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Dr Raana Anjum

Friday, May 5, 2023

OPEN APEX ROOTS OF A TRAUMATIZED TOOTH

    

TEETH WITH AN OPEN APEX

When a tooth does not close at the end of root it is called an 'open apex', in other words, absence of sufficient root development to provide a conical taper to the root canal with thin dentinal walls which are less resistant to fractural stresses.                                                                                                                                                                                                                                                                                           

# crown fracture

                         CAUSES OF OPEN APEX                                         

  1 *     Trauma to tooth during developing stage , children with class two div one  incisors when fall leading to fracture of crowns of  anterior teeth while roots are not fully developed, it stops further development of root result into open apex.        https://doi.org/10.1515/ijamh-2018-0061        2 *     Caries causes loss of vitality of tooth when root is not fully developed resulting in  open  apex  , mostly in mandibular molars.                                                                                              

 3 *     Anomalies , eg dens in dente that is tooth within tooth, result into early inflammation, infection and open apex.                

 4 *    Orthodontic forces , if heavy orthodontic forces are used , these can cause root resorption resulting into open apex.                                                                                                          


                                                                                                                                                                                                                                    TYPES OF OPEN APEX   


                                               1 : Blunderbuss     
                                                                                                            

                                              2 : Non blunderbuss    

                                                                                                                                                                                                                                        BIUNDERBUSS                                                                         Funnel shaped root apex, it means apical opening can be wider than the coronal root canal orifice. it appears when trauma to tooth hit during 1st two stages of root development when less than half of root has formed, it is a disastrous situation.                


                                                                                                                                                                                                                                        NON BLUNDERBUSS                                                                                        

The walls of root canal may be parallel to slightly convergent as canal exit the root apex, it is the situation when trauma occur during 2nd and 3rd stages of development                                                                                                       


 



 

 
 PROBLEMS ASSOCIATED WITH NON VITAL TOOTH

  1 - Roots are not developed  ,walls very thin and fragile                                                                      2 - Apex is open, any material to fill up roots will extrude                                                                      3 - Periapical radiolucency are present and infection occurs again and again                                    4 - Due to less root length crown root ratio discrepancies can occur                                                      5 - Fracture of crown may occur                                                                                                                6 - Chances of tooth discoloration increases            

                         MANAGEMENT OF NONVITAL TOOTH WITH OPEN APEX

The aim of treatment is to save the tooth. there are two methods to manage such cases of trauma   one is Apexification and the other is  Revascularization

 .                In Apexification  an artificial or a biological barrier is formed  to close apex  with the help o calcium hydroxide or MTA . It helps to eliminate sign and symptoms of infection and pain, prevent crown fracture and root resorption.                            

                   In Revascularization root begin to achieve width and length and gains its vitality again. In this procedure barrier is placed coronally at cementoenamel junction , it will regenerate growth of root till root apex close .It is a new concept of treatment modality known as Regenerative Endodonticshttps://www.sciencedirect.com

Saturday, August 27, 2022

Want To Know About Fluoroquinolones

 All About Fluoroquinilones

Do you know about Fluoroquinolones,if not,come to this blog and update yourself to this broad spectrum group of antibiotic.

The basic formula of this group of medicine is Nalidixic acid which is quinilone.Interstingly Flourine was added to quinilones and a new group of medinces was formed known as Fluoroquinilones.

From its 1st medicines to improved formula,this group is divided into 3 generations

1st Generation

Nalidixic acid
( Norfloxacin)
It is moderately effective against gram - ve bacteria. due to its less effective distribution in body,its usage is limited to uncomplicated urinary tract and prostate infections.

2nd Generation

Ciprofloxacin
Ofloxacin
These are active against more numbers of gram - ve bacteria,gonococcus,mycobacteria,salmonella and less number of gram+ ve cocci.

Uses

These drugs are used in
Travelers diarrhea,Typhoid fever,cystic fibrosis ,Resistant Tuberclosis,Anthrerax,in combination with other drugs like Penicillin and seflosporines and also used as alternatives og Aminoglycosides

3rd Generation 

Levofloxacin
Moxifloxacin
Gemifloxacin
These are active against gram + ve rods,gram + ve cocci,gram+vebascilli,streptococcal pneumonia ,chlamydophilla pneumonia.
Moxifloxacin and gemifloxacin are also effective against Anaerobic bacteria

Uses

Skin infections,Acute sinusitis,All types of pneumonia,Acute exacebation of chronic bronchitis,sexually transmitted infections,mixed infections,prostatitis and intra abdominal infections

Absorption

Oral administeration is common,their bioavalibilty is good,now ciprofloxacin is also available in injectable form.

Excretion

These broad sectrum antbiotics are mostl excreted through urinary tract except moxifloxacin which is also eliminated through liver

Side effects|unwanted effects

: Nausia,vomiting ,diarrhea

: Headache,dizziness

: Rarely epileptic attacks in asthamitic patients on theophyllin therapy

: Spontaneuos bleeding in patientson anticoagulant therapy

: Phototoxicity

: Tendinitis in elderly patients

: Pseudomembaranous collitis is very rare but very serious side effect may lead to death

Contraindications

:  pregnancy
: Children under 18 years old
: feeding mothers
: Patients on antiarrythmatic drugs
: patients on theophyline therapy


Thursday, August 25, 2022

3 Easy Way To Get Rid Of Horrible DrySocket Pain

Dry socket" a nightmare"

 Dry socket or alveolar osteitis is a painful dental condition that sometimes occurs after permanent tooth extraction. 

" dry socket"+

It appears mostly after 3 to 4 days of tooth extraction. After tooth extraction blood clot is formed which protect underline bone and nerves and heals socket but some time clot does not form or icreased fibrinolytic activity  dissolves clot earlier,or dislogment of blood clot from dental socket render it open and unprotected, healing becomes slow . Although its exact cause is not known but there are few predisposing factors are as follows described under eteology heading

Eteology

1: smoking 


2: tobacco/beetle nuts chewing

3: contraceptive pills


4:  not following  post extraction care instructions 

5: use of drinking straw after extraction

6: poor oral hygiene 

7: localized infection present around extraction site

8: use of non sterilized instruments or infected needles 

9: traumatic extraction

10: low immunity of patient or medically  compromised patient

Symptoms

1: Worsening throbbing pain

2: fetid odor

3: bad taste 

# unhealed extraction socket

4: poorly healed extraction site

5: pain radiating to ear and neck

Treatment 

1: irrigation with normal saline


2: sedative dressing  like ugenol,alvogel etc

3: pain killer tablets or injections

4: warm saline or antiseptic gargles



Saturday, March 13, 2021

5 Most Common Diseaes Of Teeth Affecting Oral Health


5 Most Common Diseases Of Teeth Affecting Oral Health

 The WHO has defined oral health as 

‘a standard of the


oral and related tissues which enables an individual to eat,

speak and socialise without active disease, discomfort 

or embarrassment and which contributes to general 

well-being’https://www.who.int/

Oral health includes healthy and sound teeth and healthy soft and hard tissues of oral cavity.

Oral health is window  of general health of someone. Regular cleaning of teeth, healthy diet and avoiding unhealthily habits are key to maintain oral health.there are numbers of factors that influence oral health 

 1: irregular or bad brushing habits  ,its not only include not doing brush daily but also wrong technique of brushing 

 2: sugary diet

 3: frequent consumption of acidic beverages / foods

 4: tobacco 

 5:  beetle nuts chewing 

 6: unhealthy eating habits (irregular timing of meals, more refined foods, soft diets )

 7: hereditary factors 

 8: social status https://www.who.int/news-room/fact-sheets/detail/sugars-and-dental-caries#:~:text=Dental%20caries%20(also%20known%20as,may%20result%20in%20tooth%20extraction.

Bad oral hygiene leads to diseases of oral cavity

dental caries 
Dental caries

is most common and highly affecting quality of life, it causes severe pain,difficulty in chewing and eating, may lead to loss of tooth, uneasthetic appearance and traumatic effects on social life.

In children its effects are more dangerous as due to difficulty in eating may affect their growth, especially jaw growth which inturn develop orthodontic problems like overcrowded, irregular  teeth.

Now a days  bottlefeeding caries and rampant caries are very common,youg age caries leading to mandibular 1st molar loss most frequently is an alarming state, it needs  especial attention to educate parents that how to prevent dental caries in their kids.for this social media can play a good roll,numbers of sites  are available on Google to guide parents and patient,one of them is

https://www.onlinewithdental.com/2021/03/oral-health.html

Gingivitis and periodontist 
Gingivitis

Periodontitis


 This disease of gums due to poor oral hygiene causes swelling of gums,pain and bleeding of gums is also very common especially in developing countries, if it remains untreated leads to loss of teeth and also bone of ridges which further causes difficulties in replacement of artificial  teeth.

Oral cancers 

These are mostly cauesed by tobacco and beetlenuts chewing and included in 15 most commonly occurring cancers of body.

Dental and facial traumas 

Trauma to teeth and face is painful condition leading to affect overall health. these are mainly occur due to road traffic accidents or sports injury.

Mouth sores and ulcers

There are many types and causes of mouth sores. Mouth sores may be caused by an infection, a bodywide (systemic) disease, a physical or chemical irritant, or an allergic reaction . Often the cause is unknown. 

The most common specific causes of mouth sores are

  • Viral infections (particularly herpes simplex and herpes zoster)

  • Other infections (caused by fungi or bacteria)

  • Injury or irritating food or chemicals

  • Tobacco use

  • Drugs (particularly chemotherapy drugs) and radiation therapy

  • Systemic disorders

Some madical conditions show their early signs and symptoms in mouth 
Oral signs are frequently the first manifestation of autoimmune diseases. For this reason, dentists play an important role in the detection of emerging autoimmune pathologies. Indeed, an early diagnosis can play a decisive role in improving the quality of treatment strategies as well as quality of life. 
 Examples are lupus erythematosus, Sjögren syndrome, pemphigus vulgaris, mucous membrane pemphigoid, and Behcet disease .
The relationship between oral and general health has been increasingly recognised during the past two decades. Several epidemiological studies have linked poor oral health with cardiovascular disease, poor glycaemic control in diabetics, low birth-weight pre-term babies, and a number of other conditions, including rheumatoid arthritis and osteoporosis. Oral infections are also recognised as a problem for individuals suffering from a range of chronic conditions, including cancer and infection with human immunodeficiency virus, as well as patients with ventilator-associated pneumonia

     To improve oral health and educate people for healthy and happier life World Oral Health Day is observed annually on 20 March since 2013 and launches a year-long campaign dedicated to raising global awareness of the issues around oral health and the importance of oral hygiene so that governments, health associations and the general public can work together for this purpose.

Thursday, February 18, 2021

How Fascinating is this Way to Access opening of mandibular first molar


Lower mandibular 1st molar is the tooth that erupts in oral cavity at age of 6 years while all deciduous teeth are present in mouth.
Parents and kids normally don't  acknowledge presence of 1st permanent toot and brushing habits are not properly developed at this,thats why developing caries in this tooth is more common. 
           To save tooth root canal treatment is done.
access cavity is the 1st step of RCT(root canal treatment).following are the important features of tooth to be known for preparation of access opening. 

 1: mandibular first molar has two roots ,mesial root and distal root 


Mesial root 

 2 canals and 1 foramen - 40.5% 
2 canals and 2 foramina - 59.5% 

In Distal root

1 canal and 1 foramen - 71.1% 
2 canals and 1 foramen - 17.8% 

2 canals and 2 foramina - 11.1% 

Length of root canal 

M - 20.9 mm 
D - 20.9 mmv

Steps for access 

1. Initial penetration is made with a high speed diamond bur in the exact centre of the mesial pit, with 
the bur directed toward the distal
2. Once the 'drop' into the pulp chamber is felt, change to the endo-Z bur and enlarge this for 
exploration
3. Locate with endodontic explorer orifices of MB, ML and D canals (tension of explorer against the 
walls of preparation indicates the amount and

direction of extension necessary, so remove further 
tissue with endo-Z)
4. Use from inside to outside a round slow speed bur to ensure complete removal of the roof of the 
pulp chamber
5. Final prep extends to the height of mesial cusps, explore carefully the presence of a 2nd distal canal, 
if this is the case, the access will be square in shape; otherwise if 3 canals are present access shape 
is more triangular, with its base toward the mesial side of the tooth


Saturday, February 13, 2021

A Comprehensive Guideline,How complete Dentures Are Made

 For fabricating complete denture there are 27 steps starting from patient selection and diagnosis up to insertion of complete denture into patient mouth and follow.there are many steps including clinical as well as laboratory proceduresfollowing each other in a specific order. 

Starting from clinical procedures 



Clinical procedures 

1: diagnosis and treatment plan 

2: mouth prereration
3: tray selection
4: primary or initial impression 
             
           Next are lab procedures

                               Lab procedure

                               5: making primary  cast or model
                               6: spacer
                               7: special tray
               
             Lets move to clinical side

Clinical procedure

   8:  border moulding 
   9:  secondary or final impression 
                   
                  
               Again its time to move towards lab

                                 Lab procedure

                                 10: secondary  or master  cast
                                 11:  denture base
                                 12: occlusal rim
 
                  
              Lets move to clinical side

  Clinical procedure 

   13: taking bite or jaw relation
   14: teeth selection( shade selection)

               Now it turn of lab procedures 

                                  Lab procedure 

15: articulation of cast    
 
                              16 : arrangement of teeth 
                                         according to jaw relation



                Again call patient in clinic and go for clinical  procedures 

Clinical procedures

17: tyr in( checking of teeth  arrangement  in 
       Patient mouth )
     
                      Next are lab procedures 
    

                                  Lab procedures 

                               18: dearticulation oe demounting
                                     of cast
                               19: waxing
                               20: flasking
                               21: dewaxing
     


                         22: packing and curing
                               23: deflasking
                               24: finishing and polishing 
Complete denture


                   Final step will be clinical 

Clinical procedure 

25: denture delivery to patient or 
       Insertion of denture in Patient mouth
26: instructions for Patient 
27:follow up
                          
                                   

Monday, January 18, 2021

Why Teeth Appear Yellow And How To Whiten Your Teeth

Smile affects personality of human beings. For beautiful smile well aligned and white teeth are key factors.   




Sometimes teeth become discoloured  and need treatment 



   Reasons of discolouration 

There are many caustive factors of tooth discoloration. So discolorations are classified as
1: extrinsic discoloration 
2: intrinsic  discoloration 
3: combination of both 

   Extrinsic  discoloration 

Causes of  extrinsic  discolorations are as follows and easy to treat.
 
   - foods 
   - beverages 
   - tobacco use
   - plaque
    - gingival hemorrhage 
    - poor oral hygiene 
     - swimmer's calculus
     - cholorhexidine
     - metallic stains

    Intrinsic discoloration 

Eteology of extrinsic discoloration are 

Pre eruptive cause
------------------------------
 1 : Alkaptonuria
 2 : hemotological disorders
       ( erythrblastosis fetalis, sickle cell anemia, congenital porphyria)
  3 :   liver diseases 
  4 :  diseases of enamel and dentin like
          Amelogenisis imperfecta 
          Dentinogenesis imperfecta 
          Hyperbilirubinimia
          Child hood diseases 
         Malnutrition 
    5 : florosis 
    6 : tetracycline and other antibiotic stains

Post erupting causes
---------------------------------
       1: pulp changes
       2: dental trauma
       3 : dentin hypercalcification
       4 : dental caries
       5 : functional and parafunctional       
             changes 
       6 : aging
       7 : restorative materials and dental 
            procedures 




  Treatment

There are different treatment options 
1: scaling and polishing
2: whitening toothpastes and mouthwashes 
3: bleaching 
4: composite veneers 
5: porcelain veneers 

Bleaching 

Bleaching is a procdure  which involves lightening of colour of the tooth through application of a chemical agent to oxidaze organic pigmentation present in



+"bleaching kit"

"Bleaching unit"+









OPEN APEX ROOTS OF A TRAUMATIZED TOOTH

     TEETH WITH AN OPEN APEX When a tooth does not close at the end of root  it is called an 'open apex', in other words, absence of...