CATEGORY 70 AUSTRALASIAN DENTIST In this article, I am going to show you how to eliminate those annoying food traps that patients complain about in a very fast and e cient way. I am also going to share with you my step-by-step process that helps you determine and analyze areas that your patient wasn’t even aware of. Patient H Patient, H, is a young man with no medical concerns. At a routine examination, H complains about a nagging dull pain coming from the lower right. He reports that he often gets meat stuck there and has to “really dig” to get it out. Exam revealed an open contact between lower right rst molar and lower right second bicuspid, with food impaction and tissue swelling. Radiograph taken showed localized bone loss in same area, caused by H’s inability to remove all plaque despite his e orts. H says that, lately, he has even avoided going out for dinner with clients as he is embarrassed by this issue and nds himself trying to “pick it out” in front of his clients. Food Impaction & Flossing Food impaction is a common complaint and many people are not aware of the consequences of leaving this problem untreated. Food impaction can result in bone loss, periodontal pockets, in ammation, pain, decay, and is a frequent source of irritation for many patients. One of the most obvious tests that we, as dentists, can do to quickly assess these areas is to check the contact in the area that the patient complains about. Here is what to look for: u If oss goes through the contact very loosely and easily, you have an open contact u If oss shreds or rips, it’s likely that there is a piece of tooth or lling that’s chipped or broken, and this can result in food getting trapped and causing irritation u If oss feels normal (like the contact is closed) on the way down but then feels looser on the way out, then you likely have a portion of the contact open in the area where the oss feels looser, and that will contribute to food getting impacted u If oss does not feel like you have a solid contact through either down or out placement and you feel looseness at any point, it is likely that you have a portion of tooth or lling that is either under-contoured or contains a small concavity, which is an area that food and plaque can easily adhere to and become very di cult for the patient to remove. Imaging ere is an additional step that we, as dentists, need to take in order to not only ensure our patient’s best oral health, but to also pro-actively diagnose additional areas where a problem is occurring or beginning to develop. In a case where a patient already complains of a food trap, I will go through the steps above in order to assess and determine the size of the food trap as well as all the consequences resulting from it. I will discuss not only the current issues including discomfort, tissue swelling, decay possibility, irritation, bone loss, I will also go over the long-term consequences of not treating it. Once the patient understands the urgency and need for treatment (steps outlined below), I then proceed to examine the remaining radiographs in order to look for additional areas that may be present. Here are the key elements to look for: u Visible space between adjacent teeth or llings (inter-proximally) – any space on a radiograph should be checked with oss to con rm (see Figure 1 & 2) u Flash or excess restorative material, including composite, adhesive, or cement (see Figure 3) u Any chipped lling or tooth structure inter-proximally u Any concavity in either lling or tooth inter-proximally (see Figure 2) u Any missing or under-contoured lling material resulting in a “trap” or uneven area where food or plaque can adhere to and would be di cult to remove u Areas of calculus below the interproximal contact – these are rough and act as ledges which cause food debris and plaque to adhere to and create more food impaction u Localized periodontal pockets which cannot be accessed by patient in order to keep clean (see Figure 3 & 4) u Localized bone loss, which can be a result of previous chronic food impaction, or para-function(see Figure 3 & 4) Closing Contacts All of the above ndings can contribute to food impaction and, if found, patient should be questioned thoroughly to assess if they have noticed food gathering in those areas as well. Many times, when I ask the patient, “Do you get food getting stuck between these teeth?” and point to areas where any of the above are diagnosed, the patient very often responds: “Yes! I do! How did you know?”. at allows for a more thorough discussion regarding closing all contacts and restoring all problem areas at once rather than waiting until bigger issues develop. Most patients nd the food impaction a nuisance and many complain about the discomfort associated with it and, as a result, they are very motivated to restore all the areas diagnosed. Instant Relief e results of closing the contacts and restoring any chipping, ash, or poorlycontoured areas are instant and rewarding. As soon as the areas are restored, the patient no longer su ers from food impaction and its related irritation, and can feel instant CLINICAL How to get rid of food traps quickly and easily By Dr. Agatha Bis Dr. Agatha Bis Figure 1 Figure 3 Figure 2 Figure 4
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