Looking for the Best Dentist in India?

We have a Dental Clinic in Shimla, in the name of Goma Dental Clinic and Implant Center. The Clinic is run by Dr. Nisha Goma who has worked as General Dental Surgeon in Zonal Hospital, Solan, HP, India, and as Senior Resident in MNDAV Dental College, Tatul, Solan, HP, India and by Dr. Amandeep Goma who has worked as dental surgeon in Shimla Sanitarium & Hospital. The Clinic was established in 2003. It is Situated on the National Highway and is Drive in. ( no need of walking as in other places in Shimla )
The clinic is equipped with all the Ultra Modern Facilities including Latest Imported Dental Chair, X-Ray, RVG, Intra Oral Camera, Sterilization Unit, Ultra Sonic Scaling, Painless Extractions Under Local Anaesthesia, Tooth Coloured Filling, Silver Filling, Removable Partial Denture, Complete Denture, Crown And Bridge Work, Root Canal Treatment, Treatment of Irregular Teeth, Smile Designing, Dental Implants etc.
The Lab Work is done in the best labs of Chandigarh & New Delhi.Removable partial dentures are delivered the same day whereas the Complete dentures about 3 days. The clinic is registered in the Directory of Dental Tourism in India.

We never compromise in the Quality and try to deliver the best. We assure to provide the best services and never give our patients a chance to complain against us.

Looking for the Best Dentistry Clinic

Most children do quite well for dental treatment. Remember every child responds differently in the dental office. There might be a three year old getting a filling doing just fine sitting next to a twelve year old who is extremely anxious or defiant. You can get them used to coming to the dentist with regular early visits. The children get used to the water and noises of a cleaning so when more extensive treatment is needed, it is not such a big deal to them. For those children who have a harder time than most, well there are several tools that can be employed. The best and most often used are verbal techniques like positive reinforcement, tell-show-do, and voice tone control. Often, pharmcologic methods are necessary to comfortably accomplish treatment. The most common is Nitrous Oxide or Laughing Gas. It is a fairly benign easy way to help the child. Often additional medications are needed to help kids to be comfortable and cooperate to accomplish treatment. Sometimes it is even necessary to do treatment under General Anesthesia in the Hospital. Many times, however, the hospital is not an option due to lack of insurance coverage, limited treatment needs, or parental preference. The option of in-office Conscious Sedation has been a good option to help kids and parents.

Things can be unpredictable as medications elicit different responses in different children. Different medications (usually oral medications) are used for different situatuions. The younger the child, the more unpredictable the medication's effect. A certain dosage on one child may make them quite sleepy and sedated, while the same exact dose will not seem to do anything for the next child. Studies have found an individual child's temperment has a lot to do with their response. Therefore, some kids are better served with treatment under general ansthesia. In fact, if there is so much work that several sedative appointments will be required to complete the treatment, then the option of general anesthesia is usually discussed.

One problem with sedation in pediatric dentistry is that you can only give what is considered a "safe" dosage. Those chidren who do not respond to that dosage, well, you don't just give twice the dose and hope it will take. That could lead to trouble. Whatever is used, you monitor vital signs in accordance with the AAPD guidelines. The whole process is some what of an art as much as a science.

I am going to start series of posts on Sedation in Pediatric Dentistry and related topics. As this is too big a subject to address in one post, here are some important links to related topics (coming in the next few weeks):

Are You Looking for the best Dental Clinic?

They are just baby teeth, why fix them?

Most babies get their first tooth around 6 or 7 months of age; usually the bottom front two incisors. Some kids are a little slower erupting the first tooth causing parental worry. It can be even around 12 months for the first one to poke through. Additional baby teeth will continue to come in till almost three years of age. There really is a lot of variability on the sequence. Don’t feel bad if your child does not get his teeth just like your neighbor’s baby or even his own twin sister. This is important: look at the chart below and you will see that some baby teeth START falling out around 5-6 years old (again give or take a little), but the back molars do not fall out till around 12 years of age!

If your child develops a cavity in a baby tooth the decay will slowly (and sometimes rapidly) get bigger and deeper. If the tooth is really close to falling out, we have the option of just leaving it alone. If it looks like it may be a while till it would normally fall out, we need to do something. Otherwise you are in for ugly teeth, toothaches, infection and more extensive dental work.

A small cavity can be filled with a white filling, a medium cavity can be filled, but a deep or large cavity may need a crown to cover the whole tooth. If the tooth is in the back, the crown may be silver in color. It may even need a Pulpotomy or “nerve treatment”. So, get it fixed early when it is small (and less expensive)!

Remember baby teeth are there for a reason. They give the child something to chew with and (importantly) they often save space for the permanent teeth. Why don't you just pull it? Well, sometimes that is the best option, but if a back baby tooth is lost too early, without followup treatment, additional crowding problems that are often more difficult to correct will occur. So you usually will need additional work like a Space Maintainer. That's one reason why it's often easier to fix a baby tooth than just remove it.

Looking for the Best Dental Imlants Clinic?

The literature in the peer-reviewed journals seems divided on the question of connecting dental implants to natural teeth in fixed partial dentures. The problem encountered is the submersion of natural teeth producing a gap between the fixed partial denture crown margin and the prepared tooth. Some literature supports the position that dental implants and natural teeth should not be connected. Some literature supports the position that dental implants and natural teeth can be connected with rigid attachments (solid metal framework, solder joint) but not with non-rigid attachments (precision attachments).
>>>Rigid attachment with T-block>>
@Osseonews discussion for implant to natural tooth connecting

Implant to Natural Tooth Splinting
Doctors who use this philosophy will sometimes connect an implant to a natural tooth. The advantage of this is that by connecting implants to natural teeth, fewer implants are needed to complete the case. This can dramatically reduce the cost of treatment while allowing the patient to have permanent teeth. The disadvantage of this type of treatment is that should a problem arise with either the implant or natural tooth the problem has to be handled differently because the implants and natural teeth are connected. Furthermore, there are limited data regarding the effects of splinting implants to natural teeth. In this regard, it has been reported that intrusion of splinted teeth and pronounced vertical bone loss around implant abutments are potential sequelae;however, the majority of patients, , in one study suffered no adverse effects. Other reports have indicated that connecting implants to teeth in a fixed prosthesis has a good prognosis. A 5-year prospective study designed to compare bridges supported only by implants with bridges supported by both implants and natural teeth within the same patient, noted no higher risk of implant or prosthetic failure for tooth-implant fixed bridges as comparedwith implant-supported bridges.

How Children Behave at the Dentist, What to Expect

Many parents expect their children either to act up or be little angels at the dentist. With children, you really never know quite what you are going to get. Here is a list of what I generally see with children at different ages and what to expect as far as behavior in the dental office. I have to say I have had one and two year olds who do better than teenagers. I also have seen parents in worse shape than their kids. The behavior is what I usually see for dental exams or cleanings. If they do have cavities or other treatment needs, I use the cleaning/exam appointment to evaluate their response. If I think they will be fussy for treatment, then we discuss how to make that better. There are always exceptions to what I am presenting here, but this is how it goes:

Babies-They usually do well for an exam or just cry a little. Give them their pacifier and they are as good as new.

One year Olds-they usually do quite well although if they are closer to two things can get a little loud.

Two Year Olds-They don't call this age the "terrible twos" for nothing. These kids are by far the hardest to examine. They almost always cry to be examined. I mean they really scream like there is no tomorrow. They fight too. This is the age that they begin to establish independence. This is especially true for the "headstrong" kids. They really don't like to lie down for an exam. I can look a little with them sitting up, but can't really do a complete exam. So, we have them lie down, the parent holds their hands, and I take a really quick look. I don't mind the noise, although the resistance can make the exam more difficult. I always hope the parents realize this kind of fussing is normal for this age. I don't want them to think the child is in any kind of real distress. I don't want them to be mad at me for just looking at their child's teeth. The parents I worry most about are the first timers. Parents who have more than one child often understand the normal reactions. I know the child is not traumatized for life just for counting their teeth. In fact these fussy two year olds often become model patients after a couple more years of regular visits.

Three Year Olds-this is a transition age. Some three year olds are just as fussy as the two year olds just bigger and stronger. Some are model patients who let you lay them down, clean their teeth, and often do fillings without protest. Even a particular three year old may respond differently depending on what side of the bed he woke up on that day. You know what I am talking about.

Four year Olds-I like four year olds. Most of the time they are the best patients. They hop up into the chair; let you take x-rays, fillings, whatever. They can't do this for long, but most do quite well. Again, there are exceptions. Some are as "head strong" as the two year olds.

Five through Eight-Regular kids. Most do quite well. I can communicate with these kids and can guide them through almost anything.

Eight to Eleven-Most do well, but these are the "needle-phobic" years. You can have a perfectly calm child who throws a giant fit if he thinks he is going to get a "shot". Read here for more info on that bad word: Pedo Lingo. After they have received appropriate anesthesia, they revert back to cooperative patients.

Teenagers--Most do well although some have typical teenager "attitudes". You have to take into account whether they are the "I'm too cool to care/whatever" type or (usually young ladies) who are extremely preoccupied with their appearance.

Special Needs Patients--If you take your child to a Pediatric Dentist, you will likely see other children around of all ages and temperaments. You also may see some patients who have medical or developmental conditions like Down's Syndrome, or Cerebral Palsy. These children are welcome in our offices. Some can be very loud or resistant to treatment. Even just an exam can be difficult. Others are some of the best behaved in the office. In other words, there is great variety in Pediatrics. You can expect lots of commotion and activity.

If you want more, go back to the home page or click here:Pediatric Dentistry

Important Tips for Baby Dental Problems

I see this every day. A child comes in with his permanent lower incisors coming in behind the baby teeth. We sometimes call it "Shark" teeth. The baby teeth have not come out like they were supposed to. It is most common with the lower front teeth when the child is six years old and then the upper back molars when the child is around eleven years old. A common "emergency" is when a parent notices a permanent tooth coming in behind a primary (baby) tooth. It's not really an emergancy, but needs to be addressed.

In the normal course of events, the permanent teeth slowly dissolves the baby tooth root as it comes in up under the baby tooth. Finally, there is not much root left. The baby tooth gets loose and eventually falls out. The permanent tooth then comes in where the baby tooth used to be. Well, it doesn't always happen just like that.

If the child doesn't have enough room for the permanent teeth, then the permanent tooth may not come in right up under the baby tooth. Even when there is lots of room, the new tooth may not be able to resorb the baby tooth root fast enough. It then takes the path of least resistance, which is to come in behind the baby tooth. That means there is nothing "pushing" the baby tooth and there may be quite a lot of baby tooth root left.

The good news is that the permanent tooth will tend to move forward into the correct position on it's own IF there is nothing in the way and there is enough room. That usually means the dentist will need to remove the retained baby tooth and make more room by removing the adjacent baby teeth or making the baby teeth more slender by "disking" them. If the new tooth hasn't come in very much (you haven't waited too long), then the new tooth will slowly move forward. This takes a few weeks or months to move forward into a better position. They may even straighten out a little if they were coming in crooked.

Often teeth come in pairs, so if one tooth is not coming in correctly its partner on the other side won't either. A lot of parents hold out hope the baby tooth will fall out on it's own. Some children are very aggressive in wiggling their teeth. Some just let them hanging there. Remember however, that there may be more root on that baby tooth than you think, otherwise it would have come out by now. Most of the time the dentist has to get in there and get the tooth. Even if you can get that tooth out, is there enough room for it to come forward? Many times teeth come in funny because there is some inherent crowding. If the dentist needs to get it out, it's not a big deal. Most kids do quite well for this. Plus, they get to have their tooth to put under the pillow for the tooth fairy!

Important Tips for Dental Implants Surgery

OsseoNews (ON): Could you present an overview of the immediate loading protocols that you and Dr. Wolfinger have developed and are utilizing at the Institute of Facial Esthetics.
Dr.: There are several basic concepts that distinguish our protocols from the traditional approach to implant placement and restoration. In the first place, we utilize an immediate loading approach where we place the implants and subject them to loading on the day of surgery. This is our standard operating procedure in contradiction to the traditional placement followed by a waiting period where the implant fixture is undisturbed and undergoes osseointegration. We have been collecting data over two decades and have firmly established that our protocol produces a very high rate of success over the long term.
ON: Could you explain how you have encorporated computer software into your protocols.
Dr.We make a CT scan of the patient to generate a three dimensional virtual replication of the bone, soft tissue and alignment of teeth. We feed this data into our software program to generate a surgical guide, which selects the most advantageous implant sites and angulations. The surgical guide will have three guide pins, which will securely stabilize the guide stent during the drilling and placement of the implants. The stent will first be used as a guide to drill a hole for each of the guide pins. The guide pins will then be inserted through the stent and into the bone. The advantage of this technique is that the drilling and placement of the implants is very precise and accurate. The implants end up exactly where you want them, at the desired angulation and the desired occlusogingival height.
ON: How do you generate the prosthesis?
Dr.:The prosthesis is generated by the software program based on the data from bone, soft tissue and alignment of teeth. We do a CT scan of the patient at the proper vertical dimension of occlusion in centric relation position.
ON: What if the patient is already wearing removable partial dentures or complete dentures?
Dr.: We scan the patient wearing the removable dentures. We do a second scan of the removable dentures alone. All of this information that we collect enables our software program to generate a fixed-detachable partial or complete denture that will fit the abutments torqued into the implant fixtures.
ON: The permanent abutments then are also torqued down at the time of implant placement?
Dr.: The permanent abutments are torqued down permanently at the time of implant placement. They are not removed after they have been torqued down. The final form and orientation of the abutments is established at the time of implant placement.
ON: The CT scan and software program provide accurate enough data to produce a prosthesis that precisely fits the abutments?