DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India Digital Dentistry There is much more to Digital Dentistry than owning some digital tools & softwares - Dr Aslam Inamdar Implant Training Study outlines the emerging, innovative & most effective training methods in implant dentistry ” Page 01 www.dental-tribune.in 11/19 Occlusion and Posture A Clinical Observation: Relation Between Dental Occlusion & Posture ” Page 03 ” Page 04 Antibiotics use American Dental Association recommends against the use of antibiotics in most toothache cases ” Page 06 There is much more to Digital Dentistry than owning some digital tools & softwares - Dr Aslam Inamdar by Rajeev Chitguppi, Dental Tribune South Asia Inamdar, Clinical Dr Aslam the orofacial architect and the flag- bearer of digital dentistry from India answers the questions from the readers and the editor to give a glimpse of what he is doing currently and how he plans to take digital dentistry forward in India. Dr Aslam has completed his mastership in Implantology from Stony Brooks School of Medicine, New York. However, his niche remains Digital Aesthetic Dentistry and Smile Design, where he has trained extensively with Christian Coachman, Florin Kofar and Master Paulo Kano. Apart from being an expert in Digital Smile Design, Dr Aslam is the first Diplomat from India in Skin CAD-CAM and also in Natural Restorations. Currently, he is the only dentist from Asia to pursue Diploma in Digital Dentistry from JSI Institute, Spain. In the past few years, Dr Aslam has made multiple international visits (USA, Romania, Spain, Brazil, and South Korea) to upgrade his knowledge in the fields of implant dentistry and digital dentistry. Dr Aslam has founded Rich Smile education, digital solution and distribution to help the dental practitioners to raise the standards of their esthetic dentistry practice and also to raise the bar of digital dentistry in India. planning What is Digital Dentistry? A few digital devices, gadgets and software added to a dental clinic or much beyond that? That is a good question to start with! In the past decade or so, dentistry has grown by There is much more to Digital Dentistry than owning some digital tools & softwares- Dr Aslam Inamdar leaps and bounds and there has been a paradigm shift due to newer advances in technology and materials. Although digital dentistry tools to capture patient data, diagnose, plan as well as related CAD-CAM tools are freely available, one needs to be thorough with their clinical dentistry protocols. Although there is no dearth of digital tools and software available to a practising dentist, a good workflow is of utmost importance. Only tools and software aid in delivering faster, better, predictable and more repeatable restorations the patients. To conclude, merely amassing gadgets and software is not digital dentistry. Rather it is the clinical application of these tools and investment of time to learn how to make optimal use of these in the best interest of our patients. then can digital importantly to You have established yourself as a flagbearer of digital dentistry India, in with so many digital dentistry concepts being implemented in your clinic. How did your journey start? for you Thank the compliment. With great power comes great responsibility, and I constantly aspire to do justice to the best of my abilities. I am well aware of many of my hardworking colleagues who work with great passion in this field and are doing great. I graduated from Nair Hospital Dental College in 2001. Coming from a humble background I had to work different jobs as an associate dentist until I started my own clinic with my wife in 2003. Since my college days, I have dreamt of creating natural smiles for my patients. I struggled for about 10 years just like any other dentist in Mumbai city, but I cherished a dream and a passion to excel. In 2012, I came across Dr Rajiv Verma who introduced DSD through Dr Christian Coachman in India. The first DSD course in Goa 2012 was a mesmerising experience for me. My dream of doing some of the best work saw a light at the end of the tunnel. You started off with DSD. What were the other things you started along the same lines? Soon after doing my basic DSD and DSD Residency with Dr Christian Coachman at Spain and in Brazil, I realised I needed to learn more in the field of CAD-CAM dentistry to be self- dependent in terms of the entire digital workflow and the journey still continues. I personally believe there is much more to explore. I learnt the RAW protocol from Florin Cofar in Romania, new SKIN and 3D natural staining from master Paulo Kano, 3D staining for zirconia from Changhwan Kim, digital expert protocols from Jacobo Somoza, Spain. You are the only one, I have seen, who uses the term Orofacial Architect. How is an Orofacial Architect different from a prosthetic or restorative dentist? coined The term Orofacial Architect was by Christian Coachman. I liked it very much. I believe dentistry today is more than just being a dentist fixing issues related to teeth. We all have been taught at universities about the stomatognathic system related to head, face and neck. Dental issues can have a long-lasting effect on the body as a whole. Every expert focuses solely on his area of expertise. Our entire focus so far has been to get the biological and functional rehabilitation, mostly giving least importance to esthetics. Even though we deliver, we leave our patients emotionally handicapped. necessary An orofacial architect like collects any other architect information the in realtime, understands the client desires, uses technology, imagination and his expertise to create 3D miniatures of the proposed plan. This creates harmony between aesthetics and usability of the project. Similarly, in today‘s times, the orofacial architect becomes the pilot of the project who starts his plan with maximum aesthetics as a priority and finding a balance between form, function and biology. Once the aesthetic plan is approved, then the clinical aspect begins in reverse order. Thus giving importance to biology, form, function and completed with a possible and desired level of aesthetics by the patient in the plan. This way we address the often neglected aspect of dentistry- the emotional dentistry! Tell us how digital dentistry changed completely has
2 News evaluation, treatment the and patient experience in your practice. Which is the commonest treatment modality that has undergone complete transformation of digital dentistry? because intraoral There is no particular digital treatment modality as such I can say but it‘s the whole philosophy of digital dentistry. It begins with DSD treatment planning in 2D which comes from Christian Coachman. As and when we look after chief complaint and basic hygiene of the patient and we see slightest opportunity to serve a patient with better treatment outcomes we do the photo -video protocol, scanning if required CBCT and convert all this data to make patients digital clone. After this DSD 2D planning is done. This helps us to find the gaps from patients current situation to the final best possible aesthetic outcome of treatment. Again our team as per the expertise will look into possible difficulties and how to reach for the dream smile with minimally invasive dentistry while maintaining Biology and function. A 3 D printed digital mock-up based on Natural Restorations is created to provide for TEST DRIVE and seek patient acceptance. This is a somewhat normal routine we follow. This method has set us different from the routine dental practice and patients love the fact that before actually committing for treatment a final look test is done and a lot of options regarding choice of materials and related things is discussed. This helps them understand the benefits and the value of financial investments into dental health as per their choice. We believe this is a more ethical, patient-centric approach while providing holistic dentistry. If you want to see how these tools and devices are used and integrated with various concepts, read my article published in an earlier issue of Dental Tribune South Asia. Click here to read how the entire digital workflow has been simplified into six steps. What between PVS and lab scanning? is the difference intraoral scanning, an Technically, intraoral scanner scans up to 5 microns accuracy and many lab scanners do scan to similar levels. Most labs convert PVS impressions to digital workflow though lab scanners to create prostheses. The errors of PVS impression do get copied by the lab scanners and then the entire workflow gets those flaws. An intraoral scanner gives us a chance to correct the errors instantly, saves the time of physical transfer. Another biggest advantage of an intraoral scanner, in my opinion, is its ability to scan a bite and preserve it all through the case completion phase so that it is available to be reused whenever there is a change in the treatment plan. This possibility itself is responsible for bringing out a lot many innovations in digital dentistry which is not possible with lab scanners. How to communicate with a Digital Lab? It is necessary to develop a synergy between clinical digital tools and laboratory digital tools. It is easier for those big practices who invest for in-house use, but if you are outsourcing then you should visit the lab and understand the tools and software that your technicians are using. Understand the requirements and limitations from a laboratory perspective. Digital Dentistry is growing by leaps and bounds so frequent interactions with each other is very important. We have heard about your Natural Anatomical Shape Restorations. It simply sounds like Biomimetic Dentistry to me. Is it the same? No, it is not! Biomimetic dentistry is an attempt at trying to copy nature, while Natural Restoration is the exact copy and recreation of Natural teeth shape, surface morphology in monolithic restorations. form The natural shape, and morphology the basic essence of dental white aesthetics! Thanks to Master Paulo Kano and his philosophy of New Skin which got further developed into 100% digital workflow now we call it as Natural Restorations. So I don‘t call it Biomimetic dentistry. I call it Copy-Paste dentistry because it duplicates nature precisely. Coming to the other concept: what exactly is the Injected Smile concept? This is a very fast, repeatable, predictable and economical way to restore teeth and smiles. It can be used as interim restoration or in certain cases as a long term solution too. We use DSD 2D planning followed by 3D digital wax-up and print 3D models. Clear silicone indices are made and these indices can be used to build a predictable composite. At the end inject bulk flowable composites. This gives exact natural shape and morphology without the need for the dentist to spend unnecessary clinical time sculpting to mimic nature. What is the downside of Digital Dentistry? I don‘t see any downside of digital dentistry. As and when you embrace it and cover the learning curve, you will feel it‘s the Golden era of Dentistry. Of course, you will feel the cost of investment is higher initially, and a beginner may be overwhelmed by the sheer number of tools available and their workflows. However, one can find out better ways to workaround manage this. How difficult or easy is the learning curve in Digital Dentistry? How was it for you? It will depend upon one‘s literacy and clinical the digital experience implement digital workflow in practice. to For me, I was so much digitally ignorant that I didn‘t know what powerpoint was and how to use it when I attempted my first DSD course in 2012 with Christian Coachman. Again DSLR camera was never heard of by me. It took me an entire one year to understand DSD philosophy and do my own treatment planning using powerpoint software. It was difficult to find time from routine busy practice. But I pursued against all difficulties and thanks to Dr Rajiv Varma who pushed hard for me. Next hurdle after learning to plan 2 D DSD was to make it understand the team which hardly existed in those years for me. The final analogue wax-up was again dependent on technicians understanding and expertise. interdisciplinary it. I I worked with the DSD concept with great difficulty initially due to various obstacles like technicians having difficulty implementing learned computers better and DSLR photography and kept myself updated in CAD-CAM dentistry from many other mentors and reputed institutes globally. I have consistently kept myself updated in learning and implementing the and invested accordingly in relevant CAD-CAM tools. My wife and associate dentists and my teams at both clinics have been a great support throughout. protocols digital I pursued my answers in 3D CAD-CAM world and visited many other countries and mentors like Florin Cofar, Paulo Kano, Jacobo Somoza and likewise many others. The journey continues and I am enjoying every bit of it. Persistence is the key to get through. still What advice will you give to youngsters who are eager to incorporate Digital Dentistry in their practice but have cost 11/19 workflow. Milling is currently outsourced. If you want to see how these tools and devices are used and integrated with various concepts, read my article published in an earlier issue of Dental Tribune South Asia. What is a typical digital dentistry day in your clinic Dental studio? At the moment, in my day to practice with every new patient we collect photos, videos and intraoral scans. After completion of routine dental treatment by the associate dentists, we schedule a test drive. After the test drive if the patient consents, we begin the treatment. In between patients, I practice my learning on software and teach my upcoming team at Rich Smile. You said Rich Smile. What is it? Rich Smile is my dream project which will have various verticals mainly clinics, digital design services and digital lab services. The idea is to establish a premium dental practice with all the digital gadgets and workflows under one umbrella providing world-class dentistry. How is Rich Smile going to raise the standards of dental care in India? How can practitioners become a part of this? There are a lot of practitioners who do not wish to invest heavily financially or in infrastructure but wish to provide great dentistry to their patients. Rich Smile will provide the digital design, workflows and the lab services to them. As of now, Rich Smile provides consultants to various practices so that they can deliver custom made natural smiles to their patients. Rich Smile education will provide continuing education the upcoming talent of the country to take the mantle forward. to We at Rich Smile education wish to introduce some methods for ease of planning in terms of esthetic as well as 3D implant planning. To become a part of this, practitioners can click here: http://bit.ly/richsmile and take this survey and tell us their exact requirements. concerns? How can they start small and cut costs? This question suddenly makes me wonder am I so old..! Haha... from youngsters Ok, then let‘s change the word to beginners. What would be your advice to them? I consider myself still a novice in the game of dentistry!! For dentists who have a stable dental practice, my advice is digital dentistry is here to stay. Whenever you feel you are ready, start investing slowly in digital equipment, but spend more time on gaining knowledge on digital workflows and clinical integration. Start with digital documentation of your work which doesn‘t cost much. Move out of comfort zone and develop a new (digital) culture in your practice. the What would be your advice to the ambitious fresh graduates who are looking for quality higher education, not only digital dentistry but any type of higher education? My advice to the beginners would be not to look for quick returns as soon as you graduate. The focus for early 3 to 5 years should be on gathering experience. For this one needs to associate with good clinicians and practices, and also help them grow as associates. While doing this, you will automatically learn many things. Keep attending continued dental educations on a timely basis. There are many and it is natural that one gets confused. Follow your subject of passion and gut feeling. Most of the time when I attend such workshops I may learn only one thing but that could drastically change many things for me. Keep changing your mentors as soon as you learned enough from them. No cost-cutting when you have to get an education first. Earn, survive and keep investing back in the profession at least for 10 years. Follow your passion and money follows you at the right time. So you have followed your passion in digital dentistry. What are the various digital tools and gadgets that you are using in your clinic to apply the concepts and philosophies of digital dentistry? thing The most basic is documentation for which I have a DSLR camera and related flashlights. Coming to clinical execution, I have 3Shape intraoral scanner, 3Shape dental designer, implant planning software, photon 3D printer, and of course the laptops that support the 3D
3 News 11/19 Study outlines the emerging, innovative & most effective training methods in implant dentistry by Dental Tribune International implant LISBON, Portugal: Technological progress is not only helping the development of newer treatment techniques but also creating a need to update the education methods and models in implant dentistry. Recent research from Portugal, the UK and the US on the trends in implant dentistry education has summarised the most effective training methods in implantology. The publication non- discusses traditional and to seek encourages dentists professional after their university training has ended. innovative, methods education Nowadays, traditional teaching methods are being replaced by modern techniques that involve awe-inspiring images, dynamic videos and interactive exercises in lectures, and quizzes or anonymous question sessions, for on-site learning, to engage participants who would usually be too shy to ask questions. and learning, two main The researchers of this study learning evaluated learning and models: action blended also reviewed - augmented reality, artificial intelligence, haptics and mixed reality and also analyzed the experiences and opinions of expert authors. They stated: “One challenge in implant dentistry education is that professional learners who wish to learn are still, too often, taught in traditional ways of knowledge sharing rather than involving students directly in the application of knowledge to solve, or better still prevent, clinical problems.” to solving Action learning is a learning approach where people are committed real- through action. life problems Research highlights hands-on exercises as an essential tool in implant dentistry training. Standardised plastic models which mimic patients’ real situations are a good way of implant placement. simulating Digital planning, customised 3D-printed models, animal and human cadaver models, and dynamic navigation systems simulate real-life situations and allow surgeons to practise in an interactive way. Different studies have shown how hands-on exercises promote Ad THE FIRST AND UNIQUE DENTAL IMPLANT IN THE WORLD MANUFACTURED THROUGH DIRECT LASER METAL FORMING TECHNIQUE BY MICROFUSION OF TITANIUM PARTICLES SURFACE l SPONGY l TRIDIMENSIONAL l ISOELASTIC CAVITIES l INTERCONNECTED l 2-200 µm Cleared! ACTIVE POROUS SURFACE l THICKNESS TO 250 µm l DESIGNED TO PROMOTE BONE GROWTH MORE THAN 15 YEARS OF EXPERIENCE BY DOCTORS ALL AROUND THE WORLD OVER 250.000 UNITS SOLD WORLDWIDE References available upon request ONE STEP BEYOND LifeCare Devices Private Limited 210 Udyog Mandir 1, 2nd Floor, 7-C Bhagoji Keer Marg, Mahim West, Mumbai - 400 016 Phone: +91 22 6146 4725 / 27 E-mail: email@example.com A recent review has summarised the most effective training methods for implant dentistry. (Image: Photographee.eu/Shutterstock) students’ learning by building on their intrinsic motivation. A survey conducted among 372 undergraduate students who experienced both passive and active learning showed that active instruction had more positive effects on their psychological and behavioural outcomes. However, limitations this method has too. Action learning models are expensive as they require more resources - facilitators, equipment and space, which are not needed in the case of a single instructor giving a lecture in a lecture hall. An action learning environment, owing to unfamiliarity, can create a sense of discomfort among participants, who are taking on new processes. Not all learners are comfortable revealing what they do not know to other participants, who may be strangers. The publication also covers blended learning - a term that has caused much confusion. However, a popular definition states that this learning model blends online and face-to-face interaction to enhance meaningful interaction between students, teachers, and resources. Many studies have demonstrated that the blended learning model provides superior outcomes when compared with more traditional teaching methods. However, even with all the evidence and all the technological advancements that can help us overcome the obstacles of different time zones and geographical location, the process of integration of blended learning programmes within mainstream implant education has been slow. dental Artificial significant intelligence (AI) and machine learning (ML) are two technological contributors to blended learning, as they incorporate significant advances in computing power. Furthermore, augmented reality (AR) and virtual reality (VR) are considered innovative advances in implant dentistry education. AR allows the user to feel as though he or she is connected to an enhanced environment. VR brings together a combination of multiple technologies, allowing users to interact with virtual entities in real-time. Blended learning has its own challenges and limitations. The construction of sufficiently “real” environments requires expensive and technically interface design. challenging Another critical issue is data and user privacy. sometimes learning interactive The researchers recommended in online small working groups via social media as this method allows dentists to share their clinical cases and also the day-to-day clinical challenges that they face in their daily practice. Webinars, due to their flexibility of location and to promote interaction via Q & A, are also considered to be a good learning method. their ability in “Education innovative […] Going implant dentistry will evolve quickly over the next decade as technologies already being used in other industries are incorporated into new and learning models. forward, instead of traditional models of education being used to achieve all educational objectives, now traditional formats that will be ineffective with today’s learner will be replaced, where appropriate, with online education, AR, ML, VR, and MR [mixed reality],” stated the authors. in The study, titled “Innovative implant dentistry trends training education: A narrative review”, was published in the October 2019 issue of the Journal of Clinical Medicine. and
4 News 11/19 A Clinical Observation: Relation Between Dental Occlusion & Posture by Dr. Rinku Jain The relationship between stomatognathic and postural system has been investigated by many health care professionals. Posture and the mandibular function are strongly influenced by the position of the teeth. We know any missing tooth if not replaced for long period of time may lead to change in the bite, because of the change in the position of the adjacent and/ or opposing teeth, especially in pateints with poor oral hygiene. A successful clinical outcome of any dental restorative work depends on proper occlusal harmony. With advanced digitization, we can measure dynamic occlusal forces and achieve occlusal stability with T-Scan. Here is a case report with treatment of traumatic bite and its influence on posture, before and after achieving the occlusal harmony using T-Scan. Introduction: “The relation between dental occlusion, body posture and temporomandibular disorder is a controversial topic in dentistry, though the role of dental occlusion in the development of TMDs cannot be overruled”(2). “During the routine oral examination, the signs and symptoms of dental occlusal disease must be noted, and the patient should be educated about the further diagnosis and treatment” (2). This is a case report showing how occlusal changes can lead to postural changes. This case report details the correction of traumatic bite with restorative work and measurement of occlusal forces with T-Scan. It shows importance of correction of the traumatic bite at the earliest to prevent TMD and postural changes. It was observed that minimal changes in occlusion can affect the posture. the Case report: Patient aged 38, reported to our office to get her missing teeth fixed. She informed of habitual spine (Fig 13 a,b,c & d). A year later the temporary crown with 26 replaced with E-max layered zirconia crown, and again finished the occlusal analysis with T-Scan. Change in posture: After completion of the treatment, there was a drastic change in the posture of the patient which can be compared in the before and after photographs. (Fig 13) Conclusion: It was observed that there was a remarkable change in the posture on creating an occlusal harmony both in MIP and achieving canine guidance and DTR (disclusion time reduction) treatment by measuring of occlusal forces with T-Scan. T-Scan overcomes the known limitations of articulating paper. This shows dental occlusion influences posture. This also shows there needs to be a holistic dental treatment approach and not mere symptomatic treatment. “Patients presenting with any signs of occlusal disease should be thoroughly examined and the cause should be determined while treating. The occlusal disease may have a detrimental effect on the general well-being of the patient in the long run. Conservative treatment approach with high success rate should be practised” (2). Further studies having a sufficient number of cases are required to establish the relationship between dental occlusion and cranio-cervical posture. References: 1. Pacella E, Dari M, Giovannoni D, Mezio M, Caterini L, Costantini A, et al. The relationship between occlusion and posture: a systematic review. WebmedCentral O R T H O D O N T I C S 2017;8(11):WMC005374 S, Zahid 2. Khan MT, Verma SK, Maheshwari SN, Chaudhary PK. Neuromuscular dentistry: Occlusal diseases and posture. J Oral Biol Craniofac Res. Occlusal correction and restorative treatment resulted in a remarkable improvement in the posture of the patient, pertaining to the head position and curvature of the spine. (Photograph: by Dr. Rinku Jain) chewing of food only on the right side of the jaw. Medical History: Chronic sinusitis & headaches 2-3 times in a week. No other relevant medical history. Dental History: Extraction of upper left molar a year back and extraction of a lower right molar 2 years back. Intra oral examination: Intraoral photographs. Incisal attrition with 12, 11, 21, 22, 31, 32, 41, 42, 43 (Fig 1, 2, 3, 4) Missing tooth no 26 & 46 Reduced mesio-distal space between 45 & 47 (Fig 3) Mesialy tilted 47 (Fig 5), Supra erupted 36 (Fig 6), Cervical abrasion with 23, 34, 44 Caries with 11, 12, 16, 17, 21, 22, 24, 25, 27, 45, 47, 48 Extraoral examination: No relevant signs related to TMJ, and other facial structures Investigations: CBCT. Postural photographs. Treatment plan: Oral prophylaxis followed by treatment of carious teeth with biomimetic restorations. An incisal build-up for all the anterior teeth with stress-reduced direct composite restoration, Indirect Sinus Lift & implant placement with 26. Occlusal force analysis with T-Scan. Discussion: The patient had fair oral hygiene. The extracted teeth were not replaced hence there was supra eruption of the opposing molar on the left side and mesial inclination of 47, leading to traumatic bite, thus leading to incisal attrition of upper and lower anterior teeth and abrasion with 23, 34 & 44. Pre-treatment and post-treatment postural photographs were taken to see if the correction of occlusion had any effect on posture. After explaining the to the patient, about intraoral findings and the importance of occlusal correction not only for the prognosis of the implant but also for the health of the teeth and mouth, the patient agreed to the planned treatment. Firstly oral prophylaxis was done followed by treating all the carious lesions with biomimetic restorations. The incisal build-up was done with stress-reduced direct composite restorations on all the attrited teeth (Fig 7, 8), to achieve canine guidance in lateral excursive movements of the jaw. Sinus Indirect lift was performed with 26 because the residual alveolar bone height was 5 mm. Nova bone putty was used as a grafting material and GenXt implant 4.2 x 8 was placed. Immediate Bis-acrylic temporary crown was placed, the temporary crown was kept out of occlusion and splinted to the proximal surfaces of 25 & 27 with flowable composite. 46 was not replaced because of reduced mesiodistal space between 45 & 47. Other alternative treatment to replace 46 would have been orthodontic tooth movement of 47 and then place an implant to restore 46. As the patient was from another country, looking at the amount of time it would require he denied the option. Occlusal force analysis was done using T-scan (Fig 11 & 12). Enameloplasty was done on 36 & 27 and occlusal stability achieved. After the completion of treatment postural photographs were taken. There was a remarkable difference noted in the posture of the patient, pertaining to the head position and curvature of the the Fig 1 Fig 2 Fig 3 Fig 4 Fig 5
6 Clinical 11/19 American Dental Association recommends against the use of antibiotics in most toothache cases gastrointestinal of effects. adverse Dentists should reevaluate the clinical condition within 3 days. Also, they should instruct their patients to discontinue antibiotics 24 hours after their symptoms resolve, irrespective of reevaluation after 3 days. antibiotics, Due to a higher bacterial by resistance demonstrated to azithromycin compared patients other should be on azithromycin instructed to closely monitor their symptoms and call their dentist if their infection worsens while on therapy. The guideline, titled “Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association,” was published in the November 2019 issue of the Journal of the American Dental Association. an algorithm to identify where and how to prescribe antibiotics as an adjunct to DCDT. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. A vital pulp with symptomatic irreversible pulpitis or a necrotic pulp with symptomatic apical periodontitis does not warrant antibiotic prescription if there is only pain and no swelling. The report quotes enough evidence that suggests that nonsteroidal anti-inflammatory drugs may be effective in managing dental pain. Dentists should consider antibiotics only in cases of pain with swelling, and that too when an acute apical abscess leads to systemic involvement (fever, swollen lymph nodes etc). over The expert panel recommends both amoxicillin and penicillin as first-line treatments but prefers amoxicillin penicillin because of two reasons. First, amoxicillin is more effective against a range of gram-negative anaerobes, and second, is associated with a lower incidence it American Dental Association (ADA) has issued a new set of guidelines recommending that antibiotics are not needed in most toothache cases. (Photograph: pxhere/Creative Commons CC0) by Rajeev Chitguppi, Dental Tribune South Asia of CHICAGO, U.S.: To combat the menace antibiotic overprescription of antibiotics that results in the development of antibiotic-resistant bacteria, the American Dental Association (ADA) has issued a new set of guidelines recommending that antibiotics are not needed in most toothache cases. (2017 Various reports published recently -2019) suggest that 30- 85% of dental antibiotic either prescriptions are suboptimal or not indicated, the cost-related and raising public health concerns, which has made the appropriate use of antibiotics a critical issue in the health care agenda. The new guidelines published in the Journal of American Dental Association recommend against the use of antibiotics for most they recommend, pulpal and periapical conditions. Instead, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen. Definitive, Conservative Dental Treatment (DCDT) refers to pulpectomy, nonsurgical root canal treatment, or incision for drainage abscess. Only those clinicians, who are authorized or trained to perform the specified treatment, should do so. The new report has developed pulpotomy, Relax your patients and make them feel more comfortable during dental procedures Ad Matrx Nitrous Oxide and Oxygen Conscious Sedation Systems There are many good reasons to use nitrous oxide sedation in your dental practice: • Safe - N2O/O2 has been used globally for over 100 years • Relieves patient anxiety and discomfort • Patients remain awake, yet more relaxed, making it an excellent patient management tool • Improves patient experience, resulting in return visits Matrx is made in the USA 210 Udyog Mandir 1 7-C Bhagoji Keer Road Mahim West, Mumbai 400016 India Phone: +91 22 61 46 47 48 Email: firstname.lastname@example.org www.lifecare.in
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