Amidst the pandemic state with the high transmissibility of the disease through air & droplets and considering that routine dental procedures usually generate aerosols; alterations to dental treatment is of prime concern to maintain a healthy environment for patient & dental team.Here is where the approach of performing minimally invasive dental treatment becomes crucial.
What is minimal intervention dentistry?
Minimal intervention dentistry( MID) is a conservative philosophy of professional care concerned with first occurrence,early detection & earliest possible cure of caries at a micro level ; followed by minimally invasive and patient friendly treatment to repair irreversible damage caused by dental caries.
Goals & Principles:
.Early diagnosis of dental caries
.Assessment of individual caries risk
.Disease control by remineralisation of incipient carious lesions.
.Repair rather than replacement of defective restorations
.Minimal invasive treatment
.Periodic follow up.
Includes early diagnosis & caries risk assessment
Non invasive procedures: Biological approach
Minimal invasive treatments:
.for abrading the surface of old composites prior to new restoration ; minimal class I & class II preparations for composites ; for abrading ceramic or cast restorations for bonding ; for widening pits & fissures for sealants.
2) Sono Abrasion
.opening pits & fissures for sealant restorations ; minimal preparation of incipient class II cavities
3) Chemicomechanical Caries Removal (CMC)
Carisolv – 2 syringe system ,one containing NaOCl & other with 3 amino acids (glutamic acid,leucine ,lysine); carboxymethylcellulose gel;NaCl,NaOH;Erythrosine.The contents are mixed together to form a pink gel which is applied onto carious dentin and left in place for 30 seconds to allow it to soften & degrade the infected dentin.
Advantages – relatively painless, removes only carious dentin, no vibrations,better substrate for adhesive bonding
Disadvantages- expensive, time consuming
2 commonly developed lasers-
.Er:Cr:YSGG(2780 nm)- Erbium,Chromium,Yttrium,Scandium,Gallium,Garnet laser – works by agonizing water droplets as they travel towards the target tissue.
.Er:YAG(2940nm)-Erbium,Yttrium,Scadium,Aluminum,Garnet laser – uses pulses of light energy to micro vaporize water within the target tissues.
Caries treatment with ozone – based on Niche environment theory .Ozone kit consists of portable apparatus & disposable silicon cups. Follow up 3-6 months.
Disadvantages – can cause porosities or abrade tooth surface ,in case of heavy exposure.
Other techniques (in brief):
7)Atraumatic restorative treatment (ART)
Cavity designs for minimal tooth preparation:
According to the new classification based on site,size & severity of lesion,following are the designs –
Restorative materials used in minimal invasive dentistry :
Minimal intervention techniques cause less tooth destruction than conventional techniques,thus increasing the long term survival of teeth ,also cause less discomfort to the patient and ensure healing of the disease not only the symptoms. With a reduction in chair side time and simplified techniques there is lesser chances of exposure of the dentist to aerosol contamination,thus maintaining which is the need of the hour.
1) Select a local anesthetic with a duration of action that is appropriate for the length of the planned procedure.
2) Advise the patient and accompanying adult about the possibility of injury if the patient bites, sucks or chews on the lips, tongue and cheek. They should delay eating and avoid hot drinks until the effects of the anesthesia are totally dissipated.
3) Reinforce the warning with patient stickers and by placing a cotton roll or rolled up gauze (“Bite on the ghost”) in the mucobuccal fold if anesthesia symptoms persist.
4) The management of soft tissue trauma involves reassuring the patient and parent (it’s okay if the tissue turns white), allowing up to a week for the injury to heal, and lubricating the area with petroleum jelly or antibiotic ointment to prevent drying, cracking and pain.
References: Internet; Handbook of LA, 6e by Stanley F Malamed
Bence Jones protein in urine – Also seen in leukemia, polycythemia
⬆️ Alkaline phosphatase
1. Cells are closely packed in large sheets..👇🏻
Nuclei – eccentric placed
Chromatin clumping in a cart wheel/checkerboard pattern
Perinuclear halo (Golgi complexes)
2. Russell bodies: Russell bodies are multiple round cytoplasmic hyaline inclusions that are frequently seen in bone marrow aspirates in myeloma. They are composed of immunoglobulin molecules within vesicular structures derived from rough endoplasmic reticulum. Plasma cells containing them are sometimes referred to as Mott cells.
➡️ Vit. D along with Parathyroid hormones & calcitonin play primary roles in regulating the concentration of Calcium & inorganic phosphate in plasma & ECF and in controlling mineralization of bones & teeth.
➡️ Quantitive defect in enamel tissue from metabolic injury to Ameloblasts – ENAMEL HYPOPLASIA
Clinical Significance: Roughened surface with discrete pitting / circumferential band like irregularities which post eruptively acquire a yellow brown stain.
Carbohydrate intolerance & Dental Caries:
➡️ Intolerance occurs because of deficiency of a specific enzyme involved in metabolism of sugar.
Hereditary fructose intolerance: (Froesch,1959)
Inborn error of fructose metabolism transmitted by an autosomal recessive gene.
Episodes of pallor, nausea, vomitting, coma & convulsions following ingestion of fruit containing fructose/cane sugar.
⬇️ Dental caries.
➡️ Dietary sucrose has 2 effects on plaque:
Frequent ingestion – S. Mutans colonization ⬆️
Mature plaque exposed to sucrose metabolizes to organic acids – ⬇️ pH
No. of meals + snacks as low as possible.
Sugars – eliminated; Active chewing foods ➡️ desirable
Flouride, Calcium, Phosphate, fats & proteins – in diet.
➡️ Dietary and nutrition education appropriate for dental settings are an essential component of guidelines or standards of practice that determine successful management of dental caries and the patient’s quality of life accross time.
References: Practical manual guide by CM Marya, Internet