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Question 1: What are the real and potential side effects of strong analgesics commonly

used in dentistry?

Answer: Analgesics used in dentistry are

Paracetamol

NSAIDS Opioids

Paracetamol is commonly used but is not a strong analgesic. It has very few side effectsand is very safe drug. Liver toxicity can occur due to overdose of paracetamol.

NASAIDs are the most commonly used strong analgesics in dentistry.

Common drugs include Ibuprofen, Aspirin etc.1. Most common side effect is gastric irritation and peptic ulcers. Ulcers usually follow

the chronic use of NSAIDs. Mild gastric irritation is very common. Drugs combine with

NSAID to reduce the gastric irritation include

Antacids Proton pump inhibitors e.g. omeprazole

H2 antagonists e.g. ranitidine2. Reyes Syndrome It is the potential side effect of Aspirin when given to children.

3. Patient with blood coagulation disorders can have excess bleeding if taking Aspirin.

Aspirin has anti platelet property.4. Asthmatic attack may be precipitated in allergic patients taking NSAIDs.

5. Hepatic toxicity in overdose situations.

6. Other common side effects like nausea, vomiting, diarrhoea etc

Opioids are very strong analgesics and very less used in dentistry.

E.g. Morphine, codeine, tramadol etc

Strong opioids like morphine are given only in very painful conditions like cancer, post

operative severe pain, severe trauma patients etc. Side effects include euphoria, addiction,

constipation, diarrhoea, respiratory depression etc. Withdrawl of morphine leads towithdrawl symptoms hence it is not given for chronic uses.

Codeine is usually prescribed in combination with paracetamol for severe pain. Codeine

has less side effects compared to other opioids. Common are diarrhoea, constipation etc.

Question 2: A young patient with deep carious lesion in first molar. Caries is deep but not

reaching the pulp as seen in IOPA. Occasional pain present. Hot and cold sensitivitypresent but pain on percussion is absent. Patient doesnt want to lose the tooth. What

treatment you will do to the patient? Also explain the possible sequel of your treatment

options?

Answer: Following observations can be drawn from the given case

Deep caries in first molar

IOPA shows caries near the pulp but not involving the pulp.

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Sensitivity to hot and cold with occasional pain.

Pain on percussion absent

Based on these observations a provisional diagnosis of Deep caries near the pulp can be

drawn.

Patient should be advised in advance about the possibility of pulp involvement which isless likely but cannot be excluded.

In the treatment part

Remove grossly all the caries with high speed handpiece and bur. Remaining soft caries should be removed with slow speed handpiece and large round

bur or spoon excavator. Finish the cavity preparation.

Leave the remaining soft caries adjacent to the pulp horn as there are chances of pulp

exposure. Put the quick setting calcium hydroxide like dycal on the remaining soft cariesas a base. This is the method of indirect pulp capping.

If the pulp horn is exposed during cavity preparation then put dycal directly on exposed

pulp as direct pulp capping.

Fill the cavity with Intermediate restorative material like GIC or IRM etc. Ask the patient for follow up after 2 to 3 months. Check the history of sensitivity and

pain. Also take the IOPA to confirm the non involvement of pulp. Do the permanent restoration with amalgam or composite etc.

Advice the patient about the need for Tooth crown as the tooth structure is very weak

due to carious destruction.Possible Sequel to the treatment

Favourable sequel is that the pulp capping will make a calcific barrier between the pulp

and soft caries by mineralizing the soft caries. This will save the tooth without the needof RCT. A full crown can be given in future.

Unfavourable sequel is that the soft caries will involve the pulp. In that case, root canaltreatment is needed to save the tooth. This is followed by making the crown for tooth as

the tooth structure is weakened. It is very important that patient should be advised about

this unfavourable sequel.

Question 3: A female pt with the C/o of spacing between maxillary incisors. Spacing is

increasing from last 1 year. Pt had swollen gums and bleeding during pregnancy 3 years

back and didnt attend the clinic since then. What is ur diagnosis and treatment plan?What further tests you will recommend? What treatment options will u give t the patients

for space closure?

Answer: The following observations can be drawn from the history, clinical picture, perio

charting and OPG

Spacing in the anterior teeth which is increasing from past 1 year. Deep pockets in the majority of the dentition.

Considerable bone loss present.

Mobility of the teeth present.

Generalised bleeding on probing present.

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Patient didnt attend the clinic since 3 years.

Based on these observations a diagnosis of Chronic generalised periodontitis can bedrawn.

Treatment plan will include Motivation of the patient about the oral hygiene and regular timely visits to the dentist.

Scaling and root planning of the teeth.

Evaluation of the overall dental health. Placement of restorations or endodontic work if required.

Prescription of antibiotics and chlorhexidine mouth washes if required.

Refer to periodontist if perio surgery is reuired and if patient is willing to go for that.

Regular follow ups and reminder of the strict oral hygiene maintainance.

Other tests required may include

Vitality test of the teeth with very deep pockets as if they may be non vital.

IOPA of the specific tooth to evaluate the remaining bone accurately etc.

Treatment options for space closure may include Anterior Porcelain or composite veneers will give the best results

Orthodontic closure if the sufficient bone support is present

Full crowns of large mesio-distal dimentions Direct composite aesthetic makeovers