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ePaper created 2016-11-11, 09:18:10 | version 1.38.0
Editor - Online Haseeb Uddin 14 DENTAL TRIBUNE Pakistan Edition May 2016 PDA(K)office-bearers administered oath Continued from front page Dr Mohammad Ali (Joint Secretary), Dr Hassan Mehdi (CME Chairman) and Dr Noorul Wahab(President-Elect). Executive Members are: Dr Atta-ur-Rehman, Dr MohammadAmin, Dr Rizwan Jouharand Dr Haroon Ashraf. Dr Rafia Burhan was also elected as executive member of the PDA (Karachi) but later she tendered her resignation due to some personal reasons. Meanwhile, Dr HaroonAshraf has been nominated as media relations manager. In his speech, President PDA Central Council Prof Saqib Rashid commended the role of the election commission in conducting the PDA (Karachi) polls in a transparent manner despite facing challenges. He congratulated the newly-elected office-bearers of PDA Karachi and hoped that they will work hard to bring positive changes for the betterment of the profession. Prominent, among those, who attended the ceremony includedDr Kamran Vasfy, Dr Mumtaz Khan, Dr Baqar Askary, Dr Shah Faisal, Dr Azfarand many others. The proceedings began with the recitation of the Holy Quran by Dr Abbas Mehdi while Dr Shahper Shahryar was master of the ceremony. Later, the newly-elected body named Dental News as its official media partner and announced that the PDA, Karachi, will soon form a Women's Wing as an initiative of its new president. Sponsors were acknowledged on the occasion. Oral cancer assuming epidemic proportion ... Continued from front page tissues). As the disease progresses, the jaws become rigid to the point that the person is unable to open the mouth. The condition is remotely linked to oral cancers and is associated with areca nut or betel quid chewing, a habit similar to tobacco chewing, is practiced predominantly in Pakistan and some other South Asian countries. "Exposure to areca nut (Arecacatechu) containing products with or without tobacco (ANCP/T) is currently believed to lead to OSF in individuals with genetic immunologic or nutritional predisposition to the disease. SYMPTOMS: In the initial phase of the disease, the mucosa feels leathery with palpable fibrotic bands. In the advanced stage the oral mucosa loses its resiliency and becomes blanched and stiff. The disease is believed to begin in the posterior part of the oral cavity and gradually spread outward. Other features of the disease include xerostomia, recurrent ulceration, pain in the ear or deafness, nasal intonation of voice, restriction of the movement of the soft palate, a budlike shrunken uvula, thinning and stiffening of the lips, pigmentation of the oral mucosa, dryness of the mouth and burning sensation. CAUSES: Dried products such as gutka, pa'an masala have higher concentrations of areca nut and appear to cause the disease. Other causes are immunological diseases, extreme climatic conditions, prolonged deficiency to iron and vitamins in the diet. TRETAMENT: Although biopsy screening is necessary, it is not mandatory because most dentists could visually examine the area and proceed with the proper course of treatment. New X-ray imaging technique ... Continued from page 04 to do so, 1.4 million scatter images were taken and then processed using a specially developed algorithm that builds up a complete reconstruction. “A sophisticated CT method is still more suitable for examining large objects. However, our new method makes it possible to visualise structures in the nanometer range in millimeter-sized objects at this level of precision for the first time,” said Florian Schaff, a PhD student at the institute and lead author of the paper. The new imaging technique could be of interest for the characterisation of not only biomaterials such as bone and teeth, but also functional materials such as fuel cell and battery components, the researchers believe. The results of the study were published online on 19 November in the Nature journal in an article titled “Six-dimensional real and reciprocal space small-angle X-ray scattering tomography”. DT Germany Clinical Management Approach ... Continued from page 10 involvement. The oral soft tissue appeared healthy with fair oral hygiene, microdontia of upper lateral incisors (peg shaped), with Stained fissures of lower primary molars. Radiographic investigations were done including (OPT and PA radiographs) to assess the proximity of the coronal defect to the pulp and to evaluate the periapical region and to ascertain the presence and stage of development of remaining permanent dentition (especially lower 7s, 5s and 8s). MIH was diagnosed based on clinical appearance. See Figures 1 (a, b, c, d & e) for clinical features. Figures 2 (a, b & c) for radiographic findings. A diagnostic list and treatment plan was formulated by a specialist of Paediatric dentist as well as orthodontist and explained in detailed to the father. Diagnostic Summary A fit and healthy 10-year-old girl in the late mixed dentition with molar incisor hypomineralisation (MIH). MIH was diagnosed based on clinical appearance. Aims and objectives of treatment • To alleviate the pain and sensitivity. • To preserve the structure of the weakened FPMs. • To formulate an individualized realistic preventive scheme and reinforce it regularly. • To monitor the occlusion of developing dentition and treat as necessary. • Maintain good oral health in the long term. Treatment Plan Short /medium term • Emergency phase o Sedative filling of 26 • Preventive care phase o Oral hygiene instructions o Diet analysis and advice o Plaque score o Fluoride advice • Restorative treatment phase o Stainless steel crowns for all permanent first molars • Recall and reviews o Regular recall 3 months, radiographs every 6 months and fluoride varnish application every 3 months Medium / long term • Monitor the eruption of permanent dentition • Interdisciplinary management Treatment The treatment plan was set in two phases including Short/Medium term and long term. The short term will start with Emergency phase for restoring the 26 with GI as a temporary filling. An extensive preventive programme was implemented to improve SS’s oral hygiene in addition to diet assessment, analysis, and advice and fluoride application. In several visit crown preparation was done under local anesthesia for 36, 46, 16, and 26 followed by stainless steel crown placement. Patient’s occlusion was checked for any discrepancy in each visit. As S.S’s is considered to be of high caries risk status .She was kept on regular recall programme including recall visits and fluoride varnish application every 3 months, radiographs every 6 months. See Figures 3 (a, b, c, d & e). Long Term Treatment Plan and Future Considerations • Regular long-term diet monitoring and reinforcement of oral hygiene practices. • Periodic review of the restorations with radiographic assessment. • Review the first permanent molars status. • Monitor eruption and development of dentition. • Educate patient and parents about the poor long- term prognosis of first permanent molars these teeth and available future treatment options. Discussion Children with MIH have higher treatment needs and significant challenges in behaviour management than other children. S.S was a quiet girl who was apprehensive in the beginning of the dental treatment but willing to have the treatment. S.S was diagnosed as MIH in first permanent molars. Using non- pharmacological behaviour management techniques including tell-show-do, distraction helped to acclimatize S.S to dental treatment. These techniques are widely used in children’s dentistry and well accepted by parents. The technique works well combined with behaviour shaping. S.S was rewarded with a gift after each appointment as positive reinforcement for her good behaviour and cooperation. 26 was temporized with glass ionomer to relief discomfort, stabilize the situation and to reduce bacterial count present in the oral cavity. Failure of achieving complete anaesthesia of first permanent molars was related to the nature of MIH. S.S received supplemental intralegmental infiltration. The innervations density in the pulp of hypomineralised molars is significantly greater than of normal molars. This can explain why lower left 6 was hard to be anaesthetised. Due to poor quality of the FPM teeth of S.S and significant tooth break down full coverage by preformed metal crowns was done. Preformed metal crowns prevent further tooth loss, control sensitivity, establish correct interproximal and proper occlusal contacts, are not costly and require little time to prepare and insert. Conclusions • The presence of MIH molars not only requires the dentist to identify problems at the earliest opportunity, but also to clarify the problem thoroughly and explain the treatment options to the parents and child. • It is advisable to consider children with a poor general health in the first four years after birth at risk for MIH. These children should be monitored more frequently during eruption of the first permanent molars. • Whilst many potential approaches exist for the restorative management of molar incisor hypomineralisation, few are yet supported by good quality clinical research data. Preformed Metal crowns have been recommended as the prosthesis of choice in MIH afflicted posterior teeth with post- eruptive enamel breakdown in majority of the literature available. • The use of nitrous oxide inhalation sedation can be a useful adjunct in obtaining satisfactory analgesia in MIH patients. Nitrous oxide was not used in the case of S.S. due to parental refusal because of limited financial resources. • Had this patient presented earlier, consideration for enforced extraction of FPM would have been considered. DT UAE