This question was submitted by a general dentist: Is inadequate osseointegration a concern in patients who have received radiation therapy for a head and neck malignancy if implants are treatment planned? Dr. Jeff Chadwick, at Princess Margaret Hospital, Dental Oncology, Ocular, and Maxillofacial Prosthetics Group, provided a preliminary response to this question Yes, however … As with most questions related to this patient population, the answer is: “it depends.” Careful examination is a vital step in determining which restorative/prosthodontic approach best suits the individual. Examination also mandates a thorough review of their cancer diagnosis as well as the constituents and sequence ...Read More »
Supporting Your Practice
What are the risk factors for osteoradionecrosis (ORN), in a xerostomic radiation-treated patient, if extractions are required?
This question was submitted to us by a general dentist: If extractions are required, what are the risk factors for osteoradionecrosis (ORN) in a xerostomic patient with rampant decay two years after the successful treatment of their head and neck cancer (radiation, chemotherapy and surgery)? Dr. Jeff Chadwick, at Princess Margaret Hospital, Dental Oncology, Ocular, and Maxillofacial Prosthetics Group, provided a preliminary response to this question: With the numerous comorbidities associated with head and neck radiation (oral mucositis, radiodermatitis, dysgeusia, dysphagia/odynophagia, trismus, and xerostomia), arises a critical issue with tooth extraction is the altered biology of the maxilla and mandible due ...Read More »
This question was submitted by a general dentist: Has anyone seen ‘pre-eruption caries’? I have several cases where radiographically. there appeared to be caries on the occlusal surfaces of unerupted teeth. On eruption, I observed them for a while and after the first one increased in size over time, I went in and restored all of them. All seemed to be carious. Dr. Anuradha Prakki, Assistant Professor in Restorative Dentistry at the University of Toronto School of Dentistry, provided this quick initial response: Researchers identify these cases as pre-eruptive intra-coronal radiolucency (PEIR), as the etiology of pre-eruptive intra-coronal radiolucent lesions is not ...Read More »
This Urgent care Scenario is presented by the JCDA Oasis Team in collaboration with Dr. Ignacio Christian Marquez, Associate Professor in the Division of Periodontics, Department of Dental Clinical Sciences, Faculty of Dentistry at Dalhousie University Periodontal Abscess Localized, purulent infection within the tissues adjacent to the periodontal pocket that may lead to the destruction of periodontal ligament and alveolar bone. Investigation Inquire about any history of chronic periodontitis and the nature of any recent dental/periodontal interventions. Determine the existence of a periodontal pocket. Confirm the presence of purulent exudate. Obtain radiographic evidence of bone loss. However, the lack ...Read More »
This question was submitted by a general dentist: My patient requests that her tooth-coloured restorations be free of BPA and estrogen-mimicking agents. Can you suggest any tooth-coloured materials and cements that meet those criteria? Dr. Omar El-Mowafy, Professor and Head of the Restorative Dentistry at the University of Toronto, provided this quick initial response: Bisphenol A (BPA) is an organic compound with the chemical formula (CH3)2C(C6H4OH)2. It is widely used in the industry when making plastic products. Tooth-colored restorations that are Bisphenol-A-free would automatically exclude almost all resin composite restoratives and their corresponding bonding agents. Therefore, in this case the ...Read More »
How is the “Dahl appliance” used in the treatment of severely worn maxillary anterior teeth prior to reconstruction?
This question was submitted by a general dental practitioner: Does anyone have experience with the “Dahl appliance” used in the treatment of a severely worn maxillary anterior teeth prior to reconstruction? Dr. Effrat Habsha, Prosthodontist at Prosthodontic Associates offered this quick initial response: The Dahl Concept and the Dahl Appliance The Dahl Concept refers to the relative axial tooth movement that is observed when a localized appliance or localized restorations are placed in supra-occlusion and the occlusion re-establishes full arch contacts over a period of time. This concept can be achieved with a Dahl appliance, which refers to any interim restoration or prosthesis ...Read More »
This Prescription Drug Consult is presented by the JCDA Oasis Team and is also available through JCDA Oasis Mobile Epinephrine in LA (Adrenalin®) Presentation Epinephrine is a an alpha-/beta-agonist that is administered as an adjuvant in local anesthetic cartridges. Epinephrine is also used as an emergency drug for treatment of anaphylactic reaction and a vasoconstrictor to decrease systemic absorption of local anesthetics and to increase the duration of anesthetic action. The use of Epinephrine may decrease superficial hemorrhage. Dosage May be used in concentrations of 1:500,000 to 1:50,000. 1:100,000 and 1:200,000 is used most commonly in a typical 1.8 ml local anesthetic dental ...Read More »
This question was submitted to us by a general dentist: Are you concerned about mandibular blocks and possible injury to blood vessels (Inferior Alveolar Artery/Vein) in patients continuing anti-coagulant therapy (Warfarin)? Potential Hematomas? Management? Dr. Jason Goodchild provided this quick initial response: For patients on anticoagulant therapy, a careful review of the medical history including consultation with the patient’s physician is warranted. This consultation should include information on the patient’s INR (International Normalized Ratio). Ideally, a recent INR (with 24-48 hrs) is needed in order to ascertain the patient’s bleeding risk during surgery. The literature is consistent on this issue: If the patient’s ...Read More »