brush your teeth twice a day with a fluoride toothpaste.
• Consider using an electric toothbrush, which may be more effective.
• Floss at least once a day to remove plaque.
• Visit your dentist at least twice a year for a professional cleaning.
• Don’t smoke or chew tobacco.

Professional cleanings

During a professional cleaning, your dentist will remove plaque buildup and tartar from your teeth and their roots, and then polish your teeth and treat them with fluoride. Any periodontal pockets that have formed could require deep cleaning to enable healing. A deep-cleaning method called scaling and root planing will help scrape off tartar and also remove any rough spots on the tooth root where bacteria tend to gather.


In some cases, your dentist will prescribe antibiotics to help with persistent gum infections that haven’t responded to cleanings. The antibiotic might be in the form of a mouthwash, gel, or an oral tablet or capsule.

Follow-up appointments

Your dentist will want to follow up with you after a few weeks, and then about every three to six months after that to assess your progress. If periodontal pockets are still present, they may recommend other treatment options, like surgery.


If inflammation persists in sites that are inaccessible to brushing and flossing, your dentist may recommend a surgical procedure called flap surgery to clean deposits under your gums. Under anesthesia, your gums are lifted away and the
roots of your teeth cleaned. Your gums are then sutured (stitched) back into place.



Tooth decay (dental caries) is damage to a tooth that can happen when decay-causing bacteria in your mouth make acids that attack the tooth’s surface, or enamel. This can lead to a small hole in a tooth, called a cavity. If tooth decay is not treated, it can cause pain, infection, and even tooth loss.

People of all ages can get tooth decay once they have teeth—from childhood through the senior years.

Young children are at risk for “early childhood caries,” sometimes called baby bottle tooth decay, which is severe tooth decay in baby teeth.

Because many older adults experience receding gums, which allows decay-causing bacteria in the mouth to come into contact with the tooth’s root, they can get decay on the exposed root surfaces of their teeth.


Tooth getting Decayed

When decay-causing bacteria come into contact with sugars and starches from foods and drinks, they form an acid. This acid can attack the tooth’s enamel causing it to lose minerals.

This can happen if you eat or drink often, especially foods and drinks containing sugar and starches. The repeated cycles of these “acid attacks” will cause the enamel to continue to lose minerals. Over time, the enamel is weakened and then destroyed, forming a cavity.


In early tooth decay, there are not usually any symptoms. As tooth decay advances, it can cause a toothache (tooth pain) or tooth sensitivity to sweets, hot, or cold. If the tooth becomes infected, an abscess, or pocket of pus, can form that can cause pain, facial swelling, and fever.


Dentists commonly treat cavities by filling them. A dentist will remove the decayed tooth tissue and then restore the tooth by filling it with a filling material.


Here are some things you can do to prevent tooth decay:

  • Use fluoride, a mineral that can prevent tooth decay from progressing, and even reverse, or stop, early tooth decay. You can get fluoride by
    • Brushing with a fluoride toothpaste.
    • Drinking tap water with fluoride.
    • Using fluoride mouth rinse.
  • Have a good oral hygiene routine. Brush teeth twice a day with a fluoride toothpaste and regularly clean between teeth with floss or another interdental (between-the-teeth) cleaner.
  • Make smart food choices that limit foods high in sugars and starches. Eat nutritious and balanced meals and limit snacking.
  • Do not use tobacco products, including smokeless tobacco. If you currently use tobacco, consider quitting.
  • See a dentist for regular check-ups and professional cleanings.

A note to parents: Visit A Healthy Mouth for Your Baby and The Tooth Decay Process: How to Reverse It and Avoid a Cavity, to learn how to care for your baby’s and children’s teeth, including information on when to start using fluoride toothpaste. In addition, when your child’s permanent (second) teeth come in, talk to your dentist about sealants. They cover the chewing surfaces of teeth and can help prevent decay.


Teeth are one of the most vital parts of the human body. Negligence or ignorance of proper oral healthcare will lead to severe damage to the teeth and gums. With the advancement of technology and ready accessibility of dentists, it is quite easy to get dental check-ups done.

It is imperative to go for a complete oral and dental check-up at least every six months. This will help detect dental and oral conditions, if any, at the earliest.



Catching tooth decay early can save your teeth. And speaking of saving teeth, did you know the greatest cause of tooth loss in adults is gum disease? About half of adult over age 30 have some degree of gum disease. Regular dental appointments help prevent gum disease and assist you in managing any oral health issues you may be having.


During a professional cleaning, built-up tartar and calculus are removed that simply can’t be reached or removed by brushing alone. Dentists are professionally trained to clean your teeth with advanced equipment or specialized tools and help you rid of plaque and tartar without causing any damage to the tooth enamel.


Studies have repeatedly confirmed that oral health provides insight into your overall health. Poor dental hygiene can lead to other diseases and conditions such as heart disease, diabetes, osteoporosis and endocarditis. Gum disease has also been linked to low birth weight and premature birth.


Do you have impacted wisdom teeth? Do you need a root canal? X-rays can show the answer. Surprisingly, not all dental problems involve a toothache. Sometimes the biggest problems go undetected, and by the time they become painfull, the damage is much more extensive. Regular x-rays also help your local dentist determine if teeth have shifted due to an uneven bite or jaw problems.


Last, but not the least, regular dental check-ups can lay the foundation for a healthy set of teeth in children. We should set positive example for our children and help them get fully acquainted with the importance of regular dental check-ups and good oral hygiene routine.

Dry Mouth

Do you have a Dry Mouth?

Dry mouth is caused by an inadequate flow of saliva.

The term xerostomia refers to a dry mouth sensation experienced by the patient, whereas hyposalivation refers to reduced salivation measured objectively. Reduced salivation or hyposalivation is a significant side effect of specific drugs and is related to a number of systemic diseases

Dry mouth, also known as xerostomia, is not a disease, but rather a symptom of a medical disorder or a side effect caused by gland problems, mouth breathing, or certain medications (allergy antihistamines, cold decongestants, pain killers, and others). It is also a side effect of diseases or medical problems such as Sjogren’s Syndrome.

Dry mouth is especially prevalent in seniors due to the large number of medications that have a side effect of dry mouth. This can be harmful to keeping a healthy mouth as age increases, but a dentist can help to manage the effects of dry mouth.

Common Causes of DRY MOUTH?

  • Medications: medications for cardiovascular diseases, diuretic drugs, psychopharmacological drugs, anticholinergic drugs
  • Systemic diseases: diabetes mellitus, rheumatic diseases, Sjögren syndrome
  • Salivary gland diseases
  • Radiation therapy
  • Mouth breathing
  • Hormonal causes (pregnancy, menopause  )
  • Anorexia nervosa
  • Bulimia
  • Fasting

Medications and Oral Health

As adults age, they go through a second round of cavity susceptibility, which is often attributed to naturally-receding gums and worn-out fillings. However, medications are one of the most common reasons for an increase in cavities in seniors.

Dry mouth is a common side effect of many medications. Since dry mouth prevents saliva from performing its natural job of rinsing away harmful bacteria between meals, an increase in plaque is common in older adults. This plaque can result in rapid tooth decay.

How to Alleviate Dry Mouth

There are a few ways to help lessen the side effects of dry mouth, especially as caused by medication. You can also ask a dentist for additional recommendations for your specific case.

Here are a few ways to help lessen the effects of dry mouth:

  • Use over-the-counter oral moisturizers, like spray or mouthwash
  • Drink more water
  • Use lozenges or sugar-free gum to stimulate saliva production
  • Get a humidifier to help keep moisture in the air
  • Avoid foods and beverages that irritate dry mouths such as coffee, alcohol, carbonated drinks, and acidic fruit juices
  • Ask your physician if you can adjust the dosage or take a different medication


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