Clefts of the lip and palate are very common congenital deformities (defective developments seen at birth). Cleft lip is seen as a split usually in the upper lip, producing bad facial appearance. Cleft palate is seen as a cleft or furrow in the palate, sometimes producing a communication between the nose and the mouth, which causes difficulty in nursing the child and may later pose problems of speech.

The clefts of the lip and palate occur due to a verity of reasons, with the most important being genetic. The other causes include the intake of certain teratogenic drugs/chemicals (which cause malformation of the embryo) during pregnancy.

Clefts pose numerous problems. They are treated by a multidisciplinary approach by involvement of orthodontics, pediatric dentistry, oral/plastic surgery, prosthodontics, etc.

Teeth extractions are done for a variety of reasons. Below are some examples. 1. Large cavity/caries that cannot be restored with cements. 2. Mobile/infected tooth (abscess) 3. Fractured/broken teeth 4. Teeth that fail to erupt/are unable to erupt and are deep inside the bone (‘impacted teeth’) 5. Abnormally developed teeth, i.e., structure, shape, size, etc. 6. Teeth involved in cysts/tumors. 7. Ectopic teeth (erupted in a wrong place) 8. Sometimes the orthodontist may remove some teeth to correct crooked teeth.

Teeth are extracted after administering local anesthesia, which makes the tooth and the surrounding tissues numb. Thus, extractions are not painful. But a feeling of pressure may be experience during the procedure. This is often coupled with fear and anxiety, which makes the patient feel some sort of ‘pain’.

The following care should be taken after extraction: 1. Bite on a gauze pack for 15-20 minutes. 2. Take rest and avoid physical activities. 3. Avoid eating till numbness persists. 4. Avoid warm food; it can result in bleeding. In addition, soft food is advised. 5. We may advise cold fomentation for some, to reduce the inflammation and swelling. 6. After 24 hours warm saline mouthwash helps in keeping the wound clean. 7. Avoid biting lips/cheeks.

Sutures are stitches which may be used after extraction, to approximate the gums together and restrict the size of the wound. They also control the bleeding.

Sutures are of two types: absorbable and non-absorbable. The absorbable sutures are broken down by the human body. They just dissolve in a few days and need not be removed. The non-absorbable sutures need to be removed after 7-10 days.

Once the tooth is extracted a wound is created and therefore bleeding occurs. Bleeding stops once a stable clot forms. In some patients, minor seeping of blood may be seen for a day or two after extraction, and their saliva may be tinged with blood. This need not be a cause for worry to the patient. However, profuse bleeding must be brought to our notice.

They may not erupt or emerge from your gums until your late teens or early twenties - if they erupt at all. Most often, they are impacted/trapped in the jaw-bone and gums, usually because there is not enough room for them in your mouth. In fact, wisdom teeth often do more harm than good, and in-case of any problems related to them, we may suggest removing them. There are 5 possible ways in which wisdom teeth may cause problems:

1. Gum disease: Most people are aware of the pain experienced during the eruption of these teeth. This generally happens because these partly erupted teeth are difficult to keep clean, and the accumulated food particles cause the gums around the tooth to get infected. Such an infection is felt as swelling and pain around the area. Sometimes the tooth is trying to erupt but has not yet broken through the gums. When the upper tooth bites down onto this gum, pain can be caused.

2. Impacting: There may not be enough space in the mouth for these teeth to erupt. In such cases they may try to erupt in an abnormal direction/get locked into the jaw. This locking is known as impaction.

3. Decay: A wisdom tooth may decay unnoticed, since they are the most difficult teeth to keep clean. Most importantly, decay is caused in healthy neighboring teeth because of food stagnation and plaque accumulation.

4. Crowding: An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.

5. Cyst: If the sac that holds the crown of the wisdom tooth remains in the bone, it can fill with fluid, forming a cyst that can destroy surrounding bone.

The wisdom teeth are often inside the bone and therefore cannot be removed by forceps. Also, their position/angulation may be abnormal. This often require surgical extraction (cutting open the overlying gums & cutting the bone around the teeth).

Some extractions are followed by appearance of swelling. This is nothing to worry about, as it is a part of the normal healing process. In reaction to the extraction, the tissues show an inflammatory reaction to heal the wound created by the removal of the tooth. Swelling is a part of the normal inflammatory process. However, we may advice you to have cold fomentation over the area to reduce the swelling.

Dry socket is a condition characterized by onset of pain and foul odor a few days after the extraction. This occurs due to lysis/dislodgment of the clot that forms after the extraction leaving behind the bony socket that is very sensitive and tender. This socket may, in very rare cases, also get infected.

Teeth are embedded in bone. In extraction, the tooth is held by forceps and rocked from side to side to get it free of the bony socket. In older patients, the bone is very hard and mature and does not easily give way. In addition, the teeth also become brittle with age or may have been weakened due to dental decay. The two factors, (weakened teeth & brittle bones) may result in breaking of the tooth during extraction. The small piece of tooth left behind can be removed by appropriate root forceps or may require surgical opening of the gums and cutting of the bone to remove the broken fragment.

Those teeth that cannot be gripped by a forceps or are embedded inside the bone may require cutting of the gums and the overlying bone to remove the teeth.

We must be informed of any medical problems that you may have or had in the past. There are certain systemic problems, which may require certain precautions during the dental treatment to avoid complications. In some cases, we may require consent from your physician before we can extract.

Usually extractions may not pose any problems for heart patients. However, we may require your physician's consent. If the patient is on anticoagulants, the drug must stopped 4 days before extraction. In addition, prophylactic antibiotics may be prescribed prior to the extraction as a precautionary measure. Some sedative may also be prescribed prior to the extraction.

Patients who have their diabetes under control, by diet and medication, can undergo extraction. However, we may give you a prophylactic antibiotic prior to the procedure. We would also advise you to have normal food and medicine before the appointment. Sedative may or may not be prescribed.

Most oral cancers may appear as a swelling or painless ulcer. Sometimes a patch of whitish tissue or red tinged tissue may be seen. Pain is usually a feature in the late stages due to infection of the lesion.

1. Chemotherapy: Tumors may be treated by drugs or chemicals that kill the tumor cells but are usually also very toxic to the body and may cause many side-effects.

2. Radiation therapy: The tumor is exposed to targeted radiation, which kills the cancerous cells. Radiation is, therefore, also harmful to normal tissue and may cause many side-effects.

3. Surgical removal: The entire tumor is removed along with a border of normal tissue. In case the tumor has spread to nearby lymph glands, they may also be removed surgically.

Radiation therapy for treatment of oral cancer is usually followed by reduced salivary quantity due to atrophy of the oral glands. Thus, the cleaning action of the saliva on the teeth is reduced, which may result in increased dental decay. Thus, patients who have had radiation therapy need to maintain good oral hygiene and may also require professional fluoride application to offer resistance to caries.

Extraction and other minor oral surgical procedures are usually completed prior to radiation therapy. Soon after the radiation therapy, it has been found that the blood supply to the irradiated zone is reduced, which may cause infection in the tissue around the extraction. Thus, surgical procedures and extractions are avoided after radiation therapy.

Biopsy is surgical removal of a small sample of tissue from a lesion such as a tumor. This tissue is studied under the microscope to determine what type of lesion it is so that appropriate treatment can be planned.