Super Fruit for Healthy Eyes

Eyes are the most important part of the body, without eyes, we will be a little mean. Eyes are organs that always be aware of their health so that we can smoothly activities Maintain eye health, not only by using glasses, but we also need to maintain the health of the eye. Custody of the is to eat foods and fruits are important for the eyes. Many fruits are important for eye health. These foods must be considered in the diet, so that our eyes become healthier.

Apricot - Nutrients in apricots can help protect the heart and eyes, as well as provide the disease-fighting effects of fibre. The high beta-carotene content of apricots makes them important heart health foods. Apricots contain nutrients such as vitamin A that promote good vision. Vitamin A, a powerful antioxidant, quenches free radical damage to cells and tissues. Free radical damage can injure the eyes' lenses. The degenerative effect of free radicals, or oxidative stress, may lead to cataracts or damage the blood supply to the eyes and cause macular degeneration.

Papaya - Papaya helps in keeping eyes bright and protected. Papaya is a source of beta-carotene along with carotenoids lutein and zeaxanthin that protects against high intensity blue light and reduces the onset of age related macular degeneration (AMRD). It is also found to help against cataract. For a natural way to brighten your eyes, eat papaya. It's rich in the enzyme papain which helps nourish and support the creation of bright eyes and healthy skin, says Snyder. Papaya also contains high concentrations of vitamins A and C, which repair the skin, keeping it youthful. Eat papaya alone or throw them in a fruit salad.

Guava -Guava responsible for good eye sight. Guava is rich in retinal, so if you don’t like carrots, you can try a guava for improving  your eyesight. Guava contains good amount of Vitamin A. As Vitamin A is antioxidants, so it becomes highly preferred food to be consumed to improve eye health. Due to high antioxidants figs protect eyes from free radicals. Also it effective to prevent retinal damage caused due to free radicals. Thus it improves eye vision and protect from cataract or oracular degeneration.

Orange - Oranges are good for your vision because they're an excellent source of vitamin C and potassium, and they also contain fiber, calcium and folate. Oranges will do more than help keep your eyes healthy. The folate found in oranges, other fruits and green leafy vegetables is essential for early neurological development in embryos, so women who are pregnant or might become pregnant need to get plenty of folate from their foods.The potassium and fiber will help to keep your heart healthy and the vitamin C is important for immune system function, strong connective tissue and healthy blood vessels.With their tough protective peels, oranges make great take-along snacks. You can also enjoy a glass of orange juice any time.

Mango – One cup of sliced mango supplies 25 percent of the needed daily value of vitamin A, which promotes good eye health. It increases eye vision and protect from free radicals. As it is a rich source of other antioxidants, thus it is highly effective to prevent degeneration of the eye retina. So mango protect from cataract and macular degeneration. Mangoes help in promoting good eye sight, fights dry eyes and also prevent night blindness.

peach – can be improved by eating peaches due to the carotenoids present. They help protect the eyes from harmful sunlight and slow the progression of eye diseases like night blindness and cataracts. Beta carotene is responsible for eye health. Lots of people around the world are in sight problem for lacking of beta carotene. Peach fruit can be their hope. Peaches are a rich source of beta carotene that improves vision health by increasing circulation of blood in the all body parts.

Strawberry – Strawberries are helpful for healthy eyes because they're packed with vitamin C, and they also offer foliate a B vitamin, fiber, and an array of photochemical, some of which may help to prevent cancer. Vitamin C was one of the nutrients used in the Age-Related Eye Disease Study -- a major clinical trial sponsored by the National Eye Institute. Vitamin C is an antioxidant, and your body needs it to make connective tissue and for healthy blood vessels, including those found in your eyes. Strawberries make a great snack just as they are, or they can also be topped with a dab of whipped cream and chopped nuts for a healthy sweet treat. Or add strawberry slices to a bowl of oatmeal or on top of a salad. Antioxidants, Vitamin C, flavonoids, Phenolic Phytochemicals and Elagic Acid in strawberry protects against the free radicals from the sun’s UV-rays. 
Avocado – Avocados contain more carotenoid lutein than many common fruits, which defend against macular degeneration and cataracts, and slow age-related eye disease. Avocado is an excellent source of carotenoid lutein, which known to help protect against age-related macular degeneration and cataracts. Eating avocados can increase your levels of Lutein which protects against macular degeneration and the formation of cataracts. Further research is needed to determine exactly what it is that may assist in eye protection.

Rock Melon – Rock Melon is rich in beta carotene which help in maintaining healthy eyesight. On absorption by the body, these beta carotene get converted into Vitamin A which helps in preventing cataract and improving vision. Studies have proved that regular consumption of foods having high vitamin content can reduce the risk of developing cataracts by 40%. The orange fleshy interior of the cantaloupe gets its color from the beta-carotenes it contains. Beta-carotenes are important as antioxidants and can be converted to vitamin A - an important vitamin for healthy vision. Not only does a diet rich in vitamin A reduce the risk of cataracts and macular degeneration of the eyes, it also improves night vision and prevents uncomfortable dry eyes.

Grapes - Healthy vision can be achieved by the intake of grapes. Antioxidants present in grapes help in reducing the occurrence of diseases like macular degeneration. These antioxidants also prevent the process of oxidation and vision loss. Cataracts can also be prevented by it. The flavonol compounds in grape seeds are effective for the treatment of night blindness, retinal disorders and vision improvement. "Eating grapes may slow or prevent the onset of age-related macular

The Benefits of Raspberry Leaf

Raspberries on display at roadside fruit stands have long been a harbinger for summer and hot weather. Their slightly tart and unique flavour are favourites in jams, cold drinks, and desserts. However, our focus is not on the fruit of this marvelous plant. Often ignored, the leaf of red raspberry has a long medicinal history that is slowly reviving today.

When you mention red raspberry leaf, or “RRL,” most people immediately think of pregnancy. After all, it was once consumed as an infusion every day of pregnancy in traditional societies. This is because the chemical Fragrine has a toning effect on smooth muscles, including the uterus. It simultaneously strengthens and relaxes the uterine muscles, allowing for more efficient contractions during labour but also for an easing of menstrual cramps. It is said to prevent miscarriage, enrich breastmilk, and prevent hemorrhage. For optimal benefits, drink regularly.

Because of raspberry leaf’s healing benefit to smooth muscles, the digestive system may also benefit from its consumption, both for constipation and diarrhoea. Tannins in RRL tea also provide ease to digestive cramps. The tea was used to treat nausea by Native Americans. Medicinally, RRL can also be used in treating urinary tract infections, kidney infections, and even be used as an eyelash due to its gentle, antibacterial nature.

RRL is also rich in nutrients, such as calcium, vitamin C, vitamin E, phosphorus and potassium. For these reasons, those with high blood pressure or dental decay would do well to add this green to their diet as a tea or in smoothies.

If this isn’t enough good news, consider that raspberries grow wild all throughout North America, on roadsides and along fields. They sprout fresh greens throughout most of the year, so young and tender leaves are almost always available, even if the berries are not.

Add to salads, green smoothies, make a warm or iced tea, or even wrap around the berries or a banana for a snack! For tea, mix 1tsp for every cup, and allow to steep at least 15 minutes.

AYURVEDA AND MEMORY ENHANCEMENT

From ancient times, AYURVEDA has been known to be the storehouse of a number of herbs which can help in increasing the memory capacity of a person.  This method of medicinal treatment is highly effective and is recognized all over the world to be a truly powerful medium of treatment.    It has various memory enhancing remedies which can go a long way to regain your lost memory functions.

According to Ayurvedic literature, the human body is made up of three energies called as Tridoshas.  These tridoshas are called as Vata, Pitta and Kapha.  In order that the body maintains its balance in harmony with nature, three doshas play a very vital part. 

To improve your memory Ayurveda has prescribed some special herbs, the daily usage of which can improve your memory cells and enhance your memory storing capacity.  All these herbs are safe from any side-effects and as such can be used by virtually any person.  These herbs are the perfect memory enhancers for you.

·        Brahmi – This is the most common herb used as a tonic for memory enhancement.  It improves the brain power and helps to make your memory sharp and clear.  Brahmi contains chemicals which help in the protein synthesis of the brain which in turn clears the mental capacity of a person.  It is also used to enhance the mental powers.  This herb also acts as an anti depressant and anti-anxiety agent and as such Brahmi Oil is used as a head massage for relaxing the mind. 

·        Ginkgo Biloba – This is another important herb prescribed in Ayurveda as a memory enhancer.  Ginkgo Biloba helps in improving the blood circulation in the central nervous system resulting in the proper functioning of the brain.  This herb is also used in the treatment of Amnesia and Alzheimer’s disease.  Ginkgo repairs the damaged brain cells and helps in the overall development and functioning of the brain.  A must-have medicine for memory.

·        Ashwagandha – Aswagandha acts as a stress buster as well as revitalizer for the brain and as such helps in keep the brain active and calm.  It is mainly used in soothing the brain and keeping it cool for better performance.  It also increases the memory power and enhances the brain and its nerves. 

·        Gotu Kola – The main function of this herb Gotu Kola is to improve the blood circulation in the body as well as the brain.  It energies the person as well as protects the brain cells.  Its most important function is to enhance the brain power and enhance its capacity.  It is also used for improving concentration levels as well as memory.

·        Muleti – The perfect herb to rejuvenate the brain.  It is mainly used as a stress relieving medicinal herb due to its calming effect.  This helps in the overall brain development keeping it calm and cool.  It also improves the blood circulation in the nervous system. Muleti is an important ingredient in any brain enhancing tonics given to students and children for memory improvement.

·        Vacha –  Also known as Sweet flag, Vacha is another memory enhancer which is used to improve brain functioning.  The roots of vacha herb contain some essential oils and terpenoids which help in giving that sedative action that strengthen the nervous system.  It gives instant results in terms of improving the memory as is prescribed for persons suffering from amnesia and other memory disorders.

·        Malkangani – This herb, also known as the intellect tree, is used in Ayurveda as a sedative and antidepressant for mental treatment.  It has been used as a brain tonic since ancient times and is mainly used for persons suffering from memory loss.  Malkangani has neuroprotective actions in it to improve memory loss.

·        Shankhpushpi – This is the most common and most used Ayurvedic Herb.  Shankhpushpi is said to make the memory sharp and is a natural memory enhancer.  It has been used from ancient times in India as a memory tonic as well as a medicinal herb to relieve mental stress as well as controlling blood pressure.  People use this herb in India for children during their exams. 

·        Medhya Dravya – This herb, or Licorice plant (Glycerrhiza glabra) is a new addition to Ayurvedic medicine for memory enhancement.  It is said to have a number of benefits along with memory sharpness such as prevention of cough and cold, improving eye sights and cure against gastric ulcers.  It is said to be the best herb which can improve your memory considerably.

·        Giloy – Giloy is another herb which can improve the dying brain cells and rejuvenate the nervous system.  It is also used as a memory enhancing herb in Ayurveda.  It is said to repair the damaged cells of the brain.

These 10 Ayurvedic Herbs for Memory can surely help in improving your memory as well as enhance the brain functioning. 

Vitamins for Pregnancy

A healthy diet contains most of the necessary vitamins. These vitamins give the body essential nutrients that are required, especially during pregnancy. Also, it helps pregnant women to stay healthy and repair damages, if there are any. According to a recent study, women with poor diets before pregnancy are more likely to give birth prematurely than women who have healthy diets. So a balanced healthy diet is required during pregnancy to ensure good health of the mother and baby.  The food for a healthy diet during pregnancy should include fruits and vegetables, dairy products, poultry, whole grains (breads and pastas), beans, fish with a low mercury level, and lean red meat. This article discusses the role of vitamins during pregnancy and various food varieties that contain those vitamins. It would help expecting mothers to include the right variety of food in their meals.

Role of Vitamins in Pregnancy

Vitamins help in the normal functioning of the human body. It becomes all the more important during pregnancy. The diet of a pregnant woman should comprise different food varieties, including vitamins,minerals, proteins, fats, and carbohydrates. These provide proper nutrients required for the development of the baby and the health of pregnant women. However, it is also very important to take appropriate amounts of these vitamins and minerals during pregnancy.

Vitamin A and Beta Carotene: Vitamin A and beta carotene both help in the development of bones and teeth. Approximately 770 mcg of vitamin A and beta carotene is required by pregnant women. It is mainly present in milk,eggs, potatoes, carrots, pumpkin, cantaloupe,spinach, broccoli, green and yellow/orange vegetables, and yellow/orange fruits. Other foods such assalmon, as well as fortified breakfastcereals, are a good source of vitamin A. Research suggests that vitamin A deficiency is very rare in women and newly born babies. This vitamin is known for aiding a healthy reproductive system. For malnourished women, vitamin A is effective in reducing problems during or after pregnancy. A deficiency of vitamin A may causexerophthalmia in pregnant women and increase the risk of anemia, and may lead to slow infant growth.

Vitamin B1 or Thiamin: Vitamin B1 or thiamin is required to increase energy levels and regulating the nervous system. A deficiency of this vitamin in pregnant women can cause Infantile Beriberi in the newborn baby. Babies are usually affected with this disease through their mother’s milk. Low levels of vitamin B1 may also cause peripheral neuritis or inflammation of the nerves outside of the brain. It is found in whole grain cereals, wheat germ, fortified cereals, kidney beans, Brussels sprouts, eggplant, tomatoes, spinach,mushrooms, green peas, nuts, legumes, pasta, rice, eggs, organ meats, and pork. Approximately 1.4 mg of vitamin B1 is required by pregnant women. Do not overcook your food and don’t refrigerate it for a longer duration, since it can destroy this vitamin.

Vitamin B2 or Riboflavin: Vitamin B2, also known as riboflavin, maintains healthy skin, good eyesight, and proper energy levels. It is mainly found in dairy products, eggs, meat, fish, poultry, broccoli, avocado, mushrooms, dried peas, millet, beans, green leafy vegetables like spinach and asparagus, and fortified cereals. Approximately 1.4 mg of vitamin B2 is required by pregnant women. This vitamin is very important for a healthy pregnancy, as it ensures the development of the reproductive organs and body tissues.

Vitamin B3 or Niacin: Vitamin B3 is also known as niacin. Approximately 18 mg of vitamin B3 is required during pregnancy. It not only promotes the nerves and digestion, but also helps to maintain healthy skin.Vitamin B3  is found mainly in high protein food, legumes, curd, brown rice, potatoes, eggs, peanuts, fortified cereals, brewers’ yeast, cheese, breads, barley, oats, fish, meat, and milk.

Vitamin B6 or Pyridoxine: Vitamin B6 (pyridoxine) helps pregnant women to overcome morning sickness, nausea, and vomiting. It helps to form RBC (Red Blood Cells). It also helps in brain development of the baby during pregnancy and also helps in improving the immune system. Vitamin B6 is present in eggs, fish, poultry, pork, liver, soybeans, peas, beans, broccoli, carrots, cantaloupe, cabbage, cauliflower, carrots, soya bean, spinach, banana, sunflower seeds, whole grains, wheat germ, cereals, brown rice, peanuts, oats, walnuts, and bran. Starchy vegetables, including potatoes and non-citrus fruits, are also among the major sources of vitamin B6. Approximately 1.9 mg of vitamin B6 is required by pregnant women.

Vitamin B9 or Folic Acid or Folate: Vitamin B9 helps to prevent NTD (Neural Tube Defects) such as spina bifida. A deficiency of folate may lead to abnormalities in the mother as well as the baby. It also helps to support the placenta. Deficiency of folate can lead to anemia, including symptoms such as headaches, shortness of breath, weakness, fatigue, palpitations, irritability, and difficulty in concentrating. Folic acid is found in green leafy vegetables such as spinach and other foods such as broccoli, mushrooms,beets, cauliflower, peas, beans, legumes, margarines, breads, brown rice, brewers’ yeast, strawberries, orange,orange juice, banana, pasta, nuts, and fortified cereals. Approximately 400 – 600 mcg of folic acid is required by pregnant women. Folic acid should be taken before conception.

Vitamin B12: Vitamin B12helps in the neurologicaldevelopment of the unborn baby. It also helps in the formation of blood cells. Deficiency of this vitamin during pregnancy may cause health issues in both the infant and the mother. Some of these include intra-uterine growth, resistance to insulin (for children who are 6 yrs. old), poor brain development, and anemia. Other abnormalities such as Neural Tube Defects (NTD) in the infant or even pre-term delivery may be caused due to a deficiency of this vitamin. Animal products, dairy products such as milk, yoghurt, tuna, trout fish, beef, ham, and poultry are some of the best sources of vitamin B12. Approximately 2.6 mcg of this vitamin is required during pregnancy.

Vitamin C: Vitamin C helps to increase immunity in the body. Also, it helps the body to absorb iron. Moreover, it is an antioxidant that protects the tissues from damage. Some of the food varieties that are rich in vitamin C are strawberries, papaya, broccoli, green beans, tomatoes, potatoes, and bell peppers. Citrus fruits mainly contain vitamin C. Approximately 80 to 85 mg of vitamin C is required by pregnant women. A lack of vitamin C can cause Barlow disease in the newborn baby.

Vitamin D: Vitamin D is the anti-rachitic vitamin that helps in the formation of bones and teeth. It helps the body to use calcium and phosphorus and thus safeguarding mother and the fetus. Approximately 5mcg of vitamin D is required by the pregnant women. It is mainly found in milk, egg, meat, margarine, soy products, powdered milk, fish (especially fatty fish), and natural sunlight.

Vitamin E: Vitamin E is known for its antioxidant properties. It is used by cells for carrying out vital functions of the body. It helps to strengthen the immune system and promotes the widening of blood vessels. It is very useful for the treatment of neo-natal jaundice, IUGR (Intra Uterine Growth Retardation), and toxemia of pregnancy. Approximately 15 mg of vitamin E is required by pregnant women. It is mainly found in fortified cereals, vegetable oil, spinach, wheat germ, and nuts.

Vitamin K: Vitamin K is useful in treating blood clotting problems. It helps in preventing neonatal hemorrhaging in newborn babies as well. Leafy green vegetables, sprouts, cabbage, broccoli, meat, fish, and eggs are good sources of Vitamin K. Approximately 90 mcg of vitamin K is required by pregnant women.

The intake of the vitamins listed above will help in healthy pregnancy and proper growth and development of the unborn baby. However, higher amounts of these vitamins without a healthcare professional’s guidance should be avoided.

Apart from vitamins, other important minerals required during pregnancy include:

Iron: Iron reduces the risk of maternal anemia, low birth weight, and iron deficiency. It also prevents premature delivery, low birth weight, developmental delays, and cognitive impairment. Research studies suggest that approximately 27 mg of iron is required by pregnant women. It is mainly found in meat,chicken liver, tuna, pork,oysters, beans, oatmeal, tofu, spinach, turnip, sprouts, broccoli, lentils, legumes, breads, and soy beans,.

Calcium: Calcium is required by pregnant women, since it helps to form strong bones and teeth. Also, it helps in the functioning of the nerves and muscles and prevents blood from clotting. Approximately 1000 – 1300 mg of calcium is required by pregnant women. Calcium is present in dairy products (such as milk, yoghurt, and cheddar cheese), tofu,  juices, nuts, cereals, bread, black-eyed peas, green peas, oysters, and calcium-fortified foods such as soy milk, green leafy vegetables such as spinach, broccoli, and canned fish with bones.

Protein: Proteins help to repair the cells and also help in the production of amino acids. They are required by the body to maintain good health, healthy bones, skin, and muscles. Proteins are also present in eggs, meat, animal foods, dairy products, poultry, beans, nuts, legumes, and vegetable burgers. Approximately 71 mg of protein is required by pregnant women.

Zinc: Zinc is among the nutrients that are required by the human body to maintain good health. It is required during pregnancy and infancy for proper growth and development. Zinc has wound healing properties and it plays a key role in developing proper senses of smell and taste.  Deficiency of zinc during pregnancy can lead to a poor immune system and even poorer pregnancy outcome. Zinc is present in fortified cereals, oats, nuts, red meat, poultry, whole grains, oysters, turnip, ginger roots, peas, beans, pumpkin seeds, peanuts, and dairy products. As per the research study, approximately 8 mg of zinc is required by pregnant women.

Do You Need Vitamin Supplements?

It is a good idea to include a large variety of foods and maintain a balanced diet. This would help you to receive all the nutrients required during pregnancy. Vitamin supplements are beneficial, but always check with your doctor before taking them. Remember, a healthy diet is of utmost importance. Any supplements taken cannot replace a healthy diet. They work best only when taken along with a healthy diet in order to ensure that the pregnant woman is receiving all of her required daily nutrients.

Management of severely curved roots

Management of severely curved roots

Preparation of curved canals presents one of the greatest challenges in endododontics.  Improper management of those cases can lead to undersirable outcomes such as ledges, blockages, perforations, apical transportation and instrument separation.

To avoid the unwanted procedure errors, it is important to have a good understanding of  the root canal anatomy using properly taken radiographs.  To accurately determine the degree of the canal curvature, a straight-on radiograph with minimal distortion is essential.  Additional angle radiographs also elucidates useful information.  However, the conventional dental radiograph is limited because it can only tell the curvatures in the mesio-distal plane, but not the curvature in bucco-lingual plane.  Recently, cone beam CT (CBCT) radiograph was introduced to dentistry, and it might be a helpful tool in determining the actual canal curvature.

Proper instrumentation protocol is also important in preventing the procedure errors.  A successful endodontic therapy starts with access preparation.  The size and shape of the access cavity should be modified  based on the degree of curvature of canals so that straight-line access to the canals can be achieved.  Properly prepared access will eliminate many frustrations during the canal instrumentation.  The first file introduced in to the canal should be a smallest file such as #06.02, #08.02, or #10.02 K-type file.  Careful observation of the file after removing it from the canal can often elucidate many critical information regarding the canal curvature.  All hand files placed in to the canal should be pre-curved so that it would follow the original shape of the canal and prevent procedural errors such as ledge formation or apical transportation.  Excessive use of chelating agent such as EDTA or citric acid should be avoided because it tends to soften the dentin and increases the chance of ledge, perforation, or apical transportation.  Canal patency should be obtained at least up to #15.02 or #20.02 to provide a gliding path to the NiTi rotary file.  Pre-mature use of rotary file can lead to its separation.  Excessive reaming action with NiTi rotary file is another reason for file separation and canal transportation.

It is often wise to perform coronal flare-up before introducing the rotary file to the portion of the canal beyond the curvature.  This step will create a straighter access and reduce the file binding to the canal.  In some case, it is not feasible to use rotary file to instrument the canal beyond the curvature.  For example the acute canal curvature in the distal root of #30 (the above case) might prevent the rotary file from advancing further.  In addition, such acute curvature greatly enhance the file separation during the instrumentation.  For those type of cases, hand instrumentation might be a better approach and the apical size of the canal preparation should be kept small to retain the original canal shape. 

 

Mandibular premolar with three canals

Mandibular premolars are one of the most challenging teeth to perform endodontic therapy because of the variations in root canal anatomy.  The goal of root canal treatment is to throughly instrument and obturate the entire root canal system to prevent and eliminate apical periodontitis.  Thus, failure to recognize the variations in root canal anatomy and properly treat them can lead to persistent root canal infection or symptom.

The canal morphology of mandibular premolar can be very complex.  Based on the literature, about 25% of the mandibular first premolars have 2 canals with 2 separate foramina.  Comparatively, about 5% of the mandibular second premolars have two canals with two foramina.  Only 0.5% of the first and second premolars have three canals with three foramina.  Although the incidence of the third canal in lower premolars is low, missing the canal can lead to endodontic failure.  The following points may help to identify the third canal in the mandibular premolars:

• careful evaluation of multiple preoperative radiographs (parallel, mesially and distally angulated films).  Multiple periodontal ligament space may indicate multiple roots.  A sudden change in radiographic density of a root canal space (fast break) might suggest a main canal branches in to multiple canals.
• off-centered canal on radiograph might indicate possible extra canals
• a third canal can also be suspected clinically when the buccal and lingual canal orifices do not follow the rule of symmetry.  If one of the canal orifices is larger than the othe, there might be two canals in the one with larger canal orifice
• Surgical operating microscope with high magnification

 

Mandibular molars: three mesial canals

Recent literature shows that mandibular first molars have a 1-15% chance of a middle mesial canal.  Most of reported cases show the middle mesial canal join either mesiobuccal or mesiolingual canal.  It is rare occurence to have a true independent middle mesial canal as shown in this case. 

The third mesial canal is often located in the isthmus between MB and ML canals.  The isthumus is a narrow connection between two root canals that contains pulpal tissue.  Failure to instrument this area can potentially causes endodontic failure.  Careful observation of angle radiographs and understanding of tooth morphology is important in identifying those canals.  Today, with the use of the surgical microscope, we can predictably locate the middle mesial canal of a lower molar.

 

Retreatment of a mandibular molar

 The goal of endodontic therapy is to prevent and eliminate apical periodontitis. This is achieved by thorough intra-canal disinfection, three-dimensional fill of the root canal system, and good coronal restoration. Occasionally, even with our best effort, a root canal treated tooth might not heal as expected. Most common reasons are missing canal, coronal leakage, recurrent caries, poor quality of the previous endodontic therapy and tooth fracture. Once the tooth is determined to be non-healing, the options left are to save or extract the tooth.

To save the tooth, it could be accomplished by either endodontic retreatment or endodontic surgery. The decision of which option to choose should be based on fulfilling the biological requirement for successful endodontics. A recent systematic review study by Dr. Torabinejad* showed significantly higher success rate found for endodontic surgery at 2-4 years (77.8%) compared with nonsurgical retreatment for the same follow-up period (70.9%). However, at 4-6 years, this relationship was reversed, with nonsurgical retreatment showing a higher success rate of 83% compared with 71.8% for endodontic surgery. It appeared that the success for endodontic surgery declines progressively over time while it increases for the retreatment.

Since root canal infection is the cause of apical periodontitis, the biological aim of endodontic therapy is to eliminate root canal microbes. Endodontic retreatment has higher long-term success because it removes enough microbes from the root canal to ensure predictable success. On the other hand, endodontic surgery merely entombs the intra-canal microbes by placing retrofill after apicoectomy. Thus, depending on the seal and durability of the retrofill material, the success varies. If feasible, endodontic retreatment should be attempted first.

Orthograde endodontic retreatment yields hight incidence of tooth retention.  A recent epidemiologic study evaluated 4744 endodontically retreated teeth that were performed by endodontists participating in Delta Dental Insurance (that insures approximately 15million individuals in the USA).  Overall, 89% of teeth were retained in the oral cavity 5 year after the treatment.*

 

Surgical retreatment of a maxillary molar

Endodontic surgery is often required if apical periodontitis does not heal or patient’s symptoms persist after nonsurgical retreatment. Some of reasons are persistent or refractory intracanal infection, extra-radicular infection, apical inflammatory cyst, and cyst or tumor of non-endodontic origin.

Due to the complex root canal anatomy, bacteria can potentially survive in the isthmus, lateral canals or dentinal tubules even after meticulous root canal instrumentation. In such cases, the only option is to seal the intracanal infection by performing endodontic surgery. Occasionally, surgical intervention is necessary because the source of the problem is outside the tooth. Bacteria can potentially survive in the lesion or forming biofilm on the apical root surface, which is called extra-radicular infection. Or there might be a cystic lesion or tumor that is not associated with root canal infection. Clearly, conventional root canal treatment can not address those problems.

Endodontic surgery involves three steps: apicoectomy (root resection), retro-preparation, and retrofil. The modern apical surgery is mostly done under a surgical operating microscope with ultrasonic instruments and retrofil materials such as MTA. It has shown that the modern technique has higher success than the traditional method. A meta-analysis study showed positive outcome in 59% of the cases for traditional root-end surgery and a 94% positive outcome for microscopic surgery*. Even with much improved success, endodontic surgery should not be considered the first option in case the primary root canal treatment fails for the reasons we mentioned earlier.

 

MTA direct pulp capping for apexogenesis

A carious pulpal exposure in a mature tooth is a good indication for root canal treatment because of its predictable long-term success. Research consistently showed an endodontic success rate of 90-95% for vital teeth in 5-10 follow-ups.* Other treatment options include direct pulp capping and pulpotomy. However, 10-year success rates are 20% and 50%, respectively, for direct pulp capping and pulpotomy.* Thus, root canal treatment is a preferred treatment option for adult patients in cases of pulpal exposure.

However, for a developing tooth, the root canal treatment can cause irreversible damage and result in the arrest of root development. Because of the thin root structure, there will be a higher risk of root fracture after the root canal treatment in immature roots. In addition, technical difficulty and patient compliance can further compromise the long-term prognosis for tooth retention. Therefore, for the immature roots, our treatment objective is to maintain pulpal vitality so that normal root development (apexogenesis) can continue. This is accomplished by removing of a portion of the affected vital coronal pulp tissue and preserving as much healthy pulpal tissue as possible. Therefore, direct pulp capping or pulpotomy should be considered.

Two of the most common materials that have been advocated to induce normal root development are calcium hydroxide and MTA. Both materials have high clinical success for direct pulp capping and pulpotomy procedures. However, MTA seems to produce a thicker dentinal bridge, less inflammation, less hyperemia and less pulpal necrosis compared to calcium hydroxide. Here, we present a case of MTA direct pulp capping for #19 with open apices.  Please note the closure of root apices at 1 year follow up evaluation.

 

Endodontic treatment of mandibular molar with open apex: MTA apexification

An immature root with open apices often presents challenges to the routine endodontic therapy. Because it is difficult to create a good apical stop using the conventional method, canal overfill and poor apical seal frequently occur to compromise the long-term success of the treatment. Thus, an apexogenesis procedure is preferred if the tooth is vital. However, if the tooth is necrotic and infected, the only option left is to perform root canal treatment. To prevent the incident of overfill and allow adequate root canal seal, an apical barrier is desired.

Apexification is a procedure to create an apical barrier in a tooth with open root apex. Traditionally, a long-term calcium hydroxide therapy is used for this purpose and has shown clinical success of up to 95%*. However, this procedure usually requires 3-24 months for the hard tissue formation to complete at the root apex. In some cases, this might not be practical either due to patient’s non-compliance and increased chance of re-infection from loss of temporary restoration. In addition, some studies showed long-term use of calcium hydroxide intracanal dressing predisposes the tooth to fracture.

Recently, an alternative technique using MTA was introduced for the apexification procedure. Studies showed a 95% clinical success rate, which is comparable to calcium hydroxide apexification*. MTA is a biocompatible material that induces hard tissue formation in dental pulp and periradicular tissue. It also provides excellent seal against microleakage. On average, MTA takes 4 hour to set. Thus, most endodontic therapy using MTA apexification can be completed in 2 visits. Here we present a case using MTA apexification during the root canal treatment. 

 

Maxillary Molar: three MB canals

 

Maxillary Molar with two DB canals

 

Maxillary Molar: four mesial buccal canals

 

Mandibular Molar: Radix entomolaris

Mandibular molars can have a supernumerary root called the radix entomolaris (RE). This additional root is often located distolingually in mandibular first molar. 

The prevalence of radix entomolaris is:

·         African populations: < 3%

·         Eurasian and Indian population: <5%

·         Mongoloid trait (such as Chinese, Eskimo and American Indians): 5-30%

·         Caucasians: 3.4 – 4.2%

To identify the radix entomolaris, a thorough inspection of the multiple angle radiographes is essential. CBCT might also be useful in identifying the additional root. Once the RE is suspected, the opening cavity has to be modified to allow an easy access to the root canal of an RE. Gaining a straight-line access to the canal can be very challenging. Most of RE has a severe root inclination. Often the canal has an initial curve in the coronal third of the root canal and requires removing of dentin on the lingual side of the cavity and orifice of the RE. Another challenging aspect is to instrument the canal without procedural errors. In many cases, RE has a sharp root curvature at the apical third of the root which frequently leads to straightening of the root canal or a ledge, with root canal transportation and loss of working length resulting.

 

Lower Molar with 3 distal canals

 

S-shaped root canal curvatures

 

Management and Prognosis of the separated instrument

Instrument separation is one of the most troublesome incidents in root canal therapy. Depending on the clinicians’ skill levels, the incidence of fractured instruments in the canals range from 0.4% - 3.7%.* The most common reasons for the instrument separation include overuse, improper use, curved canals, manufacturer defect, and clinician’s technical skill.

Although the file separation within a root canal is an unpleasant experience, the prognosis of the endodontic treatment is not significantly reduced. A recent meta-analysis study showed 80.7% of the lesions healed when a periapical lesion was present, compared with 92.4% remaining healthy when no lesion was initially present*. Of course, the prognosis can be further compromised if effective canal disinfection cannot be achieved. Thus, the outcome of endodontic treatment is related to how well the canals are disinfected prior to the file separation and the prevention of recontamination during and after the procedure.

Several approaches to manage the separated instrument within the canals include removal of the file using an ultrasonic device or extractor such as an IRS instrument, bypass the file, or surgical removal of the file. Most of these procedures will require the use of a dental operating microscope and it is prudent to refer to a microscopic endodontist to manage these cases.

Nonetheless, the removal procedure might result in loss of considerable tooth structure. This could lead to clinical complications of root perforations, ledge, transportation, and possibility of root fracture in the future. Thus, the benefit of removing the instrument and the risk of damage has to be weighed before attempting file removal. For some situations, it might be in the patient’s best interest to leave the file alone.

 

Reporation Repair with MTA

Perforation is a mechanical or pathologic communication between the root canal system and the external tooth surface. A perforation that was not repaired or not successfully repaired can lead to serious periodontal problem. If possible, the repair of a perforation should be done immediately with materials of good sealing ability to minimize any further tissue damage.

Some of common reasons for mechanical (iatrogenic) perforations are:

·         Excessive tooth structure removal during access preparation can lead to crown perforation or furcal perforation

·         Improper orientation, size, and length of post placed in endodontically treated teeth can lead to root perforations

·         Excessive coronal flare-up of root canal space (especially with the usage of large “gate glidden” bur) during endodontic therapy

·         Improper management of curved root canal during the treatment

Some of causes for pathological perforation include:

·         Gross caries

·         Internal/external root resorption

·         Cervical root resorption

 

The success of the perforation repair depends on (1) location of perforation, (2) size of perforation, (3) the time lapsed before sealing the defect, (4) type of sealing material. In general, the middle third and apically situated perforations are less serious than those that occurred in the coronal third of the canal, including furcal perforations. However, crown perforation usually can be effectively sealed and has a good long-term success.   A small size perforation tends to have favorable outcome than a large size perforation. Ideally, the perforation should be repaired as soon as possible once it is identified. Delayed repair can lead to periodontal tissue damage from bacteria leakage and contamination. 

The long-term success of perforation repair largely relies on the sealing ability of the materials used. A material that provides a good seal will prevent bacteria leakage to periodontal tissue, hence, it ensures healthy periodontal tissue surrounding the perforated area. Several materials have been used to repair perforations, including Amalgam, IRM, Super-EBA, glass ionomer cement, composite resin, resin-glass ionomer hybrids, and mineral trioxide aggregate (MTA).   Among those materials, MTA is the agent of choice to repair perforations. Studies consistently show MTA has good sealability and tissue response. Most of MTA samples studied showed no inflammation and promoted cementum deposition. It does not need a barrier. The extruded material (in to the periodontal tissue) showed no adverse side effects, indicating its biocompatibility. A recent clinical study show the long-term success of MTA perforation repair is 86%.

The most common sign of perforation is unusual bleeding in the canal or pulpal floor. Obtaining hemostasis is critical to localize and repair the perforation. If a dry field cannot be achieved, placement of calcium hydroxide over the perforation for a few days will help with hemostasis. In most cases with root perforations, use of surgical operating microscope will greatly enhance the visualization. Once the perforation is suspected, a “check” radiograph with an endo file will help determine where the perforation is located. Once the perforation is confirmed, the repair should be carried out as soon as possible. Most of perforation can be successfully repaired from within the tooth using a microscope.   But with a large perforation, surgical repair might be needed.

Here, we present a furcal perforation repair using MTA. This case had a previous perforation repair with Ag but the furcal inflammation persisted due to the leaky repair material. We decided to retreat the tooth and repair the defect with MTA. Along with perforation repair, we also find two missing canals (DB and MB2).

 

Top 10 Tips for Good Sleep

There are many ways to improve the quality of your sleep, but some of the best strategies include regular exercise, reducing screen-time before bed, avoid certain chemicals, make your bedroom your sleep spot, regulate your eating schedule, keep your eyes off the clock, and many more!

Healthy, Restful Sleep

One of the things that unifies us as human beings is our need for sleep. Some people may be “morning people” or “night owls”, but every single human body requires rest, which comes in the form of sleep. Unfortunately, in our fast-paced, technology-driven, stress-filled lives, proper restful sleep can sometimes be hard to achieve. Studies show that most adults require seven to nine hours of sleep for proper functioning; this can be achieved through a single bout of sleep, or a shorter sleep pattern supplemented with naps. Sleep is a tricky thing, and affects everyone slightly differently. Your Circadian rhythms and natural habits form the basis of your sleep. If your schedule causes your sleep patterns to change regularly, then you may have adjusted to that lifestyle, while a disruption for other people can be chaotic, affecting their mental and physical prowess.

Good sleep should have a few key characteristics: undisturbed, a feeling of refreshment upon waking, alertness during the day, a lack of snoring/fitful sleep/disturbed breathing, and the sleep should come on roughly twenty minutes after lying down with the intention to sleep. If you aren’t getting your 7-9 hours or feel beaten down and tired during the day, there are probably some very good reasons for this. Whether you are suffering from insomnia, restless leg syndrome, sleep apnea, or simply a lack of good sleep habits, there are ways you can improve your situation. If you want to get back into the high-energy side of life, a few changes to your diet, daily schedule, and habits are all that you require. Now, take a closer look at the 10 Best Tips for Good Sleep.

10 Best Tips for Good Sleep

1. Avoid Late-Night Screen Time: In today’s tech-heavy world, it seems impossible to tear ourselves away from our gadgets and gizmos even long enough to grab some shut-eye. However, playing on a smartphone or tablet, working on the computer, or watching television late at night gets our brain stimulated and active, making it harder for us to go to sleep. Also, our mind is occupied by thoughts of work, social media platform updates, and the plot of our favorite television drama, all of which keep our mind from shutting down for sleep.

2. Your Bedroom is for Sleeping: If you make it a habit of doing other things in bed, such as eating, studying, reading, or hanging out with your partner, then your body won’t associate the bedroom with sleeping. A dark room with a comfortable bed should induce sleep, but if we are constantly in the bedroom, it becomes harder to wind down for restful sleep, as we’re half-expecting to start doing something else at any moment.

3. Be Consistent in Your Choices: Although some people function normally with non-regular sleep schedules, it has been shown that establishing a firm routine in your sleep patterns is key. Given the recent changes to the traditional “workday” and the prevalence of working from home and freelancing, it becomes easier to manipulate our schedules to our convenience. This can make it hard for our body to find a comfortable pattern. Try to go to sleep and rise at the same time of day, when possible, if you are suffering from sleep deficiency or a sleep disorder.

4. Avoid Stimulating Chemicals: We often rely on coffee to wake us up in the morning, and maybe push us through the day. Energy drinks and supplements have also become very popular to squeeze out every drop of energy from day, but this can also wire us well into our scheduled sleep time. We may need to wake up at the same time the following day, but the chemicals we’ve infused our body with won’t let us fall asleep. Cut back on that third cup of coffee in the afternoon and eliminate energy drinks to see if your sleep patterns return to normal.

5. Exercise Regularly: Expending excess energy will increase the body’s demands for rest, often superseding any mental issue that are keeping you awake. If you regularly exercise in the morning or afternoon, your body will be ready for and need a restful sleep at night. Late-night exercising, however, can have a similar effect as late-night screen time – keeping your mind and body active well into your intended sleep time.

6. Throw Away Your Alarm Clock: The jarring nature of the alarm clock can be very disruptive for sleep patterns and start the day in an uncomfortable way. Having progressively louder alarms on a particular time pattern can help ease one out of sleep and start the day in a positive way, rather than slamming an angry, exhausted hand for the alarm clock. Eventually, your body may even train itself to wake up a few minutes before the set alarm time, which is the most peaceful and natural way to wake up!

7. Meditation and Visualization: If you’re suffering from sleep problems, some alternative remedies can be meditation and visualization. Meditation helps soothe the mind and clear out distracting thoughts, whilevisualization can be a powerful tool in bed when your mind is going a million miles an hour. Visualize peaceful, restful sleep, and it will soon come to you!

8. Take a Nap When You Need It: Using naps sparingly throughout the day, when your body demands it, can be beneficial, particularly if you struggle to sleep for a solid 8 hours straight. Short catnaps can energize us for the day, eliminating the need for chemical stimulants, and also ensure that the final sleep of the day we get is restful and invigorating.

9. Cut Down on Alcohol and Cigarettes: Alcohol may help you “pass out”, but that isn’t restful sleep, and has a bevy of other health impacts that one would rather avoid. Similarly, the calming nature of a cigarette may seem ideal before you close your eyes, but cigarettes and nicotine are stimulants, technically making it harder for your pulse to slow and your mind to prepare for sleep.

10. Eat Wisely: Eating large meals late at night is unwise, but there are some sleep-inducing foods that can be helpful if you’re staring at the ceiling every night. Foods high in magnesium and other important nutrients (like trytophan) can cause the release of neurotransmitters that send you right into slumber. Try adding cottage cheese, fruit, yogurt, milk, or crackers to your late-night menu!