In general practice the dentist will normally examine you radiographically with 2 bitewing radiographs. These images will show most of the posterior teeth crowns and the bone levels. These images are great for detecting caries and or bone levels.

Some dentists will routinely carry out panorama radiography called panorals, that shows both upper and lower jaws, including the wisdom teeth; but the detail is not good enough to detect caries.

Because of the extra radiation most dentists do not take panoral radiographs as a screening tool.

If one needs more detail about a specific area or 1-3 teeth then a deeper peri-apical radiograph is taken.

All radiographs must be justified to provide a benefit to the patient. The radiograph must serve a useful purpose in aiding diagnosis.

All radiographs by law must be recorded in the notes as justified, graded for quality and also reported on.

It would make no sense for a dentist to take a radiograph and then not look at it. Sadly this happens a few times in general practice.

The dentist may have asked for radiographs to be taken but then forgets to look at them.

In this interesting case a patient attended in pain with the LR6 molar. He had pain under the tooth for a week.

We did a careful examination of the face, neck, soft tissues and the teeth on the left side.

We noted that the LL6 was slightly raised, mobile and tender to the touch.

A per-apical radiograph was requested of the LR6 LR7 region.

The radiograph would be graded 2 in quality because we do not have the whole crowns in view. It may just be that the teeth are very big in any case.

It was noted that the LR6 was heavily filled with a deep filling that may have encroached onto the nerve. At the apex there is some bone loss. This would indicate a non-vital tooth.

The LR7 however seems to have a dark area associated behind it. Now many dentists would not have seen the area, as they are so busy concentrating on the LR6.

So we took another peri-apical further behind to see what that radiolucency was.

The scene becomes much clearer now as we can see an unerupted LR8 or wisdom tooth, lying on its side. There is a large dark coloured radiolucency that surrounds the crown of the LR8. The area also extend to the LR7 and there is some tipping of the LR7.

The most likely diagnosis is of a dentigerous cyst. These are fluid filled sacs that originate from the cell lining over an unerupted tooth. This cell lining usually breaks down when the tooth erupts, but in unerupted teeth the lining may continue to proliferate and then the centre breaks down into a licid sac.

This is an example of a very large unilocular dentigerous cyst associated with an unerupted LR7 or LR8.

Dentigerous cysts are slow growing and usually painless unless another tooth becomes involved.

There can be a lot of bone loss or jaw deformity that can render the bone liable to fracture.

We informed the patient and sent him to the hospital for an emergency second opinion.

Normally a cone beam CT scan is taken to ascertain the extent of the cyst and if it has involved the dental nerve underneath.

The patient underwent a surgical removal of the LR8, LR6 and the cyst. The large hole left was filled with a bone graft.

Had we not had spotted the lesion the patient could have lost more teeth or even broken his jaw.

In conclusion always ensure the dentist lets you know what he or she found on the radiographs. That way you know they have checked.

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COVID-19 has an impact on health-care professionals, including dentists, dental hygienists, and dental assistants. COVID-19 virus has been found in saliva, which puts the dental professional at risk. Furthermore, recently released statistics showing that the virus can live on up to three days on plastic and stainless-steel items, four hours on copper surfaces, and up to three hours suspended in a fine mist. The information assimilated in this document will help those in the dental profession reduce the risk of exposure to and from patients.

Practice safe infection control protocols

• Use preprocedural rinse of peroxide. The concentration of any rinse used should be at least 0.5%. Over-the-counter peroxide is typically 3%, so it would need to be diluted. Rinse at the beginning of the appointment for 60 seconds and again after the appointment.
• At this time, the ADA and CDC are only recommending peroxide to destroy the virus. While chlorine dioxide and chlorhexidine have been shown to kill some viruses, at this time, the American Dental Association and the Centers for Disease Control and Prevention have not endorsed their use for destroying COVID-19.
• ALWAYS wear appropriate personal protective equipment (PPE) when working directly with patients.This includes safety glasses, gowns, lab jackets, face shields, gloves, and a mask appropriate for the task.

Patient screening

• Front desk staff should call and screen patients prior to their scheduled appointments. Additionally, staff should screen patients when arriving for their appointments.
• Reschedule any patient who discloses they have had flu-like symptoms that include a high fever, dry cough, or difficulty breathing. Or if they have been in contact with anyone who has tested positive for COVID-19 within the last three weeks or 21 days.

General housekeeping

• Avoid direct handshaking, hugging, or greetings that require direct contact.
• Provide hand-sanitizer in all operatories, at the front desk, and in all bathrooms.
• Disinfect common areas including entry doors, throughout the day. Diluted household bleach will kill the virus.
• Wash hands often and refrain from touching your face—eyes, nose, and mouth.

O post Making patients safe when Dentistry reopens apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.