- Revision NOTES -

By: Dr.Bayan ALMahari

OCTOBER/2020

SUPJECTS: PAGE:

- Operative. 2

- Surgery 3-5

- Pediatric 6-7

- Endodontic 8

- Instruments 9-12

- Periodontic 12

- Removable 13-18

- Others:
 Fluride: 18-19
 Stirilaization & infection control 20
 Rubber dam 21
 Xrays 22-23

NOTE:

 ‫ الفلورايد في شرح كامل في ملف بيان‬+ ‫ البريو‬+ ‫االندو‬

Best of luck,
Bayan AlMahari / October 2020.

1|P ag e Dr.B ayan Al Mahari/ 2020

 - Operative –

------------------ Early caries management:--------------

- Pits & fissure: the most conservative tech. used to prevent caries in fissures of teeth by
sealing of the caries.

- PRR: use when we have active caries, its combination of small restoration *area of active
caries* and P&F in other area.

- ART: used to removal of soft caries using hand instrument only.

 Material used for PRR : Flowable composite

 Restore enamel caries / proximal caries should be open : when PASS the DEJ
 When we use hand instruments ONLY: ART
 Main advantage of GIC : Fluoride release.
 Indication of PRR: discolored pit and fissure with SHALLOW caries.
 Most important property of sealant : high retention
 Etching of P&F sealants : cause roughness
 Anticariogenic / Anti caries food : mineral
 Cariostatic food: protein.
 ART mainly used : GIC
 Proximal cavity : fluoride application
 Occlusal: pit and fissure.
 Carbohydrates affect caries by : Frequency

 CARIES RISK:
- LOW : 9-12 months
- MODERATE: 6-9 months
- HIGH: 3 months recall with bite-wing x-ray every 6-12 months

2|P ag e Dr.B ayan Al Mahari/ 2020

 - Surgery -
---------------------Local anesthesia:------------------

Bupivacaine Longest duration

Cocaine Most vasoconstrictor action

Procaine Slow onset / best vasodilator effect.

Mepivacine Fastest onset

Lidocaine/Lignocaine Minimal toxicity

Dibucaine Most toxicity / longest acting

Articaine Pt with liver disease

 Pt allergic to amide and ester :

- 1% diphenhydramine chloride
- 4% nitrous oxide.

 Maximum dose:
- In cardiac pt : 0.04mg * 2 cartidges *
- In adult without epinephrine : 4.4mg
- In adult with epinephrine : 7mg/kg
- In child : 4.4 mg
- TOTAL dose in child : 300 mg
- TOTAL dose in adult with epi. : 500 mg

 Time required for topical anesthesia to be effective:

- Minimal : 1 min - Optimal : 2 mins

 Most common LA : lidocaine 2% with epinephrine 1:100.00

 Cartilage contain : 1.7 ml of anathesia
 Anesthesia for pregnant : 2% lidocaine with epinephrine 1:100.00
 Least mechanism for nerve damage: LA Toxicity
 Pt become colorless with swelling : inject venous plexus
 Amine [ liver ] Ester [ plasma ]
 Decrease effect of LA in inflammation : decreased PH in tissue.
 Redirect anesthesia for mandibular block: superior and posterior
 Redirect anesthesia for maxillary block : superior and anterior.
 Tuberosity technique : akinosi technique
 Tuberosity block : PSA block

3|P ag e Dr.B ayan Al Mahari/ 2020

  Ideal infiltration of maxillary teeth : supraperiosteal
 Most common ester topical anesthesia : benzocaine
 Most common amide topical anesthesia : lidocane
 Contraindication tech. in hemophilia: block. *indication: intraosseous*
 Success of intrapulpal anesthesia depends on : back pressure of needle.
 Contraindication of epinephrine in : hyperthyroidism

Nerve Supply/innervations:

Lingual nerve: - Posterior lingual mucosa

- Anderior 2/3 of tongue.

Facial nerve: - Buccinators muscle

Incisive nerve : - Anterior mandibular teeth *lower

incisors and canine*

Nadopalatine nerve: - Palatal soft tissue *canine to canine*

Mental nerve: - Chin

- Labial gingival tissue anteriorly
- Lower lip

Auriculotrmporal - TMJ
nerve

Color coding anesthesia

RED 2% Lidocaine with Epinephrine 1:100,000

BLUE 2% Lidocaine ONLY *plain*

GREEN 2% Lidocaine with Epinephrine 1:50,000

BLACK 2% Prilocaine ONLY *plain*

YELLOW 4% Prilocaine with Epinephrine 1:200,000

4|P ag e Dr.B ayan Al Mahari/ 2020

 --------------Vazirani Akinoski & Gow Gates technique:-----------

 V.A: in trismus pt * called : close mouth tech. *

 Gow gates : true mandibular nerve block * anesthetizes all the nerves *

Nerves anesthetized:

Vazirani Akinoski: Gow Gates:

- Inferior alveolar - Inferior alveolar

- Lingual - Lingual
- Mylohyoid - Mylohyoid
- Mental - Mental
- Incisive. - Incisive
- Auriculotemporal
- Buccal nerve.

 Technique of V.A : Syringe is parallel to maxillary occlussal plane.

By: 25 gauge long needle.

5|P ag e Dr.B ayan Al Mahari/ 2020

 - Pediatric -
---------------------Pedo trauma / splinting:--------------

 Internal resorption:
- Asymptomatic
- RARE in permanent
- Pulp: chronic pulpits / irreversible pulpits.
- Pink color
- Management: Endodontic therapy.

 Trauma:
- To the permanent teeth : 8-12 years
- To the primary teeth : 1.5-3 years

 tooth colors:
- Pink : internal resorption
- Yellow : calcification
- Gray : necrosis
- Red : inflammation / hyperemia.

 Failure in replantation due to : external root resorption.

 Splinting for primary teeth ONLY in : alveolar fracture.

Concussion: Injury to the tooth without losing or displacement of the tooth

Subluxation: Injury to the tooth with losing of the tooth / no displacement .

*loosening*

Intrusion: Apical displacement of the tooth into alveolar bone. *inwards*

Extrusion *Partial Coronal displacement * partial * of the tooth from the socket
avulsion*: *outwards*

Avulsion: Complete displacement of the tooth out of socket *FullOut*

 Trauma of the tooth cause PDL space widening : LUXATION

 Most common type of trauma in primary : INTUSION

6|P ag e Dr.B ayan Al Mahari/ 2020

 -----------------Pedo pulp therapy:------ ----------

 We have to check:
- Primary or permenant
- Vital or non vital
- Close / open apex.

Vital tooth : - Restricted to dentin : indirect pulp cap

- Pin point / come to clinic within 2 h. / no bleeding : direct pulp cap
- Coronal pulp contamination by trauma after 24 h / caries : pulpotomy

Non vital - Permanent *close apex* : Pulpectomy: *USE: iodoform based paste or ZOE*
tooth: - Immature permenat teeth *open apex* : Apexification.

 If the tooth permanent + non vital + open apex = Apexification.

 If the tooth permanent + non vital + close apex = pulpectomy.
 If the tooth permanent + vital + open apex = DPC or Pulpotomy.

MTA - BEST for one visit pulpotomy

- Apexification.

ZOE BEST for one visit pulpectomy.

CaOH Pulpotomy in permanent teeth. * open apex *

Farmacresol - Pulpotomy in primary teeth.

- 1/5th concentration.

 Best root canal material for primary : iodoform based paste.

 Most common complication of caoh pulpotomy in primary teeth : internal resorption

 MTA:
- Vital therapy : DPC / Pulpotomy
- Non vital therapy : Apexification
- Perforation.
- Super sealing properties.

7|P ag e Dr.B ayan Al Mahari/ 2020

 - Endodontic -
-----------------------Pulpal diagnosis:---------------------

 pain to heat : irreversible pulpits

 pain to cold / sweet : reversible pulpits
 Irreversible pulpits : vital but abnormal pulp.
 Pulp in Internal resorption: irreversible pulpits
 Pulp in external resorption: necrotic
 Non-odontogenic lesion looks similar to endodontic lesion : initial stage of cemental
dysplasia.
 Sinus tract associated with : degenerated pulp ( necrotic pulp )
 Draining fistula: chronic periapical abscess

 In diseased pulp:
- Acute inflammation : neutrophils
- Chroninc inflammation: lymphocytes & macrophages

 Internal resorption:
- Pulp status: irreversible pulpits / chronic pulpitis
- Asymptomatic
- Rare in permanent teeth
- Tooth show : pink color
- Ttt: endo therapy

 Associated with vital teeth:

- Cementoma *never symptomatic*
- Condensing osteitis
- Hyperplastic pulpitis

 Associated with non-vital teeth:

- Radicular/periapical cyst
- Chronic apical periodontitis
- Peripaical granuloma

 Pathognomic of :
- Irreversible pulpits : pain on cold that lingers
- Reversible pulpits : pain on that responds to stimulus as long as it lasts
- Necrotic pulp : no response

 Common cause of reversible pulpits:

- Trauma
- Bruxism/ clenching
- Carious lesions
- Defective restoration
- Exposed dentin

8|P ag e Dr.B ayan Al Mahari/ 2020

 - instruments -
*OPERATIVE INSTRUMENTS*

 Test used to measure rotation of bur : RUNOUT.

 Finishing of : GIC [ delayed for at least 24 h.] RMGIC [ immediately ]
 Stainless steel and carbon steel used in [ instruments ] tungsten carbide used for
[ burs ]
 LEAST heat generated while using : tungsten carbide bur

 Hand instrument technique used with SHARP instrument.

- Modified pen grasp.
- Inverted pen grasp
- Palm and thumb grasp
- Modified Palm and thumb grasp
- Rests and Guards.

 Polishing burs:
- Have more than 12 blades
- Less cutting efficiency
- Made of steel and carbide.
-
 Grasping the high volume evacuator by:
- Thumb to nose grasp
- Pen grasp

 G.V. Black calcification: [WLA]

- 1st number : Width of blade
- 2nd number : Length of blade
- 3rd number : Angle of blade and cutting edge.

Instrument Uses

Chisels:
- Straight/curved/bin angled: - Cleave or split under mined enamel
- Flatten pulpal floor

- Enamel hatchet - split under mined enamel in proximal wall

- placing grooves

- Gingival marginal trimmer - beveling gingival margin / line angle

Spoon excavator - removing caries

- carving amalgam

Discoid cleiod - carving amalgam

- burnish inlay-onlay margins.

9|P ag e Dr.B ayan Al Mahari/ 2020

 *PERIODONTIC INSTRUMENTS*

Ultrasonic:

- magnetostrictive - the tip vibrates in an elliptical pattern

- all side of the tip are active

- piezoelectric
- the tip vibrates in the linear ( back and forth)
- 2 sides are more active

Schwartz periotriever: retrieve broken instrument tips from periodontal pocket.

Stieglitz pliers + masserann kit: remove instrument when they are broken in root canal.

Gracey currete: scale specific area

Sickle Scalers: remove supragingival calculus

hoe , chisel , file: remove subgingival calculus

Curettes: subgingival scaling and root planning

Gracey Universal Sickle scaler

curettes curettes

Cross section Semicircle Semicircle Triangular

Shape of blade Spoon shape Spoon shape Sickle

Blade angle 60-70 90 -

Cutting edge 1 2 2

 Angulation during perio instrumentation:

- Subgingival blade insertion : 0
- scaling and root planning : 45-90
- gingival curettage :>90
- sharpening: 100-110
- internal angle while instrumentation: 70-80

 Probes:
- DG-16 : To locate canal orifice
- nabers : detect furcation involvement
-explorer : clinical examination

 adaptation: relation between working edge of instrument and tooth surface

 angulation: relation between face of instrument and tooth surface.

10 | P a g e Dr.B ayan A l Mahari /2020

 *SURGICAL INSTRUMENTS*

Instrument Uses

Asch forceps Reduction of nasal sept and vomer fracture

Walsham forceps Reduction of nasal fracture *correct lateral deviation*

Adsons forceps Tissue holding : small narrow in anterior area*

Stillies forceps Tissue holding : in 3rd molar area.

Russian forceps Placing gauze and picking up fragments.

Allis forceps Crusting/removal of fibrous tissue *epulis fissuratum ( ill fitting )*

Blade no.15 Flaps, incision on alveolar ridge. * most common *

Blade no.12 Incision in gingival sulcus, posterior area *max tuberosity*

Blade no.11 Small strab incisions * abscess *

Crane pick elevator Used in case of a fractured root : after drilling a hole *purchase
point needed*

Root tip pick elevator Used in case of a fractured root : tease very small root end by
inserting the tip into PDL space.

Cryer elevator * east-west* Used in case of a fractured root : they come paired one for left
and one for right side.

Towel clip Pull the tongue forward

Minnesota retractor Retract Cheek and flap together

Farabeuf retractor Retract cheek and tongue.

 Extraction elevarors: handle – shank – blade.

 For bone removal : rongeur
 For bone smoothening : bone file
 For bone split : osteotome

 Scissors:
- Deans scissors : for cutting sutures , have serrated blades
- Iris scissors: for cutting soft tissue , have sharp pointed tip
- Metzenbaun scissors: cutting delicate tissue , have round tip

11 | P a g e Dr.B ayan A l Mahari /2020

 *ENDODONTIC INSTRUMENTS*

 Sequence of endodontic instrumentation: File-Broach-Reamer

 Barbed broach use for : extirpation of the pulp
 Patency file: file that reach apical constriction
 Lentulo-spiral use : take impression of post space
 Stieglitz pliers use : hold the silver point

----------------------------------------------------------------------------------------------------------------------

- Periodontal -
------------Periodontal ulcers:---------------

#Any Question Related to aphthous ulcer and herpetic ulcer, 1st thing to look for is
the location of the lesion:

CONDTION MUCOSA LOCATION TTT

Aphthous ulcer non-keratinized - soft palate Corticosteroid

lining mucosa - lips, cheeks
- floor of the mouth
- Lateral tongue
- Labial,lingual mucosa
- Pharynx

Herpes simplex keratinized/lining - gingival Supportive

mucosa - dorsal tongue
- hardpalate

Herptic keratinized/lining - hard palate.

gingivostomatitis mucosa

- Acute Herptic gingivostomatitis ( in children ) : tonsils, hard and soft palate , buccal
mucosa and gingival, tongue.

- Recurrent Herptic gingivostomatitis : only on attached mucosa ( gingiva , hard palate)

- herpetic whitlow : HSV infection , lesion on finger.

 Majority of primary herptic infection: Asymptomatic.

 Aphthous ulcer heal within : 14 days.

12 | P a g e Dr.B ayan A l Mahari /2020

 - Removable -
-------------Prosthodontic classification:-------------

Kennedy classification

CLASS I - Bilateral distal extension

- Semi-Adjustable articulator

CLASS II - Unilateral distal extension

- Semi-Adjustable articulator

CLASS III - Unilateral extension with natural teeth remaining back

- Doesn’t require an indirect retainer.
- Non-Adjustable articulator

CLASS IV - Anterior extension crossing midline.

- NO modification.
- Semi-Adjustable articulator

Seibert classification

CLASS I Bucolingual resorption with normal ridge height in apicocoronal dimension

CLASS II Apicocoronal resorption with normal ridge width in buccolingual

CLASS III Combined buccolingual and apicocoronal resorption result in normal height
and width.

Prosthodontic diagnostic index (PDI) classification

CLASS I Ideal/minimal compromised : edentulos span confined to single arch

CLASS II Moderate compromised : edentulous span in both arches

CLASS III Substantially compromised : any post. Maxillary or mand. Span that
greater than 3 missing teeth or 2 molars.

CLASS IV Any edentulous area or combination high level of pt compliance.

- Eg: maxillofacial defect , very poor prognosis abutments , class ii dev.2

13 | P a g e Dr.B ayan A l Mahari /2020

 ------------Relining and rebasing:------------

Relining Rebasing

- Resurface the tissue side of RPD with new
base material.
- Can be done in *chair or laboratory*
- Indication:
 Pt with immediate denture
 Pt wears upper complete denture against
lower natural teeth.
- Contraindication: if there is extreme over
closure of vertical dimention
- Material used : self cure acrylic
- Replacing the entire denture base material on
existing prosthesis. *changing the position of
the teeth/occlusion and relation of denture*
- Its laboratory process.
- Indication: furcated or stained dentine
- Material used : heat cure acrylic.

----------------------------------------------------------------------------------------------------------------------

-----------RPD and there functions:-----------

 [RPD] sensitivity on abutment / pain on residual ridge : FAULTY OCCLUSION

 [FPD] discomfort to heat/cold : DEFLECTIVE OCCLUSAL CONTACT.
 Material cause allergy to oral tissue : nickel
 Best material for major connector : chrome cobalt.
 Most biocompatible alloy used in intra-orally : titanium
 Posterior palatal bar major connector act as indirect retainer in : Kennedy class IV
 Major connector of palatal tours between hard and soft palate: U shape
*horseshoe*
 Major connector of mid-palatal tours *soft palate*: anterior-posterior palatal strap
 Tripoding: return the cast to the surveyor.
 Most complaint to speech after RPD placement : change in palatal form.
 Distance between border of framework and marginal gingival : at least 6mm
 Cement used for bonding porcelain veneers: resin cement.
 Failure / fracture of rest : due to under preparation.
 Function of minor connector : stability *transfer functional stress to abutment.*
 Function of rest : support.*resist*
 Function of indirect retainer : minimize movement of the base away from supporting
tissue.
 Commonly tooth used to receive indirect retainer in RPD: 1ST PREMOLARS
 Important part of Distal extension RPD that maintains stability: Denture base.
 Gide plane of path of insertion for partial denture: the tooth surface adjacent to the
edentulous area.
 Deflection of FPD increase : cube the length.
 Distal extension of RPD receives it support : mostly from residual ridge.
 RPD totally supported by teeth : Kennedy class III.
 Pier abutment: edentulous space on both sides of the abutment.
 Abutment: tooth which a bridge is attached.

14 | P a g e Dr.B ayan A l Mahari /2020

  Retainer: crown or other restoration that cemented *attached* to the abutment
 Pontic: artificial tooth that replace missing tooth, fills space and restore function
 Connector: unites the pontic and retainer.
 Gum stripping design : denture design which doesn’t have any clasps or rests and
takes support from soft tissue.
 Act against adhesive food in RPD: Retention.
 Fracture of rest seat passing over marginal ridge: Electric soldering
 Surveying done on: diagnostic cast.
 If we forget to place cingulum rest for lingual palate in major connector: impingement
of gingival tissue.

 Lingual plate:
- Indication :
* shallow sulcus and high frenum
* present of lingual tori
* mobile anterior teeth
* when depth less than 7mm .
- Contraindication : crowding of lower anterior teeth.
 Lingual bar: ‫عكس البالت‬

 Minor connector :
- Connect major connector to other components.
- Connect with major connector at 90 degree
- Should conform to the interdental embrasure

 Rigid Components:
- Minor connector
- Major connector
- Rest.

 Steps of study cast of RPD with lingual bar:

- 1st : outline basal seat area
- 2nd: outline inferior border of major connector
rd
- 3 : outline superior border of major connector
- 4th: connect 1st with 2nd and 3rd .

 Factors effecting of path of insertion:

- Esthetics
- Guiding planes
- Retentive undercut
- Interferences.

15 | P a g e Dr.B ayan A l Mahari /2020

 -------------Clasps and Rests:------------

Circumferential clasps - More rigid.

- Generally used on tooth-supported RD.

Combination clasps - Indicated for abutment adjacent to distal extension base

- Usually given in class I and II

Reciprocal clasp - Originates from minor connector and rest.

- Lake of reciprocation of RPD will cause: abutment tooth displacement during
removal and insertion.

Wrought wire clasps - Flexible / less stress to abutment

- Placed in undercut of : 0.02 inch
- Indicated if retention placed on the opposite side of fulcrum line
- Indicated for perio weakend teeth or endo treated teeth.

Ring clasp - On tilted molar

Gingival approaching clasp - On premolar abutment teeth for distal extension saddles.

Chrome metal clasps - Placed in undercut of : 0.01 inch

Embrasure clasp - Use on the side opposite to edentulous area.*teeth side*

Aker clasp - High stress to the gingival tissue.

- If caries free and good periodontal support in tooth.

 Subrabulge * originate above the survey line * :

- Circumferential clasps
- Ring clasp
- Combination clasps
- Embrasure clasp

 Infrabulge * originate below the survey line *

- I bar
- T bar
- Bar type
- Y type.

 Functional of clasps in RPD : to prevent dislodgment of denture.

Occlusal rest Cingulum rest Incisal rest

Shape Rounded Inverted U or V shape Round notch at incisal edge

*semicircular/spoonshape/triangular*
Width 2.5mm 2 mm 2.5 mm

Depth 1.5mm 1.5 mm 1.5 mm

Bur Round bur. Inverted, cone shaped diamond stone. Seldom : esthetic compromise

Notes If spoon shape not in option, will choose Contraindication in lower incisors. Used as indirect retainer
concave.

16 | P a g e Dr.B ayan A l Mahari /2020

 ----------------Impressions.----------------

Alginate: - Most economical imp. Of broken clasp in RPD

- LEAST accurate of the elastic imp.
* irreversible hydrocolloid *

Compound: - LEAST accurate imp. Material

Addition silicon: - MOST accurate imp. Material

- Can be poured two times
*polyvinyl siloxane (PVS)* - Can be poured from 24 h – 1 week.
- Hydrophobic
- For onlay / full crown veneer.

Polyether: - Use in epoxy resin pin

- Can absorbe water and swell *hydrophilic*
- Show imbibition.
- MOST stiff
- Can be poured multiple time.
- Dimensional stability/accuracy.
- Short setting time
- In presence of water they stick to teeth.

Polysulfide: - Highest tear strength of elastomers.

- Should be poured within 1 hour
- Bad odour/taste

ZOE - Use for distal extention in RPD

- Use in tissue at rest

Plaster of paris - Flappy ridge.

 +ve Bubble on the cast: during taking imp. can be removed with cleoid instrument
 -ve bubbles : voids on cast need blocking out.
 Alter alginate setting time by altering : water temp.
 Imp. Tech. used to take both arches and bite registration: triple tray imp. Tech.
 Syneresis: imp. Exposed to the air at room temp. *shrinkage associated*
 Imbibition: imp immersed in water *swelling*
 Imp. Can be used for pt had radiotherapy since last 10 months : elastomers.

 Elastomers :
- Polysulphide
- Polysilicones
- Polyether.

 Causes of tearing:
- Material contaminated by moisture.
- Prolonged mixing
- Low water/powder ratio.

17 | P a g e Dr.B ayan A l Mahari /2020

 ---------------Occlusion:----------------

 Centric occ. : tooth to tooth

 Centric relation : bone to bone.
 Difference between centric relation and occ. In complete denture: ZERO mm
 Criteria for physiologic occ. : occlusal stability
 Criteria for functional occ. : mastication
 Most destrictive occ. : non working
 Most common type of occ. Comfortable to the pt : mutually protected occ.
 Mutually protective occ. Seen in: organic occ.

- others -
----------------------------Fluoride:---------------------------

 Fluorosis:
- Less sever in primary.
- Seen in water fluoride level higher than 3ppm
- Fluoride intake after age of 8 cant cause fluorosis.

 Fluoride supplement:
- Birth – 6 months: none.
- 6 months – 3 years: 0.25 mg/day
- 3-6 years : 0.50 mg/day
- 6-16 years: 1.0 mg/day

 Common concentration of fluoride:

- 1000ppm in pediatric
- 1500ppm in adult

 Type of fluoride added to water:

- Sodium fluorosilicate
- Sodium fluoride
- Fluorosilicic acid.

 Type of fluoride added to toothpaste:

- Sodium fluoride
- Sodium monofluorophosphate.

 NO supplemental systemic fluoride for:

- Child less than 6 months
- pt over than 16 years
- child living in area with fluoride level above 0.6ppm

18 | P a g e Dr.B ayan A l Mahari /2020

  APF:
- Most popular varnish.
- PH: 3.2
- Time: 4 mins – 2 mins minimum * for uncooperative pt *
- Cons.: 1.23%

 Formulation of :
- APF: 1.23% *most popular*
- Sodium fluoride gel (NaF) : 5% NaF Varnish
- Stannous fluoride : 8%

 Safest way to remove mild :

- Fluorosis : Microabrasion
- Tetracycline stain : home bleaching.

 Most common fluoride mouth rinse in school programmers: 0.2% NaF WEEKLY
 Most common fluoride mouth rinse : 0.05% NaF DAILY.
 Skeletal fluoride occurs at : 2-10ppm
 Recommended level of fluoride in water supply: 0.7-1.2 ppm.
 Optimal water fluoridation level : 0.8-1.0 mg/L
 Fetal dose of fluoride in 3 years old : 435mg in 4-5 hours.
 Fluoride can be applied by dentist : Duraphat * fluoride varnish *
 For mentally retarded pt : 5% sodium fluoride varnish.
 Fluoride mouth rinses most beneficial to : smooth surface * proximal surface *
 1st water community city : Michigan
 Main reason for reduction caries : water fluoridation.
 Contraindication fluoride in : pt with renal failure.
 TOXIC dose of fluoride in child : 5 mg/kg.
 Fluoride is NOT TAKEN up systemically from: Dentifrices.
 Most benefits *effective* surface from water fluoridation: coronal smooth surface.
 least benefits *effective* surface from water fluoridation: occlusal surface.
 Most teeth susceptible to fluorosis : upper premolars.

19 | P a g e Dr.B ayan A l Mahari /2020

 ---------------------Sterilization and infection control:---------------------

Autoclave: Dry heat oven:

- 20 min at 121c - Ster:1-2 hours at 160c

- 3-10 min at 134c - Glass or metal objects only.
- disAdv: dull/corrode instruments. - Slow penetration of heat

Aluminium foil test Ultrasonic cleaners.

Rideal walker test evaluate power of disinfectant

Spore test check effectiveness of the sterilization process

 Gutta percha disinfectants: chemical agents *5.25% NaoCl*

 Aterilization achieved by : Changing strip indicator daily and spore former weekly.
 Immersion tech. : help all the surface of impression to be disinfected.
 Ethylene oxide: 2-3 hours at 49c
 Flash sterilization : instruments for immediate use.
 Prion protein: Extremely heat resistant / No RNA and DNA.

 Alginate impression disinfectants:

- Iodophor
- Glutraldehyde.

 Disinfectants after HBV:

- Formaldehyde
- Iodophor & hypochlorite.

 Recommended time for hand wash:

- Routine: 20-60 seconds.
- Surgical: 2-6 mins.

 Tolerance to heat and chemical:

- LEAST resistant : viruses
- MOST resistant: prion protein.

20 | P a g e Dr.B ayan A l Mahari /2020

 ----------------------------Rubber Dam:------------------------

2nd primary molar - 12A

- 13A

1ST PRIMARY Molar - 2A

Partially erupted permanent molar - 8A

clamp. - 14A
- 154A

Fully erupted permanent molar clamp. - 14

- 8

#Note: A use in pediatric dentistry.

 The retainer of rubber dam:

- Four points [ 2 buucally, 2 lingually ] WITHOUT rocking.

 rubber dam:
- too close : leakage
- too far : wrinkle.

 Steps of removing rubber dam:

- 1st : remove any tie downs if present
- 2nd : cut interdental septa
- 3rd : remove clamp
- 4th : remove frame and dam.

 Rubber dam is not used in child pt with:

- Obstructive nose
- Pt with orthodontic appliance.

 HOLE PUNCH:
- SMALL : incisors and canine / primary teeth.
- MEDIUM: bicuspid and primary molars.
- LARGE: clamp bearing tooth and most permanent molars.

 Split dam tech. used with : FPD Field.

 Placing dam when used WINGED clamp: clamp and dam together.

21 | P a g e Dr.B ayan A l Mahari /2020

 ------------------------X-ray errors:------------------------

- Bone / periapical area

- Endodontics
Periapical view: - Proximal caries in *ANTERIOR*
- Periodontal ligament *Lamina dura*

Bitewing view: - Periodontal disease *bone loss*

- Proximal caries in *POSTERIOR*

Occlusal view: - Impacted tooth/lesion

- Replace periapical film in child

Panorama - Overview of jaws

- Ortho.

MRI - Soft tissue *tumors*

- Sialolith parotid gland
- TMJ disc

Arthrography - perforation of TMJ disc

Reverse townes view - Fracture of condyles

- Bone.
- Zygomatic complex fracture
CT - All mand. Fracture

CBCT - Implant placement

IOPAR - Before placing implant

Elongation Improper periapical film

Overlapping Incorrect horizontal angulation

Cone cut Xray cone not properly pointed

22 | P a g e Dr.B ayan A l Mahari /2020

  Distance of x-ray:
- Source – pt : 5 feets *1.5 m*
- Source – dentist : 6 feets *2m*
 MPD for someone works near radiation :
- Yearly : 5/0 REM * 5000 mrem *
- Weekly : 100 mrem
 Developer :
- Activator *developing agent*
- Restrainer
- Preservation
- Hardener
- Solvent *water*
 Collimation : restrict size & shape of xray beam
 U shape RO in upper 6 : zygomatic process

Best of luck,
Bayan AlMahari / October 2020.

23 | P a g e Dr.B ayan A l Mahari /2020