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Essentials in Dentistry (A Student’s Manual)
Priyanka Jain, Balaram Naik
CHAPTER 1:
ANALGESIA AND SEDATION
LOCAL ANESTHETICS
Introduction
Classification
Chemical Structure
Duration of Action
Mechanism of Action of Local Anesthetics
LOCAL ANESTHETIC SOLUTION
Constituents
Structure
Differences of Esters and Amides
Factors Affecting the Reaction of Local Anesthetics
Failure of Anesthesia
Complications of Local Anesthetics
Local Complications
Systemic Complications
DRUGS USED IN DENTAL ANESTHESIA
Lidocaine
Prilocaine (Citanest)
Articaine (Septocaine)
Bupivacaine (Marcaine)
DENTAL ANESTHETIC TECHNIQUES
Infiltration
Regional/Nerve Block
Intraosseous
Intraligamentary
OTHER ANESTHETIC TECHNIQUES
Topical Anesthetics
General Anesthesia
Conscious Sedation
Inhalation Sedation
Intravenous Sedation
USE OF LOCAL ANESTHETICS
During Pregnancy
In Children
CONCLUSION
CHAPTER 2:
PREVENTIVE DENTISTRY
INTRODUCTION
PURPOSE
PRECAUTIONS
DENTAL CARIES
Dependency Factors Necessary for Dental Caries
Host (Tooth)
Oral Flora
Substrate Environment
Saliva and Caries
Sugar and Caries
European Workshop on Oral Care and General Health, 2003
Bacteria and Caries
Properties of Cariogenic Bacteria (Plaque and Tooth Decay)
TYPES OF CARIES
Enamel Caries
Enamel Caries Process
Clinical Manifestations of Enamel Caries
Cavities
Dentine Caries
Rate of Progression of Caries through Enamel and Dentine
Smooth Surface Caries
Caries in Pit or Fissure Surfaces
Root Caries
Arrested Caries
Recurrent Caries
Rampant Caries
Nursing Bottle Caries
EARLY CHILDHOOD CARIES
CARIES RISK ASSESSMENT
Benefits of Caries Risk Assessment
High-risk Group
Lower-risk Group
Diagnosis of Caries
PREVENTIVE DENTISTRY
CARIES PREVENTION
Mechanical and Chemical Plaque Control Methods
Chlorhexidine Mouth Wash
Xylitol
Toothpastes
FLUORIDE THERAPY
Mechanism of Action
Topical
Systemic
Antibacterial
Absorption of Fluoride
METHODS OF FLUORIDE DELIVERY
Systemic Fluoride Methods
Professionally Applied Acidulated Phosphate Fluoride Gels
Method of Application
Fluoride Varnishes
Advantages
Application of Fluoride Varnish
Home Delivered Fluoride Solutions
Dental Pit and Fissure Sealants
Indications
Types
Method of Application
Water Fluoridation
Advantages
SAFETY AND TOXICITY OF FLUORIDE
Fluorosis (Mottling)
Fluoride Toxicity
Treatment of Fluoride Overdose
Note on Caries Vaccine
Note on Ozone in the Prevention of Dental Caries
Note on Nova-Min Technology
Note on Lasers in Preventing Dental Caries
PREVENTION
Oral Health and Health Care Healthy People 2010
Goals of Prevention
Levels of Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention
Failure of Early Intervention
DENTAL HEALTH EDUCATION
Diet Analysis
Diet Counseling
Goals of Diet Counseling (Ref: DCNA, October 2006)
ORAL HYGIENE INSTRUCTIONS
INDICES
Community Periodontal Index
CONCLUSION
CHAPTER 3:
ISOLATION AND SOFT TISSUE PROTECTION IN DENTISTRY
INTRODUCTION
Sources of Moisture in the Clinical Environment
Control of the Field of Operation
The Tongue
Lip and Cheek Retraction
Facial/Lingual Sulci and the Floor of the Mouth
METHODS OF ISOLATION
Direct Methods
Indirect Methods
Aids for Retraction and Protection
Tongue Guards
Tongue Depressors
Cheek and Lip Retractors
Mouth Props
Saliva Ejectors/Low Volume Ejectors
Cotton Rolls
Absorbents
Throat Shields
Cellulose Wafers/Parotid Shield
Rubber Dam Set
Certain Factors to Keep in Mind During the Application of Rubber Dam
CONTROL OF THE OPERATING FIELD IN DIFFERENT QUADRANTS
Mandibular Right Quadrant
Mandibular Left Quadrant
Maxillary Right Quadrant
Maxillary Left Quadrant
Maxillary Anterior Teeth
Mandibular Anterior Teeth
GINGIVAL RETRACTION
Atraumatic/Nonsurgical Methods
Mechanical Retractors
Gingival Protector
Wooden Wedges
Rubber Dam
Retraction Strip
Retraction Cords
Vasoconstrictors
Astringents
Techniques for Retraction Cord Placement
Single-Cord Technique
Double-Cord Technique
Retraction Paste
SURGICAL METHODS OF GINGIVAL RETRACTION
Rotary Curettage
Electrosurgery
Lasers
Advantages of Lasers
SOME CLINICAL APPLICATIONS
Soft Tissue Management for Direct Resin Restorations and Bonded Indirect Restorations
Soft Tissue Management for Final Impression Taking
Double-Cord Technique
Single Retraction Cord Technique
Soft Tissue Control via Soft Tissue Alterations
Chemical Management of Soft Tissue and Crevicular Fluids
Soft Tissue Management for Various Procedures
Intraoral Examination Procedure
Prophylaxis
Topical Fluoride Application
Fissure Sealant Application
Simple Restorative Procedures
Endodontic Procedures
Alginate Impression Taking
CONCLUSION
CHAPTER 4:
DENTAL RADIOGRAPHY
INTRODUCTION
Radiation Dose Measurement
Sources of Radiation Exposure
BIOLOGICAL EFFECTS OF RADIATION
Factors Affecting Radio Sensitivity
RADIATION PROTECTION AND SAFETY
Dose Limitation
Radiation Workers
General Public
Dose Limits
Methods of Monitoring Radiation Dose
Film Badges
Thermoluminescent Dosimeters (TLD) (Badges and Extremity Monitor)
lonization Chambers
RADIOLOGICAL INTERPRETATION AND DIAGNOSIS
The Importance of Radiographic Interpretation
INTERPRETATION AND DIAGNOSIS
Principles of Radiographic Interpretation
Ideal Viewing Condition
Thumb Rule in Radiographic Interpretation
IMAGE ANALYSIS
Localize and Observe
Localize
Observe
General Considerations
Interpretation
Correlation
FILMS USED IN TAKING RADIOGRAPHS
Film Speed and Size
Intraoral Films
Extraoral Films
VARIOUS RADIOGRAPHIC TECHNIQUES
Intraoral Views
Periapical View
Bitewing View
Occlusal View
Extraoral Views
Panoramic View
Extraoral Views of the Mandible Other than Orthopantomogram
Oblique Lateral for the Posterior Maxila
RECENT ADVANCES IN RADIOGRAPHIC TECHNIQUES
Digital Imaging
Conventional Tomographic View
Computed Tomography
Magnetic Resonance Imaging
Ultrasonography
Cone Beam Computed Tomography
OTHER RADIOGRAPHIC TECHNIQUES IN THE HEAD AND NECK
Sialography
Temporomandibular Imaging
RADIOGRAPHIC ERRORS AND ARTEFACTS
Radiopaque Artefacts
Technique and Projection Errors
Exposure Errors
Processing Errors
Unique Radiographic Appearances
CONCLUSION
CHAPTER 5:
RADIOGRAPHIC DIAGNOSIS OF CARIES
INTRODUCTION
RADIOGRAPHIC DIAGNOSIS AND TECHNIQUES
Frequency of Taking Radiographs
Using Intraoral Films
Diagnostic Bitewing Criteria
CARIES CLASSIFICATION
Haugejorden and Slack 1975 Classification
INTERPROXIMAL CARIES
Incipient Interproximal Caries
Moderate Interproximal Caries
Advanced Caries
Severe Caries
False Interpretations
OCCLUSAL CARIES
Incipient Occlusal Caries
Moderate Occlusal Caries
Severe Occlusal Caries
False Interpretations
BUCCAL AND LINGUAL CARIES (CERVICAL CARIES)
ROOT SURFACE CARIES (CEMENTAL CARIES)
False Interpretations
RECURRENT CARIES/SECONDARY CARIES
RAMPANT CARIES
RADIATION CARIES/DRUG RELATED CARIES
ARRESTED CARIES
CONDITIONS RESEMBLING CARIES ON RADIOGRAPHS
Restorative Materials
Abrasion
Attrition
Cervical Burnout
MACH BAND EFFECT
CONCLUSION
CHAPTER 6:
RADIOGRAPHIC DIAGNOSIS OF PERIODONTITIS
INTRODUCTION
LIMITATIONS OF RADIOGRAPHS
RADIOGRAPHIC TECHNIQUES FOR PERIODONTAL DISEASE
Conventional Bitewing Radiographs
Conventional Periapical Radiographs
Structures on the Radiographs and their Significance
Teeth
Bone
Conventional Panoramic Radiographs
Advantages of Panoramic Radiographs
Disadvantages of Panoramic Radiographs
Digital Panoramic Radiography versus Conventional Intraoral Radiography
Digital Intraoral Radiography
Digital Subtraction Radiography
Cone-Beam Computed Tomography
NORMAL RADIOGRAPHIC ANATOMY
Pattern of the Bone Loss
Furcation Exposure
Types of Furcation Exposure
RADIOGRAPHIC CHANGES SEEN IN PERIODONTAL DISEASE
GINGIVAL DISEASES
Chronic Periodontitis
Aggressive Periodontitis
Periodontitis as a Manifestation of Systemic Disease
Necrotizing Periodontal Diseases
Abscesses of Periodontium
Periodontitis Associated with Endodontic Lesions
CONCLUSION
CHAPTER 7:
DENTAL MATERIALS
INTRODUCTION
PHYSICAL PROPERTIES OF MATERIALS
METALLURGICAL TERMS
AMALGAM
Components
Setting Reaction
Properties of Amalgam
Safety of Amalgam Restorations
Mercury Hygiene Precautions
LINERS AND BASES
Zinc Phosphate Cement
Clinical Uses
Chemical Composition
Strength
Setting Reactions
The Completed Mix
Precautions
Zinc Polycarboxylate Cement
Clinical Uses
Chemical Composition
Properties
Setting Reaction
The Completed Mix
Precautions
Glass Ionomer Cement
Clinical Uses
Chemical Composition
Properties
Setting Reaction
The Completed Mix
Precautions
Resin-Ionomer Cement
Cermets
Resin Modified Glass Ionomer
Modified Composites and Compomer (Acid Modified Composite)
Zinc Oxide Eugenol
Chemical Composition
Physical Properties
Clinical Uses
Ethoxy Benzoic Acid (EBA)
Calcium Hydroxide
Clinical Uses
DENTAL ADHESIVES
Acid Etch Technique
Enamel Bonding Systems
Dentin Bonding Systems
Amalgam Bonding Systems
RESINS
Composite Resins
Chemical Composition
PIT AND FISSURE SEALANTS
CAVITY LINING VARNISH
INTERMEDIATE RESTORATIVE MATERIAL
DIRECT FILLING GOLD
INDIRECT RESTORATIVE MATERIALS
Impression Materials
Classification of Impression Materials
Rigid Impression Materials
Elastic Impression Materials
Properties
Agar-Agar
Alginate
Elastomers
CAST METAL RESTORATIONS
Gold Casting Alloy
Fineness, Carat and Weighing
Annealing and Tempering
Types of Casting Gold Alloys
Chemical Composition
White Gold
Nickel and Cobalt-Chromium Alloys
Advantages
Disadvantages
DENTAL PORCELAIN (CERAMICS)
Advantages
Disadvantages
PORCELAIN FUSED TO METAL
Advantages
Disadvantages
MACHINED RESTORATIONS
DENTAL CEMENTS
MISCELLANEOUS
Root Canal Filling Materials
Gutta-Percha Points
Polishing Materials
Waxes
Inlay Wax
Baseplate Wax
Sticky Wax
Disclosing Wax
Boxing Wax/Carding Wax
Low-fusing Impression Wax
SAFETY AND EFFICACY
CHAPTER 8:
NONCARIOUS TOOTH SURFACE LOSS
INTRODUCTION
FACTORS PRECIPITATING TOOTH WEAR
TYPES OF WEAR
Restoration Wear
Clinical Implications
TOOTH WEAR
Types of Tooth Wear
Attrition
ABRASION
ABFRACTION
DEMASTICATION
RESORPTION
EROSION
Classification Based on Etiology
Classification According to Clinical Severity
Classification According to Pathogenic Activity
Effects of Tooth Surface Loss
DIAGNOSIS
MEASUREMENTS OF WEAR
Basic Erosive Wear Examination
TREATMENT
Preventive and Initial Management
Dentin Desensitization
Restorative Management
Removable and Fixed Prosthesis
Treatment with Tooth Reduction and Overdentures
Treatment with Combination of Adhesive Techniques and Removable Prostheses
Endodontic Therapy
Periodontal Therapy
PREVENTION
DENTIN HYPERSENSITIVITY
Prevalence and Epidemiology
Pathogenesis
Etiological and Predisposing Factors
Common Reasons for Gingival Recession Includes
Mechanism of Action
Direct Dentine Innervation Theory
Odontoblast Receptor Theory
Transducer Theory
Gate Control Theory
Fluid Movement/Hydrodynamic Theory
EVALUATION STRATEGIES
Subjective Evaluation Techniques
MANAGEMENT OF DENTINE HYPERSENSITIVITY
Management Strategy
Clinical Management
At-Home Treatments
Treatments Interfering with Neural Transmission
Treatments for Tubule Occlusion
Desensitizing Agents
In-Office Treatment
OTHER PROCEDURES
CONCLUSION
CHAPTER 9:
TREATMENT OF DISCOLORED TEETH
INTRODUCTION
DISCOLORATIONS
Intrinsic Discolorations
Tetracycline Stains
Fluorosis
Enamel Hypoplasia
Extrinsic Discolorations
Causes for Extrinsic Staining
MANAGEMENT OF DISCOLORATIONS
History
Clinical Examination
TREATMENT OPTIONS FOR DISCOLORED TEETH
MICROABRASION AND MACROABRASION
Microabrasion
Technique
Macroabrasion
STAIN REMOVAL AND PREVENTION BY THE USE OF DENTIFRICE
BLEACHING
Hydrogen Peroxide
Sodium Perborate
Carbamide Peroxide
Bleaching Mechanism
Bleaching Techniques for Vital Teeth
Night Guard Bleaching
In-Office Bleaching
Combination Bleaching Treatment
Light-Activated Bleaching Treatment
Over-the-Counter Bleaching Systems
Laser-activated Bleaching
Bleaching of Nonvital Teeth
Inside/Outside Bleaching Technique
In-Office Bleaching Technique
COMPOSITE RESIN RESTORATIONS
PORCELAIN VENEERS
CROWNS
CONCLUSION
CHAPTER 10:
DRUG PRESCRIBING AND THERAPEUTICS
INTRODUCTION
DRUGS USED TO CONTROL PAIN
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
Aspirin
Adverse Effects
Ibuprofen
Adverse Effects
Acetaminophen/Paracetamol
Adverse Effects
Topical Analgesic
OPIOID ANALGESICS (NARCOTICS)
Adverse Effects
Codeine
Morphine
Corticosteroids
Adverse Effects
Topical Steroids
DRUGS USED TO TREAT DENTAL INFECTIONS
Antibiotics
Adverse Effects
THERAPEUTIC ANTIBIOTICS
Penicillin
Metronidazole
Clindamycin
Chlorhexidine
Tetracycline
PROPHYLACTIC ANTIBIOTICS
Recommendations
TOPICAL ANTIBIOTICS
Precautions with Antibiotic Use
ANTIFUNGAL AGENTS
Nystatin and Amphotericin
Miconazole
Triazoles
ANTIVIRAL AGENTS
Acyclovir
AGENTS USED TO CONTROL ANXIETY
Benzodiazepines
Adverse Effects
Precautions
OTHER DRUGS USED IN DENTISTRY
Topical Antiseptics
First Generation
Second Generation
Chlorhexidine
Anesthetics
Saliva Substitutes
PREGNANT PATIENT
Local Anesthetics
Analgesics and NSAIDs
Antibiotics
Sedatives
Prenatal Fluoride
NEWER DRUGS OF USE IN DENTISTRY (APPROVED BY FDA IN 1996)
Amlexanox (Aphthasol)
Penciclovir (Denavir)
Lidocaine Transoral Mucosal Dental Delivery System (Dent Patch)
Tetracaine 2% (Viractin)
CONCLUSION
CHAPTER 11:
DRUG INTERACTIONS
INTRODUCTION
Drug-Drug Interactions
Drug-Food Interactions
Herbal Supplements
Adverse Drug Reactions
TYPES OF DRUG INTERACTIONS
Pharmacokinetic
Absorption
Distribution
Metabolism
Excretion
Pharmacodynamic
ADVERSE ORAL AND DENTAL EFFECTS OF DRUGS
Xerostomia (Dry Mouth)
Intraoral Hemorrhage
Dysgeusia (Taste Changes)
Oral Candidiasis (Thrush)
Gingival Hyperplasia (Enlarged Gums)
Tooth Discoloration
Stomatitis
Oral Ulceration and Necrosis
DENTAL DRUG REACTIONS
Aspirin and Oral Anticoagulants (Coumarins)
Epinephrine
With Propranolol
With Tricyclic Antidepressants
Erythromycin
With Carbamazepine (Tegretol)
With Ketoconazole-Terfenadine (Seldane)
Theophylline
Ibuprofen
Lithium
Oral Anticoagulants (Coumarins)
LOCAL ANESTHESIA INTERACTIONS
Amides
Amides with Epinephrine
Amides without Epinephrine
Esters
Ester Local Anesthetics with Sulfonamides
Amide Local Anesthetics
Local Anesthetics with Opioid Sedation
Local Anesthetic-Induced Methemoglobinemia
SEDATIVE AND ANXIOLYTIC DRUGS
Chloral Hydrate
Barbiturates
Benzodiazepines
Drugs that Increase the Metabolism of Benzodiazepines
Drugs that Inhibit the Metabolism of Benzodiazepines
CONCLUSION
CHAPTER 12:
DENTAL CONSIDERATIONS IN MEDICALLY COMPROMISED PATIENTS
INTRODUCTION
Recognition
Assessment
Management
Adjuvants
MEDICAL HISTORY AND ASSESSMENT
SIGNIFICANT INVESTIGATIONS IN DENTISTRY
Hematological Tests
Renal Assessment Tests
Diabetes Assessment Tests
Liver Assessment Tests
Bone Assessment Tests
HIV/AIDS Status Assessment Tests
International Normalized Ratio
BLOOD TESTS FOR RENAL FUNCTION
BLOOD TEST FOR DIABETES
The Moderately Controlled Patient
The Uncontrolled Patient
LIVER FUNCTION TESTS AND HEPATIC SEROLOGY
Enzymes
HIV/AIDS ASSESSMENT TESTS
CD4 Count and Viral Load
INFECTIVE ENDOCARDITIS, SURGICALLY CORRECTED HEART DISEASE AND ANTIBIOTIC COVERAGE
ENDOCARDITIS PROPHYLAXIS RECOMMENDED
High-risk Category
Moderate Risk Category
ENDOCARDITIS PROPHYLAXIS NOT RECOMMENDED
DENTAL PROCEDURES FOR WHICH PROPHYLAXIS IS RECOMMENDED
ANTIBIOTIC PROPHYLAXIS FOR DENTAL PATIENTS WITH TOTAL JOINT REPLACEMENTS (ADA)
DENTAL MANAGEMENT IN SPECIFIC ILLNESSES
Anemia
Disease Nature
Dental Management
Anemia and Anesthetics
Anemia and Analgesics
Anemia and Antibiotics
BLEEDING DISORDERS
Dental Management
CARDIAC PROBLEMS
Dental Considerations
Hypertension
Stroke (Cardiovascular Attack)
Ischemic Heart Disease with Angina
Myocardial Infarction
Cardiac Arrhythmias
Congestive Heart Failure
Heart Transplants
Pacemakers
Coronary Artery Bypass Grafts
Medications of Concern in Patients with Cardiac Problems
ENDOCRINE CONDITIONS
Diabetes Mellitus
Disease Nature
Dental Management
HYPER/HYPOTHYROIDISM
Hyperthyroidism
Hypothyroidism
PATIENT ON CORTICOSTEROIDS
EPILEPSY
RENAL DISEASE
PULMONARY DISEASES
Bronchial Asthma
Dental Management
CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND TUBERCULOSIS
LIVER DISORDERS
Dental Management
INFECTIOUS DISEASES
Viral Hepatitis
Dental Management
Precautions
HIV/AIDS
Mild/Moderate Neutropenia
Severe Neutropenia
CONCLUSION
CHAPTER 13:
MEDICAL EMERGENCIES
INTRODUCTION
PREPARATION FOR EMERGENCIES/MEDICAL RISK ASSESSMENT
EMERGENCY TRAINING
Pharmacological Agents
Equipment
Other Equipment
DRUGS
Epinephrine 1:1000 Concentration
Adverse Effects of Epinephrine
Glucagon
Diphenhydramine (Benadryl) 50 mg Injection
Adverse Effects
Nitroglycerin (GTN)
PROPOSED OFFICE EMERGENCY PLAN
Anxiety Reduction
Recognition of an Emergency and Initial Emergency Procedures
Airway (A)
Breathing (B)
Circulation (C)
HANDLING SPECIFIC MEDICAL EMERGENCIES
AIRWAY OBSTRUCTION
Symptoms and Signs
Management
Prevention
ASTHMA/BRONCHOSPASM/CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Causes
Symptoms and Signs
Management
Prevention
ALLERGY
Pathophysiology
ANAPHYLAXIS
Risk Factors
Hypersensitivity Classification (Gell and Coombs)
Symptoms and Signs
Typical Progression
Management
ACCIDENTAL ANESTHETIC OVERDOSE
Rapid Intravascular Injection
Too Large a Dose
Rapid Absorption
Slow Biotransformation and Elimination
Clinical Signs and Symptoms
Low to Moderate Doses
High Overdose Levels in the Blood
Management
Mild Reaction: Slow Onset
Severe Reaction: Rapid Onset
ACUTE ADRENAL INSUFFICIENCY
CARDIAC EMERGENCIES ANGINA PECTORIS (CHEST PAIN)
Signs and Symptoms
Management
Dose
Prevention
MYOCARDIAL INFARCTION (HEART ATTACK)
Probable Causes
Symptoms
Management
Prevention
HEART FAILURE/SUDDEN CARDIAC ARREST
DIABETES
HYPOGLYCEMIA
Risk Factors
Clinical Features
Management
Prevention
HYPERGLYCEMIA/DIABETIC KETOACIDOSIS
SYNCOPE (FAINTING)
Clinical Features
Presyncopal Phase
Syncopal Phase
Management
Prevention
SEIZURES
Clinical Features
Management
Pharmacological Management
TRANSIENT ISCHEMIC ATTACK/CEREBROVASCULAR ACCIDENTS (STROKE)
Risk Factors for Stroke
Risk Factors You Cannot Change
Signs and Symptoms
Management
Prevention
HYPERVENTILATION
RESPIRATORY ARREST
CONCLUSION
INDEX
TOC
Index
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