Endodontic management of dental pain in an inhibitor positive, severe Hemophilia A patient: A brief review and report of a case

Dental health care providers often have to deal with patients requiring special care during treatment planning, and certain precautions while carrying out the procedures, and patients with bleeding disorders are one of them. Hemophilia, an X-linked blood dyscrasia, is the most common bleeding disorder. While hemophilia-A is a deficiency of factor VIII, hemophilia-B (Christmas disease) is a deficiency of factor IX. The present paper presents a case discussing endodontic management of mandibular molars with irreversible pulpits in an inhibitor positive severe hemophilia-A patient. As such patients may require administration of inferior alveolar nerve blocks, so adequate factor levels should be ensured before initiation of local anesthetics. Furthermore, the authors have tried to highlight the barriers to oral health care suffered by such patients and the larger role played by the physicians and oral health care providers in the prevention, early detection, and timely intervention in these cases

Management of complicated crown fracture by reattachment with super bond: A case series

Coronal fracture of teeth is a prevalent form of dental trauma. Mainly it affects anterior teeth due to accidental injury, but sometimes posterior teeth may also get affected. The immediate restoration of the original fractured segment not only offers an alternative treatment in the emergency but also restores patien

Comparison of Detection Rate of Root Canal Orifices of Maxillary First Molar Using Various Techniques: An in-vivo Study

Objective: To compare the detection rate of root canal orifices of maxillary first molar by various techniques in the Indian population. Material and Methods: A total of 50 maxillary 1st molar cases were selected and sequentially divided into four groups: Group I: Naked eye; Group II: Surgical loupe; Group III: Surgical operating microscope; and Group IV: Fluorescein sodium dye. After access opening, the number of root canal orifices was detected in all cases with these methods. Results: By naked eye and surgical loupe, a total of 171 root canal orifices were detected, by a surgical operating microscope, 176, and by fluorescein sodium dye, 177 root canal orifices were detected. The detection rate of root canal orifices is as follows: Group I (96.61%) = Group II (96.61%) < Group III (99.44%) < Group IV (100%) and detection rate of MB-2 canal orifices Group I (40%) = Group II (40%) < Group III (50%) < Group IV (52%). No significant difference in the number of canal orifices detected could be seen for any of the comparisons. No significant difference was observed between the naked eye and surgical loupe techniques. Although the surgical operating microscope detected more root canal orifices, it did not have a significantly higher detection than the other two techniques. Conclusion: No significant difference was seen among various methods. However, the use of a surgical operating microscope and fluorescein sodium dye increased the detection rate of root canal orifices

A comparative evaluation of smear layer removal using apical negative pressure (EndoVac), sonic irrigation (EndoActivator) and Er:YAG laser - an in vitro SEM study

This study aimed to compare the smear layer removing efficacy of the EndoActivator, EndoVac and Er:YAG laser in extracted mandibular premolars, at the apical, middle and coronal third of root canal, through scanning electron microscopy. 40 extracted mandibular premolars were decoronated to a standardized length of 12 mm. Specimens were shaped to ProTaper F4 size and irrigated with 5.25% sodium hypochlorite at 370C between instrumentation. Teeth were divided into four groups (n=10), one control (needle irrigation) and three experimental, according to the irrigant activation technique used i.e. sonic irrigation (EndoActivator), apical negative pressure (EndoVac) or laser (Er:YAG). The final irrigants used were 10ml,17% ethylenediaminetetraacetic acid (EDTA) and 10ml, 5.25% sodium hypochlorite. Root canals were then split longitudinally and observed under a scanning electron microscope. The presence of smear layer at the apical, middle and coronal third of root canal was evaluated. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Intraexaminer and interexaminer reliability were determined by Kappa test. The EndoVac system was significantly more effective in removing debris from the apical third than all other groups. EndoActivator performed better than laser at the apical third. All three experimental groups (EndoVac, EndoActivator, and laser) were better than needle irrigation at the middle and apical third. At the coronal third, no significant difference was seen between the four groups. None of the activation systems completely removes the smear layer from the dentine walls; nevertheless, EndoVac is significantly better in removing debris from the apical third of canal

Comparative evaluation of antibacterial effect of nanoparticles and lasers against Endodontic Microbiota : an in vitro study

Present study was conducted with the aim of evaluating antimicrobial efficacy of silver (AgNP) and gold nanoparticles (AuNP) with and without Nd: YAG laser (L) irradiation against experimentally inoculated Enterococcus faecalis in infected human root dentin. 120 extracted single rooted human teeth were prepared and inoculated with E. faecalis for 24 hrs. The teeth were then randomly divided into 4 experimental group: AgNPs group: irrigation for 3minutes with 50 ?l of 100 ppm, the AuNPs group: irrigation with 50 ?l of 100 ppm, the AgNPs & Nd: YAG lasers group: irrigation with 50 ?l of 100 ppm + irradiation with 1.5W laser for 60 seconds, the AuNPs & Nd: YAG lasers group: irrigation with 50 ?l of 100 ppm + irradiation with 1.5W laser for 60 seconds. One control group consisting of 2% CHX irrigation for 3 minutes was also there (n = 20). The specimens were collected from the canal before and after irrigation, and colony forming units were observed. Significant difference was found among all the groups in comparison to the control group (p<0.05). The greatest reduction in CFU?s was observed with combination of AgNPs & Nd: YAG lasers group. AgNPs in combination with Nd: YAG laser irradiation has the potential to be used as root canal disinfectant

Preserving the Natural Smile by Immediate Re-attachment of Fractured Tooth: Report of Two Cases

Abstract : Traumatic injuries are most common in maxillary anterior teeth which mainly affect the esthetics and function. This article describes the immediate reattachment of fractured tooth fragment for the restoration of function and esthetics at the emergency visit.These case reports describe immediate treatment of oblique crown root fracture of maxillary right lateral incisor, and mandibular left central incisor. By reattaching the natural tooth fragment in the first case the root canal treatment was done then after fractured fragment was reattached with the titanium post. While in the second case the tooth was previously root canal treated, in which titanium post was used to reattach the fractured fragment .Successful pain management with immediate restoration of function, esthetics, and phonetics was the prime objective when treating these cases

A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in chronic apical periodontitis

Aim of this trial was to evaluate the combined clinical and radiographic success rate of endodontic treatment using passive ultrasonic irrigation (PUI) and laser activated irrigation (LAI) as compared to conventional syringe irrigation. Permanent incisors and single rooted premolars were assessed for eligibility and 69 patients were randomly divided into three treatment groups (n=23) by allocation concealment method and irrigation was performed in accordance with the allocated group. Teeth were evaluated clinically and radiographically with CBCT after 6 months and 12 months of the treatment. A significant difference was observed in the radiographic healing rates among three groups (?2=12.29, p=0.05). On comparing the final outcome among the three groups (n=19), it was found that 2 (10.5%) cases of group I(Conventional Syringe irrigation), 7 (36.8%) cases of group II (Passive ultrasonic irrigation) and 8 (42.1%) cases of group III(Laser activated irrigation) were healed while under healing category 13 (68.4%) cases of group I, 12 (63.2%) cases of group II and 11 (57.9%) of group III were observed whereas 4 (21.1%) cases were categorised as diseased in group I only. LAI and PUI can increase the predictability of the endodontic treatment success in cases of chronic apical periodontitis

Oral care needs, barriers and challenges among elderly in India

Objective: This paper presents an approach to the assessment of oral health needs of elderly and barriers to receive oral care in the life course. Background: The dental needs of the elderly are changing and growing day by day. The management of older patients requires not only an understanding of the medical and dental aspects of ageing but also provide them good oral health service. In the life course of elderly there are many hurdles to receive proper oral care. The use of an assessment of oral health need will be essential in the development of care pathways to the elderly. Methods: The proportion of older people is growing faster than that of any other age group. There is no sound database regarding the oral disease burden and treatment needs of the elderly in India. Physical and biological barriers with age can also affect oral health care either directly or indirectly. Conclusion: Oral care guidelines designed to assist elderly should consider not only prevention and treatment modalities but also the means of implementing such therapies in varying settings and utilizing the whole dental team