The only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is hemorrhage -William S Halsted.
Also known as loop of Willis,Willis polygon and cerebral arterial circle.
Blood vessels supplying the brain consists of 2 separate vascular systems:
Internal carotid arteries
In the base of the brain both systems are connected bilaterally by posteriorcommunicatingarteries and left to right side by anteriorcommunicatingarteries forming the “Circle of Willis”(COW).
Other key points:
In subclaviansteal syndrome ,blood is “stolen” from COW to preserve blood flow to upper limb.
This syndrome results from a proximal stenosis of the subclavian artery.
Variations in the shape of COW is also seen in mentally ill and migraine patients which include hypoplasia of component vessels,absence of posterior communicating arteries,duplication/triplication of anterior communicating arteries,etc.
Cell is Clearly Circulating
Sources: BD Chaurasia’s Human anatomy 7th edition-volume 4
Slideshare.net -Circle of Willis by Luiz Roberto Meier Update 2
Getting or having braces is quite a big deal for sure with the long treatment period, follow-ups & the discomfort faced during and after adjustments made which includes dull soarness or throbbing pain along with some amount of restrictions on munching your favorite food during this period. 😦
But the end result of all this is an improved facial appearance with properly aligned teeth aiding in speech & mastication ; in short – A healthy new smile :).
Is that the end of the story ?? Certainly not !!
The main part of the whole treatment is how you maintain the corrections made & retain it for future.
Here’s where terms like retention & relapse come into picture.
What is retention?
Maintaining newly moved teeth in position,long enough to aid in stabilizing their correction.-Moyers
Why do patients need retention?
Because of the post treatment changes that occur leading to relapse.
Relapse-Loss of any correction achieved by orthodontic treatment. Causes of relapse:
Periodontal ligment traction
Due to growth related changes
Failure to eliminate the cause of malocclussion
Eruption of third molars
Role of occlusion
Schools of retention:
Theories of retention:
Riedel summarized the nine theories and Moyers added another theory which is the tenth theory mentioned here.
Theorem 1: Teeth that have been moved tend to return to their former position
Theorem 2:Elimination of the cause of malocclussion will prevent relapse
Theorem 3:Malocclussion should be over-corrected as a safety factor
Theorem 4: Proper occlusion is a potent factor in holding teeth in their corrected positions
Theorem 5:Bone & adjacent tissues must be allowed time to reorganize around newly positioned teeth
Theorem 6: If the lower incisors are placed upright over basal bone they are more likely to remain in good alignment
Theorem 7: Corrections carried out during the periods of growth are less likely to relapse
Theorem 8: The farther the teeth have been moved ,the lesser is the risk of relapse
Theorem 9: Arch form,particularly in the mandibular arch,cannot be permanently altered by appliance therapy
Theorem 10: Many treated malocclussion require permanent retaining devices
Remember as : REOP TLP FAR (REOPening To Let Patients Follow And Retain)
Many lesions that occur on the jaw present with similar radiographic appearances making it difficult to differentiate among them .Despite development of various cross sectional imaging modalities ,the radiographs arestill remain the first and most important investigations.
So some of the common features that we as dentist might come across are listed below.I believe this wouldcome handy for your radiodiagnosis😊.
The real importance of learning radiographic signs associated with specific disease is of relevance to clinical examination of the head & neck ; at the same time aiding in differentiating – what is normal from abnormal & hence appropriate treatment can be instituted for such conditions /abnormalities.
Here are the list of few radiographic appearances .
Antral halo appearance-acute sinusitis
Ball in hand appearance-sialographic appearance of intrinsic benign tumor
Tobacco intakers who are motivated to quit the habit & are dependent on nicotine should be offered NRT.
Prescribed for 6 to 8 weeks,in blocks of up to 2 weeks,contingent on continued abstinence.
If one type of NRT is not working for the patient ,the health professional is advised to prescribe a suitable type informing about the dosage & maximum amount to take a day.
Is it safe?
NRT is safe because of the facts that the nicotine levels are low and it’s lessaddictive delivery mechanism (unlike smoking tobacco where the nicotine reaches the brain quickly) and also because most of the harmful problems are caused by the other components of tobacco smoke ,not by the nicotine.
NRT is safe for most adults and in people with stable cardiac diseases, but caution needed in unstable,acute cardiovascular disease,pregnancy,or breastfeeding or in those aged under 18 years.
Brownie points-reduces the constant urge to munch on food,thus reducing weight gain.😊
When should one stop using NRT?
Most courses of NRT recommend use for about 12 weeks.This is because it takes this much time for the brain to adjust to working without the high doses of nicotine that the cigarettes supply.However there is no hard and fast rule.After starting the therapy,most people mistake the lack of discomfort for the belief that the addiction is over,leading to stop using the product too soon. This can result only in reappearing of the symptoms.
The best method is to take the help of the health professional when you start the therapy and keep them updated about the progress.
Lastly ,we all are not the same….each tobacco smoker’s tendency & pattern to quit may vary & it depends on different factors like age,gender,environment, general physical and mental health.
Tobacco is the leading preventable cause of death in the world and is the only consumer product that kills when used as intended by its manufacturers ;which may become deadly for non-smokers also.
FACTS & FIGURES:
Tobacco causes 1 in 10 adult deaths worldwide,nearly 5 million deaths a year or one death every 6.5 seconds,killing 50% of regular users.
Total global smoking prevalence is 29%;47.5% men & 10.3% women.
By 2030,70% of deaths in the world is attributable to tobacco.
It’s a known or probable cause of about 25 diseases.
Smokeless tobacco causes oral cancer,especially in lips,tongue,mouth and throat area.
Breathing Environmental Tobacco Smoke(ETS) (i.e .side stream,exhaled smoke from cigarettes,cigars and pipes)causes serious health problems & aggravates allergies and increase the severity of symptoms in children & adolescents, with asthma and heart diseases.
People who start using tobacco early have more difficulty in quitting,are more likely to be heavy smokers and if young people donot begin to use tobacco before the age of 20,they are unlikely to start the habit.
The World Bank estimated that smoking prevention is among the most effective of all health interventions.
EFFECTS OF NICOTINE :
Increased circulating levels of catecholamines, vasopressin, growth hormone,adenocorticotropic hormone,cortisol,prolactin,and beta-endorphin.
Increased metabolic rate
Lipolysis,increased free fatty acids.
Heart rate acceleration, nicotine can increase the heart rate by 10-15 beats/min.
Cutaneous & coronary vasoconstriction
Increased cardiac output & blood pressure by 5-10 mm Hg
Skeletal muscle relaxation
Nicotine can induce pathogenic changes to the endothelium associated with atherosclerotic process.
Halitosis,staining of teeth and soft tissues(smokers melanosis),drying of mouth.
‘Nicotine itself is not carcinogenic unless it undergoes nitrosation toform nitrosamines(during tobacco curing & combustion).’
HOW TO ASSESS TOBACCO DEPENDENCE?
A question-answer session with the individual would be very helpful ….
THE 5 A’S :
ASK-health care professionals / dentists should ask the patient about his or her tobacco intake habits which includes the questions discussed above,during every visit.
ADVICE-health care professional / dentists should continually advice patient to quit the habit thereby emphasizing the importance of the issue.
ASSESS- patients readiness & motivation to quit the habit must be assessed- cause this is a ‘major lifestyle change & requirespreparation, readiness & several failed attempts’.
ASSIST-health care professionals/ dentists should assist those individuals who are motivated- by informing,suggesting and prescribing a pharmacological cessation aids ( nicotine replacement therapy ) and providing or referring the patient to counseling ( individual, group or over telephone ) and behavioral therapies and support services where available.
Lastly,ARRANGE-follow up services are often critical & the dentists can help the patient be tobacco free by providing services like advising availability of national hotlines,support from non-smoking friends or colleagues,or community based support groups.
Lastly ,dentists play a major role in helping a patient quit smoking because we might be the first to detect an abnormality( be it a small stain or an abnormal mass ) in the oral cavity during routine examination. Do yourpart ,every small step counts……
Sources- S.S Hiremath textbook of preventive and community dentistry ,www.alhambraesd.org ,www.tobaccofreekids.org
Correct and early diagnosis of a lesion / abnormality in the oral cavity is very crucial as these could be vital indicators to some of the underlying systemic diseases or other chronic conditions. Most of the oral conditions show a peculiar pattern of occurrence only on specific sites.Hence,knowledge of these common sites can help to some extent in proper identification, differentiation from other similar conditions and treatment planning.A few of such conditions and findings has been mentionedhere.
Sources:Shafers textbook of oral pathology ,burkets oral medicine ,www.aurametrix.weebly.com