Speaker 1: You know, usually when we talk about like engineering or
Speaker 1: a structural repair, there's this expectation of pristine conditions.
Speaker 2: Well, absolutely total control over the environment.
Speaker 1: Right, you build a suspension bridge in the open air,
Speaker 1: or you repair a high performance engine in this you know, dry,
Speaker 1: well lit, temperature controlled garage, the environment is entirely on
Speaker 1: your terms.
Speaker 2: Yeah, you can see everything perfectly, you control the humidity,
Speaker 2: and you have like infinite space to maneuver your tools exactly.
Speaker 1: But then you step into the world of modern clinical
Speaker 1: dentistry and suddenly that pristine garage is just entirely gone.
Speaker 2: It's gone. You are suddenly doing micro engineering in a tiny, dark,
Speaker 2: incredibly sensitive space and.
Speaker 1: It's constantly flooded with fluid and under immense physical pressure.
Speaker 1: So welcome to another deep dive. Today. We are on
Speaker 1: a very specific mission for you. If you are a
Speaker 1: dental student, maybe a young professional just starting your clinical practice,
Speaker 1: or you know, just a self learner looking to completely
Speaker 1: demystify the science of oral healthcare, this deep dive is
Speaker 1: custom tailored for you.
Speaker 2: It really is.
Speaker 1: We are going to explore the absolute fundamentals of dental.
Speaker 2: Procedures, and it truly is, like we said, the definition
Speaker 2: of an extreme biomechanical environment. I mean, the mouth is
Speaker 2: a very small anatomical space, but mastering it requires this
Speaker 2: deep intersecting knowledge of mechanics, biology, and chemistry all at once,
Speaker 2: all it once. Yeah, So we are going to logically
Speaker 2: track the life cycle of a tooth today. We'll start
Speaker 2: with the very first line of defense, which is preventing
Speaker 2: decay from ever taking hold.
Speaker 1: Right.
Speaker 2: Then we'll explore how to physically diagnose problems when they
Speaker 2: do inevitably arise, how to repair or extract damage structures,
Speaker 2: and finally, the incredible engineering required to replace teeth and
Speaker 2: restore facial aesthetics.
Speaker 1: So let's just untack this starting before a dentist ever
Speaker 1: even thinks about picking up a drill. I mean, the
Speaker 1: entire goal of oral health care is to stop pathology
Speaker 1: in its tracks, specifically dental carries, which most of us
Speaker 1: just call cavities. Where does that battle actually begin, Well.
Speaker 2: It begins with a very critical intervention window, and that's
Speaker 2: the eruption of the first permanent molars. For most patients,
Speaker 2: this happens right around age six. Now, put yourself in
Speaker 2: the shoes of a six.
Speaker 1: Year old, right, why of candy exactly?
Speaker 2: Their diet often contains a much higher amount of refined,
Speaker 2: sticky sugars, and their manual dexterity for effective toothbrushing is still,
Speaker 2: you know, severely underdeveloped.
Speaker 1: That sounds like a perfect storm for rapid two to kay.
Speaker 2: It really is. And on top of those behavioral factors,
Speaker 2: you have anatomical factors. So these permanent molars have natural
Speaker 2: deep clefts on their biting surface.
Speaker 1: So the grooves right. Yeah.
Speaker 2: Clinically these are called pits and fissures, and they essentially
Speaker 2: act as stagnation areas. So plaque, which is a sticky
Speaker 2: biofilm of bacteria and microscopic food debris, they just sit
Speaker 2: down in these deep valleys.
Speaker 1: Gross.
Speaker 2: Yeah, And even if the child is trying their absolute
Speaker 2: best to brush a toothbrush bristle is physically too large
Speaker 2: to reach down into the very bottom of that fissure.
Speaker 1: Wait. Really, so the bacteria are basically entrenched in a
Speaker 1: canyon where the bristles just physically can't reach them. Precisely,
Speaker 1: how do you defend against that?
Speaker 2: You fill the canyon. Yeah, we use what are called
Speaker 2: fissure sealants. It's an incredibly elegant application of cure chemistry. First,
Speaker 2: you need absolute moisture control. The tooth has to be
Speaker 2: totally isolated from saliva.
Speaker 1: Okay.
Speaker 2: Then the dentist applies an acid etched directly onto those
Speaker 2: biting fissures.
Speaker 1: Acid on a healthy tooth.
Speaker 2: Yes, specifically a mild phosphoric acid. And what this does
Speaker 2: is it chemically roughens the smooth enamel. At a microscopic level,
Speaker 2: it dissolves a tiny, tiny amount of the mineral content
Speaker 2: to create porosities. And when you wash that acid off
Speaker 2: and thoroughly dry the tooth, the surface actually turns a
Speaker 2: distinct chalky white color.
Speaker 1: Oh wow, So that trocky white appearance is like the
Speaker 1: visual conformation that the enamel has been successfully demineralized just
Speaker 1: enough to create a grip exactly.
Speaker 2: It creates a porous, sponge like surface on the microscopic level.
Speaker 2: So once we see that chalky white and unfilled liquid,
Speaker 2: resin has flow directly into those etched areas and it
Speaker 2: just sinks in. Yeah, it seeps into all those microscopic
Speaker 2: pores we just created, completely sealing the deep valleys. Finally,
Speaker 2: it's locked into the enamel structure by setting it with
Speaker 2: a specialized curing lamp that is so cool.
Speaker 1: You're literally paving over the microscopic potholes, so bacteria have
Speaker 1: nowhere to hide exactly. But the biting surface is only
Speaker 1: one part of the tooth. What about the sides?
Speaker 2: Well, what's fascinating here is that while ceilants protect the
Speaker 2: occlusal or top surfaces, the interproximal areas, which are the
Speaker 2: spaces where the teeth touched side by side, those are
Speaker 2: just as.
Speaker 1: Vulnerable because food gets stuck there.
Speaker 2: Right, And that is where topical fluorides and strict interdental
Speaker 2: cleaning like flossing becomes so essential. If a patient doesn't
Speaker 2: master these daily skills, all the advanced restorative work we
Speaker 2: do later is eventually doomed to fail. You just cannot
Speaker 2: out engineer bad hygiene.
Speaker 1: Which brings us to a really brilliant tool for patient education.
Speaker 1: Disclosing agents. Oh yes, I remember seeing these as a
Speaker 1: kid at the dentist. They are these vegetable dyes, usually
Speaker 1: red or blue, that come in a liquid or a
Speaker 1: chewable tablet. The patient choose the tablet for a minute,
Speaker 1: spits it out and looks in a mirror.
Speaker 2: Yep, it's quite a look.
Speaker 1: Using its closing agent. It's essentially like turning on a
Speaker 1: black light at a crime scene, right, so the patient
Speaker 1: can actually see the enemy they missed.
Speaker 2: That is the perfect analogy. Plaque is naturally a creamy
Speaker 2: white or pale yellow color which blends almost perfectly with
Speaker 2: the color of the tooth. It's practically invisible to the naked.
Speaker 1: Eye, so you think you're clean when you're really not.
Speaker 2: Right. But by staining the plaque with that vegetable dye,
Speaker 2: usually around the gingble margins, you know where the gum
Speaker 2: meets the tooth, the patient gets immediate, undeniable visual feedback
Speaker 2: on exactly where their brush of technique is failing.
Speaker 1: Speaking of brushing technique, here's where it gets really interesting
Speaker 1: to me. I always thought brushing harder, like with a
Speaker 1: stiffer brush, meant cleaner teeth, scrubbing the surface right, get
Speaker 1: the grime off. But apparently this is one of the
Speaker 1: most destructive habits that patient can have.
Speaker 2: It is pure mechanical trauma. If you scrub horizontally with
Speaker 2: heavy force, especially if you're using a hard bristled brush,
Speaker 2: you can actually saw into the necks of your teeth.
Speaker 1: Over time, just with nylon bristles.
Speaker 2: Yes, it creates these deep wedge shaped defects called abrasion cavities.
Speaker 2: It also causes severe gum recession, which exposes the root
Speaker 2: surface and the root doesn't have a hard enamel shell
Speaker 2: to protect it, so.
Speaker 1: You're literally eroding your own jaw structure through brute force exactly.
Speaker 2: That's why the clinical recommendation is always a toothbrush with
Speaker 2: a small head for better maneuverability in tight spaces and
Speaker 2: medium multi tufted nylon bristles. You want thorough sweeping motions,
Speaker 2: not aggressive scrubbing.
Speaker 1: But let's say the patient's habits aren't perfect despite their
Speaker 1: best efforts, some of that plaque gets left behind. Over time,
Speaker 1: it mineralizes and hardens into calculus, which most people know
Speaker 1: is tartar. Right at this point, no amount of brushing
Speaker 1: it's going to remove it. Right, you're moving out of
Speaker 1: prevention and into the next phase, the life cycle, diagnostics
Speaker 1: and scaling. How do we find and quantify the damage?
Speaker 2: Well, let's address the hardened calculus first. That requires a
Speaker 2: mechanical procedure called scaling.
Speaker 1: Okay, scraping it off right.
Speaker 2: The dentist or dental hygienist systematically places a specialized metal
Speaker 2: scaler against the tooth and they hook it right at
Speaker 2: the bottom edge of the calculus build up. The goal
Speaker 2: is to use a deliberate upward scraping motion to dislodge
Speaker 2: the calculus on mass, yeah, meaning breaking it off in
Speaker 2: solid chunks rather than just shaving it down layer by layer.
Speaker 1: Now I know from personal experience that this process can
Speaker 1: cause bleeding, which you might freak apation out if they
Speaker 1: are inspecting it. But that bleeding is actually a symptom
Speaker 1: of the disease, not the procedure right precisely.
Speaker 2: A lot of people think the hygienist is cutting them,
Speaker 2: but the bleeding happens because the gingible tissues the gums
Speaker 2: are already in a highly inflamed, fragile state due to
Speaker 2: the chronic presence of that bacteria laiden calculus.
Speaker 1: And that's pugevitis.
Speaker 2: Yes, exactly, this condition is gingivitis. The scaling instrument doesn't
Speaker 2: actually cut the gums, It's just that the inflame tissue
Speaker 2: is so delicate it bleeds upon literally any contact.
Speaker 1: Oh I see, Once that.
Speaker 2: Calculus irritant is fully removed, the inflammation subsides and the
Speaker 2: gums will naturally return to a firm, healthy pink appearance
Speaker 2: within just a few days.
Speaker 1: Okay, so the calculus is gone and the terrain is clear.
Speaker 1: Now the dentists has to play detective and find actual
Speaker 1: decay or deeper bone issues. I know dentists use hand
Speaker 1: instruments called probes, and there are two very distinct types
Speaker 1: on that little metal tray.
Speaker 2: Yes there are.
Speaker 1: There's a sharp ended probe and a blunt ended probe.
Speaker 1: But practically speaking, what is the dentist actually feeling for
Speaker 1: when they use these?
Speaker 2: It is all about establishing a diagnostic baseline through tactile feedback.
Speaker 2: So when the dentist lightly drags the sharp probe over
Speaker 2: the grooves of the enamel, they are feeling for texture.
Speaker 1: What kind of texture?
Speaker 2: A hard scratchy surface is x one That indicates sound
Speaker 2: highly mineralized enamel. But if the probe suddenly sticks, or
Speaker 2: if the surface feels soft and tacky, that is bad news.
Speaker 2: It means bacterial acid has demineralized, the structure carries has
Speaker 2: set in.
Speaker 1: And what about the blunt ended probe? Why do we
Speaker 1: need a dull instrument?
Speaker 2: So the blend ended probe has millimeter depth markings laser
Speaker 2: etched onto it. It is actually not used on the
Speaker 2: tooth itself, but rather it's used to measure puidonal pockets. Okay,
Speaker 2: the dentist gently walks this blunt probe around the gingerbal crevice,
Speaker 2: which is that tiny natural collar of gum tissue that
Speaker 2: surrounds the neck of every single tooth.
Speaker 1: So what does this all mean for the patient in
Speaker 1: the chair? What's a good measurement versus a bad measurement?
Speaker 2: A perfectly healthy gingal crevice is shallow, meaning it's no
Speaker 2: deeper than two millimeters, and it absolutely does not bleed
Speaker 2: when the blunt probe is inserted.
Speaker 1: Okay, under two milimeters, no bleeding. Right.
Speaker 2: If that blunt probe sinks three, four or five milimeters
Speaker 2: down and the area bleeds, that is the primary definitive
Speaker 2: diagnostic indicator of active periodontal disease.
Speaker 1: Wow.
Speaker 2: The deeper the probe sinks, the more severe the bacterial
Speaker 2: infection is, and the more the underlying jawbone is actively
Speaker 2: being destroyed.
Speaker 1: That is wild. Two millimeters is the literal dividing line
Speaker 1: between health and a chronic infection. That is incredibly precise.
Speaker 1: But obviously, a metal probe can't see inside the tooth
Speaker 1: or between the teeth where they touch tight.
Speaker 2: No, it can't, and that's where radiographs or X rays
Speaker 2: become non negotiable. We rely heavily on intraoral views like
Speaker 2: the bite wings exactly. Bite wing radiographs are perfect for
Speaker 2: showing innerdental carries, which is decay hiding between the teeth,
Speaker 2: or checking if an old filling has an overhang that's
Speaker 2: trapping plaque. And the other type periopical views, those are larger.
Speaker 2: They capture the entire crown, the complete root system, and
Speaker 2: the surrounding bone, so we can check for deep abscesses.
Speaker 1: Got it, And sometimes you need to see how the
Speaker 1: whole system functions together mechanically. That's when dentists takes study models. Right,
Speaker 1: I've had this done. They use this goop called alginate,
Speaker 1: which is like an elastomeric material. They load it into
Speaker 1: a tray and press it up against your entire upper
Speaker 1: or lower arch.
Speaker 2: Yes, and as a quick clinical tip for you, instructing
Speaker 2: the patient to breathe steadily through their nose during that
Speaker 2: process is absolutely vital to suppress the gag reflex and
Speaker 2: avoid a feeling of choking.
Speaker 1: Right, I remember them telling you to do that, And
Speaker 1: while they're taking those impressions. They might also take a
Speaker 1: wax wafer bite. They warm up a piece of pink
Speaker 1: wax and have you bite down into it. Why do
Speaker 1: they need the wax if they already have the mold.
Speaker 2: Because the algenate impressions only give us static models of
Speaker 2: the upper and lower jaws separately within twenty four hours.
Speaker 2: Liquidental stone is poured into those alginate molds to create
Speaker 2: hard cast replicas of the patient's teeth. But we need
Speaker 2: to know exactly how those two cast models meet together
Speaker 2: in three dimensional space. The wax wafer records the patient's
Speaker 2: precise occlusion or bite.
Speaker 1: Oh, so the dentists can hold these cast models, line
Speaker 1: them up with the wax, and physically see exactly how
Speaker 1: they teeth grind together without the patient's lips, cheeks, or
Speaker 1: tongue getting in the way. They can diagnose things like bruxism,
Speaker 1: which is severe tooth grinding exactly.
Speaker 2: If we connect this to the bigger picture. All of
Speaker 2: these diagnostic tools, the tactile feedback of the probes, the
Speaker 2: structural imaging of the radiographs, the mechanical mapping of the
Speaker 2: cast models, they are simply gathering data.
Speaker 1: Once you have the data.
Speaker 2: Once we have that data, we have to intervene, which
Speaker 2: brings us to the next phase.
Speaker 1: Restorative dentistry, the art of repair or what most people
Speaker 1: simply call getting a filling. Because once that sharp probe
Speaker 1: finds a soft, sticky spot or the X ray reveals
Speaker 1: a dark shadow between the teeth, the pathology of carries
Speaker 1: is a one way street, isn't it?
Speaker 2: It absolutely is. Tooth decay does not heal itself. The
Speaker 2: demineralization eventually breaches the hard outer enamel layer and opens
Speaker 2: up the inner layer.
Speaker 1: Called dentin and dentine is different, very different.
Speaker 2: Dentine is composed of microscopic tubules that lead directly to
Speaker 2: the tooth's nerve center. When bacteria and oral fluids invade
Speaker 2: those dentie tubules, that is exactly when you start feeling
Speaker 2: thermal sensitivity to hot coffee or cooled ice cream and
Speaker 2: eventually sharp pain.
Speaker 1: So the intervention requires stopping the pain, eliminating the disease tissue,
Speaker 1: and completely sealing the breach. Let's talk about the materials
Speaker 1: used to build that seal, starting with the workhourse of
Speaker 1: the last century dental amalgam.
Speaker 2: Amalgam is a fascinating material It is an alloy powder
Speaker 2: primarily silver, mixed with liquid mercury. When traturated or mixed rapidly,
Speaker 2: it forms appliable mass that the dentist packs into the
Speaker 2: cleaned cavity. It sets into a highly durable, solid metallic
Speaker 2: plug that can perfectly withstand intense chewing forces.
Speaker 1: But there are downsides, right beyond the fact that it's
Speaker 1: metallic silver and doesn't look like a natural tooth, It
Speaker 1: doesn't actually stick to the tooth chemically, does it?
Speaker 2: Yeah? No, it does not. Amalgam requires mechanical retention. This
Speaker 2: means the dentist has to use a drill under local
Speaker 2: anesthetic to shape the cavity in a very specific way,
Speaker 2: like how they have to create an undercut, meaning the
Speaker 2: base of the hole is slightly whiter than the opening.
Speaker 2: So when the amalgam hardens, it's physically trapped inside the
Speaker 2: tooth like a ship in a bottle.
Speaker 1: Oh wow, So that often means drilling away some perfectly
Speaker 1: healthy tooth structure just to create that mechanical lock.
Speaker 2: Yes it does, which goes against the modern idea of
Speaker 2: preserving as much natural tooth as possible. That's why tooth
Speaker 2: colored materials are so popular now. Composits and glass ionomous cements,
Speaker 2: or sometimes a hybrid of the two called.
Speaker 1: A compomer, and those stick on their own.
Speaker 2: These materials do chemically bond to the tooth structure, but
Speaker 2: the catches the working environment has to be perfect.
Speaker 1: Perfect and absolutely bone dry, right exactly.
Speaker 2: The chemical bond of composite resin is instantly destroyed by
Speaker 2: even a microscopic drop of saliva or blood. This is
Speaker 2: why you will often see the dentist place a rubber dam,
Speaker 2: which is a physical sheet of latex or non latex
Speaker 2: material stretched over the tooth.
Speaker 1: I've had that.
Speaker 2: It's so weird, it is, but it isolates the twoth
Speaker 2: from the rest of the wet mouth, creating a miniature
Speaker 2: dry surgical field.
Speaker 1: It's like building a tiny waterproof tent around the work site. Yeah,
Speaker 1: but the tradeoff is worth it, right, because here's where
Speaker 1: it gets really interesting to me. With a material like
Speaker 1: glass eyonomer, which chemically bonds and releases fluoride, sometimes there's
Speaker 1: almost no tooth preparation required at all if there's no
Speaker 1: active decay.
Speaker 2: That's true.
Speaker 1: So say you just have a defect or an abrasing
Speaker 1: cavity at the gum line from brushing too hard. Using
Speaker 1: glass eyeonomor is less like excavating a construction site with
Speaker 1: a drill and more like just patching a pothole on
Speaker 1: the highway.
Speaker 2: That's exactly how you should visualize it. You are simply
Speaker 2: cleaning the surface and flowing the material into the defect
Speaker 2: seal it. It is highly conservative dentistry. You balance the
Speaker 2: need for mechanical function with beautiful aesthetics and an impenetrable
Speaker 2: biological seal.
Speaker 1: But what happens when the decay wins the race? You know,
Speaker 1: the patient ignored the sensitivity, the curious attack progressed too
Speaker 1: far and it breached the pulp chamber. The bacteria have
Speaker 1: literally hit the blood vessels and the nerve center of
Speaker 1: the tooth. We are at the point of no return
Speaker 1: endodontics and extractions.
Speaker 2: Yeah, that's a tough spot. If the bacterial exposure into
Speaker 2: the pulp is very, very minor, there is a last
Speaker 2: ditch effort called pulp capping.
Speaker 1: How does that work?
Speaker 2: The dentist achieves absolute moisture control, stops the bleeding using
Speaker 2: a local anesthetic that contains a vasoconstrictor to shrink the
Speaker 2: blood vessels, and carefully places a highly alkaline paste of
Speaker 2: calcium hydroxide directly over the tiny exposure.
Speaker 1: Site, and that heals it.
Speaker 2: It calms the nerve and stimulates the tooth to build
Speaker 2: a bridge of secondary dentine to heal itself, and then
Speaker 2: it's sealed with a temporary dressing.
Speaker 1: But if that fails, or if the infection is massive
Speaker 1: and the tooth is dying or already dead, you are
Speaker 1: looking at a pulpectomy. Most people know this as a
Speaker 1: root canal, and the mechanical steps here are intense. Break
Speaker 1: this down for us because it sounds like exploring a
Speaker 1: microscopic cave system.
Speaker 2: It essentially is a cave system. Once the dentis opens
Speaker 2: the top of the tooth, the first step is extirpation,
Speaker 2: which is physically removing the dead or infected nerve tissue
Speaker 2: using what they use specialized highly flexible hand instruments called
Speaker 2: barbed brooches, which have tiny hooks that grab the tissue
Speaker 2: and pull it out.
Speaker 1: Oh wow, so the canal is empty, but it's still infected. Right.
Speaker 2: Yes, The walls of that microscopic canal are coated in bacteria,
Speaker 2: so the canal system has to be mechanically widened. Laterally,
Speaker 2: and aggressively smoothed out all the way to the tip
Speaker 2: of the root, which is called the apex. Dentists use
Speaker 2: sequential instruments called reamers to widen the space and endodontic
Speaker 2: files to scrape the walls perfectly smooth, removing any irregularities
Speaker 2: that could harbor surviving bacteria.
Speaker 1: And they are constantly irrigating right, flushing the canal with
Speaker 1: chemical solutions.
Speaker 2: Yes to dissolve debris, kill bacteria, and frankly, to lubricate
Speaker 2: those microscopic metal files so they don't snap off inside
Speaker 2: the tooth.
Speaker 1: That would be bad. But wait, how do they know
Speaker 1: they've reached the exact bottom of the root without drilling
Speaker 1: straight through the jawbone. They can't see down there.
Speaker 2: It's amazing. We use an incredible piece of technology called
Speaker 2: an electronic apex locator. It measures the electrical impedance between
Speaker 2: the inside of the tooth and the patient's oral mucosa
Speaker 2: to tell the dentist down to the fraction of millimeter
Speaker 2: when their file is reached the end of the root.
Speaker 1: That is sci fi level stuff, right.
Speaker 2: And once the length is verified and the canal is
Speaker 2: completely sterile, it must be obdurated or sealed right, They pack.
Speaker 1: The empty space with a natural biocompatible rubber called Guda percha.
Speaker 1: They smear it in a cement ceilant and shove it
Speaker 1: down the canal to completely obliterate the void, so bacteria
Speaker 1: can never move back in.
Speaker 2: Exactly, and this leads to a very dangerous paradox for
Speaker 2: the patient regarding their aftercare.
Speaker 1: I was just wondering about this. If the plpectomy was
Speaker 1: a success, the tooth is essentially dead. The nerves are
Speaker 1: completely gone, So how can a patient still get a
Speaker 1: cavity in a root canal tooth?
Speaker 2: Because the outer hard tissues, the enamel and the dentane,
Speaker 2: they are still perfectly susceptible to dietary acids and new
Speaker 2: bacterial attacks. But because the tooth has absolutely no sensory
Speaker 2: nerves left, the patient's early warning system is gone. They
Speaker 2: feel zero thermal sensitivity.
Speaker 1: And zero pain, so they have no ideas rotting none.
Speaker 2: A brand new cavity can develop and completely undermine the
Speaker 2: remaining tooth structure in total silence, until one day the
Speaker 2: patient bites down on something soft and the entire tooth
Speaker 2: catastrophically fractures right at the gingible margin.
Speaker 1: A silent collapse.
Speaker 2: Ye.
Speaker 1: And if that fracture is too severe, or if the
Speaker 1: tooth simply cannot be saved in the first place, we
Speaker 1: arrive at the absolute last resort extractions, removing the tooth entirely. Yes.
Speaker 2: Extractions are generally categorized into simple and surgical. A simple
Speaker 2: extraction usually involves loosening the tooth with an elevator and
Speaker 2: pulling it.
Speaker 1: With forceps, which is what most people picture, right.
Speaker 2: But surgical extractions are major biomedical procedures.
Speaker 1: Let's walk through a surgical extraction. The chair is angled perfectly,
Speaker 1: the lighting is focused. What actually happens.
Speaker 2: The dentist uses a scalpel blade to carefully incise and
Speaker 2: peel back a flap of the gingerble tissue to expose
Speaker 2: the jawbone. Often the tooth is completely impacted or encased.
Speaker 1: In bone, right like wisdom teeth.
Speaker 2: Exactly so under copious sterile irrigation to prevent heat damage,
Speaker 2: the dentist uses a surgical bird to drill away the
Speaker 2: surrounding jawbone just to access the roots.
Speaker 1: And sometimes they have to physically section the tooth right,
Speaker 1: cutting it into halves or thirds just to get it
Speaker 1: out of the socket. Without shattering the jaw.
Speaker 2: Exactly after the tooth is finally removed, the surgeon articulously
Speaker 2: checks the empty socket for any loose microscopic bone fragments
Speaker 2: left behind called bony sequestrae.
Speaker 1: Because those cause problems.
Speaker 2: If left these cause severe infections. The socket is flushed,
Speaker 2: the gum flap is repositioned, and it's securely sutured back
Speaker 2: into place. Finally, the patient clamps down on a sterile
Speaker 2: byte pack to achieve hemostasis, which is the stabilization of
Speaker 2: blood clotting.
Speaker 1: It's incredibly heavy, which brings us to the final phase
Speaker 1: of the life cycle. The tooth is gone. We have
Speaker 1: a gap in the mouth, or perhaps the teeth are
Speaker 1: present but misaligned. How do we rebuild the landscape? Prosthetics
Speaker 1: and esthetics. Let's talk prosthetics.
Speaker 2: To restore mechanical function and appearance, we have a few options.
Speaker 2: Dentures are removable replacements. They can be fabricated with pink
Speaker 2: acrylic bases or much thinner, stronger metal chrome bases. The
Speaker 2: laboratory process to construct them involve something called flasking, where
Speaker 2: the artificial teeth are permanently joined to the base under
Speaker 2: high heat and pressure. We also have fixed bridges which
Speaker 2: cement a false tooth to the adjacent natural teeth.
Speaker 1: But the gold standard now is dental implants, and the
Speaker 1: engineering here is just staggering. The dentist surgically places a
Speaker 1: threaded titanium cylinder directly into the living jawbone, but they
Speaker 1: don't attach the faked tooth right away.
Speaker 2: They cannot. The gingible tissue is sutured over the titanium implant,
Speaker 2: and it requires a mandatory healing period, usually around three months.
Speaker 2: Why so long we are waiting for a biological process
Speaker 2: oco integration. The living bone cells literally have to grow
Speaker 2: into and fuse with the microscopic pores of the titanium.
Speaker 2: Only when that structural foundation is completely solid can the abutment,
Speaker 2: which is the post that holds the final porcelain tooth
Speaker 2: be attached.
Speaker 1: Incredible, it becomes part of your skeleton. But what if
Speaker 1: all the natural teeth are present, but they are just
Speaker 1: severely misaligned. That's orthodontics. We have removable appliances, which are
Speaker 1: usually acrylic bases equipped with retentive midtal cribs that clasp
Speaker 1: on to the teeth and active springs that push the
Speaker 1: teeth in specific directions. And then we have fixed appliances
Speaker 1: or traditional brackets and wires.
Speaker 2: This raises an important question, though, about why we do this.
Speaker 2: Orthodontics isn't just about a pretty straight smile.
Speaker 1: It's not no.
Speaker 2: Correcting crowded teeth makes them dramatically easier to clean. Preventing
Speaker 2: decay and fixing severely proclined teeth that lean aggressively forward
Speaker 2: is crucial because they are at a massive risk of
Speaker 2: being physically snapped off in an accident. Orthodontics fundamentally improves mastication,
Speaker 2: the physical efficiency of chewing your food.
Speaker 1: Esthetics do play a major role in modern dentistry, though,
Speaker 1: especially with tooth whitening. Patients want that bright smile. There
Speaker 1: is home whitening where the patient applies a oxide paste
Speaker 1: into custom vacuum form trays over a period of weeks.
Speaker 1: But then there is in house power whitening. I was
Speaker 1: reading about this process and I had no idea it
Speaker 1: was basically a biohazard construction zone in the mouth.
Speaker 2: It really is. It requires extreme isolation because the chemical
Speaker 2: agents are incredibly powerful.
Speaker 1: They literally put high SBF suncream and lipbalm on your
Speaker 1: face before they begin. They insert rigid plastic retractors to
Speaker 1: hold your lips and tongue completely out of the way.
Speaker 1: They pack the vestibules of your mouth with cotton gauze,
Speaker 1: and then they pipe a specialized protective paste across your
Speaker 1: delicate gum lines that sets into a hard light proof barrier.
Speaker 1: All of this happens before the whitening paste even touches
Speaker 1: your tarth.
Speaker 2: Yeah, and the reason for the sun cream and the
Speaker 2: light proof barrier is because of the power light used
Speaker 2: to rapidly activate that whitening paste. It is a highly
Speaker 2: intense light source, usually applied in three consecutive fifteen minute cycles.
Speaker 2: Because of that intense localized radiation, patients who are on
Speaker 2: certain photosensitive medications or even specific herbal products can actually
Speaker 2: develop severe sunburn on their face or sunstroke like symptoms
Speaker 2: just from sitting in the dental chair. That is wild,
Speaker 2: So the dentist has to screen the patient's medical history meticulously.
Speaker 1: It just goes to show how interconnected the whole body
Speaker 1: really is. You know, you can't treat the mouth without
Speaker 1: treating the patient. Well, let's summarize our journey today. We
Speaker 1: started at the microscopic level, preventing decay with acid h
Speaker 1: and chemical fissure sealants. We learned how to use tactile
Speaker 1: feedback and a blunt probe to measure a healthy two
Speaker 1: millimeter gingible crevice. We navigated the moisture critical world of
Speaker 1: composite chemical bonding, the intense biomechanics of root canal, and
Speaker 1: finally the surgical reality of bone sectioning, titanium ossio integration,
Speaker 1: and power whitening.
Speaker 2: It really is a comprehensive life cycle of mechanical and
Speaker 2: biological care.
Speaker 1: So before we go, a quick review question for you,
Speaker 1: the listener, to test your new diagnostic skills out in
Speaker 1: the field. If a patient comes to your clinic and
Speaker 1: you are examining a gingible crevice that bleeds upon probing
Speaker 1: and it measures exactly four millimeters deep, what specific diagnostic
Speaker 1: tool was just used and what does this depth then
Speaker 1: bleeding indicate.
Speaker 2: The tool used was the blunt ended periodontal probe. And
Speaker 2: because that pocket is significantly deeper than the two millimeter
Speaker 2: baseline and it bleeds, it strongly indicates that the patient
Speaker 2: has active destructive periodontal disease meld it. As we wrap
Speaker 2: up this deep dive, I want you to consider this
Speaker 2: final thought. Think about a single structure like a lower
Speaker 2: permanent molar. It must simultaneously survive intense, repeated mechanical crushing
Speaker 2: forces every single day. Yeah, it has to withstand constant
Speaker 2: chemical acid attacks from modern diets and send off endless
Speaker 2: aggressive bactieal invasions. And it has to do all of
Speaker 2: this while sitting completely exposed in the wettest, warmest, most
Speaker 2: dynamic environment in the human body. Clinical dentistry isn't just healthcare.
Speaker 2: It is extreme structural engineering.
Speaker 1: It really is. So the next time you're sitting in
Speaker 1: that dental chair, remember you weren't just getting a check up.
Speaker 1: You are bringing your biomechanical machinery into those complex, highly
Speaker 1: specialized garage on Earth.
Speaker 2: Keep brushing and keep learning.
Speaker 1: See you next time on the deep Dive.