It is vital that the type of sterilizer being used is clearly identified as this dictates not only what can be processed in the chamber but also how the machine is tested and validated.
When purchasing a new machine the cost is obviously a focal point. What is often not apparent is the ongoing cost of validating the machine after purchase. This is particularly essential when purchasing a vacuum sterilizer. Continue reading
Bullae may present on any oral or oropharyngeal surface, but typically arise in the buccal, palatal and gingival regions. Occasional patients have lesions restricted completely to the gingiva. Skin lesions are similar except that the more heavily keratinized epidermis allows blisters to remain intact much longer. Most patients have circulating autoantibodies which can be detected by indirect immunofluorescence using serum from other affected individuals. Titers are directly proportionate to the severity of the disease. Continue reading
Pemphigus vulgaris is an autoimmune or “self-allergy” disease in which a patient’s own circulating antibodies become altered so that they attack the points of adhesion of the epithelial cells, one to another, of the skin and mucous membranes. Women are more frequently affected than men and the disease is usually diagnosed between the ages of 50-70 years, often with oral blisters as the first sign. Children are rarely affected. The typical lesion is a small or large, clear-fluid blister which breaks rapidly in the mouth to leave a flat white, somewhat tender ulcer with a thin red line around it. Skin blisters may last for hours or days, and blisters may be caused by pressure on the skin or membranes of the mouth. There is no cure, but pemphigus is treated with heavy doses of corticosteroids and azathioprine, with frequent relapses after the therapy is stopped. Secondary infection is common because of the immune system suppression from these drugs. The overall mortality is less than 6%, usually from infection or loss of body fluid from a large number of blisters. Continue reading
Dental implant
Dental Implants are used to replace missing teeth. Theoretically it is possible to do this successfully for a person with OI and there is anecdotal evidence that this has been accomplished. However, there are no controlled studies on the use of dental implants in people with OI and only a few case reports in the literature. The high failure, reported to be 50 per cent within 3 years of surgery is a concern.
Dental implants are somewhat like screws. In order to function, there must be enough bone in the jaw for the implant to be securely placed. After healing, a “post†is placed in the implant and an artificial tooth is attached. Good, strong healing around the implant is critical. Continue reading
Children with OI and dentinogenesis imperfecta need the same basic care as discussed in Part 1, but they also need to be monitored for cracking, chipping and abrasion of the teeth. Special care will be needed even with the baby teeth. All of the teeth may not be affected by DI, and primary teeth usually are affected to a greater extent than the permanent teeth. Restorative treatment may be needed at some point. Continue reading
Osteogenesis imperfecta (OI) is always associated with bone fragility. In addition, OI may affect the growth of the jaws and may or may not affect the teeth. About half of the people who have OI have teeth that appear normal, and their major concerns are routine care. However, the other half has a defect in the teeth called dentinogenesis imperfecta (DI), sometimes referred to as opalescent teeth or brittle teeth. These teeth may be misshapen, may chip or break easily, and will require special care. Continue reading
Dental osteomyelitis (or osteomyelitis of the jawbone) is an acute or chronic jawbone infection, usually caused by bacteria. It is extremely difficult to diagnose and treat. Continue reading
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a condition found in patients who have received intravenous and oral forms of bisphosphonate therapy for various bone-related conditions. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) manifests as exposed, nonvital bone involving the maxillofacial structures. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is thought to be caused by trauma to dentoalveolar structures that have a limited capacity for bone healing due to the effects of bisphosphonate therapy. Continue reading
The incidence of macroglossia has been reported as 11-60% in persons with Down Syndrome although the presence of true macroglossia has been questioned by some investigators. There is agreement, however, on the presence of a relative macroglossia due to the small palatal space and hypotonic tongue. Continue reading
Midface dysplasia is a cardinal characteristic of persons with Down Syndrome (DS). Nose malformations including a flat broad bridge of the nose has been reported in 59-78% of these individuals. Ear malformations, including “lop” ears, low-set ears and ears with a flat or absent helix have been reported in 54%. Eye malformations are common. Epicanthal folds with slanting almond-shaped eyes (narrow palpebral tissue slanting toward the midline), which was responsible for the term mongoloid, are reported in 78%. Strabismus (cross eyes) is reported in 14-54% and nystagmus (constant involuntary cyclical movement of the eyeballs) and refractive errors are also common. The majority of persons with Down Syndrome exhibit brachycephaly (broad, short head) and lack of supraorbital ridges and hypotelerism (secondary to hypoplasia of the central face) are common findings. Absence of frontal sinuses and absent or reduced maxillary sinuses have been reported. Nasal septum or nasal conchal deviations are often observed which can produce a partially obstructed or narrow air passage and can contribute to the problem of mouth breathing. Continue reading