Periapical lesions without apparent route of infection.
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A necrotic immature mandibular, canine tooth in a two year-old, male, intact Chow Chow was endodontically treated. This tooth had an open apex, wide root canal, thin dentinal walls, and there was periapical bone resorption. An apexification procedure was used to induce apical closure by calcified tissue formation, with resolution of the periapical inflammation.
Following extraction of a maxillary left first molar tooth in an eight year-old retriever, the dog re-presented five days later because of oral pain, which did not respond to analgesic therapy. The extraction site contained a foul-smelling fluid, but did not contain a clot or granulation tissue. Alveolar osteitis (dry socket) was diagnosed. The alveolus was curetted and flushed, and the dog was given cefalexine and prednisolone. The alveolus was filling with healthy granulation tissue one week later and the dog was no longer in pain.
The periodontal tissues and the pulp-dentine complex form an intimate continuum through which pathological changes of either one may lead to infection of the other, and whose management can be fraught with diagnostic and therapeutic difficulty. The purpose of this review paper is to explain the nature of that relationship and to provide pointers which may assist in the diagnostic process and thus enable appropriate management from the outset. Traditional classifications of lesions affecting the periodontal-endodontic complex have caused confusion by attempting to form diagnoses which indicate the putative primary source of infection. We would suggest that the origin of the infection is irrelevant to the management process, and that what is important is whether either, or indeed both, of the tissues are viable or not. Successful therapy will only result from the establishment of an accurate diagnosis, and forming such a diagnosis requires a methodical multi-staged approach.
The aim of this series of six articles is to improve the quality of endodontic treatment in general dental practice by considering what is currently being taught in dental schools. This article first considers the possible reasons for persisting symptoms following preparation of the root canals. It then reviews the many and varied methods of obturating the prepared root canal system that are available to the general dental practitioner. By considering the objectives of their treatment, and their own level of expertise, readers may decide that one or more new techniques may benefit their practice.
There are many infectious agents found within the oral cavity. Bacteria form an important group of micro-organisms found in both healthy and diseased mouths. The current article will discuss those bacteria resident within the mouth and review the oral diseases with which they are associated.
UNLABELLED: A case report is presented of the preventive and clinical care of an adolescent with a neglected mouth, complicated by the medical history of cerebral palsy. CLINICAL RELEVANCE: Knowledge of the treatment which ideally may be offered to patients with cerebral palsy may help such patients retain and maintain their dentition.
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