Questions & Answers

Questions & Answers

questions & answers N e rv e d a m a g e also m a y b e c a u se d by c o n ­ ta m in a tio n o f th e n e e d le , p a r tic u la rly if cold s te r...

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questions & answers

N e rv e d a m a g e also m a y b e c a u se d by c o n ­ ta m in a tio n o f th e n e e d le , p a r tic u la rly if cold s te riliz a tio n a g e n ts a r e u sed . T h is m e th o d of s te riliz a tio n is o u tm o d e d , o f c o u rse. I t is b est to d a y to u se a d isp o sa b le n e e d le , w h ic h is p r e ­ ste riliz e d b y a u to c la v in g a n d is u se d o n ly o n c e . L e r o y W . P ete rso n , D D S C la y to n , M o

S A L IN E R IN S E S

P A R E S T H E S IA

B A s a c o n s e q u e n c e o f th e e x tr a c tio n o f m y lo w e r le ft se c o n d m o la r, I h a v e h a d little se n s a ­ tio n in th e a n te r io r le ft s id e o f th e m a n d ib le a n d lo w e r lip . F e e lin g seem s to b e r e tu r n in g slow ly. H a v in g p e rfo rm e d th is o p e r a tio n c o u n tle ss tim e s w ith n o s im ila r r e a c tio n b y m y p a tie n ts , I fin d m y c o n d itio n p a r tic u la r ly a n n o y in g , ev e n th o u g h s e n s a tio n is r e tu r n in g . T o a v o id d a m a g e to th e m a n d ib u la r n e rv e w h ile g iv in g m y p a tie n ts a lo c a l a n e s th e tic in je c tio n , I use a 1 % - in c h n e e d le th a t is slig h tly b e n t. W h e n th e b e n t n e e d le is u se d , th e a n e s th e tic is d e ­ p o s ite d in th e a n te r io r r e g io n o f th e ja w . I su p p o se m y s y m p to m is d u e to tra n s ito ry d a m a g e to th e m a n d ib u la r n e rv e c a u s e d by th e lo c a l a n e s th e tic g iv e n . C a n I e x p e c t fu ll re c o v e ry o f s e n s a tio n ? G. C „ D D S □ Y o u a re p ro b a b ly c o r r e c t in a ttr ib u tin g y o u r sy m p to m o f n u m b n e s s o r p a re s th e s ia of th e a n te r io r m a n d ib le a n d lo w e r lip to tr a n s i­ to ry d a m a g e to th e m a n d ib u la r n e rv e . I n all p ro b a b ility , h o w e v e r, th e d a m a g e w o u ld n o t be c a u se d by th e lo c a l a n e s th e tic a g e n t b u t r a th e r b y c o n ta c t o f th e n e e d le w ith th e n e rv e tru n k . I p re s u m e th e r e w a s n o e x te n siv e p a th o ­ lo g ic c o n d itio n s u rr o u n d in g th e to o th th a t n e c e s sita te d c u r e ttin g o r m a n ip u la tio n th a t c o u ld h a v e in v o lv e d th e m a n d ib u la r n e rv e . T h is n u m b n e ss o c c u rs re la tiv e ly ra re ly . A c ­ tu a lly , it is m a n ife s te d m o re o fte n b y th e lin g u a l n e rv e t h a n th e m a n d ib u la r n erv e . H e re it is e v e n m o re d isc o n c e rtin g . C o m p le te re c o v e ry s h o u ld b e e x p e c te d . T h e r e is no p a r tic u la r tr e a tm e n t, e x c e p t in so m e in sta n c e s la rg e d a ily d oses o f v ita m in B a re h e lp fu l. W ith th e u se o f th e n e w e r a n e s th e tic so lu ­ tio n s, i t is n o t n e c e ssa ry to d e p o s it th e d ru g in d ire c t c o n ta c t w ith th e b o n e o r a c tu a lly seek o u t th e m a n d ib u la r su lc u s. T h e m a n d ib u ­ la r n e rv e e n te rs th e ja w a t a p p ro x im a te ly a 4 5 -d e g re e a n g le , a n d n e rv e in ju r y c a n b e a v o id e d b y d e p o s itin g th e lo c a l a n e s th e tic a g e n t in th e tissu es a p p r o x im a tin g th is n e rv e p a th w a y w ith o u t u n n e c e s s a ry p ro b in g .

IB F o r y e a rs d e n tis ts h a v e b e e n p re s c rib in g sa lin e m o u th rin se s fo r v a rio u s o ra l c o n d itio n s. I n v iew o f th e f a c t th a t c e r ta in h y p e rte n siv e p e rs o n s m u s t b e o n a lo w s a lt d ie t, I w o n d e r w h e th e r w e sh o u ld b e p re s c rib in g salin e rin se s f o r su c h p a tie n ts . H e n r y C . H e im a n s o h n , D D S D a n v ille , I n d □ A p p a re n tly , th e r e h a v e b e e n n o stu d ie s to d e te rm in e th e a m o u n t o f a b s o rp tio n of so d iu m io n s fro m th e o r a l m u c o sa , a lth o u g h th e r a p id a b s o rp tio n o f d ru g s fro m th e so ft o ra l tissu es, e sp e c ia lly th e s u b lin g u a l sp a c e , h a s b e e n c le a rly e sta b lis h e d . T h e s u b je c t is d e se rv in g o f r e ­ se a rc h . I t seem s u n w ise to r e c o m m e n d a n y m o u th w a sh c o n ta in in g th e s o d iu m io n (so d iu m c h lo rid e , so d iu m b ic a r b o n a te o r so d iu m p e r ­ b o r a te ) fo r p a tie n ts w h o a re o n a so d iu m -fre e o r a lo w -so d iu m d ie t. T h e r e a re n u m e ro u s s o d iu m -fre e p r o p r ie ta r y o r p re s c rip tio n m o u th ­ w ash es t h a t c o u ld b e p re s c rib e d w ith o u t p o sin g a p o ssib le risk to th e p a tie n t. L e s te r W . B u r k e t, D D S , M D P h ila d e lp h ia

A N T E R IO R D E C A L C IF IC A T IO N

■ T w o p a tie n ts tr e a te d w ith ro e n tg e n -ra y th e r ­ a p y fo r to n s illa r a n d n a s o p h a ry n g e a l tu m o rs, m o re th a n fo u r y e a rs a g o , n o w h a v e sev ere d é c a lc ific a tio n o f a ll a n te r io r te e th g in g iv a lly . M ig h t ro e n tg e n -ra y th e r a p y c a u se c h a n g e s in th e p a r o tid a n d s u b m a x illa ry g la n d s w h ic h a lte r th e c a rie s-in h ib itin g p ro p e rtie s o f sa liv a ? C. J. L „ D M D B ro o k ly n □ Y es, it is p o ssib le th a t r o e n tg e n -ra y th e ra p y f o r tu m o rs w o u ld a ffe c t th e m a jo r sa liv a ry g la n d s in th e p a t h o f th e b e a m a n d c a u se su ffic ie n t a tro p h y o f th e g la n d s t h a t d e n ta l c a rie s w o u ld s u b s e q u e n tly d e v e lo p . A lth o u g h it is c o n c e iv a b le t h a t th e r e m ig h t b e so m e d ire c t e ffe c t o n th e te e th , p e r se, e v id e n c e to s u p p o rt th is p o ssib ility is n o t a v a ila b le . D a v id W e isb e rg e r, D D S , M D H a r v a r d S c h o o l o f D e n ta l M e d ic in e

582 - J . A M E R . DENT. A S SN .: V o l. 71, Sept. 1965

to be resistant to the carving instrument. By the time the matrix is removed, the restoration will be hard enough that band ejection will not damage or fracture the alloy. Before removing the band, trim the flash next to the strip with an explorer. The gin­ gival wedge against the band should be re­ moved to loosen the strip from the tooth. The top of the matrix band should be tipped R ob ert L . K ush n er, D D S toward the center of the tooth being restored D a n v ille , V a and pulled gently through the contact area. This procedure will assure a dense proximal □ There is no evidence that dental caries alloy, which can be shaped to the proper activity is influenced directly by disturbances contour. H. W illia m G ilm o r e , D D S , M S D of the mucous membrane or any systemic In d ia n a U n iv e r s ity S c h o o l o f D e n tis tr y condition. Two secondary conditions might be I n d ia n a p o lis considered in this instance. First, depending on the severity and loca­ tion of the burns, injury to the submaxillary E R O S IO N and parotid glands could result in great reduc­ tion in saliva flow. In this event, caries might ■ A patient was seen in whom erosion was become rampant, as often occurs in patients manifested in three different materials—tooth after intensive radiation therapy in this area. structure, gingival tissue and silicate restora­ Second, there is always the possibility that tion material. As seen in the illustration, the a long period of convalescence would require erosion, of equal depth in all areas, runs in high calorie liquid feeding, thus providing a high carbohydrate substrate for fermentation. This, along with hygiene problems, could easily result in a change to a highly cariogenic oral flora. When this situation occurs, a strictly controlled carbohydrate intake is indicated until the bacteriological change is reversed. Unless there is a considerable amount of scar tissue, the delayed eruption of permanent teeth is probably coincidental. IN T R A O R A L B U R N S

■ A two-year-old boy suffered severe detergent burns in his mouth. At age five, the child had rampant caries of all deciduous teeth, upper and lower, anterior and posterior. Is it possible that the detergent accident had any relation­ ship to the caries? Could the accident have any bearing on the late eruption of the child’s permanent teeth?

P h ilip J a y , D D S A n n A r b o r , M ic h

M A T R IX R E M O V A L

0 We all know that a hardening amalgam restoration should not be contaminated with saliva. How can one estimate the proper time to remove a matrix so that the least damage is done to the alloy?

straight lines without regard to the material’s hardness. Gingival attachment remains normal. The patient is unable to suggest any personal habits which might be conducive to this effect. Can you suggest any causes? W a lte r W . D r o z d ia k , D D S S a n J o se , C a lif

□ The loss of labial and buccal cervical tooth structures, the wearing of the gingival silicate restorations and recession of the gingiva seem to have been caused by the combined effects □ A mixed amalgam contaminated with saliva of erosion and of the toothbrush abrasion. causes a severe delayed expansion of the alloy. Erosion may be responsible for initiation of A rubber dam should always be used to isolate the lesion, with improper and injudicious use from moisture the teeth being restored. The of toothbrushing and abrasive toothpaste or rubber dam permits the amalgam to be placed powder as secondary contributing factors. Erosion is considered essentially a chemical in a dry cavity preparation and allows the material to set without the danger of being process responsible for loss of tooth substance. Its exact etiology is not clear. Localized or wetted. The proper time to remove the matrix is generalized hyperacidity of the oral cavity and estimated by the setting reaction. The matrix malocclusion, however, have been implicated should be removed only after the occlusal por­ without convincing evidence. A . P. C haudhry, D D S tion of the restoration has been carved. Carving U n iv e r s ity o f P itts b u r g h S c h o o l o f D e n tis tr y is started when the overpack has set enough W . R ., D D S S a n F ra n cisc o