FALSE ASSOCIATION OF DENTAL PROCEDURES WITH SOME OTHER HEALTH PROBLEMS-case studies

FALSE ASSOCIATION OF DENTAL PROCEDURES WITH SOME OTHER HEALTH PROBLEMS-case studies

Introduction

Dental treatments, like any other treatments can lead to some complications. However there are false associations between dental procedure and other oral or systemic problems. A tumor inside bone may take chance of socket as a result of tooth extraction to come out of the bone into the oral cavity. Furthermore an underlying systemic disease may coincidently develop symptoms during or after dental procedure.

In this presentation we look at two cases

1.      A patient with pleomorphic adenoma which manifested following injection for tooth extraction on the palate

2.      A patient with orthodontic problems who developed systemic symptoms following fixation of orthodontic appliances

Pleomorphic adenoma

Pleomorphic adenoma (PA) is the most common tumour of the salivary glands. Although most often found in young to middle-aged women, they can occur in either sex and at any age.

80% occur in the parotid gland, 5% in the submandibular gland, 0.1% in the sublingual gland and about 10% in minor salivary glands. In the minor glands, pleomorphic adenoma typically presents as a rubbery nodule, principally in the palate and upper lip submucosa. They present as slow growing, painless nodules, often detected on routine intra-oral examination.

 Suspected pleomorphic adenomas are normally removed by excision biopsy or conservative surgical enucleation

Case 1  

On 22^nd December 2010, a 39 year old female, reported at our clinic with the main complain of painless swelling on the upper part of the mouth for about 10 yrs

The swelling started about 10 yrs ago following injection to extract a tooth from the upper jaw. The swelling was slowly increasing in size.

The patient did not take any step as she was waiting for spontaneous disappearance with time. She strongly believed that the swelling was caused by painful injection during tooth extraction. After noting that it was not disappearing by instead increasing in size; she went to one of general clinic in Kitwe Zambia where she was sent to us for consultation under provision diagnosis of Kaposi’s sarcoma.

On examination, there was a soft swelling on the right palate extending from tooth 18-13, close to mid palate and free gingival margin. The swelling was not fixed to surrounding tissues

Our provision diagnosis was pleomorphic adenoma

After examination  we informed the referring clinic our findings and planned management. However the clinic didn’t agree with our findings and plan, so they sent her to two more clinics for further but fruitless consultations. The patient decided to come back to us for the suggested management.

Management-  excision biopsy for histological analysis was done and the tumor was found to be pleomorphic adenoma.

The patient is doing fine.

Discussion

An association of the swelling with injection of LA during tooth extraction indicates that, the patient lacked awareness about oral tumors.

Waiting for about 10 yrs without going to hospital when coupled with offended extraction indicate the patient had a tendency to delay reporting oral problems until when signs and symptoms are unbearable (pain or any discomfort due to the swelling).

Discouragement by 1^st medical personnel not to have a tumor removed when coupled with his/her provision diagnosis of  Kaposi’s sarcoma indicate that even some medical practitioners lack basic knowledge on oral tumors.

TOOTH AN IMPORTANT BUT NEGRECTED PART OF THE BODY

TOOTH AN IMPORTANT BUT NEGRECTED PART OF THE BODY

By Rukoma, AM (DDS, MDent-Resorative Dentistry), May 2011.

Introduction

Together with cheeks, tongue and palate, the teeth form the first and important part of the digestive system. They help to breakdown food substances into small particles which are easily swallowed and then acted upon by digestive enzymes to the form which can be absorbed by the body for energy, growth and repair. Loss of teeth through extractions can seriously affect our general health. Further more; teeth help us in speech (articulation) and facial appearance. Imagine a person missing the anterior teeth required to address a public! If you have not experienced it, do not play for it.

Important to note, artificial teeth cost more than treating the natural teeth, at the same time they can not exactly replace the missing natural teeth. However, always something is better than nothing, if your have lost your teeth, artificial teeth is the remaining best option for you.

Interestingly, almost all disease conditions affecting the teeth are preventable and curable, but yet still dental problems remain one of the most common diseases affecting mankind. The physical and economical impact on the individual as well as the nation can not be over emphasized. However, this area of health has not received the attention it deserves both from individuals and organizations. The result is that the age old trend whereby the public visit the dentist when they are in pain and ending up in extractions continues unabated. 

Diseases that affect the teeth

All studies so far indicate that, dental caries (tooth decay) and periodontal (gum) diseases are the most prevalent conditions affecting the teeth and thus the leading cause of teeth loss.

Dental caries slowly destroys the teeth through acid produced from surgery food we eat, if untreated, the disease progresses to the extent where the only remaining option is tooth removal (extraction). On the other hand, periodontal conditions slowly destroys the gums, bones and other tissues supporting the teeth, if left untreated, the affected teeth become loose and later fall on their own or are extracted.  

As said in the introduction, these diseases are preventable and curable. And prevention is not even associated with injections or tablets as vaccines, but rather a mere change of habit. Just improving oral hygiene habits and visiting dentist regularly are enough to prevent these diseases and associated teeth loss. Moreover, even if the diseases have occurred in early stages and some cases of advanced stages, the diseases are curable. Surprisingly enough, despite these facts, the rate of teeth loss through extraction is alarming. One has to wonder why?

Injustice people are doing to the teeth

Tooth is the only part of the body which when pain, the patient will just request for its removal (extraction). I have never seen a patient requesting removal of the eye or any other part of the body simply because it pains. No matter how other parts of the body are destroyed, the patients will always ask for the treatment to maintain them, but for the tooth, even if it can be conserved, just remove! Sadly to say, even most medical insurance agents do not cover for scaling and root planning, the procedure which prevent both tooth decay and gum diseases from occurring. It is the same scaling and root planning which is the first line of treatment almost for all forms of gum diseases. Their lay argument is that, removing tarter (calculus) is an esthetic procedure (beauty), a misleading and deadly concept. More badly, some other insurers do not even cover root canal treatment, the treatment which cures advanced form of tooth decay. Another lay argument is that, the sure way of treating the painful tooth is its removal (extraction)! Why not the sure way of treating the incurable heart diseases is the removal of the heart?  Unjust indeed to the tooth, stop it.

As a treatment, tooth extraction is supposed to be done only when other methods of saving it are impossible or when such tooth can become a reason for other and more serious complications.

What should you do to prevent your tooth from extraction?

Brushing and flossing twice a day when coupled with visiting a dentist at least twice a year is enough to save your teeth. Is this costly? Every body has the answer. While consultation fee is enough to have your teeth checked routinely by dentist, tooth brush is among the cheapest commodity in the market. Early uncavitated decay can be treated by just medication, while simple fillings can save teeth with small to medium size cavities (holes). Good news is that even majority of teeth with big and deep cavities can also be served by doing root canal treatment. Always ask your dentist if he/she can do a root canal treatment on your badly decayed teeth instead of removal.

Always remember

1.      Health teeth = proper teeth brushing and regular dental visits (consultation fee + cost of toothbrush and paste),

2.      Diseased teeth cured and retained = filling or root canal treatment or scaling and root planning (consultation fee + treatment charges),

3.      Diseased teeth extracted = extraction and or artificial teeth (consultation fee+ extraction charges + cost of artificial teeth + cost of soft diet + teeth loss related problems).

Difference between food debris, dental plaque and calculus

calculus

—  Food debris are white small particles on the teeth- easily rinsed off

—  Dental plaque is a thin film of bacteria that sticks to teeth – yellow in colour can’t be rinsed off, removed only by brushing & flossing

—  Calculus is calcified plaque- hard, brownish or darkish in colour- only removed by scaling