@dental_academy


- sign & symptoms :-

Internal root resorption is usually symptom free, but in cases of perforation, a sinus tract usually forms.

- etiology & factors :-

(1) Traumatic injury to the teeth can cause horizontal root fractures and inflammatory root resorptions
(external and internal).

(2) Odontoclastic multinuclear cells are responsible for the resorption, which can grow to perforate the root if untreated.


3) The initiating factor in internal root resorption is thought to be trauma or chronic pulpal inflammation.

4) Dental resorption by odontoblasts cell death with preservation of pulp vitality.

5) long–lasting stimulation of the resorbing cells, like sharp edges, increased pressure in the tissue, infection, or certain systemic diseases.

6) Because trauma appears to be a major factor associated with resorption, questions regarding past traumatic events may provide good leads to a likely cause .

7)• predisposing factors :-
the predisposing factors to the damage of predentin are not clear , it may :-

a- Trauma .
b- caries .
c- periodontal infection .
d- calcium hydroxide .
e- vital root resection .
f- orthodontic treatment .
j- and tooth crack .
h- The primary cause of external/internal inflammatory root resorption and no healing of horizontal root fractures is the presence of infected necrotic pulp in the canal space .

8 - Resorption of the teeth may occur as a result of :-
1- inflammatory conditions,
2- mechanical stimulation,
3- or neoplastic processes.

- The resorptive process of the
dental tissues is similar to that of bone, but with some notable differences.

- The dentin-resorbing cells (dentin- oclasts) have fewer nuclei and are smaller than the
osteoclasts.

- prevention :-

Prevention of resorption includes appropriate treatment of traumatically injured teeth with frequent evaluation visits during the first year following an injury.

- treatement :-

• The prognosis for treatment of small lesions of internal root resorption is very good.

• If, the tooth structure is greatly weakened and perforation has occurred, the prognosis is poor and tooth extraction must be considered.

• Sodium hypochlorite, ultrasonic instrumentation and calcium hydroxide are the cornerstones of treatment of internal inflammatory root resorption.

• Mineral trioxide aggregate is being increasingly used as a root canal filling material, particularly in cases of perforation.

• root canal treatment remains the treatment of choice for this pathologic condition to date.

• replacement resorption still remains beyond our clincial competence.

• In cases of invasive resorption, it may or may not be necessary, whereas in replacement and pressure resorption, root canal therapy is not indicated at all (unless unrelated pulpal conditions necessitate endodontic intervention).

@dental_academy
"tips toward professional dental practice"

@dental_academy


1. Enuclation method:

It means completely removing the cyst

2. Marsupialisation method:

It means creating a window in the cyst wall to drain the contents and communicate with the mouth

3.Decopmression method:

means access and removal of Marceau's bronchial cyst and surgery of the second stage of bronchial inclusion or curettage to remove the remaining lesion

• Initial closure of the lesion
• If it is not possible to close the primary packing with a special protocol for secondary repair

4. Enucleation method with curretage:

It means removing the cyst by inoculation and then removing the surrounding bones to a thickness of approximately 1 to 2 mm by a curette or rotary device.


@dental_academy
"tips toward professional dental practice"

@dental_academy
"tips toward professional dental practice"

@dental_academy
"tips toward professional dental practice"

@dental_academy
"tips toward professional dental practice"

@dental_academy
"tips toward professional dental practice"

@dental_academy
"


Reasons and features of the treatment of aphthous stomatitis in children up to a year and older.


Children under seven years of age are immunocompromised. The reason for this is mainly the hereditary factor. With age, lifestyle and nutritional regimen help establish the proper functioning of the immune system. In childhood, cases of infectious diseases are not uncommon. One of such ailments is aphthous stomatitis. The disease is unpleasant, but treatable.

Recurrent aphthous stomatitis (RAS) is a chronic inflammatory disease in which painful ulcers form on the mucous membrane of the oral cavity, cheeks, gums, and tongue.

occurs at a frequency of 25% among the population
relapse every 3 months - in 50%

Three forms of RAS are distinguished:

Small (MiRAS; Mikulich afta)
➖ the most common form (80-50% of cases)

Овsurface ulcers 4-10 mm in size, surrounded by a redness zone and covered with yellow-gray plaque

➖ mucous membrane of cheeks, lips, tongue, palatine arches (usually concentrated in front of the oral cavity)

➖ do not cause scarring

➖ pass by themselves in 7-10 days

2. Large (MaRAS; Sutton afta)

➖ occurs in 10-15% of cases

large deep ulcers (1-3 cm), surrounded by a raised area of ​​redness

➖ lips, tongue soft palate, palatine arches

➖ often unilateral lesion

Often for anxious young people and people with HIV

➖ can heal with scar formation

heal for several weeks to months

3. Herpetiform (HeRAS)

➖ occurs in 5-10% of cases.

I rarely have children. More often beginning at 30-40 years old

➖ small superficial ulcers (1-2 mm) in large quantities (10-100 pcs); can merge, forming large foci surrounded by a reddening zone

➖ in any part of the oral cavity, on the front of the tongue and its edges, as well as the mucous membrane of the lips

➖ pass by themselves in 7-10 days

➖ not related to herpes! but look like him outwardly.

@dental_academy
"tips toward professional dental practice"

REASON UNKNOWN.

But predisposing factors are known that accelerate the appearance of aft in susceptible individuals:

Injury (accidental bite when eating or after local anesthesia during dental treatment, damage to the bristles of the toothbrush or sharp edges of the products, piercing) ⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀
Stress (people with RAS have higher anxiety and cortisol levels). School, kindergarten, training, tensions in the family - stress factors for children.
Genetic predisposition.
If someone had RAS in the family, this increases their risk in the offspring. A connection with HLA-B51, Cn7, A2, B12, Dr5 is assumed.

A genetic predisposition was also identified for individuals with PFAPA syndrome (recurrent fever, aphthous stomatitis, pharyngitis, enlargement of the cervical lymph nodes).

Local infection
An association was found between RAS and herpes viruses of types 1-8, human papillomavirus, Helicobacter and L-form streptococci.

But! this does not mean that it is necessary to flee them urgently to treat when detected.

Eating disorders: deficiency of iron, folic acid, zinc, vitamins B1, 2, 6, 12, C and E, selenium.
Gastrointestinal diseases: Crohn's disease, ULC, celiac enteropathy.
Systemic diseases: cyclic neutropenia, Reiter's syndrome, Behcet's disease and HIV infection.
Food allergies and food intolerances (flavorings essential oil benzoic acid cinnamon, gluten, cow's milk, coffee, chocolate, potatoes, cheese, figs, nuts, citrus fruits and some spices
Change in hormone levels during the menstrual cycle and relapses during ovulation or before menstruation)
The action of chemicals:
-high nitrate levels in drinking water

sodium lauryl sulfate in toothpaste

non-steroidal anti-inflammatory drugs

Poor hygiene: a significant correlation has been found between the severity of RAS and oral hygiene. Improving hygiene reduces not only the number of relapses, but their severity.

All of the above factors, individually and in combination, can cause an exacerbation of RAS, therefore, to improve the course, it is important to search for the possibility and removal of the provoking factor


@dental_academy
"tips toward professional dental practice"

@dental_academy


Aphthae (painful erosion in the oral cavity) is just a symptom. They can be with very, very different diseases and conditions.

To correctly diagnose a child with aphthae in the oral cavity and prescribe adequate treatment is fundamentally the following:

there are or not vesicles (vesicles) in the oral cavity:
viral infection (herpes simplex type 1, enterovirus infection, chickenpox, Marburg hemorrhagic fever), autoimmune diseases (pemphigus, pemphigoid, erythema multiforme)

➖: other infections, trauma, immune-mediated diseases (RAS, allergic reaction, systemic lupus erythematosus), neoplasms

is there or not fever and intoxication with the occurrence of aphthae:

viral infection (herpes simplex type 1, enterovirus infection, chickenpox, Lass and Marburg hemorrhagic fever), bacterial infections (whooping cough, syphilis, tuberculosis, Vincent’s necrotic stomatitis), fungal infection (aspergillosis), systemic diseases (Behcet's disease) Cyclic neutropenia, PFAPA

➖: RAS, allergic reaction, trauma, neoplasm

occurred acutely or periodically recurs (recurs)
repeated: RAS, chronic trauma (Bednara afta), herpetic infection, Behcet’s disease, Crohn’s disease ⠀⠀⠀⠀⠀

➖ occurs acutely: trauma, enterovirus infection, chickenpox, Lass and Marburg hemorrhagic fever), bacterial and fungal infections, neoplasms


@dental_academy
"tips toward professional dental practice

@dental_academy



DIAGNOSTICS

In the vast majority of cases, for a correct diagnosis, a well-collected medical history and examination are enough.

Sometimes additional research methods (general blood count, iron, vitamins, infections, biopsy, gastrointestinal tract tests), which are prescribed only by a doctor, based on the alleged diagnosis, may be required. ⠀⠀⠀⠀⠀

The approach to a child with aphthae in the oral cavity is one with the exception of three situations:

herpetic gingivostomatitis (due to herpes simplex virus type 1)
- Acyclovir therapy is required

2. traumatic aphthae, Bednar aphthae (due to some kind of chronic trauma: the habit of sucking a finger / pencil, biting the gum / lip, hard nipple, sharp edge of the plate / braces, intentionally causing personal injury)

- pass by themselves within 2 weeks after exclusion of the traumatic factor

3. aphthae in systemic diseases

- pass as the underlying disease is treated.

Even single aphthae can be so painful that the child will refuse to eat and drink. And this is already fraught with complications, including dehydration. Therefore, it is important for us: to anesthetize, maintain the ability to eat and drink, possibly accelerate recovery and prevent exacerbation.

anesthesia - It is precisely so that the child can safely drink, eat and feel better. Drugs of choice: ibuprofen, paracetamol.
plentiful drink - optimal - cool non-acidic drinks (for example, milkshakes, melted ice cream, yogurt, jelly)
soft non-hot foods (mashed potatoes, soups) - Avoid sour, salty and spicy foods, as well as suspected allergens.
adequate oral hygiene (brush with a soft bristle brush for two minutes twice a day)
in the presence of aphthae on the lips - any moisturizers (for example, petroleum jelly)
rinse the mouth with saline solutions (½ teaspoon of salt in a glass of water).
There is evidence of the effectiveness of rinsing with chlorhexidine to reduce pain and accelerate the healing of aphthae.

Separately, about local gels / pastes with anesthetics and anti-inflammatory drugs:

If the child is an adult, has a little aft and they are not very painful - you can use local gels / pastes.
If the child is small, he cries, eats nothing, and the parents are still trying to get into his mouth something to smear and wipe - this is not humane. More effective and calmer in this situation is simply to give syrup with paracetamol or ibuprofen. And a person will immediately feel better.
To prevent relapse of RAS, it is necessary to identify and exclude provocative factors described above.

In case of deficiency of vitamins and minerals: review of the daily diet (increase in fruits and vegetables) supplements with B vitamins, zinc and iron
There is a study showing the effectiveness of adding vitamin B12 to prevent RAS recurrence, even with normal levels of B12 in the blood.
Gluten-free diet makes sense only in patients with celiac disease
Using Toothpaste bez sodium lauryl sulfate (SLS)
Use a low intensity ultrasonic toothbrush or a conventional soft bristle brush
Use of mouthwash or toothpaste with triclosan or amyloglucosidase.
Reducing stress factors establishing a peaceful family relationship
With extensive damage to long-term non-healing ulcers - longer than 2 weeks, frequent relapses, repeated consultations are required to exclude systemic diseases of the selection of treatment.



Aphthous stomatitis in a baby up to a year and features of treatment of an infant

It is important to provide the baby with timely treatment in order to prevent an acute form of the course of the disease. A sign of complications is the presence of severe shortness of breath and seizures. If you have these symptoms, call an ambulance team immediately. It is necessary to treat such stomatitis already in a hospital setting. Neglecting this advice can be fatal.

Therapy of aphthous stomatitis in children up to a year begins with the complete isolation of the child from other children. As stated above, the disease often grows into an epidemic. In children under one year of age, the immune system is vulnerabl

e and is easily disrupted by infections.
The next step: thorough disinfection of the toys that the baby was in contact with.
After each feeding, the baby's mother should wash her breasts well.
After feeding, lay the baby on its side and rinse the oral mucosa with infusion of chamomile flowers. Rinse by treating the wounds with ointment prescribed by a pediatrician. Carefully monitor age limits for taking medications.
From stomatitis of fungal origin, the affected areas are smeared with Candide or soda solution.
In newborns and infants, aphthous stomatitis sometimes appears due to intolerance to breast milk. Determine if this is your case, you can using a series of tests. If the doctor diagnoses a similar feature, lactation will have to be abandoned. The mixture for feeding the baby should be selected by the pediatrician taking into account his needs and characteristics of the body.

@dental_academy
"tips toward professional dental practice"

@dental_academy


Classification of intracanal medicaments :

1) Eugenol :

-Antibacterial
- Analgesic
-Irritants
-Cytotoxic

2) phenol:

-Antimicrobial
-Very cytotoxic

CMCP (camphorated monochlorophenol)

Endosepton

3)Aldehydes (formaldehydes) :

Tricresol formalin:

-Vapor action
- Bactericidal action
-Cytotoxic
_Highly irritant

4) halogens:

NaOCl:

-Antibacterial effect
-Tissue dissolution
-Activity decrease with time
-May interact with TF material
-Very effective antiseptic solution
-Strong antimicrobial effect
-Vapor action
-Low tissue toxicity
-Allergic response
-Tooth staining


5) antibiotics :

-Side effects of antibiotics
-Resistance of bacteria
-Favorable conditions for fugal growth
-(minocycline) can cause tooth discoloration

6)corticosteroid-antibiotic combination :

-Ledermix paste

7)chlorohexidine gluconate:

-Antimicrobial
-Lower cytotoxicity
-Easy intoduced and removed from root canal

8)calcium hydroxide :

-Antimicrobial
-Strog base (ph about 12.5)
-Not effective against Entrococcus faecalis
-Difficult in placement and removing..


@dental_academy
"tips toward professional dental practice"

@dental_academy

orthodontic

Identifying type of occlusion and malocclusion is the first key to treatment. we will share small tips to identify correct occlusion. we will discuss more about treatment modalities and appliances.

@dental_academy
"tips toward professional dental practice"

@dental_academy


Ortho tips:

Class 1 occlusion.
MOLAR RELATIONSHIP:
Mesiobuccal cusp of the first maxillary molar occludes with buccal ridge of mandibular first molar.
MB--->B

CANINE RELATIONSHIP:
Maxillary canine lies in between canine and premolar of mandible.
3 lies in 3 & 4.

@dental_academy
"tips toward professional dental practice"

@dental_acadmey

Ortho tips:

Class 2 malocclusion :

Mesiobuccal cusp of the first maxillary molar lies ahead of buccal ridge of mandibular first molar.
MB cusp ahead of B ridge

Class 2 div 1 : class 2 molar relation with protruded incisors.

Class 2 div 2 : class 2 molar relation with retruded incisors.

Canine relation: Maxillary canine is touching mandibular canine,or ahead of it.


@dental_acadmey
"tips toward professional dental practice"

@dental_acadmy

Ortho tips:


Class 3 malocclusion : Mesiobuccal cusp of maxillary first molar lies behind buccal ridge of mandibular first molar.


Subdivision:
If there is class 1 molar relation on one side and class 2 or 3 on other side, it is referred as subdivision.

Class 2 div 1 subdivision:
Class 2 div 1 on one side and class 1 on other side.

Class 2 div 2 subdivision :
Class 2 div 2 on one side and class 1 on other side.

Class 3 subdivision: Class 3 on one side and class 1 on other side.

@dental_acadmy
"tips toward professional dental practice"

@dental_academy


Ortho tips:

These classification are easy to remember and practically easy to apply in day to day practice.
You have to look only at Mesiobuccal cusp, buccal ridge and canine.
Most of the cases can be easily treated if you can identify the occlusion properly.
It's like a key to treatment modalities which we will reveal later.
So in synopsis we have
Class 1

Class 2 div 1
Class 2 div 2
Class 2 div 1 subdivision
Class 2 div 2 subdivision

Class 3
Class 3 subdivision

Remember this and revise it many times. And of course, try to identify occlusion in each and every patient, even it's for scaling.

@dental_academy
"tips toward professional dental practice"

@dental_academy
"tips toward professional dental practice"

@dental_academy
"tips toward professional dental practice"

@dental_academy


Ortho tips :

Blue print for case presentation for more patient acceptance :

The for main topics during the case presentation may be informally summarized as follows

1. ' This is your problem....'
2. 'To fix the problem we need to do the following...'
3. 'The advantage of fixing the problem are...'
4. 'If you go ahead, we will need compliance with..'

Courtesy : John C. Bennet from the book Orthodontic management of uncrowded class 2 div 1 malocclusion in children.

@dental_academy
"tips toward professional dental practice"