Salvaging a Periodontally Compromised and Endodontically Involved Three-Rooted Mandibular First Molar With Cervical Enamel Projection

This case report describes the management of a mandibular first molar with an additional distolingual root (radix entomolaris) and grade III cervical enamel projection through a multidisciplinary approach. Diagnosis for the case was endodontic-periodontal lesion due to non-vitality and associated advanced periodontal destruction. The patient was treated with drainage of the periodontal abscess with adjunct antibiotics, phase I periodontal therapy, endodontic therapy, radiculoplasty, regenerative periodontal therapy, replacement of the missing right mandibular second molar, and long-term maintenance. Follow-up of the patient up to 9 months has been uneventful. Cases of advanced periodontal destruction typically show some degree of tooth mobility, which was absent in this case. The article discusses the tripod effect as well as the increased surface area for periodontal attachment provided by the additional root contributing to the non-mobility of the involved tooth.

Addressing healthcare needs of people living below the poverty line: a rapid assessment of the Andhra Pradesh Health Insurance Scheme

BACKGROUND

Families living below the poverty line in countries which do not have universal healthcare coverage are drawn into indebtedness and bankruptcy. The state of Andhra Pradesh in India established the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) in 2007 with the aim of breaking this cycle by improving the access of below the poverty line (BPL) families to secondary and tertiary healthcare. It covered a wide range of surgical and medical treatments for serious illnesses requiring specialist healthcare resources not always available at district-level government hospitals. The impact of this scheme was evaluated by a rapid assessment, commissioned by the government of Andhra Pradesh. The aim of the assessment was to explore the contribution of the scheme to the reduction of catastrophic health expenditure among the poor and to recommend ways by which delivery of the scheme could be improved. We report the findings of this assessment.

METHODS

Two types of data were used for the assessment. Patient data pertaining to 89 699 treatment requests approved by the scheme during its first 18 months were examined. Second, surveys of scheme beneficiaries and providers were undertaken in 6 randomly selected districts of Andhra Pradesh.

RESULTS

This novel scheme was beginning to reach the BPL households in the state and providing access to free secondary and tertiary healthcare to seriously ill poor people.

CONCLUSION

An integrated model encompassing primary, secondary and tertiary care would be of greater benefit to families below the poverty line and more cost-effective for the government. There is considerable potential for the government to build on this successful start and to strengthen equity of access and the quality of care provided by the scheme.

Failures in periodontal therapy

Studies have shown that modern periodontal therapies are effective in maintaining a healthy natural dentition as well as controlling periodontal disease. Numerous treatment strategies and various techniques have been designed & described to treat periodontal disease. Most of these procedures had drawbacks which were identified, leading to the modifications of the original techniques which lead to better treatment options, but still very less emphasis has been laid on failures. Without a regular program of clinical re-evaluation, plaque control, oral hygiene instructions, and reassessment of biomechanical factors the benefits of treatment are often lost and inflammatory disease in the form of recurrent periodontitis may result. So, this review describes the most common failures noticed in periodontal therapies and also discusses the possible solutions to reduce the incidence of failures in periodontal therapy.Key words: Periodontal therapy; risk factors; failures.DOI: 10.3329/bjms.v9i4.6680Bangladesh Journal of Medical Science Vol.09 No.4 July 2010 pp.193-198