Diagnosis Demystified – Case 22

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A 65-year-old woman presents with a throbbing pain affecting her left temple. The headache began about a week ago and is accompanied by pain in the muscles around her jaw joint on eating. She has no previous history of facial pain or headache. Intraoral examination is unremarkable. There is no evidence of dental pathology or parafunctional habits.

The recent onset of unilateral pain of this nature in this site without any previous history should immediately raise the possibility of giant-cell arteritis. The patient is in the right age group (usually = 50 years). The accompanying pain in the muscles of mastication on chewing could represent temporomandibular joint dysfunction but is entirely consistent with giant-cell arteritis.

RESEARCH

Giant-cell arteritis (GCA), also known as temporal arteritis or Horton’s arteritis, is a systemic vasculitis that primarily affects large and medium-sized vessels, particularly the extracranial branches of the carotid arteries (Calvo-Romero, 2003). It is most commonly observed in individuals over the age of 50 (Joseph et al., 2019). GCA is characterized by inflammation of the blood vessels, which can lead to various symptoms and complications (Shenoy et al., 2023).

The diagnosis of GCA can be challenging, and early recognition is crucial to prevent serious complications such as blindness, stroke, and necrosis of the lips and tongue (Gualtierotti et al., 2018). The diagnosis of GCA is typically based on a combination of clinical features, laboratory tests, and imaging studies (Liedtke et al., 2023). The gold standard for diagnosis is a temporal artery biopsy, which reveals histologic evidence of arteritis (Bengtsson & Malmvall, 1981). However, it is important to note that giant cells are not required in the histopathological diagnostic criteria for GCA (Armstrong et al., 2008).

The symptoms of GCA can vary but commonly include severe temporal headaches, low-grade fever, malaise, depression, weight loss, and visual changes (Gualtierotti et al., 2018). Patients may also experience dental pain, dysphagia, dysarthria, chronic cough, and, rarely, necrosis of the lips and tongue (Gualtierotti et al., 2018). In some cases, GCA can present with orofacial symptoms such as toothache and pain/difficulty in chewing, which may lead patients to seek dental care initially (Shenoy et al., 2023).

Dentists play a crucial role in the early recognition and referral of patients with suspected GCA. Increased awareness of GCA among dental practitioners can minimize the risk of serious complications such as blindness and stroke (Shenoy et al., 2023). Dental practitioners should be alert to the possibility of GCA and should direct suspected cases to their general medical practitioner or a hospital specialist (Shenoy et al., 2023).

The management of GCA typically involves high-dose steroid treatment (Calvo-Romero, 2003). Early initiation of treatment is essential to prevent complications and improve outcomes (Lee et al., 2011). However, many questions about the diagnosis, treatment, and optimal patient follow-up of GCA remain unanswered (Iudici et al., 2023). International guidelines exist, but some aspects are based mainly on low-quality data or expert opinion (Iudici et al., 2023). The management of GCA patients can also be influenced by factors such as the care setting, physician’s experience, or resource availability (Iudici et al., 2023).

In conclusion, GCA is a systemic vasculitis that primarily affects large and medium-sized vessels. It can present with a wide range of symptoms, including orofacial symptoms such as dental pain and difficulty in chewing. Early recognition and referral of suspected cases are crucial to prevent serious complications. Dentists play an important role in the early detection of GCA and should be aware of the signs and symptoms associated with the condition. Further research is needed to improve the diagnosis, treatment, and management of GCA patients.

REFERENCES

Alimohammadi, M., Knight, A. (2013). Scalp Necrosis As a Late Sign Of Giant-cell Arteritis. Case Reports in Immunology, (2013), 1-2. https://doi.org/10.1155/2013/231565 Antonelli, J., Hottel, T. (2003). Oral Manifestations Of Renal Osteodystrophy: Case Report and Review Of The Literature. Special Care in Dentistry, 1(23), 28-34. https://doi.org/10.1111/j.1754-4505.2003.tb00286.x Armstrong, A., Tyler, W., Wood, G., Harrington, T. (2008). Clinical Importance Of the Presence Of Giant Cells In Temporal Arteritis. Journal of Clinical Pathology, 5(61), 669-671. https://doi.org/10.1136/jcp.2007.049049 Bajko, Z., Balasa, R., Maier, S., Motataianu, A., Barcutean, L., Andone, S., … & Filep, R. (2021). Stroke Secondary To Giant‑cell Arteritis: a Literature Review. Exp Ther Med, 2(22). https://doi.org/10.3892/etm.2021.10308 Bengtsson, B., Malmvall, B. (1981). The Epidemiology Of Giant Cell Arteritis Including Temporal Arteritis and Polymyalgia Rheumatica. Arthritis & Rheumatism, 7(24), 899-904. https://doi.org/10.1002/art.1780240706 Calvo-Romero, J. (2003). Giant Cell Arteritis. Postgraduate Medical Journal, 935(79), 511-515. https://doi.org/10.1136/pmj.79.935.511 Elad, S., Zadik, Y., Caton, J., Epstein, J. (2019). Oral Mucosal Changes Associated With Primary Diseases In Other Body Systems. Periodontol 2000, 1(80), 28-48. https://doi.org/10.1111/prd.12265 Gualtierotti, R., Marzano, A., Spadari, F., Cugno, M. (2018). Main Oral Manifestations In Immune-mediated and Inflammatory Rheumatic Diseases. JCM, 1(8), 21. https://doi.org/10.3390/jcm8010021 Iudici, M., Hemmig, A., Stegert, M., Courvoisier, C., Adler, S., Becker, M., … & Group, N. (2023). Management Of Giant-cell Arteritis In Switzerland: An Online National Survey. Swiss Med Wkly, 4(153), 40051. https://doi.org/10.57187/smw.2023.40051 Joseph, A., Pradeepan, J., Kumanan, T., Malaravan, M. (2019). Combined Left Central Retinal Artery Occlusion and Bilateral Anterior Ischemic Optic Neuritis: A Rare Presentation Of Giant Cell Arteritis. Case Reports in Rheumatology, (2019), 1-3. https://doi.org/10.1155/2019/3236821 Kawamoto, T., Ogasawara, M., Nakano, S., Matsuki−Muramoto, Y., Matsushita, M., Yamanaka, K., … & Tamura, N. (2019). Diagnosis Of Giant Cell Arteritis By Head-contrast Three-dimensional Computed Tomography Angiography: Two Case Reports. J Med Case Reports, 1(13). https://doi.org/10.1186/s13256-019-2199-0 Lee, Y., Padera, R., Noss, E., Fossel, A., Bienfang, D., Liang, M., … & Docken, W. (2011). Clinical Course and Management Of A Consecutive Series Of Patients With “Healed Temporal Arteritis”. J Rheumatol, 2(39), 295-302. https://doi.org/10.3899/jrheum.110317 Liedtke, F., Daher, I., Moura, M., Murad, A., Ferrari, R., Neiva, E., … & Souza, P. (2023). Clinical Evidence and Diagnosis Of Temporal Arteritis: A Concise Systematic Review. MedNEXT, 2(4). https://doi.org/10.54448/mdnt23203 Lim, Z., Sharp, C. (2021). Neck Swelling and Airway Narrowing As An Initial Manifestation Of Giant Cell Arteritis. BMJ Case Rep, 3(14), e237743. https://doi.org/10.1136/bcr-2020-237743 Mahe, E., Demellawy, D., Bane, A., Alowami, S. (2012). Giant Cell Temporal Arteritis Associated With Overlying Basal Cell Carcinoma: Co-incidence or Connection?. Rare Tumors, 3(4), 148-149. https://doi.org/10.4081/rt.2012.e46 McDonald, L., Baker, G., Kerr, O. (2019). Scalp Ulceration: a Rare Manifestation Of Giant Cell Arteritis. BMJ Case Rep, 11(12), e230795. https://doi.org/10.1136/bcr-2019-230795 Nayar, A., Casciello, M., Slim, J., Slim, A. (2013). Fatal Aortic Dissection In a Patient With Giant Cell Arteritis: A Case Report And Review Of The Literature. Case Reports in Vascular Medicine, (2013), 1-4. https://doi.org/10.1155/2013/590721 Nitta, S., Tanaka, T., Yanagihashi, R., Nonaka, H., Suzuki, S., Kimura, T., … & Nishiyama, H. (2021). Granulocyte Colony‐stimulating Factor Associated Arteritis In a Patient With Castration‐resistant Prostate Cancer. IJU Case Reports, 1(5), 29-31. https://doi.org/10.1002/iju5.12376 Regezi, J. (2002). Odontogenic Cysts, Odontogenic Tumors, Fibroosseous, and Giant Cell Lesions Of The Jaws. Modern Pathology, 3(15), 331-341. https://doi.org/10.1038/modpathol.3880527 Schmidt, W. (2006). Takayasu and Temporal Arteritis., 96-104. https://doi.org/10.1159/000092388 Seko, Y., Minota, S., Kawasaki, A., Shinkai, Y., Maeda, K., Yagita, H., … & Tada, Y. (1994). Perforin-secreting Killer Cell Infiltration and Expression Of A 65-kd Heat-shock Protein In Aortic Tissue Of Patients With Takayasu’s Arteritis.. J. Clin. Invest., 2(93), 750-758. https://doi.org/10.1172/jci117029 Shenoy, R., French, K., Eke, T., Mukhtyar, C. (2023). Recognizing Giant Cell Arteritis In Dental Practice. Dent Update, 3(50), 204-208. https://doi.org/10.12968/denu.2023.50.3.204 Sørensen, P., Lorenzen, I. (2009). Giant-cell Arteritis, Temporal Arteritis and Polymyalgia Rheumatica. Acta Medica Scandinavica, 1-6(201), 207-213. https://doi.org/10.1111/j.0954-6820.1977.tb15683.x Vrînceanu, D., Dumitru, M., Bănică, B., Eftime, I., Patrascu, O., Costache, A., … & Georgescu, M. (2021). Role Of Temporal Artery Resection In Horton’s Arteritis (Review). Exp Ther Med, 4(22). https://doi.org/10.3892/etm.2021.10533 Zakrzewska, J. (2013). Differential Diagnosis Of Facial Pain and Guidelines For Management. British Journal of Anaesthesia, 1(111), 95-104. https://doi.org/10.1093/bja/aet125

Bioactive Glass in Dentistry

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Hey peeps! 🌟 Let’s talk about the coolest thing in dentistry right now – bioactive glass! 🦷💎 This stuff is like magic – it bonds to living tissues and helps regenerate bones and teeth! 😮💪 Made of fancy ingredients like silicon dioxide, calcium oxide, and fluoride, it’s like a superhero dental material! 🦸‍♂️✨ Bioactive glass toothpaste? Yep, it exists! It protects our pearly whites from dental bleaching damage! 🙅‍♀️😁 And get this – it’s used in dental restorations, root canals, and even implants! 😎🚀 Plus, it’s rocking the world of tissue engineering too! 🧪🧬 But hold up, we need more research to unlock its full potential and make sure it’s safe! 💡🔍 So, brace yourselves for the future of dentistry with bioactive glass! 💙🦷

Bioactive glass has gained significant attention in the field of dentistry due to its unique properties and potential applications. Bioactive glass refers to a group of materials that can bond to living tissues and promote the regeneration of hard tissues such as bone and teeth (Skallevold et al., 2019). It is composed of silicon dioxide, sodium dioxide, calcium oxide, and phosphorus pentoxide (Al-Harbi et al., 2021). The addition of fluoride to bioactive glasses has been of great interest in the development of dental biomaterials (Brauer et al., 2009). Fluoride-containing bioactive glasses combine the bone-bonding ability of bioactive glasses with the anticariogenic protection provided by fluoride ions (Pedone et al., 2012). These glasses have been used in various dental applications, including dental restorative materials, mineralizing agents, coating materials for dental implants, pulp capping, root canal treatment, and air abrasion procedures (Skallevold et al., 2019).

The use of bioactive glass in dentistry has been driven by the need for improved dental materials that are biocompatible, regenerative, and compatible with advanced technologies (Montazerian & Zanotto, 2016). Dental glass-ceramics, which are easy to process and have outstanding properties, have gained significant importance in the field (Montazerian & Zanotto, 2016). Bioactive glass-based toothpaste has been developed to protect enamel against the deleterious effects of dental bleaching (Vieira-Junior et al., 2016). Bioactive glass nanoparticles have also been used to modify glass ionomer cement, resulting in increased compressive, tensile, and flexural strengths (Leung et al., 2022). However, further studies are needed to determine the long-term effects of these nanoparticles on the human body before their widespread clinical application in dentistry (Leung et al., 2022).

Bioactive glass has shown promising results in the remineralization of demineralized enamel and dentin, making it a potential material for the management of dental caries (Mei & Chu, 2019). It has been incorporated into toothpastes as a mineralizing and desensitizing agent (Gjorgievska et al., 2013). The release of fluoride ions from acrylic resin modified with bioactive glass has also been studied, highlighting its potential for preventing tooth decay and promoting remineralization (Raszewski et al., 2021).

In addition to its applications in restorative dentistry, bioactive glass has been used in endodontics as a direct pulp capping agent and in periodontology for the regeneration of periodontal bone support (Hanada et al., 2018; Curtis et al., 2010). It has also been incorporated into scaffolds and coatings for tissue engineering purposes, including bone tissue engineering (Covarrubias et al., 2018; Erol-Taygun et al., 2013). The use of bioactive glass in dental implants has been explored, with bioactive glass coatings being applied to zirconia substrates to promote bone bonding and accelerate healing (Zhang & Le, 2020).

Overall, bioactive glass has shown great potential in various dental applications, including restorative materials, mineralizing agents, dental implants, pulp capping, and tissue engineering. Its unique properties, such as biocompatibility, bioactivity, and regenerative capabilities, make it a promising material for the advancement of dentistry. However, further research is needed to fully understand its long-term effects and optimize its properties for specific applications.

REFERENCES

Al-Harbi, N., Mohammed, H., Al-Hadeethi, Y., Bakry, A., Umar, A., Hussein, M., … & Nune, M. (2021). Silica-based Bioactive Glasses and Their Applications In Hard Tissue Regeneration: A Review. Pharmaceuticals, 2(14), 75. https://doi.org/10.3390/ph14020075 Alizadeh-Osgouei, M., Li, Y., Wen, C. (2019). A Comprehensive Review Of Biodegradable Synthetic Polymer-ceramic Composites and Their Manufacture For Biomedical Applications. Bioactive Materials, (4), 22-36. https://doi.org/10.1016/j.bioactmat.2018.11.003 Benetti, F., Queiroz, Í., Oliveira, P., Conti, L., Azuma, M., Oliveira, S., … & Cintra, L. (2019). Cytotoxicity and Biocompatibility Of A New Bioceramic Endodontic Sealer Containing Calcium Hydroxide. Braz. oral res., (33). https://doi.org/10.1590/1807-3107bor-2019.vol33.0042 Brauer, D., Karpukhina, N., Law, R., Hill, R. (2009). Structure Of Fluoride-containing Bioactive Glasses. J. Mater. Chem., 31(19), 5629. https://doi.org/10.1039/b900956f Cannio, M., Bellucci, D., Roether, J., Boccaccini, D., Cannillo, V. (2021). Bioactive Glass Applications: a Literature Review Of Human Clinical Trials. Materials, 18(14), 5440. https://doi.org/10.3390/ma14185440 Covarrubias, C., Cádiz, M., Maureira, M., Celhay, I., Cuadra, F., Marttens, A. (2018). Bionanocomposite Scaffolds Based On Chitosan–gelatin and Nanodimensional Bioactive Glass Particles: In Vitro Properties And In Vivo Bone Regeneration. J Biomater Appl, 9(32), 1155-1163. https://doi.org/10.1177/0885328218759042 Curtis, A., West, N., Su, B. (2010). Synthesis Of Nanobioglass and Formation Of Apatite Rods To Occlude Exposed Dentine Tubules And Eliminate Hypersensitivity. Acta Biomaterialia, 9(6), 3740-3746. https://doi.org/10.1016/j.actbio.2010.02.045 Erol-Taygun, M., Zheng, K., Boccaccini, A. (2013). Nanoscale Bioactive Glasses In Medical Applications. Int J Appl Glass Sci, 2(4), 136-148. https://doi.org/10.1111/ijag.12029 Gjorgievska, E., Nicholson, J., Slipper, I., Stevanovic, M. (2013). Remineralization Of Demineralized Enamel By Toothpastes: a Scanning Electron Microscopy, Energy Dispersive X-ray Analysis, And Three-dimensional Stereo-micrographic Study. Microsc Microanal, 3(19), 587-595. https://doi.org/10.1017/s1431927613000391 Guduric, V., Belton, N., Richter, R., Bernhardt, A., Spangenberg, J., Wu, C., … & Gelinsky, M. (2021). Tailorable Zinc-substituted Mesoporous Bioactive Glass/alginate-methylcellulose Composite Bioinks. Materials, 5(14), 1225. https://doi.org/10.3390/ma14051225 Hanada, K., Morotomi, T., Washio, A., Yada, N., Matsuo, K., Teshima, H., … & Kitamura, C. (2018). in Vitro and in Vivo Effects Of A Novel Bioactive Glass‐based Cement Used As A Direct Pulp Capping Agent. J. Biomed. Mater. Res., 1(107), 161-168. https://doi.org/10.1002/jbm.b.34107 Leung, G., Wong, A., Chu, C., Yu, O. (2022). Update On Dental Luting Materials. Dentistry Journal, 11(10), 208. https://doi.org/10.3390/dj10110208 Mei, M., Chu, C. (2019). Mechanisms Of Bioactive Glass On Caries Management: a Review. Materials, 24(12), 4183. https://doi.org/10.3390/ma12244183 Montazerian, M., Zanotto, E. (2016). Bioactive and Inert Dental Glass-ceramics. J. Biomed. Mater. Res., 2(105), 619-639. https://doi.org/10.1002/jbm.a.35923 Pedone, A., Charpentier, T., Menziani, M. (2012). The Structure Of Fluoride-containing Bioactive Glasses: New Insights From First-principles Calculations and Solid State Nmr Spectroscopy. J. Mater. Chem., 25(22), 12599. https://doi.org/10.1039/c2jm30890h Raszewski, Z., Nowakowska, D., Więckiewicz, W., Nowakowska-Toporowska, A. (2021). Release and Recharge Of Fluoride Ions From Acrylic Resin Modified With Bioactive Glass. Polymers, 7(13), 1054. https://doi.org/10.3390/polym13071054 Skallevold, H., Rokaya, D., Khurshid, Z., Zafar, M. (2019). Bioactive Glass Applications In Dentistry. 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Diagnosis Demystified – Case 21

Anisha ValliLeave a comment

A 71-year-old woman attends your surgery complaining of a sharp pain which affects the back of her tongue and the area just beneath the angle of her jaw, always on the left-hand side alone. The pain lasts for about a minute and comes on when she swallows or chews. Her lower left first and second molar teeth are present and restored but they appear sound, are vital and are not tender to percussion.

While the tongue is commonly affected in burning mouth syndrome, the pain is of too short a duration and is described as sharp. The involvement of the area just below the angle of the jaw and pain on chewing might suggest dental pathology but the teeth are sound and not TTP. Similarly, were it not for the involvement of the tongue, a diagnosis of TN might be considered. However, taking into account the sites affected, the nature of the pain and when it is experienced, the diagnosis is glossopharyngeal neuralgia.

RESEARCH

Glossopharyngeal neuralgia is a rare condition that causes severe, stabbing pain in the throat, tongue, and ear. It happens because of a problem with a nerve called the glossopharyngeal nerve. This nerve is responsible for sending messages about feeling and pain from the throat and tongue to the brain. The exact cause of glossopharyngeal neuralgia is not fully understood, but it may be due to pressure on the nerve from blood vessels.

When someone has glossopharyngeal neuralgia, they experience sudden and intense pain attacks that can last for a short time. The pain can be triggered by things like swallowing, talking, or even just touching the affected area. It usually affects only one side of the face and can be very uncomfortable.

To diagnose glossopharyngeal neuralgia, doctors will ask about the person’s symptoms and do some tests. These tests may include imaging scans like an MRI to look for any problems with the nerve.

Treatment for glossopharyngeal neuralgia can involve medications to help manage the pain. Common medications include carbamazepine, oxcarbazepine, or gabapentin. In some cases, surgery may be necessary to relieve the pressure on the nerve. This can involve a procedure called microvascular decompression, where the blood vessels causing the compression are moved away from the nerve.

It’s important for dentists to be aware of glossopharyngeal neuralgia because it can cause neck pain that may be mistaken for dental problems. If a dentist suspects glossopharyngeal neuralgia, they will refer the patient to a specialist for further evaluation and treatment.

Overall, glossopharyngeal neuralgia is a rare condition that causes severe throat and ear pain. It can be diagnosed through medical tests and treated with medications or surgery. Dentists should be aware of this condition to provide appropriate referrals for their patients.

References:

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Int J Otorhinolaryngol Head Neck Surg, 9(6), 1725. https://doi.org/10.18203/issn.2454-5929.ijohns20203582 Martinez-Alvarez, R., Martinez-Moreno, N., Kusak, M., Rey-Portolés, G. (2014). Glossopharyngeal Neuralgia and Radiosurgery. JNS, Suppl_2(121), 222-225. https://doi.org/10.3171/2014.8.gks141273 Matak, I., Lacković, Z. (2014). Botulinum Toxin A, Brain and Pain. Progress in Neurobiology, (119-120), 39-59. https://doi.org/10.1016/j.pneurobio.2014.06.001 Memon, A., Samad, A., Finan, K. (2018). A Middle Age Woman With the Episodes Of Excruciating Pain In The Neck And Ear. Arch Clin Med Case Rep, 03(02), 65-67. https://doi.org/10.26502/acmcr.96550026 Nagata, K., Tajiri, K., Ueda, A., Okuda, Y., Tokimitsu, Y., Shinagawa, K., … & Yasuda, I. (2019). Glossopharyngeal Neuralgia With Syncope Caused By Recurrence Of Esophageal Squamous Cell Carcinoma. Intern. Med., 7(58), 933-936. https://doi.org/10.2169/internalmedicine.1838-18 Nishimura, S., Kubota, K., Okuyama, S., Matsuyama, J., Kazama, K., Tomii, M., … & Watanabe, K. (2021). Microvascular Decompression For Glossopharyngeal Neuralgia In the Semi-sitting Position: A Report Of Two Cases. Tohoku J. Exp. Med., 3(254), 183-188. https://doi.org/10.1620/tjem.254.183 O’Neill, F., Nurmikko, T., Sommer, C. (2017). Other Facial Neuralgias. Cephalalgia, 7(37), 658-669. https://doi.org/10.1177/0333102417689995 Pommier, B., Touzet, G., Lucas, C., Vermandel, M., Blond, S., Reyns, N. (2018). Glossopharyngeal Neuralgia Treated By Gamma Knife Radiosurgery: Safety and Efficacy Through Long-term Follow-up. Journal of Neurosurgery, 5(128), 1372-1379. https://doi.org/10.3171/2017.3.jns162542 Rahman, S., Singh, J., Muthusamy, R., Alam, M. (2018). The Development Of Eagle’s Syndrome After Neck Trauma. Contemp Clin Dent, 2(9), 319. https://doi.org/10.4103/ccd.ccd_870_17 Romero-Reyes, M., Salvemini, D. (2016). Cancer and Orofacial Pain. Med Oral, 0-0. https://doi.org/10.4317/medoral.21515 Souza, V., Passerini, M., Sobral, B., Baiardi, V. (2021). Clinical and Physiopathological Aspects Of The Glossopharyngeal Neuralgia. HM, 1(12), 5-11. https://doi.org/10.48208/headachemed.2021.2 Swain, B., Vidhya, S., Kumar, S. (2020). Eagle’s Syndrome Managed Successfully By Pulsed Radiofrequency Treatment. Cureus. https://doi.org/10.7759/cureus.10574 İlgüy, M., İlgüy, D., Güler, N., Bayirli, G. (2005). Incidence Of the Type And Calcification Patterns In Patients With Elongated Styloid Process. J Int Med Res, 1(33), 96-102. https://doi.org/10.1177/147323000503300110

Cantilever abutments (2m)

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  1. A cantilever abutment is a type of dental prosthesis where an artificial tooth is supported by only one natural tooth
  2. The forces applied such as vertical, torsional, and bending forces to the prosthesis can cause the screw holding it in place to become loose or break, and the abutment tooth may also fracture
  3. Using a cantilever bridge with a resin coating has been found to be a reliable way to replace missing teeth in the lower jaw.
  4. The use of a support system with a short implant and ball-type abutment can reduce stress distribution and displacement in the cantilever extension of dental prostheses.

Lesion Sterilization Tissue Repair

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Lesion Sterilization Tissue Repair (LSTR) is a therapeutic approach used in dentistry for the treatment of oral infectious lesions, including dentinal, pulpal, and periradicular lesions (Vijayaraghavan et al., 2012). It involves the use of a combination of antibacterial drugs to disinfect the affected pulp and periapical tissues (Tedesco et al., 2021). The concept of LSTR was developed by the Cariology Research Unit of Niigata University School of Dentistry in Japan (Sain et al., 2018).

The antibacterial drugs used in LSTR therapy may vary, but commonly used combinations include metronidazole, ciprofloxacin, and minocycline (Vijayaraghavan et al., 2012). These drugs have been shown to have bactericidal activity against selected microorganisms (Nalawade et al., 2015). The mixture of three antibacterial drugs, known as 3Mix, has been found to effectively sterilize carious lesions, necrotic pulps, and infected root dentine of primary teeth (Nakornchai et al., 2010). The use of 3Mix in LSTR therapy has been shown to promote tissue repair and regeneration (Nanda et al., 2014).

LSTR therapy is considered a non-instrumentation endodontic treatment, as it does not involve mechanical instrumentation of the root canal system (Duanduan et al., 2013). This approach helps prevent over-enlargement of the root canal and unnecessary irritation of periapical tissue (Duanduan et al., 2013). Instead, LSTR therapy focuses on disinfecting the affected pulp and periapical tissues with an antibacterial paste (Tedesco et al., 2021). The antibacterial paste is typically applied to the lesion and left in place for a certain period to allow for disinfection and tissue repair (Doneria et al., 2017).

The success of LSTR therapy has been demonstrated in various studies. It has been shown to be effective in the treatment of infected primary molars (Nakornchai et al., 2010), pulpotomies of infected primary molars (Daher et al., 2015), and non-vital pulp treatment in primary teeth (Duanduan et al., 2013). LSTR therapy has been found to increase the longevity of deciduous teeth in young children (Sain et al., 2018). It has also been shown to be a suitable alternative to conventional pulpectomy in primary molars (Agarwal et al., 2011).

In addition to its effectiveness, LSTR therapy offers several advantages. It preserves tooth structure by avoiding excessive instrumentation of root canals (Singhal et al., 2021). It also promotes tissue repair and regeneration through the host’s natural tissue responses (Sain et al., 2018). LSTR therapy has been found to have a high success rate and can be considered a reliable treatment option (Malu & Khubchandani, 2022).

However, it is important to note that LSTR therapy may be associated with some limitations. Discoloration of the treated tooth has been reported as a potential side effect of LSTR therapy (Prasad et al., 2017). Antibiotic resistance can also decrease the efficacy of endodontic filling pastes used in LSTR therapy (Rivera-Albarrán et al., 2021). Further research is needed to explore the clinical applications and long-term outcomes of LSTR therapy (Garrocho-Rangel et al., 2021).

In conclusion, Lesion Sterilization Tissue Repair (LSTR) is a therapeutic approach used in dentistry for the treatment of oral infectious lesions. It involves the use of a combination of antibacterial drugs to disinfect the affected pulp and periapical tissues. LSTR therapy has been shown to be effective in various dental conditions, including infected primary molars and non-vital pulp treatment in primary teeth. It offers advantages such as preserving tooth structure and promoting tissue repair and regeneration. However, it may be associated with limitations such as tooth discoloration and antibiotic resistance. Further research is needed to explore the clinical applications and long-term outcomes of LSTR therapy.

References:

Agarwal, A., Das, U., Vishwanath, D., Praveen, B. (2011). A Comparative Evaluation Of Noninstrumentation Endodontic Techniques With Conventional Zoe Pulpectomy In Deciduous Molars: An In Vivo Study. World Journal of Dentistry, 3(2), 187-192. https://doi.org/10.5005/jp-journals-10015-1081 Betal, S. (2022). Antibiotic Usage In Pediatric Dentistry: a Review. JDP, 2(4), 64-69. https://doi.org/10.18231/j.jdp.2022.013 Castro, M., Lima, M., Lima, C., Moura, M., Moura, L., Moura, L. (2023). Lesion Sterilization and Tissue Repair With Chloramphenicol, Tetracyline, Zinc Oxide/eugenol Paste Versus Conventional Pulpectomy: A 36‐month Randomized Controlled Trial. Int J Paed Dentistry. https://doi.org/10.1111/ipd.13056 Daher, A., Viana, K., Leles, C., Costa, L. (2015). Ineffectiveness Of Antibiotic-based Pulpotomy For Primary Molars: a Survival Analysis. Pesqui. bras. odontopediatria clín. integr., 1(15), 205-215. https://doi.org/10.4034/pboci.2015.151.22 Desai, A., Jathar, P., Kulkarni, S., Panse, A., Salunkhe, B., Jathar, M. (2022). Treatment Of Pulpally Involved Primary Molars Utilizing Lstr: Report Of Two Cases. Int. J. Appl. Dent. Sci., 3(8), 118-123. https://doi.org/10.22271/oral.2022.v8.i3b.1595 Dias, G., Tramontin, J., Santos, P., Rossi, F., Rigoni, M. (2021). Evaluation Of Pulping Therapy In Deciduous Teeth Using Chlorhephenicol Tetracycline and Zinc Oxide. RGO, Rev. Gaúch. Odontol., (69). https://doi.org/10.1590/1981-863720210004920200008 Doneria, D., Thakur, S., Singhal, P., Chauhan, D., Keshav, K., Uppal, A. (2017). In Search Of a Novel Substitute: Clinical And Radiological Success Of Lesion Sterilization And Tissue Repair With Modified 3mix-mp Antibiotic Paste And Conventional Pulpectomy For Primary Molars With Pulp Involvement With 18 Months Follow-up. Contemp Clin Dent, 4(8), 514. https://doi.org/10.4103/ccd.ccd_47_17 Duanduan, A., Sirimaharaj, V., Chompu-inwai, P. (2013). Retrospective Study Of Pulpectomy With Vitapex® and Lstr With Three Antibiotics Combination (3mix) For Non-vital Pulp Treatment In Primary Teeth. CMUJNS, 2(12). https://doi.org/10.12982/cmujns.2013.0012 Garrocho-Rangel, A., Jalomo-Ávila, C., Rosales-Berber, M., Pozos-Guillén, A. (2021). Lesion Sterilization Tissue Repair (Lstr) Approach Of Non-vital Primary Molars With a Chloramphenicol-tetracycline-zoe Antibiotic Paste: A Scoping Review. Journal of Clinical Pediatric Dentistry, 6(45), 369-375. https://doi.org/10.17796/1053-4625-45.6.1 Hossain, I., Choudhury, N., Alam, S., Beauty, S., Uddin, F. (2020). Evaluation Of Lstr 3 MIX Mp Therapy For Healing Of Periapical Pathosis Of Nonvital Teeth. TAJ: J of Teachers Assoc, 2(33), 76-84. https://doi.org/10.3329/taj.v33i2.51343 Hossain, I., Parveen, M., Choudhury, N., Wakia, T., Uddin, F., Rahman, S. (2020). Evaluation Of Conventional Root Canal Treatment For Healing Of Periapical Pathosis Of Nonvital Teeth. TAJ: J of Teachers Assoc, 1(33), 25-30. https://doi.org/10.3329/taj.v33i1.49821 Kharadly, D., Tawil, S., Nasr, R., Beshlawy, D. (2022). Triple Antibiotic Paste and Simvastatin In The Treatment Of Non-vital Primary Molars With Inflammatory Root Resorption. ijhs, 3715-3728. https://doi.org/10.53730/ijhs.v6ns6.10439 Malu, K., Khubchandani, M. (2022). Triple Antibiotic Paste: a Suitable Medicament For Intracanal Disinfection. Cureus. https://doi.org/10.7759/cureus.29186 Nakornchai, S., Banditsing, P., Visetratana, N. (2010). Clinical Evaluation Of 3mix and Vitapex®as Treatment Options For Pulpally Involved Primary Molars. International Journal of Paediatric Dentistry, 3(20), 214-221. https://doi.org/10.1111/j.1365-263x.2010.01044.x Nalawade, T., Bhat, K., Sogi, S. (2015). Bactericidal Activity Of Propylene Glycol, Glycerine, Polyethylene Glycol 400, and Polyethylene Glycol 1000 Against Selected Microorganisms. J Int Soc Prevent Communit Dent, 2(5), 114. https://doi.org/10.4103/2231-0762.155736 Nanda, R., Koul, M., Srivastava, S., Upadhyay, V., Dwivedi, R. (2014). Clinical Evaluation Of 3 MIX and Other Mix In Non-instrumental Endodontic Treatment Of Necrosed Primary Teeth. Journal of Oral Biology and Craniofacial Research, 2(4), 114-119. https://doi.org/10.1016/j.jobcr.2014.08.003 Parakh, K., Kothari, S., Daga, P., Harsha, G., Sarda, R., Tamrakar, A. (2021). Lesion Sterilization and Tissue Repair Therapy Using Gam Antibiotic Paste. ijhs, 453-458. https://doi.org/10.53730/ijhs.v5ns2.6189 Prasad, M., Ramakrishna, J., Babu, D. (2017). Allogeneic Stem Cells Derived From Human Exfoliated Deciduous Teeth (Shed) For the Management Of Periapical Lesions In Permanent Teeth: Two Case Reports Of A Novel Biologic Alternative Treatment. J Dent Res Dent Clin Dent Prospects, 2(11), 117-122. https://doi.org/10.15171/joddd.2017.021 Rai, R., Shashibhushan, K., Babaji, P., Chandrappa, P., Reddy, V., Ambareen, Z. (2019). Clinical and Radiographic Evaluation Of 3mix And Vitapex As Pulpectomy Medicament In Primary Molars: An In Vivo Study. International Journal of Clinical Pediatric Dentistry, 6(12), 532-537. https://doi.org/10.5005/jp-journals-10005-1686 Rivera-Albarrán, C., Morales-Dorantes, V., Ayala-Herrera, J., Castillo-Aguillón, M., Soto-Barreras, U., Cabeza-Cabrera, C., … & Domínguez-Pérez, R. (2021). Antibiotic Resistance Decreases the Efficacy Of Endodontic Filling Pastes For Root Canal Treatment In Children′s Teeth. Children, 8(8), 692. https://doi.org/10.3390/children8080692 Sain, S., Reshmi, J., Anandaraj, S., George, S., Issac, J., John, S. (2018). Lesion Sterilization and Tissue Repair–current Concepts And Practices. International Journal of Clinical Pediatric Dentistry, 5(11), 446-450. https://doi.org/10.5005/jp-journals-10005-1555 Singhal, Y., Srivastava, N., Rana, V., Kaushik, N. (2021). Changing Perception Of Pediatric Dental Practice During Global Covid-19 Pandemic: the New Normal. Int. J. Appl. Dent. Sci., 2(7), 229-236. https://doi.org/10.22271/oral.2021.v7.i2d.1213 Taneja, S. (2011). Use Of Triple Antibiotic Paste In the Treatment Of Large Periradicular Lesions. Journal of Investigative and Clinical Dentistry, 1(3), 72-76. https://doi.org/10.1111/j.2041-1626.2011.00082.x Tedesco, T., Reis, T., Mello-Moura, A., Silva, G., Scarpini, S., Floriano, I., … & Raggio, D. (2021). Management Of Deep Caries Lesions With or Without Pulp Involvement In Primary Teeth: A Systematic Review And Network Meta-analysis. Braz. oral res., (35). https://doi.org/10.1590/1807-3107bor-2021.vol35.0004 Vijayaraghavan, R., Mathian, V., Sundaram, A., Karunakaran, R., Vinodh, S. (2012). Triple Antibiotic Paste In Root Canal Therapy. J Pharm Bioall Sci, 6(4), 230. https://doi.org/10.4103/0975-7406.100214

Diagnosis Demystified – Case 20

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A 65-year-old woman complained of a deep-seated aching sensation affecting the right-hand side of her face from her top jaw up to her forehead. She has suffered from the pain more or less continuously for about 4 years. There are no exacerbating or ameliorating factors. Analgesics have proved ineffective. Her GP referred her to an ENT consultant who carried out an MRI to check for sinus problems. She has also been seen by two other dentists and had root canal treatment on several teeth, two of which have subsequently been extracted. On examination, you detect no abnormalities.

So, what’s the dealio? Drumroll, please… It’s atypical facial pain! 💥🎉 The pain is constant, doesn’t get worse or better, and there are no triggers. Classic atypical vibes! 💯 We throw in an MRI just to make sure, but honestly, it’s mostly for reassurance. 🙌

Basically, it’s chronic face pain without any obvious causes. 🙅‍♀️ The diagnosis is like playing detective – ruling out other possible causes first! 🔍 This condition can be tricky since exams and tests often come back normal. 🤔 So, what’s the deal with treatment? It’s not a walk in the park! 😬 Docs try different approaches like meds, nerve blocks, physical therapy, even alternative therapies! 🌿💊 But here’s the kicker – evidence for their effectiveness is limited, and more research is needed!

RESEARCH

Atypical facial pain is a condition characterized by chronic facial pain without any identifiable structural or specific causes (Maarbjerg et al., 2016). It is often diagnosed based on the patient’s history, absence of neurological and radiological signs, and negative imaging results (Derbyshire et al., 1994). The pain is typically described as dull, aching, or nagging, and it may be continuous or intermittent (Deun et al., 2020). Atypical facial pain is considered a diagnosis of exclusion, meaning that other potential causes of facial pain must be ruled out before making this diagnosis (Deun et al., 2020).

Patients with atypical facial pain often present with normal neurological, radiological, and dental examination findings (Derbyshire et al., 1994). This can make the diagnosis challenging, as there are no specific tests or imaging studies that can definitively confirm the presence of atypical facial pain (Benoliel & Gaul, 2017). However, it is important to conduct a thorough evaluation to rule out other possible causes of facial pain, such as dental issues, temporomandibular disorders, sinusitis, and neuropathic conditions (Goel et al., 2015).

The exact etiology of atypical facial pain is not well understood. Traumatic neuropathic mechanisms are suspected to play a role in the development of the condition (Benoliel & Gaul, 2017). It has been suggested that the pain may be related to dysfunctional pain processing in the central nervous system (Weiss et al., 2017). Psychological factors, such as stress and anxiety, may also contribute to the development and maintenance of atypical facial pain (Mykletun et al., 2006).

Treatment for atypical facial pain is often challenging and may require a multidisciplinary approach. The goal of treatment is to alleviate pain and improve the patient’s quality of life. Various treatment modalities have been used, including medications, nerve blocks, physical therapy, cognitive-behavioral therapy, and alternative therapies such as acupuncture (Weiss et al., 2017; Naik et al., 2014). However, the evidence for the effectiveness of these treatments is limited, and more research is needed to determine the optimal approach for managing atypical facial pain (Weiss et al., 2017).

In conclusion, atypical facial pain is a chronic condition characterized by facial pain without any identifiable structural or specific causes. It is diagnosed based on the patient’s history, absence of neurological and radiological signs, and negative imaging results. The exact etiology of atypical facial pain is not well understood, but traumatic neuropathic mechanisms and dysfunctional pain processing in the central nervous system are suspected to play a role. Treatment for atypical facial pain is challenging and often requires a multidisciplinary approach. Further research is needed to improve our understanding of the condition and develop more effective treatment strategies.

References:

Akbaş, M., Salem, H., Emara, T., Dinc, B., Karsli, B. (2019). Radiofrequency Thermocoagulation In Cases Of Atypical Trigeminal Neuralgia: a Retrospective Study. Egypt J Neurol Psychiatry Neurosurg, 1(55). https://doi.org/10.1186/s41983-019-0092-9 Benoliel, R., Gaul, C. (2017). Persistent Idiopathic Facial Pain. Cephalalgia, 7(37), 680-691. https://doi.org/10.1177/0333102417706349 Delcanho, R., Peck, C. (2018). Neuropathic Pain: Diagnosis and Treatment From The Dental Clinic To The Multidisciplinary Pain Clinic. Aust Endod J, 2(44), 114-124. https://doi.org/10.1111/aej.12276 Derbyshire, S., Jones, A., Devani, P., Friston, K., Feinmann, C., Harris, M., … & Frackowiak, R. (1994). Cerebral Responses To Pain In Patients With Atypical Facial Pain Measured By Positron Emission Tomography.. Journal of Neurology, Neurosurgery & Psychiatry, 10(57), 1166-1172. https://doi.org/10.1136/jnnp.57.10.1166 Deun, L., Witte, M., Goessens, T., Halewyck, S., Ketelaer, M., Matic, M., … & Versijpt, J. (2020). Facial Pain: a Comprehensive Review And Proposal For A Pragmatic Diagnostic Approach. Eur Neurol, 1(83), 5-16. https://doi.org/10.1159/000505727 Foerster, Z., Kleinmann, B., Schlueter, N., Vach, K., Wolter, T. (2022). Multimodal Pain Therapy For Persistent Idiopathic Facial Pain – a Pilot Study. BioPsychoSocial Med, 1(16). https://doi.org/10.1186/s13030-022-00254-1 Forssell, H., Alstergren, P., Bakke, M., Bjørnland, T., Jääskeläinen, S. (2016). Persistent Facial Pain Conditions. Tidende, 1(126). https://doi.org/10.56373/2016-1-7 Garcia, R., Chen, Q., Posadas, E., Tran, J., Kwon, A., Qian, X. (2023). Continuous Ketamine Infusion As a Treatment For Refractory Facial Pain. Cureus. https://doi.org/10.7759/cureus.35638 Goel, R., Kumar, S., Panwar, A., Singh, A. (2015). Pontine Infarct Presenting With Atypical Dental Pain: a Case Report. TODENTJ, 1(9), 337-339. https://doi.org/10.2174/1874210601509010337 Kalyani, P., Chaudhary, M., Kumar, M. (2020). Prevalence Of Orofacial Pain Among Working Adults – a Retrospective Study. ijrps, SPL4(11), 496-502. https://doi.org/10.26452/ijrps.v11ispl4.3889 Lucas, J., Nida, A., Isom, S., Marshall, K., Bourland, J., Laxton, A., … & Chan, M. (2014). Predictive Nomogram For the Durability Of Pain Relief From Gamma Knife Radiation Surgery In The Treatment Of Trigeminal Neuralgia. International Journal of Radiation Oncology*Biology*Physics, 1(89), 120-126. https://doi.org/10.1016/j.ijrobp.2014.01.023 Maarbjerg, S., Wolfram, F., Heinskou, T., Rochat, P., Gozalov, A., Brennum, J., … & Bendtsen, L. (2016). Persistent Idiopathic Facial Pain – a Prospective Systematic Study Of Clinical Characteristics And Neuroanatomical Findings At 3.0 Tesla Mri. Cephalalgia, 13(37), 1231-1240. https://doi.org/10.1177/0333102416675618 McCartney, S., Weltin, M., Burchiel, K. (2013). Use Of An Artificial Neural Network For Diagnosis Of Facial Pain Syndromes: An Update. Stereotact Funct Neurosurg, 1(92), 44-52. https://doi.org/10.1159/000353188 Mykletun, A., Øverland, S., Krokstad, S., Bjerkeset, O., Hickie, I., Aarø, L., … & Prince, M. (2006). A Population-based Cohort Study Of the Effect Of Common Mental Disorders On Disability Pension Awards. Am J Psychiatry, 8(163), 1412. https://doi.org/10.1176/appi.ajp.163.8.1412 Naidu, J., Bhattacharya, P., Mendonsa, J., M, M., Satish, K. (2020). Multidisciplinary Management Of Chronic Atypical Facial Pain Of Psychogenic Origin: a Unique Case Report. International Journal of Clinical Pediatric Dentistry, 2(13), 196-198. https://doi.org/10.5005/jp-journals-10005-1729 Naik, P., Kiran, R., Yalamanchal, S., Kumar, V., Goli, S., Vashist, N. (2014). Acupuncture: An Alternative Therapy In Dentistry and Its Possible Applications. Medical Acupuncture, 6(26), 308-314. https://doi.org/10.1089/acu.2014.1028 Petra, N., Šarac, Z., Zovko, R., Ćurlin, M., Filaković, P. (2020). Dental Medicine and Psychiatry: The Need For Collaboration And Bridging The Professional Gap.. https://doi.org/10.31219/osf.io/a6cyg Potru, S., Singh, V. (2022). Treatment Of Persistent Idiopathic Facial Pain With High Cervical Spinal Cord Stimulation: Case Report.. https://doi.org/10.21203/rs.3.rs-2268308/v1 Rath, M., Pöllmann, W., W, K. (1993). Atypical Facial Pain–application Of the Ihs Criteria In A Clinical Sample. Cephalalgia, 12_suppl(13), 84-88. https://doi.org/10.1177/0333102493013s1218 Sanker, V., Devaragudi, S., Shariff, S., Deva, S., Mathew, R., Gupta, U. (2023). A Case Of Vagal Cephalgia As a Manifestation Of A Lung Neoplasm—a Case Report And Review Of Literature. Clinical Case Reports, 6(11). https://doi.org/10.1002/ccr3.7373 Shephard, M., MacGregor, E., Zakrzewska, J. (2013). Orofacial Pain: a Guide For The Headache Physician. Headache: The Journal of Head and Face Pain, 1(54), 22-39. https://doi.org/10.1111/head.12272 Tinastepe, N., Oral, K. (2013). Neuropathic Pain After Dental Treatment. Agri, 1(25), 1-6. https://doi.org/10.5505/agri.2013.55477 Vadhanan, P. (2022). Persistent Idiopathic Facial Pain Treated With Botulinum Toxin and Pulsed Radiofrequency Of Infraorbital Nerve: A Case Report. J Dent Anesth Pain Med, 1(22), 67. https://doi.org/10.17245/jdapm.2022.22.1.67 Weiss, A., Ehrhardt, K., Tolba, R. (2017). Atypical Facial Pain: a Comprehensive, Evidence-based Review. Curr Pain Headache Rep, 2(21). https://doi.org/10.1007/s11916-017-0609-9 Zakrzewska, J. (2016). Chronic/persistent Idiopathic Facial Pain. Neurosurgery Clinics of North America, 3(27), 345-351. https://doi.org/10.1016/j.nec.2016.02.012

Yield Strength – Concept Explained

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Yield strength in dentistry refers to the amount of force or pressure a material can handle before it starts to permanently change its shape. Let’s relate it to something you might find in the kitchen.

Imagine you have a piece of soft bread. When you press on it lightly, it stays in shape. But if you press on it really hard, it gets squished and changes its shape, right? The point at which the bread starts to change shape and get squished is similar to the yield strength.

In dentistry, there are materials like dental wires or orthodontic appliances that need to have a high yield strength. For example, think of a sturdy fork you use to eat. The tines of the fork need to be strong enough to withstand the pressure when you’re cutting through a tough piece of meat or stabbing into a vegetable. If the tines were weak and had a low yield strength, they could bend or permanently change shape.

Another example is a metal spoon. When you use it to scoop ice cream, the handle needs to be strong enough to handle the pressure you apply while digging into the frozen treat. If the handle had a low yield strength, it might bend or deform under the force.

So, yield strength in dentistry is like the amount of force a material can handle before it starts to change its shape permanently. It’s similar to how the bread gets squished when you press on it really hard or how a fork needs to be strong enough to cut through tough food. In dentistry, materials with a high yield strength are important to ensure they can withstand the forces they’ll encounter without getting permanently deformed or damaged.

Brittleness – Concept Explained

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Certainly! In dentistry, the term “brittle” refers to a material that is hard but tends to break or shatter easily when it is subjected to pressure or force.

To help you understand this, let’s think about some examples from the kitchen. Have you ever seen a glass cup? Glass is a good example of a brittle material. If you accidentally drop a glass cup on the floor, it often breaks into small pieces. That’s because glass is not very flexible and can’t absorb or distribute the force of the impact, so it breaks apart.

Another example is a cookie. Imagine you have a very thin and crispy cookie. If you try to bend or twist it, it will probably snap or break into pieces. That’s because the cookie is brittle.

In dentistry, there are materials used for dental crowns or dental bridges that can be brittle. These materials need to be strong to withstand the biting and chewing forces in your mouth. However, if they become too brittle, they may break or chip if you bite down on something hard, like an apple pit or ice cube.

So, brittle in dentistry means that a material is hard but can break easily when pressure or force is applied. It’s like the glass cup that shatters when it falls or the crispy cookie that breaks when you try to bend it. In dentistry, it’s important to choose materials that have a balance of strength and flexibility to prevent them from becoming too brittle and prone to breaking.

Ductility – Concept Explained

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Ductility in dentistry refers to the ability of a material to be stretched or pulled into a long, thin wire without breaking. It’s like how easily you can stretch and bend a piece of chewing gum.

Imagine you have a piece of chewing gum. When you first take it out of the wrapper, it’s soft and pliable. You can easily stretch it and pull it into a long, thin string. That’s because chewing gum is a ductile material.

In dentistry, there are materials like orthodontic wires or certain dental alloys that need to be ductile. For example, when you get braces, the orthodontist uses wires that can be bent and shaped to fit around your teeth. These wires need to be ductile so that they can be easily adjusted and guided into the right position to straighten your teeth.

Another example is dental fillings. When a dentist fills a cavity in your tooth, they use a material that can be shaped and molded to fit the space. This material needs to be ductile so that it can be easily manipulated and formed to restore the shape and function of your tooth.

So, ductility in dentistry means that a material can be stretched or pulled into a long, thin wire without breaking. It’s like stretching and bending chewing gum without it snapping. Ductile materials are important in dentistry because they allow dentists to shape and mold materials to fit your teeth and provide the necessary treatment.

Resiliency – Concept Explained

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Resiliency in dentistry is like the ability of a material to bounce back or spring back to its original shape after it has been compressed or deformed.

Let’s imagine you have a rubber ball. When you squeeze it with your hand, it gets squished, right? But when you let go, it quickly bounces back to its original round shape. That’s because the rubber ball is resilient.

In dentistry, materials like dental impressions or mouthguards need to be resilient. For example, when the dentist takes an impression of your teeth, they use a special material that can be compressed to capture the shape of your teeth. But after they remove the impression from your mouth, it should quickly regain its original shape, so the dentist can make an accurate model of your teeth.

Another example is a mouthguard. If you play sports, you might wear a mouthguard to protect your teeth. A good mouthguard is made of a resilient material that can absorb the impact of a hit or fall and then bounce back to its original shape, providing cushioning and protection for your teeth.

So, resiliency in dentistry means that a material can be squished or deformed but then quickly goes back to its original shape. It’s like the rubber ball bouncing back after you squeeze it. It’s important for dental materials to be resilient so they can perform their job effectively and provide the necessary protection or support.