PHYSIOLOGIC AND PATHOLOGIC RESORPTION
HOW TOOTH IS NORMALLY RESISTANT TO RESORPTION...
Explained by 4 hypothesis..
RANK/RANKL/OPG SYSTEM
DEFINITION OF RESORPTION
CLASSIFICATION BY COHEN, WEINE, INGLE, ANDREASON
CELLS INVOLVED IN RESORPTION
ETIOLOGY AND PREDISPOSING FACTORS
MECHANISM OF TOOTH RESORPTION
FACTORS REGULATING TOOTH RESORPTION
TYPES: EXTERNAL AND INTERNAL
EXTERNAL RESORPTION: SURFACE, REPLACEMENT AND INFALAMMATORY RESORPTION.
EXTERNAL CERVICAL RESORPTION
EXTERNAL APICAL ROOT RESORPTION
INTERNAL RESORPTION
IDIOPATHIC ROOT RESORPTION
TRANSIENT APICAL BRAKEDOWN
ETIOLOGY, HISTOLOGICAL APPERANCE, RADIOGRAPHIC FEACTURES, CLINICAL FEATURES, PREVENTION AND MANAGEMNT OF ALL TYPES OF RESORPTION
Host modulation therapy is recommended as an adjunct to scaling and root planing in the periodontal therapy. The basic purpose of host modulation therapy is to restore the balance between pro-inflammatory and anti-inflammatory mediators.
PHYSIOLOGIC AND PATHOLOGIC RESORPTION
HOW TOOTH IS NORMALLY RESISTANT TO RESORPTION...
Explained by 4 hypothesis..
RANK/RANKL/OPG SYSTEM
DEFINITION OF RESORPTION
CLASSIFICATION BY COHEN, WEINE, INGLE, ANDREASON
CELLS INVOLVED IN RESORPTION
ETIOLOGY AND PREDISPOSING FACTORS
MECHANISM OF TOOTH RESORPTION
FACTORS REGULATING TOOTH RESORPTION
TYPES: EXTERNAL AND INTERNAL
EXTERNAL RESORPTION: SURFACE, REPLACEMENT AND INFALAMMATORY RESORPTION.
EXTERNAL CERVICAL RESORPTION
EXTERNAL APICAL ROOT RESORPTION
INTERNAL RESORPTION
IDIOPATHIC ROOT RESORPTION
TRANSIENT APICAL BRAKEDOWN
ETIOLOGY, HISTOLOGICAL APPERANCE, RADIOGRAPHIC FEACTURES, CLINICAL FEATURES, PREVENTION AND MANAGEMNT OF ALL TYPES OF RESORPTION
Host modulation therapy is recommended as an adjunct to scaling and root planing in the periodontal therapy. The basic purpose of host modulation therapy is to restore the balance between pro-inflammatory and anti-inflammatory mediators.
The prognosis is a prediction of the probable course,
duration, and outcome of a disease based on a general
knowledge of the pathogenesis of the disease and the
presence of risk factors for the disease.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
In periodontology, classifications are widely used to categorize defects due to periodontitis according to their etiology, diagnosis, treatment and prognosis.
Several classifications have been proposed in the literature in order to facilitate the diagnosis of gingival recessions.
Microbiology of Endodontic Infection.Mechanisms of MicrobialPathogenicity and Virulence Factors
Biofilm and Community-Based Microbial Pathogenesis
Biofilm and Bacterial Interactions
Biofilm Community Lifestyle
Quorum Sensing—Bacterial Intercommunication
Methods for Microbial Identification
Diversity of the Endodontic Microbiota
Primary Intraradicular Infection
Spatial Distribution of the Microbiota
Microbial Ecology and the Root Canal Ecosystem
Secondary/Persistent Infectionsand Treatment Failure
Fenestration
Dehiscence: lack of cortical bone at the level of dental root, at least 4mm apical to the margin of interproximal bone, the measurement was per found by graduated probe.
Or: lowering the crestal bone margin to expose root surface.
Fenestration: localized defect in the alveolar bone that exposed the root surface usually the apical or the medium third but did not involve the alveolar margin.
Or: is isolated areas in which the root is denuded of bone and the root surface is covered only by periosteum and overlying gingiva.
Fenestration is a term derived from Latin ward fenestra, meaning window, describe area of alveolar process devoid of bone, creating a window exposing the root surface.
Gingival recession: is the apical movement of the marginal soft tissue surrounding the tooth exposing root surface.
According to some studies that irreversible recession can be caused by fixed appliances for 1.3% to 10.0% of treated cases.
We can use CBCT to measure the labial and lingual thickness of the bone related to roots.
ABT: apical buccal thickness. MBT: middle buccal thickness. CBT: cervical buccal thickness.
ALT: apical lingual thickness. MLT; middle lingual thickness. CLT: cervical lingual thickness.
== naturally occurring alveolar bone dehiscence and fenestration are common finding in different type of malocclusion especially in anterior region of class III.
== fenestration and dehiscence may lead to gingival recession and additional bone loss during orthodontic treatment in addition to large amount of labial inclination such as decompensation in class III malocclusion may pose a greater risk of periodontal complication such as:
Alveolar dehiscence, fenestration, gingival recession.
Clinically gingival recession, is always accompanied by alveolar bone dehiscence whether underlying bone dehiscence is developed before or parallel to gingival recession.
N:B- gingival recession; is described as exposure of root surface by an apical shift in the position of gingiva.
Factors affect recession increase:
1- Difficulty of plaque control due to fixed appliances
2- Proclination of teeth.
3- Coronally attached Frenum.
4- Muscle attachment.
5- Abnormal tooth position.
6- Overhanging restoration or crowns.
7- Fenestration and dehiscence.
** Classification of fenestration according to their apicocoronal location in relation to root length to:
1- At the level of the apical third of the dental root 48% all in maxilla.
2- At the level of the middle third of dental root 28% in maxilla and mandible.
3- At the level of the coronal third of the dental root 19% all in mandible.
4- Extending from the apical to the middle third of the dental root 4.3% of them located in maxilla.
** Etiology of dehiscence:
1- Ectopically positioned teeth which are outside of the bony limits of the alveolus are often lacking the normal amount of bone on the overlying facial surface.
2- Roots of the toot
The prognosis is a prediction of the probable course,
duration, and outcome of a disease based on a general
knowledge of the pathogenesis of the disease and the
presence of risk factors for the disease.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
In periodontology, classifications are widely used to categorize defects due to periodontitis according to their etiology, diagnosis, treatment and prognosis.
Several classifications have been proposed in the literature in order to facilitate the diagnosis of gingival recessions.
Microbiology of Endodontic Infection.Mechanisms of MicrobialPathogenicity and Virulence Factors
Biofilm and Community-Based Microbial Pathogenesis
Biofilm and Bacterial Interactions
Biofilm Community Lifestyle
Quorum Sensing—Bacterial Intercommunication
Methods for Microbial Identification
Diversity of the Endodontic Microbiota
Primary Intraradicular Infection
Spatial Distribution of the Microbiota
Microbial Ecology and the Root Canal Ecosystem
Secondary/Persistent Infectionsand Treatment Failure
Fenestration
Dehiscence: lack of cortical bone at the level of dental root, at least 4mm apical to the margin of interproximal bone, the measurement was per found by graduated probe.
Or: lowering the crestal bone margin to expose root surface.
Fenestration: localized defect in the alveolar bone that exposed the root surface usually the apical or the medium third but did not involve the alveolar margin.
Or: is isolated areas in which the root is denuded of bone and the root surface is covered only by periosteum and overlying gingiva.
Fenestration is a term derived from Latin ward fenestra, meaning window, describe area of alveolar process devoid of bone, creating a window exposing the root surface.
Gingival recession: is the apical movement of the marginal soft tissue surrounding the tooth exposing root surface.
According to some studies that irreversible recession can be caused by fixed appliances for 1.3% to 10.0% of treated cases.
We can use CBCT to measure the labial and lingual thickness of the bone related to roots.
ABT: apical buccal thickness. MBT: middle buccal thickness. CBT: cervical buccal thickness.
ALT: apical lingual thickness. MLT; middle lingual thickness. CLT: cervical lingual thickness.
== naturally occurring alveolar bone dehiscence and fenestration are common finding in different type of malocclusion especially in anterior region of class III.
== fenestration and dehiscence may lead to gingival recession and additional bone loss during orthodontic treatment in addition to large amount of labial inclination such as decompensation in class III malocclusion may pose a greater risk of periodontal complication such as:
Alveolar dehiscence, fenestration, gingival recession.
Clinically gingival recession, is always accompanied by alveolar bone dehiscence whether underlying bone dehiscence is developed before or parallel to gingival recession.
N:B- gingival recession; is described as exposure of root surface by an apical shift in the position of gingiva.
Factors affect recession increase:
1- Difficulty of plaque control due to fixed appliances
2- Proclination of teeth.
3- Coronally attached Frenum.
4- Muscle attachment.
5- Abnormal tooth position.
6- Overhanging restoration or crowns.
7- Fenestration and dehiscence.
** Classification of fenestration according to their apicocoronal location in relation to root length to:
1- At the level of the apical third of the dental root 48% all in maxilla.
2- At the level of the middle third of dental root 28% in maxilla and mandible.
3- At the level of the coronal third of the dental root 19% all in mandible.
4- Extending from the apical to the middle third of the dental root 4.3% of them located in maxilla.
** Etiology of dehiscence:
1- Ectopically positioned teeth which are outside of the bony limits of the alveolus are often lacking the normal amount of bone on the overlying facial surface.
2- Roots of the toot
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1. Community Dentistry
The Management of a Muslim Patient
Samy Darwish
Wahidah/Denty/Khairunnisaa/Nurul ‘Adilah
2. Content Page
Objectives
Summary of Article
Relevance to OHTs in Singapore
Prayer
Fasting
Hijab/Tudung
Gender issue
Dental materials
Summary- learning points
References
Cultural Competence: The Management
of a Muslim Patient
3
3. Objectives
Explain how cultural competency is important to the
provision of oral health care in Singapore
To provide insight on managing a Muslim patient
Focus on certain points relevant to Oral Health Therapists
in Singapore
Cultural Competence: The Management
of a Muslim Patient
4
4. Article - Summary
This article provides
knowledge of the normal
practices and belief of
Muslims and explains rituals
done by Muslims that may
affect dental treatment
offered.
It is necessary for us to
manage Muslim patients well,
due to the significance of
Singapore’s multi-racial &
multi-religious population.
Cultural Competence: The Management
of a Muslim Patient
5
5. Relevance to us, as OHTs
encounters with
Madrasah students
✔ operator-patient
relationship
cultural
competence and
understand certain
actions or
decisions made by
patient
effective patient
care to meet
standards of
patient
Cultural Competence: The Management
of a Muslim Patient
6
6. Prayer
Friday prayers (for males only)
Management:
Appointments may have to be short/fast
Avoid afternoon appointments
Cultural Competence: The Management
of a Muslim Patient
7
7. Fasting
Yearly practice in the month of Ramadhan
Lasts for 29-30 days
Issues with dental treatment during fasting
month:
Wrong diagnosis of malodour
Cultural Competence: The Management
of a Muslim Patient
8
8. Fasting
Refusal for certain procedures
LA
Extraction
Refusal for dental treatment
Accidental swallowing of water
Foreign object in mouth
Cultural Competence: The Management
of a Muslim Patient
9
9. Fasting
Management:
Comply to patient’s belief
Eg: if patient believes that brushing/flossing will invalidate their
fast, operator has to accommodate without compromising the
patient’s oral health
Reschedule appointment
Postpone certain dental treatments
Cultural Competence: The Management
of a Muslim Patient
10
10. Hijab/Tudung
Management:
Ask for consent to remove hijab (if necessary)
Cultural Competence: The Management
of a Muslim Patient
11
11. Gender issue
Cultural Competence: The Management
of a Muslim Patient
12
Management:
Find out if patient has any
request
Eg: for staff of the same
gender
12. Gender issue
Management:
Operator has to be cautious when treating
Muslim patients of the opposite gender;
minimize direct skin contact, maintain
professional physical proximity
Cultural Competence: The Management
of a Muslim Patient
13
13. Dental Materials
Prohibited materials:
Alcohol based mouthwashes
Porcine materials- bone grafting
Gold restorations for males; crowns
Management:
Provide all treatment options, allow patient to make own decision
Inform patient of the materials if they are not aware
Respect patient’s decision/wish
Cultural Competence: The Management
of a Muslim Patient
14
14. Conclusion
Dental professionals should be aware of religious and
cultural rituals that affects management of patient in order
to treat the patient with empathy and understanding
We should be open-minded to culture-specific patient
opinions and health beliefs, and acknowledge how it
affects dental and medical decision making in everyday
life
Cultural Competence: The Management
of a Muslim Patient
15
16. References
http://www.bu.edu/bhlp/Resources/Islam/health/guidelines.html#
Respect
TIPS FOR DENTAL CARE DURING FASTING, Reported by
Tuti Ningseh Mohd Dom & Shahida Mohd Said
http://dentalzara.com/v1/index.php?option=com_content&view=
article&id=77:dentalcare-during-fasting&catid=56:dental-story-category&
Itemid=91
http://www.freedentistfinder.com/articles/257/Muslims-Need-
Special-Oral-Care-During-Holy-Month-of-Ramadan.html
http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=13
230#.UK9zVo5BoTN
Cultural Competence: The Management
of a Muslim Patient
17
Editor's Notes
Frequent encounters with Madrasah students Muslim Religious School in HPB
To build better operator-patient relationship
Able to increase cultural competence and understand certain actions or decisions made by patient
For effective patient care executed with a level of respect and dignity they deserve, that are being perceived as comfortable and meeting their standards
Retain pts so that they stay on for their full length of treatment that they need
Avoid stereotyping, treat as individuals
Clinic experience
LA: some pts may perceive LA to be intake of fluid therefore invalidating their fast
EXO: accidental swallowing of blood
Accidental swallowing of water (water spray from triple syringe/handpiece)
Antibiotic prophylaxis- invalidate fast so pt may request to postpone appt until after ramadhan
Eg: Advise patient to brush their teeth after their pre-dawn meal before starting their fast
Ask the class if they have any problems treating madrasah girls?
In Muslim culture men and women do not mix freely. Some men/women are okay with treatment by opp gender, some may feel more comfortable if there is another person with them, some prefer same gender (if can choose)
Denty’s case.
Cultural norm to avoid direct eye contact and direct skin contact with opp gender.
Operator not to take offence if patient refuses hand shake/ avoid eye contact when talking/OHI