牙醫師討論區﹝壹﹞
Discuss
Area For Dentists : 1
This area is open to the dentists,
dental students, and even the
public (if you are intrested). Some of these are from journal
papers, some from textbooks, the others are my personal
opinions. So there might be some
disagreement or
errors (I
mean, my personal opinions). Your
opinions or your personal
experience will be greatly appreciated.
You can E-Mail me at
the address: (hnchiu@ms14.hinet.net).
Thank you!
CONTENTS
Topic One: Why
Replace a Missing Back Tooth?
Topic Two: The
Step by Step Procedures of Oral Cancer Examination
Topic Three: Clinic
Procedures of CI V Composite Filling Tooth #5
Topic Four: Clinic
Procedures of CI IV Composite Filling Tooth #8
Topic Five: Clinic
Procedures of CI IV Composite Filling Tooth #8
Topic
Six: Prophylactic Antibiotics
Topic
Seven: Procedure of Cl II Amalgam filling of tooth #30
Topic
Eight: Why Do We Need Root Canal Therapy?
Topic
Nine: Is It Safe To Use Silver Amalgam In Dental Therapy?
Topic
Ten: Dentin hypersensitivity
Topic
Eleven: OS Terminology
Topic
Twelve: How Do You Brush Your Teeth
Topic
Thirteen: Journel Paper From: JADA - 1994 - 9
Topic
Fourteen: About Dental X Ray
Topic
Fifteen: Treatment Plan Presentation
Topic
Sixteen: Tooth Preparation: Principles and Common Errors
Topic
Seventeen: The relative infective route of periapical diseases
Topic
Eighteen: The D. D. of Granuloma & Cyst
Topic
Nineteen: Pain
Topic
Twenty: CPR Ready Reference
Topic One: Why
Replace a Missing Back Tooth?
"If you fail to replace an extracted back tooth with
a false tooth, you could lose all of your
teeth."
WHY? WHY? WHY?
> Recent extraction of a lower molar #30 has created
a space. So upper molar #3
is now useless because
it no longer has a tooth to chew against. Therefore,
losing 1 tooth can result the loss of the use
of two.
> A series of problems begins. Let's see what will happen!
> Back teeth have a lifetime tendency to erupt. The loss
of #30 will cause the
overeruption of #3. The
resulting unevenness among #29, #30 and #31 will
create areas between these teeth that trap
debris. It is very difficult to clean the
areas. Unclean teeth usually cause inflammation of
the surrounding gums.
> #31 will jam food in between #3 and #2 during eating.
And the pressure will
cause #2 to move backward and
separate slightly from #3. So there will be a
space between #2 and #3. And food can
pack into this space during chewing
followed by a serious inflammation of the gum.
> The overeruption of #3 will cause some of its root
to expose and it get decays
much faster.
> Back teeth also has a lifetime tendency to tilt and
drift(mesial drift) toward the anterior teeth. The
loss of #30 will cause #31 to tilt and drift forward.
And it
will become worse and worse as time goes
by.
> When #31 tilts over, it will develop a gum pocket along
its forward(mesial) root. The pocket will
trap food debris and bacteria easily and cause inflammation
of
gum.
> When an area of the gums is constantly inflamed, the
bone immediately
adjacent to it can become inflamed
too. Inflamed bone softens and slowly
begins to disappear. Then the process of gum
inflammation and loss of the
bone holding a tooth is called periodontal disease.
> Let us see what is worse.
> #31 continues to tilt and drift until #2 no longer
bites on it. This allows #2 to
overerupt too. So decays
will begin on both #2 and #3, particularly on the
exposed portions of the roots.
> How about the lower molar #31. Decay also starts to
develop on it. The
periodontal disease - gum
pocket, gum inflammation, and loss of bone -
continues to worsen.
> Now the deep decay will allow bacteria to enter and
infect the pulps("nerves")
of #2 and #3. These two
teeth become seriously infected and cause periapical
abscess. They are so badly damaged
by decay that they must be extracted.
Now you have lost three teeth. Is it the end? Not yet!
> Let's see what will happen to #31. Because of inflammation
from the mesial
gum pocket of #31, bone
loss has spread around the mesial root of the tooth
and extended to part of the posterior root
too. The tooth has lost so much bone
support that it is now loose and must be extracted.
> Now you have lost four teeth, four molars of the right
side. Because all the
molars on this side of the
mouth have been removed, the upper and lower
second premolars(#4, #29) have no support
behind them and are forced
backward by the action of chewing. Food jams between
#4, #5 and #29, #28.
Gum inflammation has begun. Followed by gum pockets
and bone loss and
decay. Eventually #4 and #29 will
be extracted. After the loss of the second
premolars(#4, #29), the destructive process
can move farther forward. The
anterior teeth will start to spread apart, gum pockets
will form, and decay
begin. Now you may lose all of your teeth.
> Conclusion: "Failure to replace a single molar tooth
may start a chain of events:
overeruption, tilt, drift, gum
pockets, decay, bone loss. Over the years this
chain of events can lead to the loss
of all of your teeth. Inserting a false tooth
today will avoid grief and much greater expense
tomorrow."
* The note is abstracted from "Why Replace a Missing
back tooth?" by Berns, Joel M. - Quintessence
Books 1984.
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Topic Two: The
Step by Step Procedures of Oral Cancer Examination
### The examination is done in 2 minutes, 1 min for extraoral
and 1 for intraoral.
$ What you need for O.C.E. are: mouth mirror, tongue
blade, mask, gloves, 2 X 2 gauze and especially
a dentist.
@ Extraoral exam
> Facial skin
> Conjunctiva
> Parotid gland
> Preauricular lymph nodes
> Cervical and supraclavicular lymph node
> Vermilion borders
@ Intraoral exam
> Lips and labial gingiva
> Buccal mucosa and gingiva vestibule
> Tongue and floor of mouth
> Soft palate and pharynx, uvula
> Hard palate and gingiva
> Submandibular gland and submental lymph nodes
& Key words about extraoral exam:
1. Observe: symmetry, swelling, skin color, ulcer,
TMJ deviation, lesion etc.
2. Inspect: ask about any abnormal finding.
3. Palpate: soft or hard, fixed or movable, one or
several ......etc.
& Key words about intraoral exam:
1. Inspect: same as above.
2. Palpate: same as above.
% Important messages about "Oral Cancer":
1. P't with habit of smoking or alcohol and is over
40 yrs is high risk.
2. Male : female is 2 : 1.
3. High risk area inside the mouth: floor of mouth,
lateral tongue, ventral
tongue, soft palate and tonsilar pillars.
4. Benign or malignant salivary gland tumor are seen
most often in palate.
5. Most of O.C. 5 yrs survival rate: 40% ------ AND
IF YOU DO PAY
ATTENTION TO YOUR O.C.E., YOU
MIGHT FIND SOME EARLY
SIGN OF O.C.. AND YOU
CAN SAVE A PRECIOUS LIFE. YOUR P'T
ALL COUNT ON YOU!
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Topic Three: Clinic
Procedures of CI V Composite
Filling Tooth #5
> Patient and cubicle preparation: napkin, napkin holder,
cubicle cleaning, SIP.
> Shade matching while the tooth is still wet.
< Apply composite over tooth, recap right after
using it.
< Light curing 60" and check the color change,
if acceptable then perform the
next step. If color not matching,
repeat the step again.
> Apply local anesthesia.
< How much do you know about L. A.? --- Los Angels
???
< Lidocaine HCl 2% .
< 2% means 20 mg per ml, each cartridge contains
1.8 ml -> 36 mg per
cartridge
< 1 : 100,000 epinephrine -> cardiac stimulator
and vasoconstrictor, will
prolong the efficient time of
L.A., but is not used in IV or should not be
injected into blood vessel which
can be prevented by aspiration, proper
needle size, slow deposition
(1ml/ min).
< 1 : 50,000 epi may be used in perio surgery.
< 4% Citanest Plain (brand name; generic name is
Prilocaine HCl): without epi
is suitable for medical compromised P't (hypertension,
unstable angina, DM
..... etc.). Be careful, the duration is very short
(maybe 30' only).
< Other L. A. used : 4% Citanest Forte (with epi
1: 200,000, 2 carpules is
maximum), Polocaine 3% (generic name is Mepivacaine
HCl), Polocaine 2%
(with Levonodefrin 1 : 20,000) and Marcaine HCl 0.50%
with epi 1 :
200,000 (generic name is Bupivacaine, is a long act
[wait 15 mins to act] &
long onset [ last 8 hrs]).
< One last thing about L. A. : most common trouble
happening after injection
is FAINT.
> Rubber dam application: for I. infection control, II.
better visualization and III.
better working field.
< Heavy R.D., from tooth #3 - #10 at least by using
template; R.D. napkin
under R.D. (forceps, punch,
shaving cream).
< #14 clamp on tooth #3, secured with floss, #10
tied with floss too.
< R.D. frame (Woodbury type?) holds R.D.: try to
make R.D. smooth without
any wrinkle.
< Invaginate R.D. with air and beaver tail or 3A
explorer.
< Ivory #9 clamp on tooth #5, green compound to
fix it.
> Prepare toothl.
> Pumice polish, don't use prophylactic paste , because
it contains fluoride which
will hinder the composite setting.
> Clean and dry the tooth but not to desiccate the tooth.
> Following steps are from "TENURE" instruction:
> 1. All - Surface Preparation: Etch enamel for 20" with
Etch 'N' Seal to achieve
micromechanical retention and Tenure Dentin Conditioner
30"-60" for dentin
to remove smear layer and partially occlude dentin
tubules. Then wash and
dry it. --- To be continued!
> 2. Select/Apply Bonding Agent: Application of Tenure
A & B over dentin and
enamel (mix equal drops of A & B then apply and
evaporate with the use of
air syringe or Handi-Dri. Allow to dry for 10" to
20". Apply 2 - 5 coats).
Best bondable surface obtained when dry Tenure
makes dentin appear
glossy. Then bonding agent (Visar
Seal) is applied a thin layer for wetting
surface. Light cure 15" (Visar Seal is optional for
dentin).
> 3. Select And Bond Restorative Composite: Apply composite
in increments no
thicker than 2 mm with ICP, then blend the surface
with soft brush. Light
cure 60".
> 4. Finishing The Margins, Adjusting Occlusion (is not
necessary for Cl V) and
Contouring & Polishing: Use #11 or #12 knife
-> 12 - flute finishing bur or
composite polishing white stone (slow speed) -> finishing
strip or Solfa - Lex.
> Are you satisfied with your "artful and scientific
project"? If yes, how about
P't? If P't is satisfied too, get checked by instructor.
And you get 2 points.(
During the whole procedure, you'd better get checked
by instructor to make
sure you are making every step
correct.)
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Topic Four: Clinic
Procedures of CI IV Composite
Filling Tooth #8
> The procedures are basically the same as the one of
"Clinic Procedures of Cl
V Composite Filling Tooth #5" (Please check the previous
topic). But there are
some variations or modifications:
> You may apply local anesthesia before or after shade
matching.
> How do you perform shade matching? You can find the
details about value,
hue and chroma in the note of "Preclinic fixed prothodontics"
("Color science
in ceramo-metal restoration" in Chapter 5).
> The main difference between Cl V and Cl IV is occlusion.
Usually there is no
occlusion problem involved in Cl V. But it's not the
same when dealing with Cl
IV. In Cl IV composite filling, before we polish it
we should check the
occlusion. Our goal is to make the new filling out
of occlusion in CO, lateral
movement, protrusion and retrusion. The rationale is
that we don't want any
force apply on the new filling, otherwise it could
break the filling which is the
usual cause of failure.
> Armamentarium list:
< Sterile bag, paper, napkin holder.......basic
setup.
< Topical local anesthesia, Q-tip, local anesthesia,
needle and syringe.
< Shade guide, composite resin, Tenure kit, light
curing machine.
< Rubber dam, puncher, Woodbury type frame, #9 and
#14 clamp, clamp
holder and dental floss.
< Slow speed hand piece, prophy cup, prophy hand
piece and pumice powder.
< High speed hand piece, burs and Mylar strip.
< #11 or #12 knife, 12 flute or football shape finishing
burs, composite
polishing stone, finishing strip and Solfa - Lex.
< Thin articulating paper.
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Topic Five: Clinic
Procedures of CI IV Composite Filling
Tooth #8
> The procedures are basically the same as the one of
"Clinic Procedures of Cl
V Composite Filling Tooth #5" (Please check the previous
paper). But there're
some variations or modifications.
> You may apply local anesthesia before or after shade
matching.
> How do you perform shade matching? You can find the
details about value,hue
and chroma in the note of "Preclinic fixed prothodontics"
("Color science in
ceramo-metal restoration" in Chapter 5).
> The main difference between Cl V and Cl IV is occlusion.
Usually there is no
occlusion problem involved in Cl V. But it is not the
same when dealing with Cl
IV. In Cl IV composite filling, before we polish it
we should check the
occlusion. Our goal is to make
the new filling out of occlusion in CO, lateral
movement, protrusion and retrusion. The rationale is
that we don't want any
force apply on the new filling,
otherwise it could break the filling which is the
usual cause of failure.
> Armamentarium list:
< Sterile bag, paper, napkin holder.......basic
setup.
< Topical local anesthesia, Q-tip, local anesthesia,
needle and syringe.
< Shade guide, composite resin, Tenure kit, light
curing machine.
< Rubber dam, puncher, Woodbury type frame, #9 and
#14 clamp, clamp
holder and dental floss.
< Slow speed hand piece, prophy cup, prophy hand
piece and pumice powder.
< High speed hand piece, burs and Mylar strip.
< #11 or #12 knife, 12 flute or football shape finishing
burs, composite
polishing stone, finishing strip
and Solfa - Lex.
< Thin articulating paper.
> There might be some errors, if you find them please
tell me. I will correct them.
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1. 診所簡介
2.醫師簡介
3.口腔衛教
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