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Supporting Your Practice

What is Pre-Eruptive Intra-Coronal Radiolucency (PEIR)?

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 ...

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How do you treat a periodontal abscess?

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 ...

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Are there any tooth-coloured materials that are free of BPA and estrogen-mimicking agents?

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 ...

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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 ...

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How and When Is Epinephrine Used As A Vasoconstrictor in Local Anesthetics?

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 ...

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Are You Concerned About Mandibular Blocks In Patients Taking Anticoagulants?

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 ...

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Can An Avulsed Permanent Incisor Be Immediately Replanted?

This Urgent Care Scenario (USC) is presented by the JCDA Oasis Team in collaboration with Dr. Mike Casas from the Department of Pediatric Dentistry at the University of Toronto. It is also available through JCDA Oasis Mobile The immediate replantation of an avulsed permanent incisor is to be performed on suitable avulsed incisors with extra-alveolar time of less than 5 minutes (to avoid reduced predictability of periodontal healing). Dentists who have the occasion of performing immediate replantation likely witnessed the traumatic injury or arrived at the scene immediately after the injury that produced the avulsion. Presentation Missing incisor tooth after ...

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Is there a really good way to brush the teeth of very young children?

With the reported rise in incidence of early childhood caries in North America in recent times, dental professional organizations are re-doubling efforts to encourage parents to bring children for a dental visit by the first birthday. For many children, caries is a largely preventable disease, and I have always found it really sad to see a mouthful of cavities in the mouths of young children, especially when simple measures can have a profound impact on preventing the disease in young children. A colleague that I respect very much pointed me to a neat resource the other day that demonstrates how to brush the teeth of very ...

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