A coaching institution for ADC examination, ORE and Government dental jobs exam.
The 2017 ACC/AHA guideline for high BP in adults provides four BP categories based on the average of two or more in-office readings on 2 or more occasions:
Even though they are benign and slow-growing lesions, ameloblastomas exhibit locally destructive behavior with a high recurrence rate. Thus, most relapses (50% and even over 80%) occur during the first 5 years after the primary surgery. The major contributing factor for recurrence seems to be the inadequate initial surgical procedure rather than the histological type [1].
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| Fig. 1. Ameloblastoma: multilocular appearance |
The surgical options for ameloblastoma vary from simple enucleation (with or without bony curettage) to radical excision.
Extra numbers of teeth are known as supernumerary teeth. When they are present in the anterior maxilla in midline, they are known as mesiodens. When the extra teeth are present in the molar region as fourth molar, they are known as paramolar teeth. The anterior midline of the maxilla is the most common site whereas the maxillary molar area is the second most common site for supernumerary teeth.
Supernumerary tooth-mesiodens in anterior mandible in midline [1]
Radiograph showing mesiodens in anterior maxilla [1]
The investigation involves routine blood examination and IOPA or OPG radiographs. Depending on the anticipated level of difficulty of the surgery, additional investigations may be advised.
Treatment involves surgical extraction.
Oral candidiasis is a fungal disease that is caused by Candida albicans. It looks like a white or creamy plaque or patch that can be wiped off with the help of a cotton swab or a tooth brush leaving a red base.
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| Gingival thrush |
It occurs due to disturbance in the oral microflora due to antibiotics, corticosteroid, Xerostomia , immune defects especially in HIV infection, immunosuppressant, leukaemia or lymphomas and diabetes. It rarely occurs in a healthy individuals except in neonates.
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| Chronic mucocutaneous candidosis: note the wide adherent plaque. |
Gram stain smear shows the Candida albicans hyphae. It should be differentiated from Koplik's spot or Fordyce's granules.
The treatment involves treating the cause. Antifungal agents, for example, nystatin oral suspension or pastilles, amphotericin lozenges, or miconazole gel or tablets or fluconazole tablets can be given.
Ref:
1. Oral diseases 2nd Ed. Crispian Scully, Roderick A. Cawson Churchill Livingstone
MALOCCLUSION
Proposed by Edward H. Angle in 1890, the Angle Classifications are based on the relationship of the buccal groove of the mandibular first permanent molar and the mesiobuccal cusp of the maxillary first permanent molar. This classification is considered to be one of the most commonly used as its easy to use.
Bleeding disorders: dental considerations
Acquired or congenital bleeding disorders of dental treatment concern include haemophilia, von Willebrand disease, other factor deficiencies and thrombocytopenia. Some systemic conditions also interfere with haemostasis, such as kidney, liver and bone marrow disorders.
Patients with bleeding disorders should be managed in a specialist setting, with appropriate consultation with the patient’s specialist or multidisciplinary team.
Other factor deficiencies
thrombocytopenia
Bleeding disorder may be due to defect in platelet activation, function and contact activation. It may also be due to defect in clotting proteins or antithrombin function.
The commonest caused of bleeding disorder are
aspirin
Warfarin is the commonest anticoagulant that interferes by preventing the production of clotting factors by blocking vitamin K.
von Willebrand disease is the most common inherited bleeding disorder.
The single most important evaluation part is an adequate history since screening tests for bleeding disorders do not always detect mild defects. A history suggestive of a bleeding tendency must be taken seriously. History of previous dental extraction or tonsillectomy provide a useful guide. Physical examination is also necessary and for conformation of diagnosis, laboratory test are needed.
An accurate diagnosis is essential for replacement therapy, if needed and enable other management protocols to be followed.
Congestive heart failure or heart failure occurs when the heart muscle weakens and doesn't pump enough blood as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.
Certain heart conditions, for example, coronary artery disease or high blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.
Antibiotic prophylaxis is recommended for invasive dental procedures that involve the manipulation of gingival tissue or periapical region or perforation of the mucosa when performed on high-risk individuals. Australian guidelines have provided a list of dental procedures that are likely to cause a high incidence of bacteraemia that always require prophylaxis. These are as follows:
Procedures that cause a moderate incidence of bacteraemia might be considered for prophylaxis if multiple procedures are being conducted, in cases where the procedure is prolonged, or in the setting of periodontal disease.
Antibiotic prophylaxis is not recommended for procedures with a low possibility of bacteraemia such as:
The current infective endocarditis/valvular heart disease guidelines [2] state that use of preventive antibiotics before certain dental procedures is reasonable for patients with:
Paediatric Patients
Congenital heart disease can indicate that prescription of prophylactic antibiotics may be appropriate for children. It is important to note, however, that when antibiotic prophylaxis is called for due to congenital heart concerns, they should only be considered when the patient has:
The prophylactic antibiotic should be effective against viridans group streptococci. The guidelines recommend 2 grams of amoxicillin given orally as a single dose 30-60 minutes before the procedure as the drug of choice for infective endocarditis prophylaxis. It has bactericidal activity against streptococci and enterococci. It reaches peak concentrations within one to two hours of oral administration, it has a short half-life of 1.5 hours, but therapeutic levels are maintained for nearly six hours. It has high oral bioavailability. The usual paediatric dosage is 50 mg/kg, with a maximum up to 2 gr. If the patient is unable to take oral medications, parenteral administration of 2 gr amoxicillin or ampicillin is considered as an alternative.
Oral or parenteral administration of cephalexin 2 gr for adults or 50 mg/kg for children, or parenteral administration of cefazolin or ceftriaxone 1 gr i.m./i.v. for adults or 50 mg/kg i.m./i.v for children are other alternatives. Cephalexin can be replaced by another first- or second-generation oral cephalosporin of equivalent dosage.
In patients hypersensitive to penicillin, guidelines are in agreement that the alternative drug of choice is clindamycin 600 mg (15-20 mg/kg up to 600 mg for children). It can be administered orally or intravenously 30-60 minutes before the procedure (as per European association of cardiologist [2], not as per ADA or AHA-see table). Clindamycin is a bacteriostatic protein synthesis inhibitor. Peak serum concentrations are achieved within 45 to 60 minutes after oral administration. Clindamycin is effective against streptococci and methicillin-sensitive staphylococci. However, some studies have questioned the potency of clindamycin prophylaxis. While ESC guidelines recommend solely clindamycin in penicillin-allergic patients, the AHA and Australian guidelines provide a variety of alternatives in this group of patients. The AHA guidelines recommend macrolides, 500 mg of azithromycin or clarithromycin (15 mg/kg for children). The Australian guidelines recommend glycopeptides; however, the ESC guidelines do not recommend glycopeptides and fluoroquinolones due to the lack of evidence on their efficacy. Cephalosporins should be refrained from use in patients who have encountered anaphylaxis, angioedema or urticaria related to penicillins.
It is important to administer prophylaxis before the procedure so that minimal inhibitory concentrations of the drugs will be present from the beginning of the procedure. If the patient cannot receive a prophylactic antibiotic before the procedure, it can be administered up to two hours after the procedure; however, delay in the treatment might lead to increased bacteraemia. If the patient needs multiple interventions, prophylaxis should be repeated with each. It is advised to finish necessary interventions in one or two sessions if possible. Given that consecutive exposures to the same antibiotic increase resistance rates, the healthcare provider might opt to choose different antibiotics for subsequent sessions. These might be the second-line alternative therapies mentioned in the guidelines or administering the patient a combination beta lactamase inhibitor such as amoxicillin-clavulanate or sulbactam-ampicillin. If the patient is already on antibiotic therapy with penicillins, the operation could be delayed until after the cessation of the antibiotic and restoration of the oral flora. If this is not possible, an alternative group of antibiotics could be preferred.
Ref:
1. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/vol16no33#:~:text=The%20prophylactic%20antibiotic%20should%20be,choice%20for%20infective%20endocarditis%20prophylaxis.
2. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/antibiotic-prophylaxis
3.https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000969
