Challenges of root canal treatment in poor countries


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  • Good work Dr Rukoma, however I expected you to give suggested solution to those challenges. I think is well known in almost all you said. Now what is a way forward?
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Challenges of root canal treatment in poor countries

  2. 2. Introduction RCT is changing in terms of  Demand  diagnosis techniques  treatment techniques  Equipment, instruments and materials used
  3. 3.  This necessitates a workforce which is well equipped and able to cope with the current situations- A global challenge
  4. 4. 1. Demand Is increasing as a result of:  Increased awareness  population expansion and aging  Combination of the two  more people with increased awareness, the demand is even higher
  5. 5. 2. Diagnostic techniques  X-ray is still the reliable means of diagnosis and assessment of the endodontium  Can show  Pulp status  Canal morphology  Periodontal and periradicular status  Determine if RCT can be done or not
  6. 6. Conventional X-ray  Most commonly used in poor countries  The reliability is about 60%-overlapping hides some details multiple pictures +associated cons.  Time consuming in developing-several minutes  Difficult to store for future references Despite these, some clinics don’t even have them
  7. 7. 3D Digital X-rays  Not new but uncommon in poor countriesexpensive vs. conventional  Very accurate -adjustments can be made all along  Quick  Easy to store  Easy to share  The recommended Far from reach especially in public clinics
  8. 8. 3.Treatment techniques  Relatively unchanged, mostly conventional. However, advocates for surgical or combined are increasing.  Exploratory surgery to diagnose the problem that cannot be diagnosed in any other way; for example, when NS-RCT and retreatment have failed and the reasons for failure have not been established.
  9. 9. Other indications for S-RCT include:  Repair of perforations, root resection, end filling, apical curettage and biopsy  These need a practitioner with adequate knowledge of the root anatomy and endodontium in general Note: additional canals in molars currently is almost normal
  10. 10. Single visit RCT  Another area which is being promoted  Inter-visit burden is eliminate from both patient and practitioner  The success rate is similar to multiple visits
  11. 11. Single visit cont.  depending on the nature of the disease as well as:  availability of instruments and materials  availability of time  skill and experience of the operator  and accessibility of the treated tooth for instrumentation In poor countries it is still a story of the future
  12. 12. 4. Equipments, instruments and materials  Power demanding-electricity availability and reliability  Not adequate and not reliable  Quantity and quality-national and health facility level  Not enough and uncertain quality Unfourable for RCT
  13. 13. Dental chair and accessories Generally,  Not enough, rarely serviced and old fashion  RCT is a demanding procedure  needs a full functioning (obeying) Dental Chair
  14. 14.  X-ray  Not enough, rarely serviced and mainly conventional-2D for 3D object -overlappingꜜ accuracy  Handpieces  Quality and quantity  Autoclave every after patient  Light cure machine  Composite era
  15. 15. BUT WHY?  Inadequate funding  Few technicians with or without adequate knowledge END RESULT  Failure to perform as expected
  16. 16. Instruments Some are  Outdated  Overused  Not readily available  Not even known
  17. 17. What instruments are we using for?  Filing  Compaction of GP  Cutting GP  Instruments to removing GP from the canals NiTi flexo type are recommended
  18. 18. Visual aids  The use of magnification and adequate lighting assist in accurate location of the root canals  Rarely used in poor countries
  19. 19. 5. RCT irrigating and filling materials Not a big challenge  Irrigants Naocl  Core filling material  GP, Resin based e.g. Resilon points  Sealers  resin based sealers eg. AH series, endorez and diaket
  20. 20. Crown filling material  Poor obturation but adequate crown seal has better prognosis than adequate obturation but poor crown seal  Ideally all root canal treated teeth must have artificial crown fixed  Situation on the ground- very rare
  21. 21. 6.Work force  General practitioners  The number is still low  Taught under poor conditions  No continued education  Endodontists  The number is very low even in rich countries- mostly in Dental schools
  22. 22.  WHY?  Funding  expensive to train a dentist  Endodontist even more  Motivation
  23. 23. Complete dental chair
  24. 24. 19TH CENTURY DC
  25. 25. Handpieces with light source
  26. 26. Visual aids Dental loop with light Dental surgical micr.
  27. 27. GP Devices Easy Cut NiTi rotary flexo file
  28. 28. 7. Conclusion  There is a lot of challenges in performing RCT in poor countries
  29. 29. 8. Recommendation  RCT should be included under 10 health care procedures and be given priority it deserve
  30. 30.