Management of Maxillary Sinusitis of Endodontic Origin

Management of Maxillary Sinusitis of Endodontic Origin A case report ABSTRACT: Endodontic implications of the maxillary sinus include extension of periapical lesion into the sinus. Though the actual cause of sinusitis is difficult to determine accurately, majority of the cases occur through a dental cause. The purpose of this paper was to present the management of maxillary sinusitis of endodontic origin. A 48 year old generally healthy male patient reported to the dental clinic for the implant placement in the area of missing #26. During the procedure, the dental surgeon noticed a thick granulation tissue in the deep area with painful sensation. Further endodontic consultation revealed the tooth #25 was endodontically treated 9 years ago and CBCT showed periapical lesion perforated the maxillary sinus. Extraction and enucleation was done and the biopsy sent to the histopathological lab revealed periapical granuloma. After 2 months, patient was asymptomatic and ENT examination showed the floor of maxillary sinus with reduced hyperplasia. Symptoms of m axillary sinusitis can evoke pain of dental origin, and a careful differential diagnosis is important when dealing with pain in the maxillary posterior area. Keywords: maxillary sinusitis, mucositis, odontogenic origin Introduction Endodontic implications of the maxillary sinus include extension of periapical lesion into the sinus. The literature mentions many cases of extension of periapical infection to the maxillary sinus 1-2-3-4. Stafne estimated that 15–75% of the sinusitis cases occur through a dental cause although the actual cause is difficult to determine accurately 5. Sinusitis can be divided into acute, subacute and chronic types. Symptoms produced by acute or subacute maxillary sinusitis can be mistaken with those of pulpal origin 6. A comprehensive examination of the patient’s medical and dental history will draw the attention of the clinician to endodontic implications of odontogenic origin. The purpose of this paper was to present the management of maxillary sinusitis of endodontic origin. Case report A 48 year old generally healthy male reported to the dental clinic for the implant placement in the area of missing #26. During the procedure, the dental surgeon noticed a thick granulation tissue in the deep area and the patient started feeling painful sensation even with repeated anesthesia. The surgeon then put bone graft material and closed the flap for further consultation. Patient was then shifted from implant clinic to the diagnosis clinic for examination of tooth #25 that had periapical lesion (figure 1). It was revealed during the examination that the tooth #25 had undergone root canal treatment 9 years ago. The pre-operative radiograph had revealed a large periapical lesion with interrupted lamina dura around the tooth #25 with previous root canal filling material and filling on the crown (Figure 2). The periodontal probing was within normal limits for all teeth in the upper left region and the teeth #24 and #25 was restored with amalgam. (figure 3 and 4). The tooth showed no response to cold and electric pulp testing and it was tender on percussion but not on palpation. The tooth was diagnosed as previously treated with symptomatic periapical peridontitis. After the clinical examination, CBCT radiography was taken to check the maxillary sinus involvement. CBCT revealed a periapical lesion that perforated the maxillary sinus with thickening of the maxillary sinus floor (figure 5, 6 and 7). Patient then referred to ENT department for consultation. They advised (i) extraction of the involved tooth to remove the source of infection and the thickening of the floor will get resolved upon follow up, or (ii) to inoculate the lesion completely through endoscope under GA. Patient presented to the endodontic clinic for treatment plan and decision making. The endodontist advised root canal re-treatment of #25 followed by surgical root end resection and retrograde filling along with enucleation of the lesion with precaution to the maxillary sinus perforation. But after consultation with prosthodontist, it was decided to extract the tooth #25 as it was questionable in restorability (figure 8 and 9). So, the recommended treatment was extraction and the final diagnosis was maxillary sinusitis of endodontic origin. Patient referred to OMF department where extraction of tooth #25 and enucleation of the lesion was performed (figure 10, 11 and 12). The biopsy was sent to the histopathololgy lab. Post-surgical instructions were given to the patient and was prescribed cap. amoxicillin 500mg tid, tab. brufen 600mg, Rhinocort along with anti-histamines and decongestants. Biopsy report showed periapical granuloma which confirmed the diagnosis. On follow up after 2 months, patient was asymptomatic and PA radiograph revealed socket space (figure 13 and 14). ENT examination showed the floor of maxillary sinus with reduced hyperplasia. Discussion Radiographic examination of the maxillary sinus includes periapical, occlusal, panoramic and facial views7. Panoramic radiography provides a wide overview of the sinus floor and its anatomical relation with the tooth roots allows the determination of the size of periapical lesions. The symptom associated with maxillary sinusitis is dull pain, mostly unilateral and during mastication, or a feeling of ‘fullness’ around the upper posterior teeth. The patient may complain of pain exacerbated when lying down or bending due to increased intracranial pressure from blood flow and the affected sinus may be tender to palpation8. The teeth in relation to affected sinuses will be moderately or extremely sensitive to palpation and/or percussion. Nasal discharge is considered to be important sign of sinus infection. The use of a topical nasal decongestant may help in differentiating pain from sinusitis or from dental origin. On the other hand, the pain of dental origin ranges from the rmal sensitivities to continuous sharp pain which may be associated with localized swelling. Radiographic changes in sinusitis show thickened sinus mucosal membrane and air-fluid filled. The first time that showed the direct extension of dental infection into the sinus was in a study by Bauer in 1943. His study was done on cadavers and revealed the pulp of involved teeth with histological evidence of extension of infection into the maxillary sinus. The local hyperplasia of dental origin in the mucosa of the maxillary sinus could be removed by conservative root canal therapy. Selden and August in1970 also managed maxillary sinusitis after the treatment of a periodontal-endodontic lesion in first and second premolars. For the refractory cases after a conservative management, the surgical approach was recommended10. In this case the restorability of the tooth made the final decision. At least 70% of bacterial contamination of sinusitis is caused by Streptococcus pneumonia and Haemophilus37 influenzae11. Antibiotics are a significant part of management in acute suppurative sinusitis. Pinheiro et al recommended amoxycillin as a first-line of treatment aimed to cover both gram-positive and gram-negative organisms. Topical decongestants are beneficial for oxygenation and facilitate the sinus drainage of pus by decreasing the edema. Analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs are beneficial for the control of pain. Conclusion The close anatomical inter-relationship of the maxillary sinus and the roots of upper posterior teeth can lead to endodontic complications. Periapical inflammation can lead to maxillary sinusitis of dental origin with resultant inflammation and thickening of the mucosal lining of the sinus in areas adjacent to the corresponding teeth. In such cases, the conventional endodontic treatment or re-treatment is the treatment of choice with surgical intervention. But there are chance of refractory cases which requires extraction to remove the source of infection. An adequate diagnosis and appropriate treatment with antibiotics, decongestants and analgesics are indicated for the treatment of sinusitis.

Frankenstein by Mary Shelley Essay -- Frankenstein Literature Dopplega

Frankenstein by Mary Shelley Mary Shelley’s Frankenstein is widely hailed as literature’s greatest gothic novel, as well as its first science fiction work. Written by a young woman in answer to a challenge from a circle of male authors (which included her husband, Percy Bysshe Shelley), the tale is drawn from her personal experiences as well as from the writings of other authors. The monster in the story is a multifaceted symbol for humanity’s fears, representing unchecked technology and the un-mothered child, among other things. As a representative of these fears, the monster itself may be described as a doppleganger. The word doppleganger is taken from the German dopplegà ¤nger, meaning â€Å"double goer.† It appears as a reflection of a person, an apparition resembling a living being. When it appears, it is often taken as a portent of death, as it was by Elizabeth I when she saw a pale vision of herself lying still upon her deathbed soon before she died (Encyclopedia Mythica, 1). On a larger scale, Frankenstein’s monster could be described as a doppleganger of humanity, personifying our fear of ourselves and of our capabilities. One classic example of a doppleganger is the reflected image seen in a window at night, sometimes mistaken for a prowler. Frankenstein’s monster acts the part of this apparition when he appears to Frankenstein in his new bride’s window on her wedding night after killing her. The doppleganger that is the monster takes on many forms in terms of what it represents. One of these is the fear of science and its role in relation to God. As scientific advancements were made in the field of medicine, questions arose as to whether or not man should try to perform acts that only God was previously capable of performing. This moral issue is initially ignored by Frankenstein, overshadowed by his zeal for accomplishing his impossible feat of reanimation. After he animates the creature and shuns it for its horrible appearance, it acts on its impulses for revenge. As the story progresses, Frankenstein realizes that he should have thought more carefully before acting, and the repercussions of his dark deed eventually lead him on a self-destructive quest to ultimately attempt to annihilate his own creation. By trying to ascend past his place in God’s universe, Frankenstein, in the end, destroys himself and all that he ever loved.... ...etheus, Adam) and destructor (Satan) of life. (Desert Aine 2, 1-2) Frankenstein and his abominable creation are two characters inexorably linked with eachother, as father and son, as inventor and invention, and even as reflections of eachother. Their conflict deals with themes of the morality of science and the fears of child birth, and their characters are drawn from a wealth of experience and reading. Shelley’s doppleganger of mankind is like a twisted vision of reality; based in some sense on reality but wildly taken out of proportion, the monster is so inhuman that it cannot reconcile itself with its master or the world of humanity. Its tragic story serves as a warning of what mankind could become as well as a reflection of Shelley’s own personal demons, and her creation has changed the face of literature. Bibliography: Desert Aine 1. 3/13/1999. 3/14/1999. http://www.desert-fairy.com/birth.shtml Desert Aine 2. 3/13/1999. 3/14/1999. http://www.desert-fairy.com/franken.shtml Encyclopedia Mythica. 3/14/1999. http://pantheon.org/mythica/articles/d/doppleganger.html Mellor, Anne K. Mary Shelley, her Life, her Fiction, her Monsters. New York: Routledge. 1988.

Deforestation and Malaria

Stephanie Saperstein ISB 201L 9. 24. 11 Deforestation and Malaria The changes in global environments is expected to affect the rate of malaria cases in humans. Malaria is a serious and at times fatal disease caused by an infectious parasite that can live within a mosquito that feeds on humans. These mosquitos breed in numerous areas and have affected many populations causing many people to suffer from its painful symptoms and effects of the disease. Researchers have been conducting tests on whether deforestation does in fact increase cases of malaria in hopes to increase the ability to control malaria’s outbreaks in certain areas.The increase in population in many areas is causing there to be an increase in deforestation due to the needs for land for settlement, cultivating agriculture and extracting resources. Research has shown that deforestation does increase the rate of malaria because of the environmental changes of breeding sites and humans moving to and from forested ar eas. Malaria’s parasites most commonly and successfully infects the female Anopheles mosquitoes and those humans that are bitten by these mosquitos, however they are both affected by the parasite differently.In humans the parasite begins by infecting the liver where it matures and begins to breed and multiply. After multiplying they begin infecting the blood stream and attacking the host’s red blood cells. These parasites continue this cycle by consistently infecting more and more red blood cells. Unlike humans the mosquito is not harmed when infected by the parasite. When a Anopheles female mosquito feeds on a human carrying this parasite a new cycle of growth and multiplication takes place in the mosquito. The parasite begins in the mosquitos stomach and then travels to the midgut wall of the mosquito where they breed and multiply.After 10-18 days, the parasites are found as â€Å"sporozoites† in the mosquito's salivary glands. (The Malaria Lifecycle 2006) Whe n the Anopheles mosquito feeds on another human, the sporozoites are injected with the mosquito's saliva and start another human infection. The mosquito transfers the parasites to multiple people by biting them and therefore acts as a vector for the disease. In one study it is said that deforestation is the largest contributing factor to malaria out of the many environmental changes and its rates are expected to increase. Where malaria is found depends mainly on factors such as temperature, humidity, and rainfall.Malaria is transmitted in tropical and subtropical areas, where Anopheles mosquitos can survive and multiply and where malaria parasites can complete their growth cycle in the mosquito. Research has recognized that deforestation increases malaria risk in Africa and the Americas and lessens it in South-east Asia. (Guerra, Snow, and Hay 2006) Malaria in the Amazon has been caused by ecosystem changes which were caused by human migration and opening of land for agricultural re asons, cattle, and natural resource extraction as well as deforestation and reforestation.The change in the ecosystems relates to the promotion or suppression of Anopheles darlingi, or the number one malaria vector in the Amazon, is ultimately the most important factor. An. darlingi is the most important malaria vector in the Amazon region. The vector breeds in partly shaded pools found in flooded areas of forests, forest creeks, river edges and pools left after river-level recession during the dry season. When humans colonize forests or near-forest areas in the Amazon it causes an increase of An. arlingi populations by increasing human exposure to this species’ natural breeding habitats and by generating new breeding habitats on the forest fringes. When deforestation takes place there are less trees to shade the given area of land and the acidity and chemical composition of the soil changes. This environmental change often creates favorable conditions for the breeding of An. darlingi and therefore increases the local risk of human malaria. Government sponsored colonization projects and significant migration, which took place with the help of deforestation, have resulted in malaria outbreaks.The â€Å"frontier malaria† phenomenon is exhibited in the Brazilian Amazon, among many other places, which increases the rate of malaria among humans. Frontier malaria is defined as a phenomenon operating at three spatial scales and with a distinctive time path. First at a micro/individual level, vector densities are high because of changes in the ecosystem that promote habitats for A. darlingi. This also occurs when human exposure is intense, such as at dusk or dawn. The second is at the community level where weak institutions, minimal community cohesion, and high rates of in and out migration characterize the frontier malaria.Third, at the state and national level, there is unplanned development of new settlement areas where agriculture had failed and peop le avoided malaria. However, this only elevates the rate of transmission. This frontier malaria has a time path where at the opening of a settlement area malaria rates rise rapidly and after 6-8 years the unstable in and out human migration and the high level of ecosystem transformations such as land clearing is replaced by urbanization and community cohesion. This frontier malaria then consists of more stable and low rates of transmission of malaria. Singer and Caldas De Castro 2006) Malaria has recently struck in the Peruvian Amazon region and research has shown that deforestation was the main cause. This research states that the risk of being bitten by the primary malaria-carrying mosquito, A. darlingi, is nearly 300 times higher in cleared areas than in those that are largely undisturbed. (Meadows 2006) A study reported in the American Journal of Tropical Medicine and Hygiene shows how deforestation is a contributing factor to the increase in malaria outbreaks.The study was cond ucted in the Loreto district of northeastern Peru, where malaria has risen from 600 cases in 1992 to 120,000 in 1997. Loreto’s population is increasing causing there to be increase is deforestation in order for more settlements such as roads for plantain, cassava, and other subsistence crops. As stated earlier, clearing forest for cropland also often creates better or more breeding sites for the A. darlingi mosquito by providing deep water and short vegetation. Researchers in Loreto experimented by measuring the rate of An. arlingi bites to test whether the population was the primary factor in the increase in malaria cases or whether deforestation was. They found that population size had no effect on the An. darlingi bite rate, but that deforestation had an enormous impact on it. The rate was 278 times higher in areas with the least forest and the most grass/crop land than in areas that were undisturbed. This study proves that areas of slash-and-burn agriculture provides a be tter environment for An. darlingi mosquitos to breed and increase in population, therefore causing more people to be at risk or in contact with the mosquitos that carry the disease.As exhibited in the previous studies and research, deforestation is definitely a contributing factor to the rise of malaria infection. The increase of population and globalization increases the need for land to raise cattle, extract resources, cultivate agriculture, and areas to migrate to. This increase then leads to a need for deforestation which has proven to be a main factor in raising the cases of malaria. In these studies deforestation increased malaria in numerous ways. By destroying forests the climatic factors in areas affecting vector and parasite reproduction and development were significantly changed.Deforestation changed ecological and landscape factors by increasing the amount of sunlight which in turn increases the temperatures of bodies of water, thereby changing the habitats for breeding areas. Overall deforestation is indeed one of the highest contributing factors to the rise in the insect vectored disease around the world. References Guerra, C. A. , R. W. Snow, and S. I. Hay. â€Å"A Global Assessment of Closed Forests, Deforestation and Malaria Risk. † American Journals of Tropical Medicine and Parasitology 100. 3 (2006): 189-204. Pub Med Central. U. S.National Library of Medicine National Institutes of Health, Apr. 2006. Web. 24 Jan. 2011. . Meadows, Robin. â€Å"Malaria Linked to Deforestation. † Conservation Magazine. 2006. Web. Sept. 2011. . Singer, Burton, and Marcia Caldas De Castro. â€Å"ENHANCEMENT AND SUPPRESSION OF MALARIA IN THE AMAZON — SINGER and DE CASTRO 74 (1): 1. † ENHANCEMENT AND SUPPRESSION OF MALARIA IN THE AMAZON 74. 1 (2006): 1-2. American Journal of Tropical Medicine â€Å"The Malaria Lifecycle. †Ã‚  TravelHealth. co. uk — the UK Independent Travel Health Site. Travel Health Co, 21 Nov. 2006. Web. 14 Feb. 2011. .

The Welfare State A Cost Benefit Analysis essays

The Welfare State A Cost Benefit Analysis essays The Welfare State - A Cost Benefit Analysis The role of welfare within our society has always been controversial. This problem emphasizes the need to understand the roles of variable factors when pertaining to the subject of welfare within our society. The proposed analysis will address the phenomenon of welfare assistance and several factors which may contribute to the increase or decrease of welfare assistance to the poor in 4 ways: (1) by defining major concepts and any other concepts about which there is likely to be misunderstanding (2) by further examining the past history pertaining to the subject of welfare assistance within the United States; (3) by developing the formulation of a hypothesis which will provide for an explanation of welfare; and finally (4) determining whether or not the benefits of welfare assistance outweigh the cost. Ultimately, the purpose of this research analysis is to investigate variable factors that may contribute to the increase or decrease of welfare assistance. This cost benefit analysis is an attempt to explain the tentative assumptions of others pertaining to the subject of welfare, in order to determine and explain the relationship of welfare to the economic cost and benefits. Before welfare assistance can be analyzed there is a need to define the terms that will be used. Policies like welfare assistance are worthwhile only if the benefits to society are greater than the costs. When choosing among a set of policies, the policy with the greatest net benefit (benefit over cost) should be chosen. Hence, this is where the term cost-benefit analysis comes from. Cost-benefit analysis is a technique for determining the optimal level of an economic activity such as welfare. In general, an activity such as welfare assistance should be expanded as long as it leads to greater benefits than costs. In purely economic terms, does the benefit of welfare assistance justify the costs of welf...

makeupp essays

makeupp essays The word cosmetics originates from the Greek word cosmos meaning order of arrangement. This business has evolved within the last half-century. In less than 60 years, the American cosmetic industry has evolved from bathtub and garage operation to a big business seducing teens. The forms of cosmetics include lipstick, lip gloss, foundation, powder, rouge, mascara, eyeliner, and nail polish. Women who didnt make their own had two choices: they could go to a pharmacist who compounded preparations under a house label or purchase commercial products. Recipes for cosmetics began to be published in the US in the late 18th century to the late 19th century. Womens access to information about cosmetics expanded. The earliest known cosmetics come from the 1st Dynasty of Egypt (about 3100-2907 BC). Tombs of this era have yielded unguent jars, and from remains of later periods it is evident that the unguents were scented. Such preparations, as well as perfumed oils, were extensively used by both men and women to keep the skin supple and unwrinkled in the dry heat of Egypt. Egyptian women also developed the art of decorating the eyes by applying dark green color to the lower lid and by blackening the lashes and the upper lid with kohl, a preparation made from antimony or soot. It is likely that the Jews adopted the use of cosmetics from the Egyptians, since references to face painting appear in the Old Testament. In Greco-Roman women wore white lead and chalk on their face to attract attention. Egyptians wore foundation to lighten their skin and kohl eyeliner. Europeans followed the Greco-Roman trend of pale faces . During the time of Louis X14 and Queen Elizabeth 1st, we took a few chances to look our best with catastrophic results. Pale skin was the flavor of the month and unknowingly, the skin was whitened with lead and it caused many early deaths. They were not satisfied with their hair either, so they bleached...

International marketing Essay Example | Topics and Well Written Essays - 2500 words

International marketing - Essay Example However, globalization has not diminished social and cultural differences across markets which suggest that marketing communication strategy needs to address these differences when communicating across cultures. Hofstede’s dimensions of national culture are the most widely applied theory in understanding national and international markets. This paper argues that the concepts of self, personality and identity differ across culture which in turn influences advertising strategy across different markets. However, advertising strategy cannot solely be based on Hofstede’s dimensions of culture. Other factors and variables could also influence the advertising appeals. It is essential to understand how advertising works in different cultures and to understand this, the advertising value has to be perceived in the right manner. Consumers and Cultural dimensions Culture is the collective programming of the mind which distinguishes the members of one group or category of people fr om another (Hofstede, 1990). National culture differentiates one nation from another but within the national culture several subcultures may exist. Consumers differ not only in their lifestyle, beliefs, attitudes and buying habits and at the root of all these, is the difference in culture. Cultural values actually represent the core beliefs of the society. It also includes education, religion and the physical environment. Attitudes develop over time and can change with age and education. In personal communication verbal and body language both can difference across cultures. Understanding cultural differences is a prerequisite for international advertising as a culture’s values are reflected in its advertising (Aillaud & Hahnel, 2006; Chang et al, 2009; Alozie, 2010). Culture and advertising Culture and advertising are inherently related and beliefs towards advertising differ across cultures (Liu et al, 2011). Advertising represents a special type of mass media discourse where verbal and non-verbal messages are unified into a single entity (Ustinova, 2008). Advertising merges the voices of authority and intimacy as they are constrained by the need to fulfill the wishes of their clients. Advertising is closely related to culture and must be adapted to meet the consumer’s needs. Tastes and desires may have become homogenous; values and needs have not become universal (Cemalovic, 2009). Cultural differences continue to exist in language, customs, and habits which heighten the importance of localizing the marketing strategy. Cultural values are an integral part of the consumer’s self. Therefore, for advertisements to be effective, they should be centered on the customer. Mental and social processes also make a difference in how advertisements are perceived (Mooij & Hofstede, 2010). Mental processes are internal – how people learn, perceive and process messages. Social processes include motivation and emotions. Both these processes affect mass communication and interpersonal communication which in turn impact the advertising appeals and advertising style. Advertising appeal and culture While designing advertisements the consumers must be focused upon. Culture influences various elements of consumer behavior and each of these have to be considered by the marketers when designing advertisements. Consumers differ in how they process information and perceive the message. Advertising appeals are specific approaches that marketers use to communicate

PICOT ASSIGNMENT#2 ( WILL SEND SPECIFIC INFORMATION) Research Paper

PICOT ASSIGNMENT#2 ( WILL SEND SPECIFIC INFORMATION) - Research Paper Example This is through the review of literature using the PICOT question, in which case it is essential in looking for evidence that supports an intervention (Vollman, 2010). The picot question involves the following elements The intubation procedure should involve the gas exchange, the hemodynamic and the neurologic care, in which case they are essential in critically ill patients (Vollman, 2010). The evidence provided is quite of high level and results in answering the PICOT questions. The application of CLRT is quite easier to maintain, and hence, the application of CLRT leads to prevention of atelectasis than it restores the alveolar patency. The inclusion criteria included all the search results, in which case it had to contain continuous lateral therapy and lung injury, lung complications and ARDS (Davis et al., 2001). The pulmonary complications are the most frequent in mortality and morbidity in critically, ill patients. Studies by the Institute for Healthcare Improvement have had to find that the ventilator-associated pneumonia is leading in the cause of hospital morbidity and mortality. Nurses have even had to implement a two-hour turning of patients in order that they prevent the complications. Despite the continued use of such strategies, there has been no significant improvement in the effectiveness of pulmonary complications. As part of the progressive mobility, the Continuous Lateral Rotation Therapy (CLRT) has been in use in order to reduce the pulmonary complications that have had to result from immobility. The therapy was through continuous motion-bed frames, in which case helps rotate the patient from one side to another. Such strategy is quite effective in improving the pulmonary outcomes in critically ill patients (Dollovich, et al, 1998). Mobilization of patients is quite an accepted practice that helps to reduce the effect of prolonged bed rest. Sometimes it is quite difficult to mobilize patients during the early acute phase