A Good Day

These are my cases from Monday. This is how I like my cases to look. Nice open canals, obturation to 0.5mm of radiographic apex & small puff of extruded sealer confirming patency. I do have a couple of little backfill voids. All cases done using gates glidden, .06 ISO sized profiles, .06 tapered gutta percha using a warm vertical condensation technique.

AAE's Updated Antibiotic Prophylaxis Guidelines

As many of you know, on April 19th, 2007, the American Heart Association announced a major change in the guidelines for antibiotic prophylaxis to prevent infective endocarditis in certain dental patients. (Click here to see the official publication)

The AAE has also released it's updated guidelines relating to dental/endodontic procedures. These published guidelines were prepared by the AAE Clinical Practice Committee and are based on the ADA guidelines. (click here to see the ADA's official statement)

The new guidelines note that the practice of premedicating patients before a dental procedure is not longer recommended EXCEPT for patients with the highest risk of adverse outcomes resulting from bacterial endocarditis.

Premedication for patients with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis or congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The American Academy of Orthopaedic Surgeons have made no changes to their recommendations for patients with joint replacement. This means that those patients should continue to take antibiotics prior to dental procedures. (click here to see the official statement from AAOS)

Idiopathic Osteoslerosis

This patient presents as a 30 year old, white female. Asymptomatic tooth #19 was identified in a routine radiographic exam. Clinical findings: normal to thermal testing, normal to percussion, normal to probing, slight pain to biting on lingual cusps. DX: Normal pulp & periapex

The radiopacent area on the mesial root is noted and diagnosed as an idiopathic osteosclerosis. As a quick review, this is a designation for a uniformly radiopacent lesion that cannot be attributed to any inflammatory, dysplastic or neoplastic source. They may also be found in other locations. Most commonly found in patients between 20 & 40 years old and may have a female predilection. Also appears more commonly in black population. 90% of cases are seen in the mandible, usually in the 2nd premolar/molar area.

No treatment is indicated. Little change is usually seen in these lesions.

Another term that is often used interchangably is condensing osteitis or focal chronic sclerosing osteomyelitis. While looking identical, these lesions are associated with necrotic pulps and are believed to be a result of chronic, low grade inflammation. The interchangable use of these terms can be somewhat confusing. However, accurate pulpal diagnosis will help determine whether the radiolucent lesion is the result of inflammation caused by a necrotic pulp (condensing osteitis) or truly idiopathic (unknown) origin (idiopathic osteosclerosis).

(Source: Neville, Damm, Allen & Bouquot. Oral & Maxillofacial Pathology, 445-446, 1995)