This case presentation is about the emergency management of a traumatized patient. The questions related with this type of accidental cases may be asked in part one examination. I can guarantee you that at least once, you will be asked about the management of an accident case in viva voce session of ADC part 2 practical examination. You are supposed to prepare a treatment plan for this patient.
If you wish, you can submit your treatment plan in the comment box. If need arises, you will get a positive response.
Case Description:
This male patient, in mid 40s was brought to the emergency room with the condition shown in the picture. He was unconscious with a GCS score of three and without any history. He was intubated to maintain airway in the emergency room. As a member of the emergency management team, you were called upon to perform your role. You were the first person to reach the emergency room. While other members are on their way, what will you do to manage this case?
Extensive facial injury of a male patient of mid 40s.
The oral manifestation of leukaemia can be summarized as follows.
In acute leukaemia- localized or generalized gingival hyperplasia is generally observed.It mainly affects the interdental papillae and the marginal gingiva.
The proximal contact point or the area refers to the surface point or area where the proximal surfaces of neighbouring teeth come in contact. Contact point/area is usually found in the occlusal one third of the natural crown of the most of the teeth.
The researchers at the University of Chicago performed a study to check the purification ability of the cloth masks. They made masks by joining one layer of tightly woven cotton sheet1 and two layers of polyester-spandex chiffon2, which is a fabric commonly used in evening gowns. These masks filtered out 80% to 90% spray particles ranging from 10 nanometres to 6 micrometres in diameter at normal human respiratory flow rate and volume.
Diabetes Mellitus refers to a group of common metabolic disorders that share the phenotype of hyperglycaemia and are caused by a complex interaction of genetics and environmental factors. It is very different from Diabetes Insipidus. Diabetes Insipidus is a syndrome characterised by the production of abnormally large volumes of dilute urine due to decreased secretion or action of Vasopressin, a hormone secreted by the posterior pituitary gland.
The pathogenic process leading to hyperglycaemia is the basis for classification of diabetes mellitus into several types. Age or insulin dependence are no longer the criteria for differentiation. Type I and Type II are the two broad categories. In Type I DM there is destruction of pancreatic β cells and insulin deficiency resulting from autoimmune β cell destruction. Type II DM is characterised by variable degree of insulin resistance, impaired insulin secretion, excessive hepatic glucose production and abnormal fat metabolism.
The biomedical waste management in India should be the burning and worrisome topic for the public as well as hospitals and health care service providers. Bio-Medical Waste (Management and Handling) Rules 2016 and further amendments in 2018 and 2019 have made enough provisions to handle all the biomedical wastes by any entity involved in anything related with health care provision. This includes, hospitals with only OPD facilities, hospitals with indoor facilities, blood donation camps, free health camps, medical services being provided in the field excluding the active war zones as well as the ships in the international water with Indian registration.
The categorization of all biomedical wastes into four color categories namely yellow, red, white, and blue made the segregation easy and practical. It does not specifically say anything about the rules and regulations to be followed in reference to COVID-19. But when, the proper biomedical waste management protocols, standard precautions also known as universal precautions and the latest guidelines issued for the control of spread of Covid-19 by MoHFW are put together; we find ourselves equipped with enough tools to deal with all types of wastes and infections.
We shall read more about the Bio-medical Waste (Management & Handling) rules 2016 and further amendments in 2018 & 2019 in further articles.
The pontic, \pŏn΄tĭk\, is an artificial tooth on a fixed partial denture that replaces a missing natural tooth, restores its function, and usually restores the space previously occupied by the clinical crown. An ideal correctly designed posterior pontic should have the following features.
All surface should have convexity with proper finish.
The contact with buccal contiguous slop should be minimal (pinpoint)) and with pressure free (modified ridge lap).
Buccal and lingual shunting mechanism should conform with those of the adjacent teeth.
Occlusal table should be in functional harmony with the occlusion of all of the teeth.
The overall length of the buccal surface should be equal to that of the adjacent abutment teeth or pontic.
Figure 1. Schematic
presentation of various pontic designs; (a) Sanitary pontic; has no contact
with the edentulous ridge, (b) ridge lap pontic; forms a large concave contact
replacing the contours of a missing tooth, (c) modified ridge lap; shows
illusion of a tooth but it has all or nearly all convex surfaces for easy
cleaning and minimize plaque accumulation, (d and e) bullet/conical; rounded
and cleanable smaller tip in relation to overall size, (f) ovate; round end
design currently in use where aesthetics is a primary concern[1].
The Pontic design can be classified into two types.
A. Pontic having mucosal contact
Sanitary/Hygienic/Fish-belly and
Modified sanitary type
B. Pontic with no mucosal contact
Saddle/Ridge lap
Modified Ridge Lap
Conical
Ovate
Sanitary or Hygienic Pontic or Fish-Belly
Sanitary pontic makes no contact with the edentulous ridge. It is made in an all-convex configuration, faciolingually and mesiodistally. The space between the pontic and the mucosa should be 2 or 3 mm[2]. It is most commonly used in mandibular molar replacement. It has the advantage of providing good access for maintaining hygiene with the disadvantage of poor esthetics.
Sanitary pontic design-note the convexity at cervical region
Modified Sanitary
The tissue facing surface of the modified sanitary design pontic has a hyperbolic parabola. The pontic is designed as a concave archway mesiodistally while the under surface is convex faciolingually. It in indicated in molar replacement, provides access to undersurface for good hygiene, alongwith poor esthetics.
Modified sanitary pontic design-note the concavity at the cervical region.
Saddle/Ridge Lap
It looks like crown of the tooth because it replaces all the contour of the missing tooth. It maintains a large concave contact with the underlying ridge and obliterates facial, lingual and proximal embrasures. Esthetic wise it provide best result but due to impossible access to under surface for cleaning, its use is limited for the replacement of maxillary incisors.
Modified Ridge Lap
Modified ridge lap combines esthetics with easy cleaning, and makes contact with ridge tissues in a shape of ‘ T‘ whose vertical arm ends at the crest of the ridge. This design is most commonly used in the area of the mouth that is visible during function, e. g. anterior teeth, premolars and sometimes maxillary molars.
Modified ridge lap pontic design: note the half concave underneath surface in contact with mucosa.
Conical
Conical pontic design is mostly limited to the replacement of thin knife edged ridges in the non-display zone of the mouth. It has a convex surface with only touching the centre of the residual alveolar ridge. It helps maintain good hygiene with poor esthetics. Conical design in indicated for the replacement of molars.
Image of conical pontic design- note the egg shaped design in green circle.
Ovate
Ovate pontic design is the most aesthetically suitable appealing design that looks like emerging from the gingiva. When ridge resorption is corrected by ridge augmentation, ovate design appears to be emerging through gingiva just like natural tooth. it is indicated for the replacement of maxillary incisors, canines, and premolars. It has the advantage of best esthetics, negligible amount of food entrapment and easy cleaning. The disadvantage is the requirement of surgical preparation of the receiving site before prosthesis fabrication.
Ovate pontic design-note the convex undersurface of pontic embedded in mucosa (green circle).
There are MCQs on pontic design in “Free silver Course“, which you may like to attempt.
Zinc as such does not participate in the amalgamation process or in the setting reaction of silver amalgam alloy with mercury during and after the completion of the restoration process.
