challenges of root canal treatment in poor countries
TRANSCRIPT
CHALLENGES OF ROOT
CANAL TREATMENT IN POOR
COUNTRIES
Rukoma A,M.
©2013
Introduction
RCT is changing in terms of
Demand
diagnosis techniques
treatment techniques
Equipment, instruments and materials used
This necessitates a workforce which is well
equipped and able to cope with the current
situations- A global challenge
1. Demand
Is increasing as a result of:
Increased awareness
population expansion and aging
Combination of the two
more people with increased awareness, the demand
is even higher
2. Diagnostic techniques
X-ray is still the reliable means of diagnosis
and assessment of the endodontium
Can show
Pulp status
Canal morphology
Periodontal and periradicular status
Determine if RCT can be done or not
Conventional X-ray
Most commonly used in poor countries
The reliability is about 60%-overlapping hides
some details multiple pictures +associated cons.
Time consuming in developing-several minutes
Difficult to store for future references
Despite these, some clinics don’t even have them
3D Digital X-rays
Not new but uncommon in poor countries-
expensive vs. conventional
Very accurate -adjustments can be made all
along
Quick
Easy to store
Easy to share
The recommended
Far from reach especially in public clinics
3.Treatment techniques
Relatively unchanged, mostly conventional.
However, advocates for surgical or
combined are increasing.
Exploratory surgery to diagnose the problem
that cannot be diagnosed in any other way;
for example, when NS-RCT and retreatment
have failed and the reasons for failure have
not been established.
Other indications for S-RCT include:
Repair of perforations, root resection, end
filling, apical curettage and biopsy
These need a practitioner with adequate
knowledge of the root anatomy and
endodontium in general
Note: additional canals in molars currently is
almost normal
Single visit RCT
Another area which is being promoted
Inter-visit burden is eliminate from both
patient and practitioner
The success rate is similar to multiple visits
Single visit cont.
depending on the nature of the disease as well as:
availability of instruments and materials
availability of time
skill and experience of the operator
and accessibility of the treated tooth for
instrumentation
In poor countries it is still a story of the future
4. Equipments, instruments and
materials
Power demanding-electricity availability and
reliability
Not adequate and not reliable
Quantity and quality-national and health
facility level
Not enough and uncertain quality
Unfourable for RCT
Dental chair and accessories
Generally,
Not enough, rarely serviced and old fashion
RCT is a demanding procedure
needs a full functioning (obeying) Dental
Chair
X-ray
Not enough, rarely serviced and mainly
conventional-2D for 3D object -overlapping-
aꜜccuracy
Handpieces
Quality and quantity
Autoclave every after patient
Light cure machine
Composite era
BUT WHY?
Inadequate funding
Few technicians with or without adequate
knowledge
END RESULT
Failure to perform as expected
Instruments
Some are
Outdated
Overused
Not readily available
Not even known
What instruments are we using for?
Filing
Compaction of GP
Cutting GP
Instruments to removing GP from the canals
NiTi flexo type are recommended
Visual aids
The use of magnification and adequate
lighting assist in accurate location of the root
canals
Rarely used in poor countries
5. RCT irrigating and filling materials
Not a big challenge
Irrigants-
Naocl
Core filling material
GP, Resin based e.g. Resilon points
Sealers
resin based sealers eg. AH series, endorez and
diaket
Crown filling material
Poor obturation but adequate crown seal has
better prognosis than adequate obturation
but poor crown seal
Ideally all root canal treated teeth must have
artificial crown fixed
Situation on the ground- very rare
6.Work force
General practitioners
The number is still low Taught under poor conditions
No continued education
Endodontists
The number is very low even in rich
countries- mostly in Dental schools
WHY?
Funding
expensive to train a dentist
Endodontist even more
Motivation
Complete dental chair
19TH CENTURY DC
Handpieces with light source
Visual aids
Dental loop with light Dental surgical micr.
GP Devices
Easy Cut NiTi rotary flexo file
7. Conclusion
There is a lot of challenges in performing
RCT in poor countries
8. Recommendation
RCT should be included under 10 health care
procedures and be given priority it deserve
