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One of the following procedures falls under high bacteremia risk for infective endocarditis:

 

# One of the following procedures falls under high bacteremia risk for infective endocarditis: 
a. Post-operative suture removal 
b. Intraligamentary and intra-osseous local anesthetics injections 
c. Intracanal endodontic treatment 
d. Placement/ removal of removable orthodontic appliances 


The correct answer is B. Intraligamentary and intra-osseous local anesthetics injections.

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa are the procedures for which endocarditis prophylaxis is reasonable.

The following procedures and events do not need prophylaxis: 
  • routine anesthetic injections through noninfected tissue,  
  • taking dental radiographs, 
  • placement of removable prosthodontic or orthodontic appliances, 
  • adjustment of orthodontic appliances, 
  • placement of orthodontic brackets, 
  • shedding of deciduous teeth, 
  • and bleeding from trauma to the lips or oral mucosa. 

Fenestration as an adverse effect of Fixed Orthodontic Treatment

 Fenestration is a notable adverse effect associated with fixed orthodontic treatment. It refers to the formation of a window-like defect in the alveolar bone, where the root of a tooth becomes partially exposed due to the bone's resorption. This condition can occur when excessive or improperly directed orthodontic forces are applied, causing the tooth to move outside the limits of the alveolar bone housing.

The main factors contributing to fenestration include:

Excessive Force Application: Applying too much force during orthodontic treatment can lead to undue stress on the bone, resulting in resorption and fenestration.

Unfavorable Tooth Movement: Moving teeth in directions that extend beyond the anatomical boundaries of the alveolar bone can cause this adverse effect.

Pre-existing Bone Deficits: Patients with naturally thin or compromised alveolar bone are more susceptible to fenestration when undergoing orthodontic treatment.

Fenestration above left maxillary canine in a female patient undergoing fixed orthodontic treatment



The clinical implications of fenestration include increased risk of periodontal problems, potential tooth sensitivity, and aesthetic concerns. Early detection and careful planning of orthodontic forces are crucial to minimize the risk of fenestration. Regular monitoring through clinical and radiographic evaluations can help in identifying early signs of this adverse effect, allowing for timely intervention to prevent further complications.

Detecting fenestration clinically involves a combination of visual examination, palpation, and radiographic assessment. Here are the primary methods used:

1. Visual Examination
Gingival Recession: Look for areas where the gum line appears lower than usual, which may indicate underlying bone loss.

Tooth Root Visibility: In severe cases, the root of the tooth might be visible through the gum tissue.

2. Palpation
Probing: Gently probing the gum tissue around the suspected area can help identify soft spots or depressions that suggest bone loss.

Tactile Sensation: Feeling for irregularities in the bone contour by gently pressing the gingiva around the suspected area.

3. Radiographic Assessment
Intraoral Periapical Radiographs: These provide detailed images of the tooth and surrounding bone, which can help identify areas of bone loss.

Cone Beam Computed Tomography (CBCT): Offers a three-dimensional view of the alveolar bone, making it easier to detect fenestration accurately.

Panoramic Radiographs: These can be used for a broader view, though they are less detailed compared to periapical radiographs and CBCT.

4. Additional Diagnostic Tools
Periodontal Probing Depths: Increased probing depths around a tooth can indicate bone loss.
Bone Scanning: In some cases, advanced imaging techniques like bone scans might be used for a more detailed assessment.

Clinical Signs to Watch For
Localized Inflammation: Swelling or redness around the affected area.
Pain or Discomfort: Patients may report unusual sensitivity or pain in the area, especially when pressure is applied.
Changes in Tooth Position: Shifts in tooth alignment may also indicate underlying bone issues.
Regular follow-up appointments and careful monitoring are essential for early detection and management of fenestration during orthodontic treatment.