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University of Dental Medicine, Yangon Bulletin SINCE 1964 Vol. 1, No.3 www.udmyangon-edu.com AN EMERGING EPIDEMIC IN DENTISTRY: CONTENTS An emerging epidemic in (DRY MOUTH) 1 AN Thein EMERGING EPIDEMIC IN DENTISTRY: Zaw Moe Dentistry: (Dry Mouth) Orthodontic Reposition of Traumatic Intruded Maxillary Right Incisors and Canine January, 2017 3 (DRY MOUTH) With the advent of the medicine and increase in the elderly population, there are escalating numbers in patients suffering from dry mouth. In a systematic review, the prevalence of dry mouth ranged from 8% to 42%. Basically, As knowledge is an unique powerful tool for continuing medical education, the aim of circulation of this bulletin is to share the information to our colleagues what we are doing; what we can do and what will be done in near future for our profession. This bulletin is going to be published every two months and The Editorial Committee cordially invites academic contributions about research activities and findings in the field of dentistry. this condition is a problem of older people; however, it was Please address all your correspondence to: subdivided into drugs, irradiation and graft versus host diseases. Prof. Zaw Moe Thein Professor/Head Department of Oral Medicine University of Dental Medicine, Yangon Email: [email protected] Phone: 0943134014 explored in daily basis with entire patient population, regardless of age. Dry mouth is commonly found in smokers, people with multiple medications, anyone with autoimmune disease, people underwent for head and neck cancer therapy, mouth breathers and old aged people. Two main causes of dry mouth are iatrogenic and diseases affecting on salivary glands. The former could be The latter includes dehydration, psychogenic, Sjögren syndrome, sarcoidosis, salivary gland aplasia and certain systemic diseases for instance, Parkinson’s and diabetes. For dentist, its diagnosis is based on clinical presentations; however, investigations are indicated for proper The Editorial Committee Email: [email protected] Phone: 01-571270, 01-570847, 01-571273 Fax: 01-571270, 01-571767 Address: No. 582, Than Thu Mar Road, Thut Wine Gyi Ward, Thingangyun Township, Yangon, Myanmar management. Blood tests (ESR, SS-A and SS-B antibodies), eye tests (eg. Schirmer’s test), urinalysis, salivary flow rate, labial salivary gland biopsy, imaging including sialography, scintiscanning, and ultrasound are generally essential based on the history and clinical presentation of individual patient. Management of dry mouth must be initiated with Restricted for Internal Use Only educating the patient to avoid factors that may increase dryness, 1 and to keep the mouth moist. Any underlying cause of dry mouth should if possible be rectified; for instance, drugs caused dry mouth may be changed for an alternative, and causes such as diabetes should be treated. To keep the dry mouth moist, here are some useful tips. Drink enough water, and sip on water and other non-sugary fluid throughout the day. Rinse the mouth with water after meals. Better keep the water at bedside. Stimulate saliva with sugar-free chewing gum, or diabetic sweets. Eat soft creamy soups (eg. casseroles, soups) or cold food with a high liquid content (eg. melon, grapes or ice cream) instead of dry or hard crunchy food. Moisten food with gravies, sauces, extra oil, margarine, salad dressing, sour cream, mayonnaise and yogurt. Avoid spices, alcohol (including in mouthwash), smoking, caffeine (coffee and some soft drinks such as Colas) and drugs, unless they are essential (eg. Antidepressants). Protect the lip with a lip slave or petroleum jelly (eg. Vaseline). Avoid hot dry environment (consider humidifier for the bedroom). References: Joanna and Thomson (2015) SDJ 36: 12-17, Scully and Felix (2005) BDJ 199: 423-427 2 ORTHODONTIC REPOSITION OF TRAUMATIC INTRUDED MAXILLARY RIGHT INCISORS AND CANINE a Toe Pyi Aung, aAung Myat Shein and bHla Hla Yee a Demonstrator, and b Professor and Head, Department of Orthodontics ,University of Dental Medicine, Yangon A 15 year-old male patient reported with intruded maxillary right central incisor, lateral incisor and canine due to accidental hitting with hand water pump. Bruising on the lower lip was seen in extraoral examination. The intraoral examination revealed lacerated lower lip, gingival inflammation, bleeding from gingival sulcus around these intruded teeth. 4 - 5 mm intrusion of maxillary right central incisor, 3 - 4 mm intrusion of lateral incisor and about 1 mm intrusion of maxillary right canine were seen. There were grade III mobility at central and lateral incisor and grade II mobility at canine. There was no alveolar bone fracture around intruded teeth. There was no relevant medical and dental history. The radiographic examinat ion showed intrusion of maxillary right permanent central incisor; lateral incisor and canine with complete root formation were seen. The incisor edges of the intruded central and lateral incisors were located at the half of the crown of the adjacent teeth. The patient had taken orthodontic treatment 3 days after injury. Orthodontic treatment plan is orthodontic reposition of the traumatic intruded teeth. Bondable buccal tube and standard edgewise bracket placement was done 3 days after injury and 0.012 inch niti upper arch-wire was used for initial alignment and leveling. The vitality, discoloration and mobility of traumatized intruded teeth were checked at every appointment. Vitality of these teeth was still vital and no discoloration was seen after 1 month of orthodontic treatment. But mobility of these teeth was still present. 2 mm extrusion of intruded teeth was seen one month after initial alignment but spacing between two upper central incisors was found about 2 mm. 0.012 inch niti upper arch wire was changed with 0.014 inch niti upper arch wire for better alignment. On the next appointment, intruded teeth were repositioned to nearly same level with contra lateral teeth and mobility was reduced into grade II. Vitality and discoloration were not changed. 0.014 inch niti upper arch wire was changed with 0.016 inch niti upper arch wire. In orthodontic clinical examination, skeletal pattern is Class II with average facial height and mandibular plane angle. The overjet is 4 mm. 3 Final space closure was done by using power At 4 month after injury, maxillary right canine and lateral incisor were same level with adjacent teeth and mobility was not seen. Central incisor had very slight mobility and close to the level of contralateral central incisor. There were no changes in vitality and color of traumatic intruded teeth. Median diastema was found between two central incisors. chain. All the bondable buccal tube and brackets were removed after one year. 0.016 inch niti upper wire was changed with 0.016 X 0.022 stainless steel upper archwire. The closure of median diastema was done by reducing the overjet by using intrusion and retraction arch spring. Possible complications Traumatic intruded teeth may be nonvital , root resorption and ankylosis. (Proffit ,2013) ok d Y ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------4