Endodontics for the aged and Geriateric. What should one look for, and what changes do we need to deal with in our clinics. A comprehensive review presentation- Dr. Abhishek John Samuel, MDS (Endodontics).
GERIATRIC ENDODONTICS , DR. ANUBHUTI BDS,MDS Anubhuti Singh
To lead a quality life in old age, one needs teeth not only for the enjoyment of food but also for proper nutrition and pleasant looks.There is also evidence that oral diseases impact cardiovascular, endocrine and pulmonary health particularly in the elderly, which will certainly provide additional stimuli for the elderly to seek dental care. Three groups of older subjects are identified.Young old (65 – 74)
Older old (75 -84)
Oldest old (greater than 85).
Pain associated with vital pulps (caused by heat, cold, sweets or referred pain) seems to be reduced with age.
After reading this chapter, the student should be able to:
1. Understand the microbial etiology of apical
periodontitis.
2. Describe the routes of entry of microorganisms to the
pulp and periradicular tissues.
3. Recognize the different types of endodontic infections
and the main microbial species involved in each one.
4. Understand the bacterial diversity within infected root
canals.
5. Describe the factors involved with symptomatic
endodontic infections.
6. Understand the ecology of the endodontic microbiota
and the features of the endodontic ecosystem.
7. Discuss the role of microorganisms in the outcome of
endodontic treatment.
8. Understand the development and implications of
extraradicular infections.
GERIATRIC ENDODONTICS , DR. ANUBHUTI BDS,MDS Anubhuti Singh
To lead a quality life in old age, one needs teeth not only for the enjoyment of food but also for proper nutrition and pleasant looks.There is also evidence that oral diseases impact cardiovascular, endocrine and pulmonary health particularly in the elderly, which will certainly provide additional stimuli for the elderly to seek dental care. Three groups of older subjects are identified.Young old (65 – 74)
Older old (75 -84)
Oldest old (greater than 85).
Pain associated with vital pulps (caused by heat, cold, sweets or referred pain) seems to be reduced with age.
After reading this chapter, the student should be able to:
1. Understand the microbial etiology of apical
periodontitis.
2. Describe the routes of entry of microorganisms to the
pulp and periradicular tissues.
3. Recognize the different types of endodontic infections
and the main microbial species involved in each one.
4. Understand the bacterial diversity within infected root
canals.
5. Describe the factors involved with symptomatic
endodontic infections.
6. Understand the ecology of the endodontic microbiota
and the features of the endodontic ecosystem.
7. Discuss the role of microorganisms in the outcome of
endodontic treatment.
8. Understand the development and implications of
extraradicular infections.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Vital pulp therapy plays important role in preserving tooth and tooth vitality in both primary and permanent teeth.
Direct pulp capping, indirect pulp capping, pulpotomy has been covered in this presentation. All materials possibly useful in vital pulp therapy as well as recent advances have been included with all the evidences.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Vital pulp therapy plays important role in preserving tooth and tooth vitality in both primary and permanent teeth.
Direct pulp capping, indirect pulp capping, pulpotomy has been covered in this presentation. All materials possibly useful in vital pulp therapy as well as recent advances have been included with all the evidences.
this lecture shows the relation between periodontal and pulpal tissues, pathways of transmission of bacteria and the different lesions of endodontic periodontal lesions.
about pathophysiology behind endo perio lesion and various methods for it. it also explains various complications related to it, dental anomalies associated.
Endo perio interrelation /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. THE AGEING PROCESS IS INEVITABLE
“The provision of Dental care for adult persons with one or more chronic
debilitating, physical or mental illness with associated medication and
psychosocial problems” - DCNA 1989
3
5. • Expectations, Desire, Demands are least from any
other group.
• The basic expectation of geriatrics are Functional
• Geriatrics are not interested in long-term solutions
5
10. Diagnosis
Based on
Pt’s complaint
History
Signs & symptoms
Testing and radiographs
Vitality of the pulp
Peraiapical pathology
Pulpitis tends to be less acute due to:
Less volume of pulp and
less nerve supply
Pulp capping not recommended – reduced blood supply
Heithersay GS, Morile AJ. Aust Dent J 1982
10
11. MEDICALLY COMPROMISED OLD
PATIENTS.They are a special category who present with more problems
and increased severity.
Diabetes Mellitus or Immuno-suppresssion may present with
delayed healing but has not been proved in endodontics.
Osteoporosis in females, the oral bone is least affected and
so no problem of healing as with endodontics.
• The decreased radio-opacity of osteoporosis is of less
magnitude to be confused with an endo diagnosis.
For any medically compromised, RCT procedure or other
endodontic procedure are better than extraction.
Fouad AF, Burleson J: The effects of diabetes mellitus in endodontic treatment outcome: data
from electronic patient record. J Am Dent Assoc 134:43, 2003. 11
12. Objective Testing
As the pulp is less innervated and the volume of
dentin is more, the pulp is generally less responsive
to stimuli in older individuals.
There is no evidence that pacemaker can be affected
by the electric pulp test but is best avoided.
Even the time tested test cavity can give false
response.
Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S: Assessment of reliability of
electrical and thermal pulp testing agents. J Endod 12:301, 1986.
12
13. Pulp Testing
Determine pulp & periapical status
Vitality responses must correlate with clinical &
radiographic findings
Vertically cracked teeth should always be considered
when pulpal or periapical disease is observed
Cracks detected – pulp vital- reasonable prognosis
Chronic nature (periapical pathologic condition) vertically
cracked teeth -prognosis - questionable
Periodontal pockets associated with cracks - a hopeless
prognosis
13
14. Radiographic
Findings
Some difference is present periapically.
There is increase in incidence of non-endodontic pathosis.
Pulp space is diminished or absent radio-graphically.
But the pulp is present.
Due to continuous cementum deposition
There is change in apical root anatomy.
Sometimes there is apical root resorption.
14
15. TREATMENT PLAN
The procedures are generally more technically complex due
to:
1. Extensive restoration.
2. History of multiple carious insults.
3. Periodontal involvement.
4. Decreased pulp space.
5. Tipping
6. Rotation.
15
16. Treatment
Access for those who use ambulation aids should
include comfort and safety
Appointments preferable time & comfort
Positioning & comfort
Patients eye- shielded from intensity of light
Jaw fatigue – bite block for long procedures
Medically compromised patients- recognize that
RCT is less traumatic than extraction
Need for anesthesia
16
17. Painful response – not encountered till actual pulp exposure has
occurred
Number of low threshold fibres are less
High conduction velocity nerve endings in dentin- reduced or absent
Cutting of dentin does not produce same level of response in an older patient
Dentinal tubules more calcified
Reduced width of PDL makes needle placement for supplementary
intraligamentary injection more difficult
Intrapulpal anesthesia, intraosseous anesthesia – not
prolonged –pulp tissue must be removed within 20 minutes
reduced volume of pulp chamber makes intrapulpal anesthesia
difficult in single rooted teeth – almost impossible in multirooted teeth
Initial pulp exposure – hard to identify
Walton RE: Endodontic considerations in the Geriateric Patient. Dent Cl. North Am. 41,
795, 1997 17
18. PROGNOSIS
Periradicular tissue heals as readily as in a young person.
But many factors can decrease the rate of success.
Every case should have pre and post treatment prognosis.
18
19. Isolation
Single tooth rubber dam isolation
Multiple-tooth isolation – adjacent teeth can be clamped
and saliva output is low or well-placed ejector can be
tolerated
Petroleum based lubricant for lips & gingiva
Artificial saliva –used just before isolation –difficult-to-
apply after dam placed
Canals should identified & their access maintained – restorative
procedures are indicated for isolation
Fluid tight isolation cannot be compromised when sodium hypo
chlorite is used as an irrigant
Difficult to isolate defects produced by root decay 19
20. Access• LA + Vasoconstrictor use: Joint National Committee on Prevention,
Detection, Evaluation, and Rx of High Blood Pressure (JNC 7)
• 0.036 to 0.054 mg of epinephrine (approximately two to three
cartridges of local anesthetic with 1:100,000 epinephrine) should be
safe for all patients except those with severe cardiovascular issues
Adequate access & identification of canal orifices - most difficult
parts of providing RCT for older patients
The effect of aging & multiple restoration reduces volume & coronal
extent of – chamber or canal orifice- but Buccolingual & mesiodistal
positions remains same
Canal position, curvature & axial inclination of roots and crowns –
considered
Coronal tooth structure or restoration – compromised for access
preparation
Magnification range 2.5x to 4.5x 20
21. Location & penetration difficult – calcified canals
DG 16 explorer for initial penetration
Not stick in solid dentin
Will resist dislodgement in the canal
Negotiation with K files – no 8
NiTi – contraindicated for initial negotiation
Watch – winding action with apical pressure – ideal
Chelating – seldom value
Dyes distinguish orifice from dentin
Supra erupted tooth – easily perforate
Modification to enhance access
Widening the axial wall - visibility
Complete removal of crown 21
22. Preparation
Calcified canals – more concentric & linear
Length of the canal from actual anatomic foramen to CDJ - with
deposition of cementum through out life
The actual CDJ width or most apical extend of dentin remains constant
with age
Flaring of canal – perform as early in procedure
Thorough & frequent irrigation / Crown – down technique
Files penetrate in to walls than reamers – calcified canals CDJ (narrow
construction) identifying by tactile sense – difficult
Reduced periapical sensitivity reduces patient response – indicate
penetration of foramen
Hypercementosis – CDJ constriction farther from apex – penetration in
to cemental canal impossible
Achieving & maintaining apical patency – more difficult
Sperber Gh, Yu DC. Patient age is no contraindication to endodontic treatment. J. Can.
Dent. Assoc 69, 2003
22
23. Obturation
Generate pressure in large mid root area – result in root fracture
Coronal seal – important role in maintaining the apically sealed
environment & significant impact in long term success
Success & failure
vital pulp/ nonvital pulp
Endodontic surgery
Medical consideration
Local consideration
Position of anatomic features
Apicoectomy
Teixeira FB, Teixeira EC, Thompson JY, Trope M: Fracture resistance of roots endodontically treated
with a new resin filling material. J Am Dent Assoc 135:646, 2004.
23
24. Structural changes
cells (both odontoblasts and fibroblasts)
also the supportive elements (blood vessels
and nerves).
of collagen and ground substance.
Calcifications
as isolated mass called Denticles
(mostly in crown) and / or as a diffuse linear
calcification in the root pulp (Pulp stones).
Key Changes in Pulp in the Elderly
24
25. Dimensional change
in the pulp size – due to dentin deposition.
Dentin formation - not necessarily continuous thro’ out life & not
uniform deposition
with Irritation
Restoration or
Periodontal disease.
More on the roof and floor of the pulp chamber than on walls
leading to flattened disc like chamber.
Effect of Ageing on Human Pulp: Bernick S and Dedalman C. J Endod 3, 88, 1973
25
28. Attrition, Abrasion, Erosion
Expose dentin thro’ slow process
Allows pulp to respond with dentinal sclerosis &
reparative dentin
Secondary dentin formn. thro’ out the life
Pulp obliteration
Maxi. Antr – Sec. dentin on the lingual wall of the
pulp chamber
Molar - on the floor of the chamber
Pulp may appear to recede, small pulpal
remnants can remain / leave a less calcific tract-
lead to pulp exposure.
Berkey D, Berg RG. The Age-old patient: Challaenges in Decision Making. JADA 127,
1996
28
29. • 100- 200 μm in youth Thickness of apical cementum 29
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dead tracts—Dentinal tubules seen in histologic sections to be devoid of cellular processes
indicating odontoblastic destruction; may contain debris and microorganisms.
dystrophic calcification —Diffuse foci of calcification frequently found in the aging pulp; usually
described as being perivascular or perineural.