Breaking a tool during the preparation of root canals. The methodology of management with a case report

Background: Breaking an endodontic instrument is a complication that really hinders or even makes impossible complete disinfection and tight obturation of the root canal system. Case presentation: A 74-year-old patient suffered a fracture of the clinical crown of the second incisor in the maxilla. The examination revealed necrotic pulp and the presence of obliteration significantly limiting the lumen of the tooth canal. It was decided to perform root canal treatment and then to do a reconstruction reinforced by crown-root inlay. An endodontic instrument was broken in the lumen of the root canal at the beginning of the endodontic treatment. A broken piece tightly filled nearly 80% of the total length of the canal. It was decided to use endodontic forceps to remove the fragment.Conclusion: Choosing the right method is a key step in the complication described above. The management technique should entail the least risk of iatrogenic complications because they can greatly affect the long-term maintenance of the tooth. The article discuss on the basis of current literature standards of conduction in the case of tool breakage in the root canal system and presents the problem on the basis of own experience

Oral health-related quality of life in patients undergoing chronic hemodialysis

Ewa Rodakowska,1 Magdalena Wilczyńska-Borawska,2 Justyna Fryc,3 Joanna Baginska,4 Beata Naumnik5 1Department of Restorative Dentistry, Medical University of Bialystok, Bialystok, Poland; 2Department of Social and Preventive Dentistry, Medical University of Bialystok, Bialystok, Poland; 3Faculty of Medicine, Medical University of Bialystok, Bialystok, Poland; 4Department of Dentistry Propaedeutics, Medical University of Bialystok, Bialystok, Poland; 5I Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland Aims: The aims of the study were to determine oral health-related quality of life (OHRQoL) in chronic hemodialysis (HD) patients and to estimate which scale describing OHRQoL, Oral Health Impact Profile (OHIP-14) or Geriatric/General Oral Health Assessment Index (GOHAI), was more useful in this particular group. Methods: This was a cross-sectional study conducted by means of a census survey. The Polish versions of OHIP-14 and GOHAI were used to assess OHRQoL. The oral examination included decayed, missing and filled teeth (DMF-T) Index; Oral Hygiene Index simplified; Plaque Index and Gingival Index. In the statistical analysis, the Kruskal–Wallis test, Mann–Whitney U test, Pearson’s χ2 test and Spearman’s rank correlation coefficients were used as appropriate. Results: The final sample consisted of 72 patients (mean age 63.2±15.2 years). The mean duration of HD treatment was 43.8 months. The mean number of teeth was 10.9. The majority of participants (81.9%) were dentate; only 22.2% of the respondents had >20 teeth. Among the dentate subjects, 44.1% wore removable dental prostheses (60.7% women). The most prevalent items for GOHAI (mean 14.71; SD 7.21) were uncomfortable to swallow, discomfort when eating and unhappy with appearance. The most prevalent items for OHIP-14 (mean 8.87; SD 10.95) were uncomfortable to eat foods, and diet has been unsatisfactory. The internal reliability (Cronbach’s alpha) was 0.637 for GOHAI and 0.918 for OHIP-14. Chewing problems were significantly related to GOHAI (p=0.001) and OHIP-14 (p<0.001) scales. Higher OHIP-14 scores were significantly associated with dental treatment needs (p=0.029) and poor self-rated oral status (p=0.001). Conclusion: The HD patients had an unsatisfactory oral status, but using only OHRQoL scale was insufficient to capture all their oral health problems. The scales did not fully reflect poor oral health in HD patients. The oral problems were not a major concern for this group of patients, which could indicate the adaptation to impaired oral health or a change in health priorities. Regular dental examinations together with the assessment of OHRQoL in HD patients are required for a comprehensive patients’ state. In our study, more variables were significantly related to the OHIP-14 scale than to the GOHAI scale. Thus, the OHIP-14 scale may be more useful in assessing OHRQoL in HD patients. Keywords: oral health-related quality of life, OHIP-14, GOHAI, hemodialysis, OHRQo