"Exploring Endodontics: Insights and Applications"

Increase exposure to fluoride during tooth formation will lead to dental fluorosis.
Normal optimum level of water fluoride is upto 1ppm
Increasesd level of fluoride more then 1ppm will cause fluorosis
Clinically it appears as white opaque areas to brown discoloration and pitting of enamal
In severe cases hypomineralised enamel becomes very fragile and undergo surface damage
Management of dental fluorosis varies according to severity
In Mild cases micro and macro-abrasions and bleaching are treatment options
In moderate cases composite restoration and veneers are treatment options
In severe cases full crowns

Broken / fractured endodontic instrument

Broken instrument is one of the procedural accidents that occurs during cleaning and shaping of root canal system.

Causes of broken instrument in root canal:

Prevention

Lubrication of instrument with irrigating solution such as sodium hypochlorite or with lubricating agent EDTA (ethyl diamine tetra acetic acid)
Instrument should be examined before use, if there is and untwisting in file which will be visible as shiny spot then it should be discarded
Small no. of files must be discarded after single use.
NiTi files do not show any sign of untwisting so they must be discarded before untwisting is seen

Management

There are three methods of management

Dental Fistula/ Cutaneous Fistula of Dental Origin/ Suppurative Apical Periodontitis/ Apical Periodontitis With Fistula.

Dental fistula is a communication between the oral cavity and cutaneous surface of face
It is a squeal of infection from dental pulp that spread beyond the apex
Generally it is a painless condition because when drainage occurs, pressure relieves and symptoms disappear.
Chronic inflammation involves apical portion of tooth’s root.
Drainage mostly occur within oral cavity on facial or buccal side of alveolar ridge
Rarely occurs on cutaneous surface of face
Intraoral sinus tracts are common but extra oral fistula is not common.
Treatment involves complete debridement and obturation of root canal or Extraction.

Additional resources

Treatment of Oroantral Fistula: Experience With 27 Cases