IS ROOT CANAL THERAPY A COSMETIC PROCEDURE?

Rukoma 2014
There is misconception among policy makers and general health stakeholders including patients that root canal treatment is an aesthetic, reconstruction and replacement procedure aiming at just improving the appearance of the affect tooth. It is forgotten that teeth serve more function than appearance; to mention a few, mastication, cutting and speech. It is likely that, the misconception is derived from the fact that most teeth which need root canal treatment are badly destroyed by decay or fracture or are discolored. These destructions, when they occur in the anterior segment of the dentition, they lender the teeth unacceptable appearance. The action of rebuilding the affected tooth to regain its full form and functions has been mistakenly taken as replacement of the whole tooth (artificial tooth). This is attributed to crown used to acquire perfect coronal seal and tooth strength following RCT. This misconception has lead to some health insurance companies’ reluctance to cover for root canal treatment especially those associate with crowning. This is a result of failure to understand that adequate coronal seal is a prerequisite for a successful root canal treatment and that it can be attained only by crowning the remaining part of natural crown and or root. The cost associated with treatment as also contributed to this scenario. The fact that, the tooth is an anatomical structure consisting of root and crown has been ignored, to the extent that replacing the crown or part of it is taken as replacing the whole tooth! Root canal treatment is aiming at maintaining natural root as there is no artificial root which will exactly mimic natural ones. The introduction of implant to replace the missing tooth roots can help to explain the importance of roots. An implant is a natural artificial root made from titanium which helps replace lost natural root and on which the artificial crown is placed. While implant is integrated into supporting jaw bones by osteointegration, the natural tooth root is joined to supporting bone by means of periodontal ligaments; thus, the proprioception function of periodontal ligaments is missing in implants. If maintaining natural tooth is expensive, remove it and try artificial one. People have turned into regular dental clients not because of routine checkups as it is supposed to be but rather because of everlasting problems associated with artificial teeth especially removable dentures. From this it can arguably be concluded that, root canal treatment and associated crown rebuilding is treating and maintaining of natural tooth as opposed to implant which qualify to be called artificial tooth and thus, root canal treatment should be included under primary health care procedures and be given the priority it deserve.
Rukoma AM, (DDS, MDent)

WRONG BELIEFS ABOUT DENTAL CARE

WRONG BELIEFS ABOUT DENTAL PROCEDURES

By Dr. Augustine Mbehoma Rukom As news travels faster like speed of light through internet and phones, rumors, urban legends and wrong beliefs spread quickly too. That includes false beliefs about dental care. So I thought I would take a few moments to clear up Misconceptions/ Myths circulating. 1.FALSE: Brushing teeth several times and using too much force help to prevent tooth decay TRUTH: Typically brushing twice a day and in right manner using soft brush with less force is enough to keep your teeth clean. Actually brushing more often and using too much force can destroy/ erode the hard tooth substance leading to sensitivity, pain or even fracture. 2.FALSE: There’s no need to see a dentist if you don’t feel or see apparent dental problem TRUTH: No matter how beautiful or strong your teeth seem to be, a regular dental checkup is the most important thing you can do for your dental health, next to brushing and flossing. You need to have your teeth checked and cleaned professionally near gum line and places you can’t easily see. Also a tooth that looks healthy and white can still have cavities, problem with roots or any issues requiring treatment. A dentist can see these problems and it’s always better and cheaper to start treatment earlier. Remember diseases like HIV/ AIDS, Diabetes, Leukemia and many others manifests in the mouth earlier before the patients gets general symptoms. 3.FALSE: Do not eat anything when you are going for tooth extraction. TRUTH: Hunger can make you collapse during the tooth extraction process. Anxiety when coupled with less blood sugar can lead to less perfusion and hence collapse. This wrong belief is associated with general anesthesia were patients are not allowed to eat for certain period of time. In tooth extraction local anesthesia is used around the area of operation so does not have any systemic outcomes. 4.FALSE: do not extract a tooth or do a root canal treatment when you have a swelling especially abscess. TRUTH: tooth extraction or root canal treatment will help to establish drainage for pus to come out and take care of infection. Sometimes even without necessitating antibiotics and pain killers. Delay in seeking dental treatment may lead to serious spread of infection to other vital parts of the body like brain and chest. 5.FALSE: a pregnant woman is not supposed to have a tooth extraction or any dental treatment until after delivery. TRUTH: A pregnant woman is supposed to live a healthy life free from any type of infections. A good nutrition coupled with healthy teeth and gums will lead to a healthy mother and baby. It is dangerous for a pregnant woman to go without dental care during pregnancy as it can cause serious infections and undue stress and pain. Most gum diseases in pregnancy (esp. periodontal infections) may cause Preterm low birth weight babies. 6.FALSE: the sure way of treating toothache is extraction. TRUTH: There are a lot of treatment options for a diseased tooth than extraction e.g Root Canal Treatment. Tooth extraction as a treatment is only done when other means of treating the tooth are impossible and mostly due to delay in seeking dental treatment. Tooth extraction can lead to some problems like; decreased chewing ability, esthetic (beauty) impairment, speech impairment, jaw joint problems, disturbed teeth relationships. Artificial teeth are available for replacement but they are relatively expensive and care demanding. 7.FALSE: putting powder of pain killers like Aspirin, Panadol and Cafenol in the hole of decayed tooth help to stop pain. TRUTH: like in any other diseases, stopping pain without treating what is causing it is a temporary solution and actually makes the disease to progress further. Further more, these painkillers can burn soft tissues surrounding the tooth and also make the tooth brittle which can lead to difficult extraction 8.FALSE: Good teeth are inherited TRUTH: Genetics contribute very little to appearance and healthy of your teeth, keeping your teeth clean and visiting the dentist regularly are the important things to keep your teeth healthy. A similar oral health status in a family may be related to the same nutritional lifestyle. 9.FALSE: there is no need to worry about baby teeth as they will eventually fall out with time. TRUTH: Children need a good nutrition for good general health and teeth to enable them grow well. Baby teeth if not taken care of may cause pain which reduce chewing ability. Premature extractions lead to improper development of permanent teeth (malocclusion) with associated consequences such as; high risk decaying, beauty and jawing joint problems. 10.FALSE: Teeth eruption causes diarrhea TRUTH: Teeth eruption is a normal biological process and does not cause diarrhea. Teeth eruption Starts almost at the same stage of crawling and passive immunity from the mother is over while child own immunity is not yet mature. As a result of crawling the child may pick and eat anything (dirty or clean) within reach, when this is coupled with immature immunity diarrhea is likely to occur. 11.FALSE : A child born with teeth (neonatal teeth) or whose upper front teeth erupt before the lower teeth is a sign of bad lack in the family TRUTH: The two cases are abnormal like any abnormality of one or many organs/structures in some of individuals are no associated with bad luck like any other abnormalities.

TOBACCO AND ORAL HEALTH

By Rukoma AM, 2013 Introduction Tobacco use is the leading preventable cause of death worldwide. Approximately 6 million deaths related to tobacco use occur each year, including 600,000 from second-hand smoke. If current trends continue, according to the World Health Organization (WHO), by 2030, approximately 8 million persons will die each year from tobacco use, and 80% of those persons will reside in low- and middle-income countries (WHO, 2012) While it is easy to start smoking, it is very difficult to stop as it is addictive due to nicotine content which it contains naturally and additionally the one in spray to control tobacco bugs. Researches have shown that about 75% 0f those who smoke have tried to stop but failed. Things which contain tobacco can be classified into two forms, those which can be smoked and smokeless. Smoking things include; cigarette, cigar, pipe and hookah while smokeless things include; snuff, chew and snus. There many health problems related to tobacco but while mention those related to oral health which include:- • Stain teeth • Tooth decay • Gum recession • Bad breath • Oral cancer It is important to know that oral health also affects the health of our whole body Know let us look into each of the oral problems related to tobacco Teeth stains There many causes of teeth stain, but tobacco is the leading cause. But tobacco causes two types of staining on teeth. Initially, it accumulates on the surface like a brownish crud, as you see in the photo below. This superficial stain can be removed with a professional cleaning. But, over the years, some of the stain will soak into the teeth and makes the whole tooth turn a darker color. No toothpaste will remove this but tooth whitening. A light tobacco stain on teeth this is a heavier stain Tooth decay Individuals who use chewing tobacco have significantly more decay on the crowns and roots of their teeth than do non-tobacco users, according to a report presented at the annual meeting of the American Association for Dental Research. The study suggests that chewing tobacco may pose a cariogenic risk for all tooth surfaces and is potentially a two-pronged threat for tooth roots. There is good evidence, according to the investigators, that tobacco products in general can contribute to gum disease and therefore make roots vulnerable to decay. Furthermore, they say, chewing tobacco is processed to contain higher levels of sugar than other forms of tobacco, and the sugar can encourage bacteria to colonize and attack both the tooth crowns and exposed roots (Carrol; 2004). Gum recession Tobacco users are more likely to have sticky plaque on their teeth that is difficult to remove because of rough surface caused by stain, which can cause gum diseases and associate recession. Bad breath There are several reasons why people who smoke are far more likely to suffer from a particular type oral malodor called smoker's breath. The most immediate way that cigarettes cause bad breath is by leaving smoke particles in the throat and lungs. This effect is typical of nearly any tobacco product that involves inhaling smoke or rolling it around in the mouth. The smell of a freshly smoked cigarette can linger in the lungs for hours, hence the stale scent associated with smoker's breath. A 1968 report published in the journal Chemical reviews found that tobacco smoke contains more than 60 aromatic hydrocarbons, most of which are carcinogenic in addition to conveying a fragrance. A more recent study published in the Journal of Agricultural and Food Chemistry focused only on which compounds can be found in the saliva after smoking one-half of a cigar. Its authors determined that ethyl pyrrole, 2,3-dimethyl pyrazine and 2-ethyl pyridine are some of the most pungent chemicals found in what is often referred to as cigar breath. They added that many such compounds are generated during the combustion of tobacco and its chemical additives (Katz; 2011). Remember my recent post in mabadilikotanzania@googlegroup.com where I narrated that, I almost failed to finish an hour minor operation because of bad breath from the patient. Oral cancer Tobacco use is known as a major risk factor for oral and other cancers. All tobacco products, including cigarettes, cigars, pipe tobacco, chewing tobacco, and snuff, contain toxins (poisonous substances), carcinogens (cancer-causing agents), and nicotine (an addictive substance). Each tobacco product is linked to an increased risk for specific cancers: About 80 percent of people with oral cancers use tobacco. Cigarettes contain more than 60 cancer-causing agents while more than 28 cancer-causing chemicals have been found in smokeless tobacco. The American Cancer Society and the American Lung Association offer the following tips to persons who use tobacco products and are trying to quit: • Think about why you want to quit. • Pick a stress-free time to quit. • Ask for support and encouragement from family, friends, and colleagues. • Start doing some exercise or activity each day to relieve stress and improve your health. • Get plenty of rest and eat a well-balanced diet. • Join a stop-smoking program, or other support group. Conclusion Despite the fact that I have touched only the effects tobacco in the oral cavity its effect on general body health can not be overemphasized. More efforts, both at individual level and community at large should be enhanced to stop this killer source of income tobacco.

TOOTH AN IMPORTANT BUT NEGLECTED PART OF THE BODY

OUTCOME OF NON-SURGICAL ROOT CANAL TREATMENT AT MUHIMBILI NATIONAL HSPITAL, TANZANIA

Outcome of non surgical root canal treatment at muhimbili national hospital, tanzania

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