The jaws, mouth and teeth

- Dr. Prasanth Pillai MDS, FICD


                Our mouth is exactly like an office where 32 people work. 16 of them work in the upper floor and the other 16 in the lower floor. The upper and lower front teeth form the reception committee and the back teeth are the back-office workers. The two batches of 16 people situated in the two floors of the upper and lower jaw have two managers ... the two jaw joints. The PRO is the tongue which plays multiple roles... There are several office assistants who help in smooth co-ordination of the office activities... they are the muscles of mastication (which aid in chewing) and the muscles of facial expression.

                 For efficient working of this office all members should be seated in their right places and should also work in unison. Any imbalance in this wonderful mechanism will cause strain on the managers - the joints and also their assistants, the muscles... causing pain and other problems. Just as is the case in any office, all problematic workers should be either disciplined to ensure they discharge their duties properly, or, thrown out (ie extracted). If such a disciplinary action is not taken,  the sincere workers in the office will be affected and the job being done turns out to be improper. In situations where problem creators are retained, just as is the case in most offices, the trouble makers survive in the office after kicking out the sincere, hard working colleagues. The functioning of the office turns out to be chaotic and pathetic and in course of time becomes totally inefficient. If an efficient member of the office has been removed, it is important that a suitable replacement is done to ensure the other members are not overloaded with work, thereby facilitating smooth functioning of the office.



1.  The lower wisdom tooth in the flat position creates a gap behind the second molar tooth where food gets trapped.

2.  Food lodgment and bacterial colonization leads to decay of the crown portion of the wisdom tooth

3.  Decay spreads to the second molar tooth from the side & the pulp of the second molar is easily affected necessitating root canal treatment.

4.  Due to lack of contact from the opposing wisdom tooth, the upper wisdom tooth migrates (supra-erupts) downwards creating a gap between it and the upper second molar.

5.  Food lodgment in the area leads to decay,  not  affecting  the “culprit”, but the upper second molar. The entire second molar is destroyed, beyond repair.

6.  Decay spreads to the upper first molar to a great extent, necessitating a root canal treatment. The dark area around the root top confirms root canal infection.


(Total treatment time - 2 weeks)


1. & 2. - Missing lower premolar and molar teeth

3. Migrating (Supra erupting) upper molar teeth due to lack of lower teeth

4. Previously root canal treated tooth is found infected due to overloads


5. Supra-erupted teeth have been reduced in vertical height to bring it to the normal bite plane

6. The teeth which have been reduced in vertical height are root canal treated

7.  The infected root canal treated tooth is extracted and an implant is affixed in place

8.  Missing teeth areas are implanted with immediate loading single piece basal implants

                Our treatment philosophy has always been driven by this concept about the oro- dento-facial structures.

            "Every tooth in a man's head is more valuable than a diamond." So wrote Cervantes in the early 17th century. The great Spanish novelist was not being quixotic. In his day, teeth were not easily replaced. But modern visitors to dentists' chairs in search of a gleaming grin find the artificial variety just about as dear as a diamond.

               In dental treatment, we can adopt two strategies... one is the "fire-fighting strategy" and second is the "fire prevention strategy". In the case of the former, dental problems are addressed only when they have started troubling the individual(s) in the form of pain, discomfort, food impaction etc. The damage done in this situation will be extensive and often requires elaborate treatment procedures to restore the conditions to normalcy. In the case of the latter, all developing problems are identified and treated well in advance. This helps eliminate pain and discomfort totally, minimizes damage as well as reduces treatment expenses in the long run. Periodic oral examination aids in prevention of oro-dental diseases.
              Dental patients generally do not report even for a preliminary dental examination till they experience some pain or discomfort. The three most important factors which prevent dental patients from consulting doctors periodically are (1) fear of pain, (2)treatment costs & (3) lengthy treatment procedures spread over multiple sittings. In all the three situations, the patients are the losers. I would prefer to call them to be "penny wise and pound foolish". By not getting preventive treatment done at the right point of time, they end up suffering more pain, undergoing more complex procedures and spending more money to get the messed up situation in which they have landed, cleared.

The dental patient is often at crossroads

Dental patients who have extensive damage to their oro-dental structures either due to dental decay or gums/periodontal disease, or both, are at cross roads.
He / she can take one of three routes:

1) Fire Fighting Route - address the problems as and when they arise. Here, the patient ends up suffering more discomfort / pain and spending more on treatment.
2) Quick Exit Route - get all teeth knocked off and go in for a removable denture... try to be done with it. The patient often ends up in a compromised dental status.
3) Fire Prevention Route - address the problems in a systematic, well-planned and meticulous manner so that all dental problems are addressed in a comprehensive way. Once treatment procedures are completed, the patient is to report for periodic checkup and maintenance as advised by his/her doctor.

Click on image to see it enlarged:


                                          - Dr. Prasanth Pillai, MDS (OMFS), FICD
                                          Dental, Oral & Maxillofacial Surgeon, Kochi