Exploration in clinical cases of dentistry
Introduction
During the intraoral exploration, the dentist, observes that the patient suffers from bruxism, that is, it brightens the teeth and squeezes them unconsciously, which causes the central and lateral incisors to have excessive wear due to excessive contact and pressureexcessive. The complementary exploration will be carried out by means of orthopantomography and periapical radiography mentioned later. While Victor performs intraoral exploration and communicates everything observed, I take note in the odontogram, of the current situation of the available patient.
Developing
Clinical case documentation. After a few minutes, Victor observes dental caries in piece 35, second lower left premolar in occlusal and piece 36 first lower left molar in occlusal and interproximal, which will surely require a small reconstruction. The presence of tartar is detected, which is cited for the next visit to the realization of an oral cleaning. The patient’s periodonto is slightly inflamed by the presence of tartar. The patient has a type 2 malocclusion. Victor, anamnesis ends with a brief interrogation to the patient about her oral hygiene habits, her relevant daily habits, the predominant feeding.
The last visit to the dentist and the beginnings of the pain he feels and how pain has evolved over time, issues to which the patient responds. Victor tells me that he wants to perform complementary explorations and asks me to make the patient an orthopantomography, to see the status of the dental pieces affected. I accompany the patient to the X -ray room for the realization of the orthopantomography and indicate to the patient to leave in the tray all the metal objects that he can carry and we explain the procedure of the realization of the radiography.
We leave the X -ray room to perform the radiography and ask the patient to accommodate again in the dental armchair to continue the consultation while we verify the load of the radiography on the computer of the room for visualization by Victor, the dentistassigned to the patient’s treatment next to me, his assistant hygienist throughout the process. The radiography shows the two decay detected with the exploration probe, although, in piece 36 the condition reveals that the tooth decay is in a fairly advanced state, which indicates an irreversible pulpitis. In piece 35 a decay is observed. Dental Caries: Incipient occlusal in the absence of determining whether there has been a condition of the pulp camera.
The degree of incursion on dentin. The patient is informed about what has been detected and the diagnosis and the need to make a second visit to the clinic to perform the treatment. We leave the cabinet and back to the reception counter we deliver the sheet with the budget previously prepared for its treatment and explain the phases of the same and the sheet with the diagnosis detailed by the dentist doctor who attended it. We cite the patient for the next visit to start the treatment and in the first place it will consist of an oral cleaning that I will perform myself. Diagnosis or declusal caries in piece 35 in an incipient state.
Caries in occlusal and interproximal in piece 36 in advanced state with possible infection. Value endodontics or extraction. Bruxism. Requires download splint. Temporary treatment: nolotil 500mg. 2 x day. Amoxicillin 500mg. 2 x 5 days prior to endodontics. Indications: oral brushing with use of antiseptic colutory, avoiding the chewing of food in the affected area, antibiotic taking 5 days before the endodontics. Before its march, the patient is explained the diagnosis and the trajectory and order to be followed for treatment are drawn. It will be the following: First visit: Contact and evaluation of the patient.
First query: tartrectomy by ultrasound. Second Consultation: Endodontics of piece 36, after periapical radiography. THIRD Consultation: Sailing of piece 35 and reconstruction and shutter of piece 36. Fourth Consultation: Treatment Review. Printing for the download splint. Fifth Consultation: Placement and adjustment of the download splint. Finally, we verify together with the patient and the dentist that there are no doubt about the diagnosis and treatment that we are going to apply. Once the consultation is abandoned, we accompany the patient to the reception counter for the delivery of documents and budget, and the fixation of the next appointment.
Description of the pathology according to the current state of the patient: the factors of the tooth decay. Caries is a multifactorial disease that causes the destruction of the dental tissue. This destruction is carried out by a series of bacteria among the most important is the Streptococcus mutans, the main person in charge of the destruction of the dental tissue. The bacteria feed on the small food remains attached to the dentition after a food intake. Bacteria produce certain acids that alter the oral pH causing the demineralization of dental pieces eliminating that protection that the dentition has naturally being exposed to bacteria.
The dental demineralization has as its main consequence the destruction of the dental enamel, the first outer layer and the hardest of the dentition of our patient and consequently the detection of dental caries in their oral cavity is surely due, to the demineralization of the pieces, possibly due to lack of oral hygiene or a deficient or incorrect dental brushing, a high sugar diet, among other possible causes. Dontogenic infection: with more than five hundred different types of bacteria, fungi and viruses, they fulfill different functions within the oral cavity.
We highlight the main ones: Biofilm consists of a film or layer acquired for a community of microorganisms found on the dental surface. It is shown in the form of white-yellowish color and its consistency is soft matt that is formed a few hours after food intake. Nutritious metabolizers whose main fusion is to metabolize ingested foods. Being a movie of salivary origin we can determine that it has advantages and disadvantages. Being an advantage of tooth protection before a possible dental demineralization and having as a disadvantage the adhesion of microorganisms to the dental surface.
Therefore, the maturation of the plate causes the dental plate as such, plate detected in the oral cavity of our patient. The plate is divided into two types of plaque by its location: the supra gingival plate is that which is located on the visible dental surface and is related to tooth decay. The subgingival plaque is one that is located between the dental piece and the gum and is not visible in its entirety with the naked eye and is related to periodontal diseases such as gingivitis and periodontitis. The plate detected in the oral cavity of our patient is located in the supra gingival part of the dental pieces.
The main factors that affect the plate in the case of our patient would be the following: oral hygiene. Feeding. Immunological factors. Native bacterial flora. Salivary composition and alterations in your flow. Ethiopathogenesis: Usually, caries is related to other periodontal diseases, such as gingivitis or eruption problems especially pericoronaritis. Also, the different dental procedures carried out prior to any level can develop a dental infection. On the other hand, acute trauma, minor trauma, but repetitive can damage dental pieces causing pulp necrosis.
conclusion
The propagation routes of the infection can occur by abscesses or cellulite. In the case of cellulite, it is a pasty swelling where there is no destruction of tissues and in the case of abscesses it is a white swelling where destruction of tissues occurs. For treatment we must previously know and evaluate the severity of the infection by elaborating an adequate medical history and a correct anamnesis and a detailed exploration. If the affected piece is negatively valued, another possibility of treatment will be sought by the practice of an endodontics or finally to the extraction if it were the case.
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