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Total Dental Health

Total Dental Health is a natural program aimed at preventing and reversing severe periodontal disease. Total Dental Health was created with the aim of ensuring people get healthy within a few days. It is an E-book that has a comprehensive, natural and easy plan to ward off periodontitis as well as fight it. Total Dental Health was designed to help people by pointing out methods that will be useful in having a great oral health. The plan is so comprehensive that the users will have no need for any external guide in the usage of the book. Moreover, it has food plans that had been tested by a lot of people and has been discovered to has a great effect in fighting teeth diseases or gum bleeding such as gingivitis. The food plan is such that the author has used it to point out foods to eat and those to avoid. Not limited to adults, Total Dental Health is well-equipped to help children in preventing teeth problems that might later cause pain and embarrassment. With its unique natural methods, the user gets the chance to spend less as opposed to when he/she visits a dentist More here...

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Caries And Existing Restorations

Crowns and fixed partial dentures are definitive restorations. They are time-consuming and expensive treatment options and should not be recommended unless an extended lifetime of the restoration is anticipated. Often, teeth requiring crowns are severely damaged or have large existing restorations. Any restoration on such teeth must be carefully examined and a determination made regarding its serviceability. If doubt exists, the restoration should be replaced. Time spent replacing an existing restoration that in retrospect might have been serviceable is a modest price to pay for the assurance that the foundation will be caries free and well restored. Studies have shown that accurately detecting caries beneath a restoration without its complete removal can be very difficult. Even on caries-free teeth, an existing restoration may not be a suitable foundation. Preparation design is different for a foundation than for a conventional restoration, particularly regarding the placement of...

Caries Excavation

Identify and remove any caries not eliminated by the proximal box preparation, using an excavator or a round bur in the low-speed handpiece. 8. Place a cement base to restore the excavated tissue in the axial wall and or pulpal floor. If necessary, the preparation can be ex tended buccally or lingually. NOTE an inlay is not a suitable restoration for extensive caries, and carrying it beyond the line angles will lead to a significant loss of retention and resistance form.

Dental Caries

Vipeholm Study

Dental caries (Fig. 32-8) is the most common cause of failure of a cast restoration. Detection can be very difficult,12 particularly where complete coverage is used. At each appointment, the teeth should be thoroughly dried and visually inspected (Fig. 32-9). The explorer must be used very carefully Fig. 32-5. Radiopacity of luting agents. These three in vitro studies compared the radiographic appearance of various luting agents to aluminum. The data were normalized to account for different specimen thicknesses used by the investigators. Excess luting agent will be more difficult to detect if materials with lower values are chosen. In addition, margin gaps and recurrent caries will be more difficult to diagnose. Fig. 32-5. Radiopacity of luting agents. These three in vitro studies compared the radiographic appearance of various luting agents to aluminum. The data were normalized to account for different specimen thicknesses used by the investigators. Excess luting agent will be more...

Cranial Nerves Functional Anatomy

Cranial nerves are involved in head and neck function, and processes such as eating, speech and facial expression. This clinically oriented survey of cranial nerve anatomy and function was written for students of medicine, dentistry and speech therapy, but will also be useful for postgraduate physicians and general practitioners, and specialists in head and neck healthcare (surgeons, dentists, speech therapists, etc.). After an introductory section surveying cranial nerve organization and tricky basics such as ganglia, nuclei and brain stem pathways, the nerves are considered in functional groups (1) for chewing and facial sensation (2) for pharynx and larynx, swallowing and phonation (3) autonomic components, taste and smell (4) vision and eye movements and (5) hearing and balance. In each chapter, the main anatomical features of each nerve are followed by clinical aspects and details of clinical testing. Simple line diagrams accompany the text. Detailed anatomy is not given.

Differential Diagnosis

A typical diagnosis will condense the information obtained during the clinical history taking and examination. For instance, a diagnosis could read as follows 28-year-old male, no significant medical history vital signs normal. Chief complaint Mesio-lingual cusp fracture on tooth 30. Teeth 1, 16, 17, 19, and 32 missing. Patient reports significant postoperative discomfort after previous molar extraction. High smile line. Caries 6, mesial 12, distal 20, mesio-occlusal and 30, mesio-occlusal-distal. Tooth 8 has received previous endodontic treatment. Generalized gingivitis four posterior quadrants, with recession noted on teeth 23, 24, and 25. 5-mm pockets on teeth 18, 30, and 31. Radiographic evidence of periapical pathology tooth 30. Tooth 30 tests nonvital.

Correction Of Existing Disease

Existing disease will be revealed during the clinical examination. The disease process can usually be arrested by identification and reduction of the initiating factors, identification and improvement of the resistive factors, or both (Fig. 3-1). For example, oral hygiene instruction will reduce the amount of residual plaque, an initiating factor, and thus will reduce the likelihood of further dental caries. It will also improve gingival health, and the resulting healthy tissue will be more resistant to disease. Additional fluoride intake (e.g., mouth rinses) is also recommended in a patient with a caries problem. Restorative care will replace damaged or missing tooth structure, but additional treatment is essential for controlling the disease that caused the damage. Fig. 3-1. Poor plaque control with dental caries. Fig. 3-1. Poor plaque control with dental caries.

Tooth Whitening as a Treatment Modality

As the techniques and materials available to dentists have improved over the past few decades, better and more conservative restorations have become possible. Extensive preparation and tooth destruction have given way to a genuine concern for the preservation of tooth structure. Most recently, much attention has been devoted to the esthetic aspects of dentistry and the patient's concerns for appearance. The past three decades have been the most dynamic period that dentistry has ever known.

Stabilization Of Deteriorating Conditions

The second phase of treatment involves stabilizing conditions such as dental caries or periodontal disease by removing the etiologic factors, increasing the patient's resistance, or doing both. Dental Caries. Treatment of carious lesions is approached in a conventional manner, and the teeth are restored with properly contoured plastic materials. These may serve as a foundation for fixed castings during a subsequent phase of treatment (see Chapter 6). However, cast restorations are best avoided in a patient with active caries because the results of such extensive treatment would be jeopardized by recurrence of the disease. This can be prevented by a combination of dietary advice, oral hygiene measures, and fluoride treatment.

Historical Background

The following era of dentistry brought the study of dental anatomy, of oral disease, and a great interest in the prosthetic replacement of teeth whose loss could not yet be avoided. As the science of dental technology expanded, dentists were better able to replicate both form and function. Then, in the nineteenth century, dentistry began its recognizably modern procedures of restoring carious, and even infected teeth. This resulted in patients retaining their teeth for a greater portion of their lives, and furthermore, an expectation that these older teeth could be made visually acceptable. While the earliest attempts at bleaching non-vital teeth were made at the end of the 19th century, no major developments came until the 1950's. As endodontic therapy became part of the regular dental armamentarium, increasing numbers of functional, but unesthetic teeth led dentists to look for new tooth whitening techniques. In 1958, Pearson reported on the use of superoxol sealed within the pulp...

Chiropractic Medicine

Chiropractic medicine is one of the most popular forms of complementary and alternative medicine (CAM) in the United States. Chiropractors are the largest group of alternative medicine practitioners and the third largest group of health care professionals in the United States (after physicians and dentists). It is estimated that more than 160 million Americans visit chiropractors yearly.

Esthetic Considerations

The restorative dentist should develop skill in determining the esthetic expectations of the patient. Patients prefer their dental restorations to look as natural as possible. However, care must be taken that esthetic considerations are not pursued at the expense of a patient's long-term oral health or functional efficiency.

The Safety of Tooth Whitening

In 1982, another rat study determined that the anticariogenic effectiveness of the oxygenating topical agents was related to their ability to release active oxygen rather than their ability to neutralize plaque acid.7 Carbamyl peroxide was found to be highly effective in reducing plaque accumulation and caries incidence. Fogel and Magill reported on the application of carbamyl peroxide in anhydrous glycerol for orthodontic caries prevention.12 Seventy full-banding patients participated in this study for periods ranging from two to three years. The material was applied four times daily, and patients were instructed not to rinse afterward, resulting in an effective tissue-contact time of up to two hours per day. The total exposure over the entire orthodontic treatment time was 1500-2300 hours per patient. The sequelae were positively anticariogenic, and there were no deleterious side effects observed.

Replacement Of A Single Missing Tooth

Uprighting Tilted Teeth

Confidence can be avoided, by thoroughly investigating each abutment tooth before proceeding with tooth preparation. Radiographs are made, and pulpal health is assessed by evaluating the response to thermal and electrical stimulation. Existing restorations, cavity liners, and residual caries are removed21 (preferably under a rubber dam), and a careful check is made for possible pulpal exposure. Teeth in which pulpal health is doubtful should be endodontically treated before the initiation of fixed prosthodontics. Although a direct pulp cap may be an acceptable risk for a simple amalgam or composite resin, conventional en-dodontic treatment is normally preferred for cast restorations, especially where the later need for en-dodontic treatment would jeopardize the overall success of treatment. Unrestored Abutments. An unrestored, caries-free tooth is an ideal abutment. It can be prepared conservatively for a strong retentive restoration with optimum esthetics (Fig. 3-17). The margin of...

Studies in MS and Other Conditions

Also, MS has been associated with both dental caries the bacterial disease of teeth that produces cavities and dental treatment. Finally, it has been proposed that MS is caused by exposure to mercury or other heavy metals. Contrary to what sometimes is claimed, no evidence demonstrates that mercury causes MS or that the removal of dental amalgam improves the course of MS. Although mercury toxicity may produce symptoms that resemble those of MS, the underlying pathologic processes of mercury tox-icity are quite different from those of MS. The levels of mercury in the brain are similar for people with MS and the general population. In addition, some people with MS have no dental amalgam, and MS was recognized as a disease before amalgam was used routinely in dental practice. Some studies of large populations have shown a trend for people with MS to have more dental caries than the general population these trends, however, have not been statistically significant....

Ceramic Inlays And Onlays

A ceramic inlay can be used instead of amalgam or a gold inlay for patients with a low caries rate requiring a Class II restoration and wishing to restore the tooth to its original appearance. It is the most conservative ceramic restoration and enables most of the remaining enamel to be preserved.

Dyskeratosis congenita

Cutaneous manifestations developing between 5 and 15 years of age tan-to-gray, hyperpigmented or hypopigmented macules and patches in a mottled, or reticulated pattern, sometimes with poikilo-derma located on the upper trunk, neck, and face, often with involvement of sun-exposed areas scalp alopecia mucosal leu-koplakia on the buccal mucosa, tongue, oropharynx, esophagus, urethral meatus, glans penis, lacrimal duct, conjunctiva, vagina, anus dental caries progressive nail dystrophy increased incidence of malignant neoplasms, particularly squamous cell carcinoma of the skin, mouth, nasopharynx, esophagus, rectum, vagina, and cer

Pinledge Preparations

Pinledge Crown

The pinledge is indicated for undamaged anterior teeth in dentitions with a low caries experience. The presence of a small proximal carious lesion, however, does not preclude its use. If a high esthetic requirement exists, the advantage of this restoration is that the labial tooth surface Fig. 10-36. A, Periodontally compromised but caries-free teeth of adequate buccolingual width are excellent candidates for a pinledge retained fixed splint. B, The master cast. C, Pinledge splint consisting of six separate castings that were soldered together and seated. D, A minimum display of metal results. The pinledge preparations permit retention of the intact labial enamel of all six anterior teeth. Fig. 10-36. A, Periodontally compromised but caries-free teeth of adequate buccolingual width are excellent candidates for a pinledge retained fixed splint. B, The master cast. C, Pinledge splint consisting of six separate castings that were soldered together and seated. D, A minimum...

Detailed Examination and Diagnosis

The use of transillumination to evaluate the internal morphology of the tooth is particularly helpful in determining the severity of the case. As the bright light passes through the different layers of the enamel and dentin, it provides information on the opacity and the depth of any discoloration or hypocalcification. The light may also reveal incipient caries missed by other diagnostic means.

Esthetic Requirements

The provisional is often used as a guide to achieving optimum esthetics in the definitive restoration. In complete denture prosthodontics, it is customary to have a wax try-in so the patient can respond to the dentist's esthetic interpretation before the denture is processed. Many dentists consider this essential because of the frequency of patient requests for changes and the ease with which such changes can be made. When fixed prosthodon-tics is being performed in the anterior oral cavity, it greatly influences appearance the patient should be given an opportunity to voice an opinion. Beauty and personal appearance are highly subjective and difficult to communicate verbally, and a facsimile prosthesis can play a vital role in the patient's consideration of esthetics and the impact that the prosthesis will have on self-image. Obtaining the opinions of others whose judgment is valued is also important. An accurate provisional is a practical way of obtaining specific feedback for the...

Principles of Tooth Preparation

Principles Tooth Preparation

Teeth do not possess the regenerative ability found in most other tissues. Therefore, once enamel or dentin is lost as a result of caries, trauma, or wear, restorative materials must be used to reestablish form and function. Teeth require preparation to receive restorations, and these preparations must be based on fundamental principles from which basic criteria can be developed to help predict the success of prosthodon-tic treatment. Careful attention to every detail is imperative during tooth preparation. A good preparation will ensure that subsequent techniques (e.g., provisionalization, impression making, pouring of dies and casts, waxing) can be accomplished.

Subgingival Margin Preparation

Undercontouring Dentistry

Dental caries, cervical erosion, or restorations extend subgingivally, and a crown-lengthening procedure (see Chapter 6) is not indicated. Margin Adaptation. The junction between a cemented restoration and the tooth is always a potential site for recurrent caries because of dissolution of the luting agent and inherent roughness. The more accurately the restoration is adapted to the tooth, the lesser the chance of recurrent caries or periodontal disease . 3 Although a precise figure for acceptable margin adaptation is not available, a skilled technician can make a casting that fits to within 10 u and a porcelain margin that fits to within 50 um, provided the tooth is properly prepared. A well-designed preparation has a smooth and even margin. Rough, irregular, or stepped j unctions greatly increase the length of the margin and substantially reduce the adaptation of the restoration (Fig. 7-16). The importance of preparing smooth margins cannot be overemphasized. Time spent obtaining a...

Cavosurface Angle Amalgam

Cavosurface Angle Amalgam

Preserving unsupported enamel may facilitate matrix placement and improve amalgam condensation (Fig. 6-7, B). 6. Remove any carious dentin carefully and thoroughly with a hand excavator or large round bur in a low-speed handpiece. Discolored but hard dentin can be left on the pulpal wall, but caries-affected areas at the enamel-dentin junction should be removed completely. If a pulp exposure occurs during the preparation, whether carious or mechanical, endodontics or tooth removal will be necessary. A direct pulp cap is not a good choice for a tooth requiring an FPD however, if endodontics is elected and the pulp cannot be extirpated immediately, a suitable sedative dressing should be placed. Fig. 6-7. The principles of preparation design for an amalgam foundation restoration differ slightly from those for a conventional extensive amalgam restoration. A, The outline form of a foundation need not include fissures or proximal or occlusal contacts, provided complete...

The Metal Ceramic Crown Preparation

Full Metal Crownpreparation

In many dental practices the metal-ceramic crown is one of the most widely used fixed restorations. This has resulted in part from technologic improvements in the fabrication of restoration by dental laboratories and in part from the growing amount of cosmetic demands that challenge dentists today. Typical indications are similar to those for all-metal complete crowns extensive tooth destruction as a result of caries, trauma, or existing previous restorations that precludes the use of a more conservative restoration the need for superior retention and strength an endodontically treated tooth in conjunction with a suitable supporting structure (a post-and-core) and the need to recontour axial surfaces or correct minor malinclinations. Within certain limits this restoration can also be used to correct the occlusal plane.

Anterior Partial Veneer Crown Preparations

Partial Veneer Crown

A, Caries-free canine and lateral incisor of adequate bulk-excellent candidates for anterior partial veneer crowns. B, The canine restored with a three-quarter crown, serving as the anterior retainer for a three-unit FPD to replace the first premolar. The lateral incisor has been restored with a modified pinledge that serves as a retainer for an anterior four-unit FPD. Satisfactory esthetics (C) with minimal display of metal are apparent. Fig. 10-23. A, Caries-free canine and lateral incisor of adequate bulk-excellent candidates for anterior partial veneer crowns. B, The canine restored with a three-quarter crown, serving as the anterior retainer for a three-unit FPD to replace the first premolar. The lateral incisor has been restored with a modified pinledge that serves as a retainer for an anterior four-unit FPD. Satisfactory esthetics (C) with minimal display of metal are apparent.

Conservation Of Tooth Structure

Endodontically treated teeth often have lost much coronal tooth structure as a result of caries, of previously placed restorations, or in preparation of the endodontic access cavity. However, if a cast core is to be used, further reduction is needed to accommodate a complete crown and to remove undercuts from the Fig. 12-10. A, It is preferable to maintain as much coronal tooth structure as possible, provided it is sound and of reasonable strength. B, Extensive caries has resulted in the loss of all coronal tooth structure. This is less desirable than the situation in A, because greater forces are transmitted to the root. Fig. 12-10. A, It is preferable to maintain as much coronal tooth structure as possible, provided it is sound and of reasonable strength. B, Extensive caries has resulted in the loss of all coronal tooth structure. This is less desirable than the situation in A, because greater forces are transmitted to the root.

Participation is paramount and clinicians who take

A survey' of fixed prosthodontic laboratories revealed that dentists delegate a significant proportion of this responsibility. The technicians surveyed were often dissatisfied with the quality of work received complaints included insufficient informa- concerning dentist-technician interaction, whether written by dentists or technicians, the authors emphasized that improvement is achievable only by

Improving communication

Working relationships between dentists and dental laboratories The current high standard of prosthetic dental care is directly related to, and remains dependent upon, mutual respect within the dental team for the abilities and contributions of each member. The following guidelines are designed to foster good relations between dental laboratories, dental laboratory technicians and the dental profession.

Considerations Affecting Future Dental Health

Tooth Path Withdrawal

An improperly prepared tooth may have an adverse effect on long-term dental health. For example, insufficient axial reduction inevitably results in an overcontoured restoration that hampers plaque control. This may cause periodontal disease or dental caries. Alternatively, inadequate occlusal reduction may result in occlusal dysfunction, and poor margin placement may lead to chipped enamel or cusp fracture.

Enrolling new centres

State whether clinicians' CVs are required and whether clinicians need to be registered with the regulatory authority - the Medicines Control Agency in the UK - before they start randomizing patients. In the UK, CVs are required if the trial involves a new unlicensed drug, or a drug used outside its licensed indications, and is being conducted under a Clinical Trial Certificate Exemption (CTX) held by a company or a Doctors' and Dentists' Exemption (DDX) held by a clinician who is not a consultant or adviser to a company (http mca) 17 .

Correction Of Defects

Even a very small undercut on the die of a tooth preparation will result in an inability to remove the wax pattern. There may be small dimples in the die (resulting from caries removal or loss of a previous restoration) that are undercut relative to the path of placement of the new restoration. Normally such areas are blocked out intraorally with glass ionomer or restored with amalgam or another suitable foundation material as part of the mouth preparation phase (see Chapter 6). Occasionally, however, blocking them out on the working die may be more practical and convenient, as long as the defect does not extend to within 1 mm of the cavity margin. Zinc phosphate cement is a suitable material, but other commercial products (e.g., resin) are available for this purpose (Fig. 18-2).

Discharge And Home Healthcare Guidelines

To prevent IE, provide patients in the high-risk category with the needed information for early detection and prevention of the disease. Instruct recovering patients to inform their healthcare providers, including dentists, of their endocarditis history, since they may need future prophylactic antibiotic therapy to prevent subsequent episodes.

Subjective Evaluation

It is very difficult, particularly for those not trained in distinguishing subtle gradations of yellowish white, to detennine whether a color change has actually occurred, and if so, how great the change was. Thus, it is impossible for dentists or patients to make a valid subjective judgment such as those teeth are whiter now than three weeks ago.

R Duane Douglas contributing author

Hygienic Pontics Dental

Pontics are the artificial teeth of a fixed partial denture that replace missing natural teeth, restoring function and appearance. They must be compatible with continued oral health and comfort. The edentulous areas where a fixed prosthesis is to be provided may be overlooked during the treatment-planning phase. Unfortunately, any deficiency or potential problem that may arise during the fabrication of a pontic is often identified only after the teeth have been prepared or even when the master cast is ready to be sent to the laboratory. Proper preparation includes a careful analysis of the critical dimensions of the edentulous areas mesiodistal width, occlusocervical distance, buccolingual diameter, and location of the residual ridge. To design a pontic that will meet hygienic requirements and prevent irritation of the residual ridge, particular attention must be given to the form and shape of the gingival surface. Merely replicating the form of the missing tooth or teeth is not...

Evaluation of Patient

It is important that every effort be made to locate the primary tumor. If found, the primary can be adequately and appropriately treated and the patient's prognosis therefore better assessed. In addition, locating the primary lesion may avoid extensive mucosal radiation and therefore avoid the often severe adverse effects of wide-field mucosal irradiation. These adverse effects include severe xerostomia, dental caries, laryngeal edema, osteoradionecrosis of the mandible, laryngeal chondritis, persistent pain, dysphagia due to submucosal fibrosis of the pharynx, hypothyroidism, hypopituitarism, and aspiration.5-8

Saffron Crocus sativus Iridaceae

Saffron, from dried stigmas of Crocus sativus, is the world's most expensive spice. It takes seventy thousand flowers to produce about half a kilogram of saffron. Its name comes from the Arabic zafaran (yellow) and saffron was the Mediterranean equivalent of the Asian turmeric. In Classical times, saffron was strewed on floors as a perfume and figured in Roman trade with India. By 960 ad, the Arabs were cultivating saffron in Spain, while the Crusaders probably introduced it to northern Europe. Being expensive, saffron was often adulterated, as described by Pliny. In 15th century Germany, traders found guilty of adulterating saffron were burned or buried alive. Saffron reputedly cured everything from toothache to plague drinking saffron tea induced optimism and saffron tea was even added to canaries' drinking water.

Stepbystep Procedure

Framework Design For Metal Ceramic

Do not place any proximal contacts on the j unction between metal and porcelain. Plaque accumulation there may result in caries of the adjacent tooth. Normally, for good appearance and because it is more easily cleaned, proximal contacts are placed in porcelain. On some posterior teeth, however, where the in-terproximal area cannot be easily seen, a more conservative preparation may be possible, with the contacts entirely in metal (see Fig. 19-3, D).

Odontogenous Osteitis of the Mandible Periapical Abscess

Dental Pulp

Fig. 7.13A, B Odontogenous osteitis related to periapical inflammation in the mandible. A Slightly tilted lateral radiograph of the right mandible in a 59-year-old man with mandibular dental pain shows bone resorption about the second molar roots (arrow) and in the extracted third molar alveolus and diffuse sclerosis (arrowheads), denoting the periapical abscess, erosions, and reactive eburnation, respectively. B Lateral pinhole scintigraph shows very intense tracer uptake focally in the molar alveolar bones (arrow) and less intense uptake around it (arrowheads). The presence of more intense tracer uptake in the periapical bone may represent infection, but infection is not a prerequisite to nonspecific, intense, mandibular tracer uptake. Indeed, frequently the painless. nonin-fective bone resorption is attended by intense tracer accumulation

Trigeminal Function and Pathology

Trigeminal neuralgia is the term given to the occurrence of intense pain, often in patients over 60 years, within one or more of the peripheral territorial divisions of the trigeminal system. The diagnosis involves the localization of the pain using a trigeminal sensory map this is useful in differentiating the pain from that involving, for example, the facial nerve. Infection of sensory nerve roots by herpes zoster causes painful shingles-like symptoms. In winter, inflammatory conditions cause nociceptive activity in afferents from the mucosa of the middle ear, larynx, pharynx, and pharyngotympanic tube. Dental pain is ascribed to nociceptive activity in trigeminal afferents, and frontal headache may be due to activation of trigeminal afferents activated by lesions distorting cerebral arteries.

And 67Ga Citrate Scintigraphy in Skeletal Infections

A CT of the anterior portion of left rib 7 in a 66-year-old male with tuberculosis shows irregular osteolytic change with host bone fragmentation and soft-tissue abscess (arrows). B Tilted AP radiograph of the left lower chest demonstrates flaring and osteolysis in the anterior part of the left rib 7 (arrow). C Anterior pinhole scan reveals fan-shaped tracer uptake with the more intense uptake in the main infective focus at the costochondral junction, the site analogous to the long bone metaphysis

Increased Tracer Uptake In The C5 And C6 Vertebral Bodies

Pyogenic Spondylitis

Tion, especially in the thoracic spine that is difficult to visualize radiographically without anatomical overlapping (Fig. 6.40A). However, pinhole scintigraphy can sensitively detect it (Fig. 6.40B). It is to be remembered that the necrosis, granulomas, and sequestrated bones of tuberculosis are not imaged positively because they do not accumulate tracer. Rib tuberculosis or caries manifests as mottled or homogeneous uptake with occasional fracture (Fig. 6.41).

School Health Services

Procedures to promote, appraise, and protect the health of schoolchildren. Services may be provided by physicians, nurses, teachers, dentists, dietitians, school counselors, and others (Brandon, 1993 Yates, 1994). School health services provide first aid and care for students who may become injured or ill at school immunization and screening for dental caries, sickle cell anemia, and other conditions. School health services are that part of the school health program provided by physicians, nurses, dentists, health educators, other allied health personnel, social workers, teachers and others to appraise, protect and promote the health of students and school personnel. These services are

Selecting A Casting Alloy

Hardness Different Gold Alloys

In most respects, clinical performance (biologic and mechanical) is more important than cost. Biologic properties that can be evaluated include gingival irritation, recurrent caries, plaque retention, and allergies. Mechanical properties include wear resistance and strength, marginal fit, ceramic bond failure, connector failure, and tarnish and corrosion.

Available Alloy Systems

*Recently, the price of palladium has greatly increased. In January 1997, palladium was 120 an ounce by February 2000, this had increased to 800 an ounce. However, by April 2000, the price has decreased to 560 an ounce. Rapid increases in alloy prices can cause many problems for dentists and the dental laboratory industry.

Nlays And Onlays Indications

An inlay can be used instead of amalgam for patients with a low caries rate who require a small Class II restoration in a tooth with ample supporting dentin. It is among the least complicated cast restorations to make and can be very durable when it is carefully done. An onlay allows the damaged occlusal surface to be restored with a casting in the most conservative manner. It should be considered in the restoration of a severely worn dentition when the teeth are otherwise minimally damaged or for the replacement of an MOD amalgam restoration when sufficient tooth structure remains for retention and resistance form.

Preparation Of The Coronal Tooth Structure

Cross Section Tooth Root Canal

Ignore any missing tooth structure (from previous restorative procedures, caries, fracture, or endodontic access) and prepare the re maining tooth as though it were undamaged (i.e., if a porcelain labial margin restoration is planned, a facial shoulder and lingual chamfer are placed).

Metformin hydrochloride

Special Concerns Cardiovascular collapse, acute CHF, acute MI, and other conditions characterized by hypoxia have been associated with lactic acidosis, which may also be caused by metformin. Use of oral hypoglycemic agents may increase the risk of cardiovascular mortality. Although hypoglycemia does not usually occur with metformin, it may result with deficient caloric intake, with strenuous exercise not supplemented by increased intake of calories, or when metformin is taken with sulfonylureas or alcohol. Because of age-related decreases in renal function, use with caution as age increases. Safety and efficacy have not been determined in children. Side Effects Metabolic Lactic acidosis (fatal in approximately 50 of cases). Oral Unpleasant or metallic taste. GI Diarrhea, N& V, abdominal bloating, flatulence, anorexia. He-matologic Asymptomatic subnormal serum vitamin B12 levels. Drug Interactions None reported that would interact with dental therapy or oral health. How Supplied...

Biofilm and Medical Devices

Biofilm, as a matter of fact, is involved in acute and chronic infectious diseases and has been described in human and experimental pathology such as native valve endocarditis, otitis media, bacterial chronic rhinosinusitis, COPD, chronic urinary infections, bacterial prostatitis, osteomyelitis, dental caries, biliary tract infections, Legionnaire's disease and amyloidosis.

Treatment Planning

Tooth Preparation Diagram

Without a careful all-inclusive diagnosis and well-designed treatment plan, the chances of success are minimal. Patients who require a removable prosthesis (Fig. 21-1) usually have sustained extensive damage as a consequence of caries, periodontal disease, or trauma. They also may exhibit acquired or congenital intraoral defects. As a result of prolonged loss of arch integrity, there may be drifting or tipping, and the occlusion is often less than ideal.

Medical Complications Direct Results of Cocaine

Other difficulties associated with chronic cocaine use include weight loss, dehydration, nutritional deficiencies (particularly of vitamins B6, C, and thia-mine), and endocrine abnormalities. Neglect of self-care may be evident, including dental caries and periodontitis exacerbated by bruxism. Addicts may medicate their pain with cocaine or other mood-altering drugs and seek medical attention only after prolonged existence of their problem(s).

Radiographic Examination

Transcranial Radiograph

Panoramic films (Fig. 1-24) provide useful information about the presence or absence of teeth. They are especially helpful in assessing third molars and impactions, evaluating the bone before implant placement (see Chapter 13), and screening edentulous arches for buried root tips. However, they do not provide a sufficiently detailed view for assessing bone support, root morphology, caries, or peri-apical pathology.

Provisional Cementation

On many occasions, cementing a restoration provisionally is advised so that the patient and dentist can assess its appearance and function over a longer time than a single visit. However, these trial cementations should be managed cautiously. On one hand, removing the restoration for definitive cementation may be difficult, even when temporary zinc oxide eugenol (ZOE) cement is used. To avoid this problem, the provisional cement can be mixed with a little petrolatum or silicone grease and applied only to the margins of the restoration to seal them while allowing subsequent removal without difficulty. On the other hand, a provisionally cemented restoration may come loose during function. If a single unit is displaced, it can be embarrassing or uncomfortable for the patient. If one abutment of a fixed partial denture becomes loose, the consequences can be more severe. If the patient does not promptly return for recementation, caries may develop very rapidly. Provisional cementation...

Keeping Your Teeth and Gums Healthy

The best way to ensure oral health is to brush your teeth at least twice a day and to floss them daily. Brushing and flossing remove the thin sticky layer of bacteria that grows daily on your teeth. This layer of bacteria is called plaque, and it is responsible for both tooth decay and periodontal disease. When you eat, the bacteria in plaque produce acids that attack the teeth and irritate the gums, making them inflamed. Over time, the gums may bleed and pull away from the teeth. Bacteria and pus accumulate in the pockets that form in the Silver amalgam fillings. Silver fillings consist of an alloy of several metals such as silver, zinc, or tin and mercury. Dentists use silver fillings to fill a tooth after all of the decayed material has been removed. Although it is a matter of some controversy, no proof exists that dental amalgam containing mercury poses any threat to your health. Crowns. Sometimes called caps, crowns are placed over a tooth that does not have enough tooth...

Neem Margosa Azadirachta indica Meliaceae

Neem has an ancient history in its native region of India. Leaves from Azadirachta indica trees were found during excavation of a 2000 bc site in what is today a part of Pakistan. Neem is also encountered in Hindu mythology, which refers to it as being of divine origin. Called margosa by the European colonizers in the 16th century, it was primarily used in medicine, and young twigs were used as chewsticks, to clean teeth and relieve toothache. Neem's most economically important application was learned by Indian farmers observing that neem trees were left uneaten during locust swarms. This indication of insecticidal properties was not widely known until the 1960s, after which time research on its pest-repellent characteristics began in earnest. Neem was found to be an effective feeding inhibitor and growth regulator for insect pests without producing toxic environmental effects.

Stepbystep Bonding Procedures

Incisal Wear

Since debonding or partial debonding can occur without complete loss of the prosthesis, visual examination and gentle pressure with an explorer should be performed to confirm such a complication. Because debonding is most commonly associated with biting or chewing hard food,96 patients should be warned about this danger. If the patient perceives any changes in the restoration, he or she should seek early attention. Early diagnosis and treatment of a partially debonded prosthesis can prevent significant caries (Fig. 26-28).

Crashes of Commercial Aircraft

In crashes involving commercial planes, the main role of the forensic pathologist is to identify the bodies. Initially, identification should be attempted using fingerprinting, dental identification and comparison of ante- and postmortem X-rays. If these methods are unsatisfactory, one can use DNA typing. DNA identification procedures can be used not only for whole bodies but also for body fragments. As a last resort, it might be necessary to utilize nonscientific methods of identification, such as documents on the bodies, jewelry, exclusion (for example, knowing that there is only one child on board), or use of nonspecific characteristics such as tattoos and scars. The forensic pathologist should always have a team of dentists on call for any major airplane crash. Both forensic and non-forensic dentists are usually willing to volunteer to make up the team. All medi-colegal offices should have disaster plans in place to be used if a major air crash occurs.

Medical Complications Of Alcoholism Gastrointestinal Tract and Pancreas

Secondary to vitamin deficiencies, alcoholics suffer from inflammation of the tongue (glossitis), inflammation of the mouth (stomatitis), caries, and perio-dontitis. A low-protein diet, associated with alcoholism, can lead to a zinc deficiency, which impairs the sense of taste and further curbs the appetite of the alcoholic. Parotid gland enlargement may be noted.

Speeding up the whitening process in selected areas

The first method of locally speeding up the rate of whitening is through the use of the foam tray liner. As dentists began to use the foam liner in the whitening tray, the entire whitening procedure was greatly accelerated. The clinical impression is that the whitening is accelerated by a factor of two.

Wrought retention clasp

The correct choice of treatment for any patient depends on a thorough history and examination and an accurate diagnosis and prognosis. Decisions concerning the restoration of abutment teeth involve many factors-caries, existing restorations, tooth vitality, shape and angulation, oral hygiene, and cost and experience-and these must all be assessed and evaluated. Only then is the selected treatment likely to achieve the planned outcome based on the functional requirements of the patient.

Why Soft Drinks

From contributing to obesity and dental caries, through allergy problems and heart ailments, and ending with a multitude of issues from the ever-flowing studies by respected scientific bodies covering numerous human health defects soft drinks have been blamed for most of these.


The need for orthodontic treatment is determined through a careful analysis of articulated diagnostic casts, whose usefulness can be enhanced with a dental surveyor (Fig. 6-22). One helpful procedure is to section a duplicate cast (Fig. 6-23) and reassemble it according to the proposed orthodontic modifications. This facilitates assessing the validity of any minor tooth movement (e.g., closing diastemas, uprighting molars, aligning tilted teeth) and is especially valuable when explaining the treatment proposal to the patient. Diagnostic preparations and waxing procedures made on these altered casts often clearly illustrate the benefits of minor tooth movement. Many dentists are now using computer imaging technology to optimize esthetic treatment planning and improve patient communication (Fig. 6-24).

Fremitus Of Tooth

Mylar Shim Stock Check Occlusion

Caries is recorded by circling the tooth number located at the apex of the involved tooth and noting the presence and location of the cavity in the description column corresponding to the tooth number on the right. Fig. 1-20. Alignment of the dentition can be assessed in-traorally, although diagnostic casts allow a more detailed assessment. This patient has caries-free teeth in good alignment. Fig. 1-20. Alignment of the dentition can be assessed in-traorally, although diagnostic casts allow a more detailed assessment. This patient has caries-free teeth in good alignment.


The complete cast crown is indicated on teeth that exhibit extensive coronal destruction by caries or trauma. It is the restoration of choice whenever maximum retention and resistance are needed. On short clinical crowns or when high displacement forces are anticipated, such as for the retainer of a long-span FPD, grooves should be included as additional retentive features.

Specific History

Chronic focus of infection Dental abscess (usually the patient has poorly maintained dentition on physical exam, with one or more sensitive teeth however, occult abscess formation without signs or symptoms has also been reported), chronic sinusitis, chronic dermatophytosis, candidiasis, intestinal parasitosis, diverticulitis.

Outline Form

Extend the outline both mesially and distally to the height of contour of the marginal ridge. As with an inlay, the boxes with an MOD on lay are prepared by advancing the bur gingi-vally and then buccally and lingually, always holding it in the precise path of withdrawal of the preparation. By ensuring that there is a thin section of proximal enamel remaining as the bur advances, damage to the adjacent tooth will be prevented (Fig. 10-51, A). Correct gingival, buccal, and lingual extension of the preparation normally depends on the contact area with the adjacent tooth. A minimum clearance of 0.6 mm is needed for impression making. Sometimes existing restorations or caries require a box to be extended beyond optimal. However, if a box requires extension beyond the transitional line angle, the preparation will have little resistance form, and an alternative restoration such as a complete crown should be considered. Preparing the boxes is a key step when fabricating an onlay. The tapered...

Tuberculosis of Bone

Tuberculosis is the chronic infective disease caused by Mycobacterium tuberculosis or rarely by M. bovis, and is characterized pathologically by caseous necrosis and granuloma formation. In the majority of cases skeletal involvement is secondary to an extraosseous primary focus in the lung or urinary tract, and is hematogenous. Tuberculous spondylitis is mediated via Bat-son's paravertebral venous plexus, whereas the tuberculosis in the other bones is via the arterial route. Unlike pyogenic infection, tuberculosis affects the spine and ribs much more frequently than the long bones. Clinically, bone tuberculosis may present either as a localized abscess or osteomyelitis. The onset is slow and insidious and the course usually protracted. Rib affection is called caries. In infants and young children, the phalangeal bones are occasionally involved, causing dactylitis that has a puffed, expansile, spine-like appearance hence, spina ventosa. As shown in Fig. 6.31, tuberculous dactylitis is...

Treated Tooth

An endodontically treated tooth should have a good prognosis. It can resume full function and serve satisfactorily as an abutment for a fixed or removable partial denture. However, special techniques are needed to restore such a tooth. Usually a considerable amount of tooth structure has been lost because of caries, endodontic treatment, and the placement of previous restorations. The loss of tooth structure makes retention of subsequent restorations more problematic and increases the likelihood of fracture during functional loading.

Selection Criteria

Pin Retained Indirect Restoration

This is a suitable choice for a small lesion. The material sets rapidly, enabling crown preparation to be performed with limited delay. When placed correctly, it exhibits adhesion to dentin, although conventional undercut retention is needed to supplement this. Glass ionomers designed for use as a core or base are radiopaque restoration formulations are more radio-lucent than dentin and should not be used as a core, because their radiographic appearance may suggest recurrent caries. The presence of fluoride in glass ionomers may help prevent recurrent caries. The chief disadvantage of glass ionomers is their comparatively low strength, although newer formulations have improved properties. At this time, glass ionomers are inferior to amalgam or composite resin for the restoration of extensive lesions.

Retention Form

Tooth Restoration Interface Pictures

Certain forces (e.g., when the jaws are moved apart after biting on very sticky food) act on a cemented restoration in the same direction as the path of withdrawal. The quality of a preparation that prevents the restoration from becoming dislodged by such forces parallel to the path of withdrawal is known as retention. Only dental caries and porcelain failure outrank lack of retention as a cause of failure of crowns and fixed partial dentures . 48,49 Selection of the appropriate degree of taper for tooth preparation involves compromise. Too small a taper may lead to unwanted undercuts too large will no longer be retentive. The recommended convergence between opposing walls is 6 degrees, which has been shown to optimize retention for zinc phosphate cement.55 Recognizing this angle is important (Fig. 7-31), although there is no need to deliberately tilt a rotary cutting instrument to create a taper, since this will invariably lead to overprepa-ration. Rather, teeth are readily prepared...

Proximal Reduction

Pinledge Crown

A, Although periodontally compromised and malpositioned, these six caries-free anterior teeth are excellent for pinledge preparations. B, Orthodontic repositioning of the teeth. C, Stabilization after the repositioning. D, Outline of the proposed preparations drawn on the teeth. Fig. 10-40. A, Although periodontally compromised and malpositioned, these six caries-free anterior teeth are excellent for pinledge preparations. B, Orthodontic repositioning of the teeth. C, Stabilization after the repositioning. D, Outline of the proposed preparations drawn on the teeth.

Composite Resin

Composite Pin Retained Core

Composite resin foundations are much stronger than glass ionomer foundations, a difference that correlates with the higher diametral tensile strength of the composite They are strong enough for larger pin-retained cores. However, the current materials have disadvantages, particularly their absorption of moisture and high thermal expansion, which has led many dentists to avoid composite resin foundations entirely. isting restorations and caries are removed. A glass ionomer is an appropriate choice of liner, with additional retention being provided by pins. For convenient access, the pinholes can be prepared and the liner placed before the pins are seated. 1. Prepare the tooth to approximate shape for a crown, removing any existing restorations and caries. Remove or block out all under cuts, and evacuate any weakly supported dentin. Fig. 6-11. Pin-retained cast core. A, Badly damaged maxillary molar. The pulp is healthy. B, Caries excavated and the tooth prepared for a pin-retained cast...

Preparation Margins

Axial Contour

The dentist should outline the margins on the dies11 (Fig. 16-4). However, in practice, few dentists do this . 12 If the teeth are properly prepared and the impression is accurate, the margins should be obvious, which makes this step unnecessary. When doubt exists, the dentist's knowledge of the extent of the preparation should resolve any uncertainty. Dentists must understand the importance of margin design. For instance, it is unrealistic to request a collarless restoration on a shoulder-bevel type of margin or an all-ceramic crown restoration on a tooth with a narrow chamfer finish line (Figs. 16-5 and 16-6).

Initial Therapy

Mechanical Debridement With Root Planing

Orthodontics can be of major benefit to periodontal therapy. Malposed teeth may be realigned to make them more receptive to periodontal treatment and to improve the efficacy of plaque-control measures. As seen in Chapter 6, restorative procedures can also be aided by minor tooth movement. Thus, for the best treatment of a patient with complex dental problems, good communication among consulting dentists is essential.

Plastic Materials

Extracoronal Amalgam Restorations

Extracoronal Restorations (Fig. 3-4). An extra-coronal cast metal restoration or crown encircles all or part of the remaining tooth structure. As such, it can strengthen and protect a tooth weakened by caries or trauma. To provide the necessary bulk of material for strength, considerably more tooth structure must be removed than for an intracoronal

Primary Prevention

Much of primary prevention is accomplished through health promotion and education and certain environmental protection actions. Interventions may include water fluoridation to prevent dental decay, eradication of mosquitoes to prevent malaria, promoting sexual abstinence among teenagers to prevent HIV AIDS transmission, and the wearing of safety equipment to prevent accidents when working with machinery.


Because shade matching is subjective, consistency is difficult to achieve. Considerable variation exists among dentists . Some dentists are unable to duplicate even their own shade selection from one patient to the next. Fortunately, a lifelike restoration does not have to be an exact color duplicate of the adjacent or contralateral teeth. It should, however, blend with the teeth as a result of the distribution of ceramic materials in the restoration. Shade selection can be improved by applying the principles of light and color and dental ceramic techniques.


A number of companies produce patient oriented pamphlets that describe vital tooth whitening. These, of course, are less personal than imaging, and do not reflect the actual work of the dentist, but can inform the patient nonetheless. The advantages of pre-printed literature are that pamphlets are usually professionally and tastefully prepared and that they are useful for those dentists who are not photographically inclined.

Clinical Technique

Types Dental Stock Trays

Transillumination can be of great help in detecting these problems. Leaky fillings or frank caries will need to be restored prior to initiation of the whitening process. The patient should be informed that these and all other existing tooth-colored fillings will remain largely unchanged, even though the teeth themselves can be expected to whiten. In fact, the degree of whitening can often be gauged by the increasing contrast between the existing composite fillings and the surrounding tooth structure. Prior to taking an alginate impression of the arch to be whitened, the dentist must also either place or replace any other restorations which will result in a change of contour. Any leaky fillings or minor caries can be left until after the impression.


Special Concerns Use with caution, if at all, during lactation. Give a lower initial dose in liver impairment. Safety and efficacy have not been determined in children less than 2 years of age. Side Effects Most commonly, headache, somnolence, fatigue, and dry mouth. GI Altered salivation, gastritis, dyspepsia, stomatitis, tooth ache, thirst, altered taste, flatulence. CNS Hypoesthesia, hyperkinesia, migraine, anxiety, depression, agitation, paroniria, amnesia, impaired concentration. Ophthalmologic Altered lacrimation, conjunctivitis, blurred vision, eye pain, blepharo-spasm. Respiratory Upper respiratory infection, epistaxis, pharyngitis, dyspnea, coughing, rhinitis, sinusitis, sneezing, bronchitis, bronchospasm, hemoptysis, laryngitis. Body as a whole Asthenia, increased sweating, flushing, malaise, rigors, fever, dry skin, aggravated allergy, pruritus, purpura. Musculoskeletal Back chest pain, leg cramps, arthralgia, myalgia. GU Breast pain, menorrha-gia, dysmenorrhea, vaginitis....

Us Contraindications

Contraindications for the metal-ceramic crown, as for all fixed restorations, include patients with active caries or untreated periodontal disease. In young patients with large pulp chambers, the metal-ceramic crown is also contraindicated because of the high risk of pulp exposure (see Fig. 7-4). If at all possible, a more conservative restorative option such as a composite resin or porcelain laminate veneer (see Chapter 25) is preferred.

Perception Of Color


Defects in color vision affect about 8 of the male population and less of the female population .23 Different types exist, such as achromatism (complete lack of hue sensitivity), dichromatism (sensitivity to only two primary hues-usually either red or green are not perceived), and anomalous trichromatism (sensitivity to all three hues with deficiency or abnormality of one of the three primary pigments in the retinal cones). Dentists should therefore have their color perception tested. If any deficiency is detected, the dentist should seek assistance when selecting tooth shades . 24

Study Qtitsiiom

DeSchepper EJ et al Clinical predictability of caries beneath restorations, Oper Dent 11 136, 1986. 2. Kidd EM Caries diagnosis within restored teeth, Oper Dent 14 149, 1989. rent caries a comparison of dental film, direct digital radiography and tuned aperture computed tomography, Dentomaxillofac Radiol 27 80, 1998. 16. Cohen BI et al A five year study fluoride release of four reinforced composite resins, Oral Health 88 81, 1998.

Dental Cements

In clinical trials, polycarboxylate performs as well or slightly better than zinc phosphate.1112 However, dentists have reported varying success rates, and claims of inferior long-term retention have been made. These problems may be related to the powder liquid ratio. At manufacturers' recommended powder liquid ratios, mixed polycarboxy-late cement is very viscous. Some dentists may prefer a more fluid working consistency for reliable seating during cementation. However, polycar- association between the choice of zinc phosphate or glass ionomer cement and increased pulpal sensitivity, provided manufacturers' recommendations were followed (Fig. 31-5). If postcementation sensitivity becomes a problem, dentists should carefully evaluate their technique, particularly avoiding desiccation of the prepared dentin surface. Resin-modified glass-ionomer materials have been reported to exhibit less post-treatment sensitivity. Again, this information is anecdotal. A desensitizing agent may...

F Periodic Recall

Patients with cast restorations should be recalled at least every 6 months. Less frequent recall may lead to oversight of recurrent caries or the development of periodontal disease. Patients who have been provided with extensive fixed prostheses (Fig. 32-6) will need more frequent recall appointments, particularly when advanced periodontal disease was present. The appointments can be coordinated by the restorative dentist or the periodontist. To ensure treatment continuity, establishing in advance who will assume primary responsibility for coordinating recall appointments is imperative.

Work Authorization

Tooth Color Chart Shade Guide

With the prevalence of metal-ceramic restorations, dentists and technicians have become acutely aware of the difficulty involved in communicating shade selection. A thorough understanding of the principles of color science (presented in Chapter 23) and the use of internal and surface colorants (discussed in Chapters 24 and 30) is essential to both parties. Many dentists and technicians have found a diagram of the tooth that allows specifications of multiple shades helpful (Fig. 16-10). 11 The diagram should be large enough to designate a cervical shade, an incisal shade, and any applicable individual characterization. Diagrams on most preprinted laboratory prescription forms do not provide adequate space (see Fig. 16-8), so other space must be available. A separate entry regarding the value or brightness can be helpful. When selecting a shade, the dentist should use a guide that corresponds to the ceramic system used by the technician. On occasion, it may not be...

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