A Short Case Study Apical Control Is Critical with the Inferior Alveolar Nerve

The pre-op x-ray shows a crown with calcifying mesial canals. It also shows the outline of the distal root and the inferior alveolar nerve. Notice how wide the inferior alveolar nerve is and its close approximation to the distal root.What Is Laser Dentistry? for more information.
A patient came in with pain on tooth No. 18. The diagnosis was a necrotic pulp with acute apical periodontitis. The inferior alveolar nerve was very close to the apex of the distal root (Figure 1). Apical control of instrumentation, irrigation, medication, and obturation were critical (Figures 2 and 3). Such patients could get paresthesia in this area if it’s violated. The following factors can help with apical control:

Apex locators;
A side-vented irrigation needle;
A good cone fit with tugback;
A cone fit radiograph;
Loose calcium hydroxide placement—don’t bend the tip and then push!
Also, use sealers that can resorb like Kerr’s EWT or zinc oxide eugenol-based sealer. Resin sealers like Dentsply Sirona’s AHplus and Brasseler USA’s Bioceramics will not resorb, and they can cause problems if they are extruded in the inferior alveolar nerve. And finally, don’t go for “puffs,” and don’t “over pump” the gutta-percha with sealer.

Keep root canaling!

Dr. Short attended the Medical College of Georgia (MCG) School of Dentistry to attain a DMD degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and then became a Diplomate of the American Board of Endodontics in 2009. Dr dental lab supplies australia. Short is an expert consultant in endodontics to the Georgia Board of Dentistry and assistant clinical professor at the Dental College of Georgia in Augusta. He is endorsed by the American Association of Endodontists speakers bureau.

Hygienists Can Practice Solo in Wisconsin Community Settings

Governor Scott Walker of Wisconsin signed Act 20, which increases the settings in which dental hygienists can practice without the authorization and presence of a licensed dentist. Written by Representative Kathy Bernier (R-Lake Hallie) and Senator Sheila Harsdorf (R-River Falls), the legislation passed the Assembly as amended and was concurred in the Senate, both on a voice vote.

The expanded settings include federal, state, county, and municipal correction and detention facilities; facilities established to provide care for terminally ill patients; charitable institutions open to the public or members of a religious sect or order; nonprofit home healthcare agencies; nonprofit dental programs serving primarily indigent, economically disadvantaged, or migrant worker populations; nursing homes; community-based residential facilities and hospitals; facilities that are primarily operated to provide outpatient medical services; adult family homes; adult care centers; and community rehabilitation programs.

The bill’s passage follows intense lobbying from the Wisconsin Dental Hygienists’ Association (WI-DHA), which visited the offices of all 132 state legislators in Madison on March 9 to deliver informational packets about the bill. Members also met with legislators or their staffs to ask for support for the bill if they hadn’t already signed on to it. WI-DHA collaborated with other healthcare groups as well, such as the Wisconsin chapter of the American Academy of Pediatrics, the Children’s Health Alliance of Wisconsin, the Wisconsin Dental Association, and the Wisconsin Oral Health Coalition.

According to WI-DHA, the new law will improve oral health throughout the state since dental diseases are nearly 100% preventable, and dental hygienists are prevention specialists. However, the organization says that dental hygienists have been underutilized due to supervision restrictions, which the law now eliminates. By working at the top of their licenses, WI-DHA adds, dental hygienists can go to patients who cannot come to them and provide direct access to preventive care, saving costs for the state while improving oral health.

For example, there were more than 33,000 visits to hospital emergency rooms in Wisconsin due to otherwise preventable dental problems. Hospital-acquired pneumonia can be expensive and deadly, though dental hygienists working in hospital settings may be able to prevent it. Plus, only 20% of expectant mothers in Milwaukee county had a dental visit in the year before their delivery dental vacuum forming machine. Dental hygienists on maternity care teams can provide that care. Similarly, diabetics are prone to periodontal disease, and dental hygienists can assist there as well.

“Removing unnecessary barriers to preventive oral care just makes sense,” said WI-DHA president Jennifer Martinson, RDH. “Licensed dental hygienists in Wisconsin look forward to providing their services without restrictive supervision, and we thank all those who recognize that value and supported this legislation. Our goal is to improve health and the quality of life especially for people who may have difficulty accessing dental care in other ways.”

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