Case History 4 in Diseases of bone and the maxillary sinus

A 35-year-old man presents with gross loosening of both his lower left premolar teeth. The gingiva around them looks swollen and is purple–brown in colour. A radiograph shows irregular bone destruction to the apices. Incisional biopsy shows multinucleated osteoclast-like giant cells in a haemorrhagic fibrous stroma.

  1. Which investigations should now be performed?
    The serum calcium level should be measured and radiographs reviewed to exclude hyperparathyroidism.
  2. If these prove negative, what treatment should be undertaken?
    The lesion should be treated by local removal with curettage.
  3. Which other lesions in the jaws contain multinucleate giant cells of this type?
    Osteoclast-like giant cells are found in
    1. giant-cell granuloma
    2. brown tumour of hyperparathyroidism
    3. Pagetʼs disease of bone
    4. aneurysmal bone cyst
    5. some fibro-osseous lesions, particularly cherubism. 

INTRODUCTION Over the ages, oral health care has been delivered to the community in different ways. The horseback dentistry of olden days has evolved into the most modern painless dental procedures. In India, about 70% of the population live in rural areas whereas 70% of the dentists practice in urban areas. We seldom find certain dental offices and few government establishments in rural areas, which lack the required infrastructure.WHAT ARE MOBILE DENTALCLINICS? A mobile dental clinic is used primarily when oral health care is be delivered to small pockets of patients that are scattered over a specific geographic area. The mobile clinic generally is parked at a facility such as a school, residential facility or community center.SALIENT FEATURES:- •Useful life is shorter than a fixed facility. •Requirement of water and waste disposal methods. •Dental equipment can be a traditional or a portable one. •Requirement of a generator on board to provide electricity.TARGETED POPULATIONS FOR MOBILE DENTAL SERVICES:- •Low-income individuals or families. •Isolated or very rural rural populations. •Persons in residential care facilities. •People who are “ homebound”, bedridden, very frail or receiving hospital services at home. •Persons with a variety of special health care needs. •Migrant and seasonal workers. •People who are homeless or temporarily displaced.WHY MOBILE CLINICS ARE PREFERRED OVER USUAL ONES? •Moderate start up costs. •It addresses the problem of transportation to the clinics. •It decreases missed appointments when run in conjunction with schools. •Services can be made available at multiple sites. •Services are made available to the needy population.   Even though mobile clinics are preferred over the usual ones, but they do have certain disadvantages. Let’s have a look at certain “disadvantages” of it:- •High maintenance costs may occur. •Difficult to access and store patient record. •Provides limited services and follow up may be difficult. •Requires permission for site use. •Difficult to use during monsoon. ESSENTIALS OF MOBILE DENTAL CLINIC:- The mobile dental clinic should be equipped with 2 dental chairs with all attachments and seating space for 15-20 people. 1.PORTABLE DENTAL UNIT:-•Dental chair should be portable and easy to handle. It should be able to be folded for easy transportation.  All the parts  should be detachable type and well balanced and sturdy. •Mobile suitcase unit: Fitted with aerotar and micromotor hand piece. •Scaler with 3 scaling tips. •Control box with transparent, regulated water tank and foot control.2.OPERATING LIGHT:- Two, intensity fixed with hinge on the top of the van. 3.DENTAL X-RAY UNIT:-  X-ray unit with digital arm timer and day light manual developer. 4.AUTOCLAVE:-  High speed automatic instrument autoclave. 5.METAL CABINETS WITH WASH BASIN 6.WATER TANK: 400 litres capacity. 7.HEALTH EDUCATION MODELSPARTNERSHIPS IN PROVIDING MOBILE DENTAL SERVICES:-Some of the group or  Individuals who could potentially be partners are:- •GOVERNMENT:-State/ Local, Health Department, Department of Social Service. •COMMUNITY:- Local community, Business Leaders, Foundations. •PUBLIC:- Patient Care  Advocate, Organizations that promote health. •POLICY:- Local and Community Policy Makers. •HIGHER/ PROFESSIONAL EDUCATION:- Medical schools ,Dental schools and Allied Health Schools.CONCLUSION A fully-equipped mobile dental clinic is to provide effective dental care at the doorsteps of underprivileged, rural population is the need of the hour. The key to a successful dental practice is a cohesive dental team, which will create an atmosphere of co-operation resulting in the achievement of the goals of oral health in the coming up years.REFERENCE Essentials of public health dentistry-Soben Peter

Public Health Dentistry at Ease..

Concepts of Health & Disease

Health is a basic human need and better health improves your quality of life.

There are various changing concepts of Health . Absence of disease being the traditional concept – Biomedical concept . Health is perceived in different ways nowadays giving rise to following concepts:

1. Biomedical concept

2.Ecological concept : Health is perceived as balance between man and his environment and one who cannot adjust is not fit to be called healthy.

3. Psychosocial concept : Health is also influenced by social, psychological , cultural , economic and political factors of the people concerned.

4.Holistic concept : is an integrated approach towards wellbeing of the human being.

This was keypoints about concepts of Health. I hope it helps .

Case History 2 – Diseases of bone and the maxillary sinus

A 60-year-old man has been treated for a T2N0M0 squamous-cell carcinoma by radical radiotherapy. He has a history of chronic alcoholism and was a heavy smoker. Six years after treatment, he develops a painful ulcer in the alveolar mucosa in the treated area following minor trauma. His pain worsens and the bone became progressively exposed. He is treated by a partial mandibular resection with graft.

  1. What diagnosis is most likely?
    The features suggest osteoradionecrosis. Recurrent carcinoma is possible but less likely.
  2. How does radiotherapy damage tissues and what structural features might be seen in the bone?
    Radiotherapy damages tissues by producing free radicals. DNA damage may prevent cell division and repair. Endoarteritis obliterans results in reduced vascular supply to the tissues. Bone may become necrotic, showing osteocyte death, sequestration and breakdown of the matrix. Infection may result in osteomyelitis
  3. What changes may arise in irradiated connective tissues 10 years after exposure?
    Mutations and other genetic damage may lead to neoplasia in irradiated tissues. Osteosarcoma can arise in this way.

Case History 1 = Diseases of bone and the maxillary sinus

A 58-year-old woman noticed that her front teeth had become spaced and seeks advice from her dentist. On entering the surgery, the dentist notices that she has difficulty in walking and does not respond to his questions. She has become increasingly deaf and her vision has also deteriorated. On examination, the maxilla and zygoma are enlarged and there is enlargement of the forehead.

1. What diagnosis would you suspect?
Pagetʼs disease of bone results in enlargement of cranial bones and deformation of weight- bearing bones. The cranium is usually expanded in thickness and symptoms may arise from cranial nerve compression.

2. What information might be gained from oral radiographs and blood tests to support this diagnosis?
Radiographs of the jaws may show hypercementosis, cemental masses, abnormal trabeculation and a cotton-wool appearance in the jaws. The alkaline phosphatase level is markedly raised.

3. What are the principal histological features of this disorder?

Disordered bone remodelling is seen; larger osteoclasts are present and the trabeculae show a scalloped outline. Numerous resting and reversal lines, resulting in a mosaic pattern, are seen and the vasculature may be increased. Globular cementum-like masses are seen in the jaws. 

Adenoid Faces

  1. Head is tilted backwards
  2. Anterior open bite
  3. Increased overjet/ Proclined anterior teeth
  4. Crowding seen in anterior segment 
  5. Supra erupted posterior 
  6. Posterior crossbite
  7. Narrow maxilla and deep palatal vault
  8. Xerostomia = prone to caries
  9. Gingival recession
  10. Bleeding from gums
  11. Narrow nasal passages

Cantilever spring/ Finger spring 2m** = 

  1. used for mesiodistal tooth movement. 
  2. Active arm is 12 mm and retentive tag is 3-5mm. 
  3. Placed along long axis of the tooth which has to be moved. 
  4. If tooth is to be moved mesially, direction of helix will be distal
  5. The finger spring is activated by moving the active arm towards the teeth intended to be moved. This is done as close to the coil as possible.
  6. Activation of upto 3 mm is considered