Emergency Management of Acute Apical Periodontitis in the Permanent Dentition Proximal ...

72 Pages·2003·2.93 MB·English

JCDA
Journal of the Canadian Dental Association
Vol. 69, No. 3 March 2003
Emergency
Management of Acute
Apical Periodontitis
in the Permanent
Dentition
Proximal Contacts of
Posterior Composite
Restorations
Treatment of
Adjacent Gingival
Recession Defects
Differential Diagnosis
of Nasolabial Cyst
Cherubism in
Siblings
Carvings by Dr. Margaret Reade
Canada’s Peer-Reviewed Dental Journal
• www.cda-adc.ca/jcda •
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JCDA
Journal of the Canadian Dental Association
CDA Executive Director
George Weber
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Editor-In-Chief
Dr. John P. O’Keefe
Senior Writer/Editor CDA is the authoritative national voice of dentistry, dedicated to the
Harvey Chartrand representation and advancement of the profession, nationally and
Assistant Editor internationally, and to the achievement of optimal oral health.
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imply that the Canadian Dental Association
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agrees with or supports the claims therein. Dr. Claude Ibbott
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Journal of the Canadian Dental Association March 2003, Vol. 69, No. 3 127
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C
ONTENTS
Journal of the Canadian Dental Association
D E P A R T M E N T S D E B A T E
What if Michael Buonocore Had Been Unsuccessful
Editorial. . . . . . . . . . . . . . . . . . . . . . 131
in His Mission?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
President’s Column . . . . . . . . . . . 133 Omar El-Mowafy, BDS, PhD, FADM
Letters. . . . . . . . . . . . . . . . . . . . . . . . 134
C L I N I C A L P R A C T I C E
News. . . . . . . . . . . . . . . . . . . . . . . . . . 136
Clinical Presentation and Differential Diagnosis
FDI Statements. . . . . . . . . . . . . . . 141
of Nasolabial Cyst. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Advertisers’ Index. . . . . . . . . . . . . 167 Donald R. Nixdorf, BSc, DDS, MS
Edmund Peters, DDS, MSc, FRCD(C)
Diagnostic Challenge . . . . . . . . . 170 Kevin E. Lung, BSc, DDS, MSc, FRCD(C)
Clinical Abstracts. . . . . . . . . . . . . 174 Cherubism in Siblings: A Case Report . . . . . . . . . . . . . . . . . . . . . . 150
Ravikiran Ongole, BDS
Point of Care . . . . . . . . . . . . . . . . . 179 Rejeev S. Pillai, BDS
Keerthilatha M. Pai, MDS
CDSPI Reports. . . . . . . . . . . . . . . 186
A Promising Periodontal Procedure for the Treatment
Continuing Dental of Adjacent Gingival Recession Defects. . . . . . . . . . . . . . . . . . . . . . 155
Education. . . . . . . . . . . . . . . . . . . . . 187 Tolga Fikret Tözüm, DDS, PhD
Emergency Management of Acute Apical Periodontitis
Classified Ads. . . . . . . . . . . . . . . . . 189
in the Permanent Dentition: A Systematic Review of the
Literature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Susan Sutherland, DDS
All matters pertaining to the Journal should Debora C. Matthews, DDS, Dip Perio, MSc
be directed to: Editor-in-chief, Journal of the
CanadianDental Association, 1815 Alta Vista
Drive, Ottawa, ON, K1G 3Y6. E-mail:
[email protected]. A P P L I E D R E S E A R C H
•Toll-free: 1-800-267-6354 •
•Tel.: [phone] • Evaluation of Proximal Contacts of Posterior Composite
•Fax: [phone] •
Restorations with 4 Placement Techniques. . . . . . . . . . . . . . . . . . . 162
All matters pertaining to classified advertising Wafa A. El-Badrawy, BDS, MSc
should be directed to: Ms. Beverley Kirk- Brian W. Leung, DDS
patrick c/o Canadian Medical Association, Omar El-Mowafy, BDS, PhD, FADM
1867 Alta Vista Dr., Ottawa, ON K1G 3Y6 Jose H. Rubo, DDS, MSc, PhD
•Toll-free: 1-800-663-7336 , ext. 2127 • Marcia H. Rubo, DDS, MSc
• Tel.: [phone]•
•Fax: [phone] •
All matters pertaining to display advertising
should be directed to: Ms. Marg Churchill
c/o Keith Health Care Inc., 104-1599 Hurontario St.,
Mississauga, ON L5G 4S1
•Toll-free: 1-800-661-5004 • An independent review* has concluded that oscillating-
• Tel.: [phone] • rotating technology, pioneered by Oral-B, is the most
•Fax: [phone] • effective at reducing plaque and gingivitis.
*For more information, and to read the published abstract, visit the Cochrane Collaboration website at
Publication of an advertisement does not www.update-software.com/toothbrush.
necessarily imply that the Canadian Dental Association
agrees with or supports the claims therein.
Please see our advertisement opposite the Editorial page.
Journal of the Canadian Dental Association March 2003, Vol. 69, No. 3 129
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Editorial
profession’s science base and its preoc- acute apical periodontitis in the
BALANCING cupation with the public good were permanent dentition.
the 2 principal reasons why dentistry JCDA is very proud to publish in
ART AND became a self-regulating profession in this issue Drs. Susan Sutherland and
the middle of the 19th century. This Debora C. Matthews’ systematic liter-
SCIENCE FOR occurred in a climate of economic ature review, upon which this guide-
liberalism where governments were line is based (abridged version is on
THE PUBLIC loath to confer monopolies on groups p. 160), as well as a 1-page summary
aspiring to professional status. of the guideline itself. The full text is
GOOD
Scientific advances during the 20th online at www.cccd.ca.
century and the public’s faith in science I know that there are some in the
and technology through most of this profession who distrust the whole
period helped raise the status of medi- process of developing CPGs, perhaps
cine and dentistry in the eyes of the fearing that these will lead to stan-
public. However, some of the lustre of dards of practice that will somehow be
used against individual dentists. This
the professions has been lost in recent
is a view that I find hard to accept.
times due, in part, to an educated
Surely, it is comforting to the profes-
public becoming aware of significant
sional to have guidance relating to the
variations in clinical treatment patterns
management of oral conditions, based
between individual professionals.
on the latest critically appraised scien-
Recognizing that each patient is
tific evidence. As a practising dentist I
unique and that there is a subjective
welcome this, especially in a climate
component to all clinical decision-
Dr. John P. O’Keefe where the empowered patient will
making, macro-level treatment pattern
increasingly ask me to justify my clin-
variations are worrisome for the profes-
ical decisions.
sions and the public alike. I believe that
When I look at the artworks
The CCCD has gone out of its way
responsible health profession groups
that grace JCDA covers, to stress that it is developing guide-
are moving to create clinical practice
I am reminded that lines “By Dentists, For Dentists.”
guidelines (CPGs) as a means of rein-
Canadian dentists are extremely Whenever I hear Drs. Matthews and
forcing the trust of decision-makers
talented artists and that the practice of Sutherland, as well as CCCD chair
and the general public. The Canadian
dentistry is a form of artistic expres- Dr. Peter Fendrich, speak about
dental profession has set up the
sion in itself. The latter insight was guidelines, they take great pains to
Canadian Collaboration on Clinical
reinforced as I worked on the Clinical describe the checks and balances that
Abstracts section dealing with shade Practice Guidelines in Dentistry CCCD has put in place to ensure that
selection, which appeared in the (CCCD) to help the profession the guidelines are good for all.
February 2003 edition of JCDA. provide the best dental care possible I would like to salute these 3 indi-
Reflecting on the articles I read to and thereby further enhance its image. viduals and their many colleagues who
prepare the feature, I had the impres- The CCCD is a collaborative effort have given countless volunteer hours
sion that it is almost a miracle how we bringing together representatives of to the profession and the public
can end up with crown shades that are CDA, provincial dental associations, through their CCCD involvement.
clinically acceptable and often indis- dental regulatory authorities, dental They know that the difficult job of
cernible from the surrounding teeth. academia and specialty organizations. sustaining this effort has just begun. I
This is particularly striking, given that This coalition has worked very hard in believe they need the support of all
colour perception is so subjective and recent years to define the process for colleagues and interested organiza-
the perceptions of patient, dentist and creating evidence-based guidelines. tions to ensure that they can continue
laboratory technician must coincide, Having made its work known to the this valuable work.
if clinical success is to be achieved. profession at large, it has produced the
But dentistry is not only an art first of — we hope — many CPGs for
John O’Keefe
form; it is also a science-based profes- dentistry. This first guideline deals 1-800-267-6354, ext. 2297
sion. We must never forget that our with the emergency management of [email protected]
Journal of the Canadian Dental Association March 2003, Vol. 69, No. 3 131
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President’s Column
dentists and their patients north of 60 continuing success, as we strive to
could be identified and resolved. This achieve optimal oral health for all
INCLUSIVITY: development has the potential to Canadians.
bring together at the same table for Another topic of interest to
COUNT ME IN! the very first time dentists from every Executive Council is CDAC’s ongo-
region in Canada for a truly national ing evolution. Accreditation began
perspective. under the auspices of CDA and has
The proposed new governance evolved to the point where CDAC is a
model is crucial to our quest for inclu- functionally autonomous unit with its
sivity. The Annual General Meeting own director, bank account, budget
(AGM) would include a General and chair, under the broad umbrella
Assembly on the first day, followed by of CDA. There has been some ongo-
a Strategic Forum on the second day. ing discussion in recent months to
The General Assembly would either make CDAC entirely indepen-
dent or move it under a proposed
include the formal portion of the
newly developed body — the
AGM. Participants would include
Canadian Dental Regulatory
voting members representing the
Authorities — or to maintain the
corporate members of CDA, dental
commission broadly within CDA.
students, Canadian Forces Dental
Dr. Tom Breneman Service, specialty sections and acade- Since there is only one unique
body of knowledge that is the raison
mic dentistry. Non-voting members
d’être of any profession, your
would include presidents and CEOs
Executive Council has asked CDA
On a recent flight cruising of the provincial dental associations
staff to do an environmental scan,
along at 35,000 feet, it was and dental regulatory authorities,
reporting on the manner in which
comforting to know that the specialty sections, board members, the
other professions manage their accred-
captain, crew and ground support CDA president and CDA staff.
itation processes.
were working together so that we Provisions will be made to allow for
It is only when our profession joins
would all reach our destination safely. AGM participants to discuss specific
forces with allied groups that we can
At a 1999 planning session, CDA’s issues during an interactive session.
truly examine an issue objectively and
Executive Council crafted a vision The Strategic Forum is meant to
respond to it proactively, instead of
statement for the Association. The define emerging issues that have the
reactively. This also allows dentistry to
Council realized that, to achieve this potential to impact on the oral
respond with a single, clear and
vision for 2010, CDA needed to be health of Canadians. Besides the
concise message that will have the
inclusive. Since dentistry is a unique aforementioned, stakeholders would
greatest impact on the profession and
body of knowledge, “inclusivity” also include representatives from
on those whom we serve.
means that we need to have an open the Association of Canadian Faculties
As an example of our joining forces
dialogue, both within and beyond our of Dentistry, Commission on Dental
with allied groups, CDA co-hosted an
profession. Accreditation of Canada (CDAC),
Oral Hygiene Shortage Forum on
I was recently privileged to attend Academy of General Dentistry, January 10 with the Association of
the annual meeting of the Northwest Canadian Association of Dental Dental Surgeons of British Columbia.
Territories Dental Association in Research, Canadian Dental Service Executive Council approved the key
Yellowknife and enjoy the northern Plans Inc., Dentistry Canada Fund, messages emanating from this forum
hospitality. At this meeting, partici- Royal College of Dentists of Canada, for consideration by the Board of
pants set in motion the creation of a Dental Industry Association of Governors in March. More on this in
northern federation of dentists, to Canada and other groups. a later edition of JCDA.
include all dentists in the Yukon, The broader and more diverse the
NWT and Nunavut. This federation discussion, the better our knowledge
could then be represented at the table base and the more successful we will
under the proposed new governance be in identifying future trends and
Tom Breneman, DMD
model of CDA, and the concerns of developing a strategy to ensure [email protected]
Journal of the Canadian Dental Association March 2003, Vol. 69, No. 3 133
Letters
Editor’s Comment tion (which cannot redefine the origi- benefit the Canadian dental profes-
The Journal welcomes letters from nal position of the tooth). sion and not the shareholders of some
readers about topics that are relevant The real problem is representing an large company. Over the years, I have
to the dental profession. The views extraction on a dental claim form that seen many improvements and proac-
expressed are those of the author and do is incorrect. It is inappropriate to call tive changes.
not necessarily reflect the opinions or the extraction of a tooth that has It would be difficult to imagine
official policies of the Canadian Dental erupted a removal of an impacted that any successful practitioner could
Association. Letters should ideally be no tooth. This was confirmed in at least not have at least 90% of his or her
longer than 300 words. If what you
2 provinces after I put the question interests (in the areas that you deal in)
want to say can’t fit into 300 words,
to the regulatory bodies. It may make totally dealt with effectively by
please consider writing a piece for our
sense in terms of maintaining licen- CDSPI or CDIP.
Debate section.
sure in good standing in your I am confident that my trust is well
province to assure that the code on the placed.
claim form represents exactly the
Dr. Andrew F. Thompson
Dental Extractions
procedure performed in all cases. Halifax
Having seen about 100,000 dental
Dr. Brian D. Barrett
claims, I am amazed by those for Amalgam Fillings
National Dental Consultant, VAC
extractions. In most cases, the claims I am being asked by some of my
Charlottetown
are accurate representations of the patients to remove existing amalgam
work done, but there are often big Kudos for CDSPI/CDIP fillings and replace them with a non-
discrepancies. I’d like to compliment Canadian mercury-containing material. While
If an oral surgeon is doing the Dental Service Plans Inc. (CDSPI) removing clinically and radiographi-
extractions, they seem to become and the Canadian Dentists’ cally acceptable fillings, I noticed that
surgical extractions “code 71200,” Investment Program (CDIP) on the several teeth had recurring decay
regardless of the appearance on the excellent job they have done for me underneath or observable cracks
radiograph. I do not think that the running under the base of cusps. Over
and for the dental profession in
Uniform System of Codes and List of several weeks, I kept a tally of my
Canada over several decades.
Services (USC&LS) defined surgical As I approach my mid-50s, it is findings, which I present below:
extractions to be ones performed by reassuring to know that they are look- “Sound” amalgam fillings were
oral surgeons, but this is often the ing after my interests (without any of removed from 48 teeth. Of the under-
case. the usual sales pressure). I am always lying teeth, 6 (or 12%) had decay and
Patients in Ontario, Alberta and cognizant of the fact that their staff observable fractures; 9 (19%) had
B.C. have very difficult teeth to has my personal interests at heart. decay with no fractures; 9 (19%)
extract, as the incidence of “surgical Several times, they have examined displayed observable fractures but no
extractions” is nearly double that material or policies I already possessed decay; and 24 (50%) were normal.
found everywhere else. One wonders (not from their company) and Granted, this is a very rough study,
but it did substantiate my clinical
why this is so, as some third parties suggested I maintain them. They did
observation that 33% to 50% of these
believe that these extractions may be not try to encourage me to change to
teeth exhibit some pathology under a
related to the fees charged. their company. I feel that this only
“normal” filling. I have always
Many providers have obviously reflects positively on the overall
removed old, large amalgam restora-
forgotten what an impacted tooth is. management philosophy and mandate
tions before doing crown preparations
Dorland’s Medical Dictionarydefines it of CDSPI and CDIP.
for the same reason. There seems to be
as one that has been prevented from I also am well aware (since I carry
more incidence of pathology with
erupting completely into the oral out yearly cost comparisons) that in
increasing amalgam-filling size.
cavity by some physical barrier. If the terms of “bang for the buck,” you
actual extraction did require some cannot do better then CDSPI/CDIP. Dr. Larry Hill
removal of bone and sectioning of the This is almost axiomatic, in that with- Nanaimo, British Columbia
tooth, it is of course a surgical extrac- out the very high sales costs of
tion and therefore a 71210, regardless commercial companies, this alone can
of the time involved to do the extrac- be re-circulated into the budget to
134 March 2003, Vol. 69, No. 3 Journal of the Canadian Dental Association