Dr. Jang Chou has a background in prosthodontics, and has a successful practice in San Antonio.  He has extensive experience with traditional microscopes, and was finding that he was only really able to use them in very specific situations – which was limiting his return on investment.  He liked to have the high magnification.  However, he often found that during the procedure, he wanted to see different angles or different magnification levels, or even to just see a “birds-eye” view using his loupes.  The traditional microscope really didn’t allow him to do this, and it wasn’t practical to stop what he was doing in mid-procedure, move it to the side, and put on loupes.

He also knew that image and video are so valuable for record keeping and patient communication.  However, all the different options (intraoral cameras, loupe-cams, dental light cameras) were either disruptive to use, lacked stability or had limited resolution to capture great imagery. 

As he researched options, he started investigating the Mielscope.  However, he had many questions.  Would it fit in his operatory?  Where would the screen be located, and where would his assistant stand so that both had visibility?  Would it be difficult to work from a screen?  Would the images and video really be as good as he hoped?

Fast forward a few months, and Dr. Chou says “The Mielscope has been working great!  I think I’ve figured out some of the optimal positioning to make it work, and I’ve been doing a lot of cases with it.  It takes fantastic videos to document cases, and I love how few ‘clicks’ it takes to get to video-taking mode.”

“It is also very unobtrusive” he continued, “so we don’t have any objections from patients when documenting cases. Furthermore, “what is nice is that I don’t have to take loupes off every time I need to look at a different view or to zoom in. Once positioning of the head and the monitor has been figured out, it works fantastically!”

Finally, he mentioned that “I’ve also been having great success with my endo cases. It’s been excellent for finding the MB2.” 

 We had a chance to sit down with Dr. Chou to chat with him about his journey with the Mielscope.  Here are some clips of the discussion.

A research paper on dental imagery discusses the importance of color when it comes to using digital imaging to maximize diagnostic value.

“Concerning soft tissues, a correct color rendition is an excellent method for distinguishing between healthy and diseased tissues and for recording pathological changes such as white patches, inflammation, ulceration, burns, lacerations, carcinoma, etc.” (1)

“Similarly, a correct color rendition of hard tissues reveals enamel translucency, decay, erosion and abrasion, as well as cervical dentine exposure and sclerosis.”

In representing color, it’s sometimes overlooked that 4K resolution not only has 4 times the resolution of HD imagery, as importantly for dental care, 4K also has much richer color representation than HD.  This depth of color representation can make an enormous difference when the dental professional needs to differentiate subtle shading differences in tissue, see mild inflammation, or locate decay. 

It’s also worth noting that to fully take advantage of the clinical information that 4K video offers, both the image source and the monitor must both be 4K capable.

A critical component of the Mielscope’s power is that it offers 4K imaging across the wide array of magnification levels, positions and angles.  This value comes not only from the spatial resolution of 8.3 million pixels, but also a dramatically deeper color pallette. 

Dental panoramic X-rays play a crucial role in the medical management of patients undergoing cardiac valve surgery. These radiographic images can help surgeons identify and treat issues that may complicate cardiac procedures. This article explores the importance of dental panoramic X-rays in the context of cardiac surgery, highlighting their role in preventing complications and ensuring optimal patient outcomes.

The Importance of Dental Health in Cardiac Surgery

Cardiac valve surgery, which includes procedures on both native and prosthetic valves, increases the risk of postoperative Infective Endocarditis (IE).¹  IE is an infection of the inner lining of the heart chambers and valves, often caused by bacteria entering the bloodstream from oral infections. Research indicates that approximately 10-20% of IE cases are linked to oral infections, with chronic periodontitis significantly raising the risk, especially in patients with pre-existing heart conditions.

Preoperative Dental Evaluation

Patients scheduled for cardiac valve surgery should undergo a comprehensive dental evaluation before the procedure. This evaluation includes a detailed medical history review, an examination of medications and allergies, and a thorough oral and dental examination. Panoramic X-rays are essential in this process, providing a broad view of the oral cavity that helps identify any potential sources of infection.

The initial dental assessment aims to detect and address oral infectious foci, such as caries, periodontal disease, and endodontic issues. By treating these conditions preoperatively, the risk of bacteremia—and consequently IE—during and after cardiac surgery is significantly reduced.

Dental Panoramic X-Rays: A Comprehensive Tool

Panoramic X-rays are particularly valuable in the dental management of cardiac surgery patients for several reasons:

1. Broad Coverage: These X-rays capture the entire mouth in a single image, including the teeth, jaws, and surrounding structures. This wide coverage is crucial for identifying hidden issues that might not be visible in a standard dental examination.
2. Early Detection: Panoramic X-rays can reveal early signs of periodontal disease, caries, and other dental problems. Early detection allows for timely intervention, reducing the risk of complications during cardiac surgery.
3. Surgical Planning: For patients requiring extractions or other dental procedures, panoramic X-rays provide detailed information that aids in surgical planning. They help determine the extent of dental issues and the best approach for treatment, ensuring minimal disruption to the patient’s overall health.

Antibiotic Prophylaxis and Anticoagulant Management

Patients who have had valve surgery have a high risk of IE, and therefore may require antibiotic prophylaxis before dental procedures. The American Heart Association and the American College of Cardiology recommend this for patients with a history of IE, prosthetic heart valves, congenital heart disease, and heart transplants with valvular dysfunction. The antibiotics are typically administered 30-60 minutes before dental procedures that are likely to cause bacteremia, such as extractions and periodontal treatments.

Conclusion

Dental panoramic X-rays are indispensable in the medical management of patients undergoing cardiac valve surgery. They provide a comprehensive view of the oral cavity, enabling early detection and treatment of dental issues that could lead to serious complications like Infective Endocarditis. By integrating these radiographic assessments into the preoperative planning for cardiac surgery patients, healthcare providers can significantly enhance patient safety and surgical outcomes. Ensuring optimal dental health through panoramic X-rays and appropriate prophylactic measures is a critical step in the holistic care of cardiac surgery patients.

The Number One Challenge When Adding a Dental Panoramic X-Ray to a Hospital or Urgent Care Clinic

1. Souza AF, Rocha AL, Castro WH, Gelape CL, Nunes MCP, Oliveira SR, Travassos DV, Silva TA. Dental management for patients undergoing heart valve surgery. J Card Surg. 2017 Oct;32(10):627-632. doi: 10.1111/jocs.13211. Epub 2017 Sep 12. PMID: 28898929.