NEET MDS Synopsis
Colla Cote
PedodonticsColla Cote
Colla Cote is a biocompatible, soft, white, and pliable sponge derived from
bovine collagen. It is designed for various dental and surgical applications,
particularly in endodontics. Here are its key features and benefits:
Biocompatibility: Colla Cote is made from natural bovine
collagen, ensuring compatibility with human tissue and minimizing the risk
of adverse reactions.
Moisture Tolerance: This absorbable collagen barrier can
be effectively applied to moist or bleeding canals, making it suitable for
use in challenging clinical situations.
Extravasation Prevention: Colla Cote is specifically
designed to prevent or reduce the extravasation of root canal filling
materials during primary molar pulpectomies, enhancing the success of the
procedure.
Versatile Applications: Beyond endodontic therapy, Colla
Cote serves as a scaffold for bone growth, making it useful in various
surgical contexts, including wound management.
Absorbable Barrier: As an absorbable material, Colla
Cote gradually integrates into the body, eliminating the need for removal
and promoting natural healing processes.
Radiographic films used in Dentistry
Radiology
Radiographic films used in Dentistry
1. Intraoral Periapical (IOPA) Film
Size 0:
Dimensions: 22 x 35 mm
For: Small children
MPD (Maximum Permissible Dose) for whole body: 0.1 Rem in 1 year
Size 1:
MPD for gonads/bone marrow: 0.5 Rem in 1 year
Size 2:
Dimensions: 24 x 40 mm or 32 x 41 mm
For: Anterior projections and adults
MPD for gestation period in relation to the fetus: 5 Rem
MPD for skin: 0.5 Rem in 1 year
Radiation Exposure:
Mean exposure from one IOPA: 300 mR
Mean exposure from improved dental X-ray techniques: as low as 110
mR
2. Bitewing Film
Size 0:
For: Very small children
Size 1:
For: Children
Size 2:
For: Adults
3. Occlusal Film
Size:
3 times larger than size 2 film (57 x 76 mm)
Used for capturing larger areas of the dental arch.
4. Screen Film
Size:
8 x 10 inches
Used for extraoral projections in conjunction with an intensifying
screen.
Additional Information
Erythema Dose: The amount of radiation necessary to
produce a noticeable skin reaction, typically 300-400 R.
ALARA Principle: Stands for "As Low As Reasonably
Achievable," emphasizing the importance of minimizing radiation exposure.
Strep viridans
General Pathology
Strep viridans
Mixed species, all causing α-hemolysis. All are protective normal flora which block adherence of other pathogens. Low virulence, but can cause some diseases:
Sub-acute endocarditis can damage heart valves.
Abscesses can form which are necrotizing. This is the primary cause of liver abscesses.
Dental caries are caused by Str. mutans. High virulence due to lactic acid production from glucose fermentation. This is why eating sugar rots teeth. Also have surface enzymes which deposit plaque.
Intraligamentary Injection
Oral and Maxillofacial SurgeryIntraligamentary Injection and Supraperiosteal Technique
Intraligamentary Injection
The intraligamentary injection technique is a simple and effective
method for achieving localized anesthesia in dental procedures. It
requires only a small volume of anesthetic solution and produces rapid
onset of anesthesia.
Technique:
Needle Placement:
The needle is inserted into the gingival sulcus, typically on
the mesial surface of the tooth.
The needle is then advanced along the root surface until
resistance is encountered, indicating that the needle is positioned
within the periodontal ligament.
Anesthetic Delivery:
Approximately 0.2 ml of anesthetic solution is deposited into
the periodontal ligament space.
For multirooted teeth, injections should be made both mesially
and distally to ensure adequate anesthesia of all roots.
Considerations:
Significant pressure is required to express the anesthetic solution
into the periodontal ligament, which can be a factor to consider during
administration.
This technique is particularly useful for localized procedures where
rapid anesthesia is desired.
Supraperiosteal Technique (Local Infiltration)
The supraperiosteal injection technique is commonly used for
achieving anesthesia in the maxillary arch, particularly for
single-rooted teeth.
Technique:
Anesthetic Injection:
For the first primary molar, the bone overlying the tooth is
thin, allowing for effective anesthesia by injecting the anesthetic
solution opposite the apices of the roots.
Challenges with Multirooted Teeth:
The thick zygomatic process can complicate the anesthetic
delivery for the buccal roots of the second primary molar and first
permanent molars.
Due to the increased thickness of bone in this area, the
supraperiosteal injection at the apices of the roots of the second
primary molar may be less effective.
Supplemental Injection:
To enhance anesthesia, a supplemental injection should be
administered superior to the maxillary tuberosity area to block the
posterior superior alveolar nerve.
This additional injection compensates for the bone thickness and
the presence of the posterior middle superior alveolar nerve plexus,
which can affect the efficacy of the initial injection.
Rotational Speeds of Dental Instruments
Conservative DentistryRotational Speeds of Dental Instruments
1. Measurement of Rotational Speed
Revolutions Per Minute (RPM)
Definition: The rotational speed of dental instruments
is measured in revolutions per minute (rpm), indicating how many complete
rotations the instrument makes in one minute.
Importance: Understanding the rpm is essential for
selecting the appropriate instrument for specific dental procedures, as
different speeds are suited for different tasks.
2. Speed Ranges of Dental Instruments
A. Low-Speed Instruments
Speed Range: Below 12,000 rpm.
Applications:
Finishing and Polishing: Low-speed handpieces are
commonly used for finishing and polishing restorations, as they provide
greater control and reduce the risk of overheating the tooth structure.
Cavity Preparation: They can also be used for
initial cavity preparation, especially in areas where precision is
required.
Instruments: Low-speed handpieces, contra-angle
attachments, and slow-speed burs.
B. Medium-Speed Instruments
Speed Range: 12,000 to 200,000 rpm.
Applications:
Cavity Preparation: Medium-speed handpieces are
often used for more aggressive cavity preparation and tooth reduction,
providing a balance between speed and control.
Crown Preparation: They are suitable for preparing
teeth for crowns and other restorations.
Instruments: Medium-speed handpieces and specific burs
designed for this speed range.
C. High-Speed Instruments
Speed Range: Above 200,000 rpm.
Applications:
Rapid Cutting: High-speed handpieces are primarily
used for cutting hard dental tissues, such as enamel and dentin, due to
their ability to remove material quickly and efficiently.
Cavity Preparation: They are commonly used for
cavity preparations, crown preparations, and other procedures requiring
rapid tooth reduction.
Instruments: High-speed handpieces and diamond burs,
which are designed to withstand the high speeds and provide effective
cutting.
3. Clinical Implications
A. Efficiency and Effectiveness
Material Removal: Higher speeds allow for faster
material removal, which can reduce chair time for patients and improve
workflow in the dental office.
Precision: Lower speeds provide greater control, which
is essential for delicate procedures and finishing work.
B. Heat Generation
Risk of Overheating: High-speed instruments can
generate significant heat, which may lead to pulpal damage if not managed
properly. Adequate cooling with water spray is essential during high-speed
procedures to prevent overheating of the tooth.
C. Instrument Selection
Choosing the Right Speed: Dentists must select the
appropriate speed based on the procedure being performed, the type of
material being cut, and the desired outcome. Understanding the
characteristics of each speed range helps in making informed decisions.
Osteomyelitis
Oral and Maxillofacial SurgeryOsteomyelitis is an infection of the bone that can occur in the jaw,
particularly in the mandible, and is characterized by a range of clinical
features. Understanding these features is essential for effective diagnosis and
management, especially in the context of preparing for the Integrated National
Board Dental Examination (INBDE). Here’s a detailed overview of the clinical
features, occurrence, and implications of osteomyelitis, particularly in adults
and children.
Occurrence
Location: In adults, osteomyelitis is more common in
the mandible than in the maxilla. The areas most frequently affected
include:
Alveolar process
Angle of the mandible
Posterior part of the ramus
Coronoid process
Rarity: Osteomyelitis of the condyle is reportedly rare
(Linsey, 1953).
Clinical Features
Early Symptoms
Generalized Constitutional Symptoms:
Fever: High intermittent fever is common.
Malaise: Patients often feel generally unwell.
Gastrointestinal Symptoms: Nausea, vomiting, and
anorexia may occur.
Pain:
Nature: Patients experience deep-seated, boring,
continuous, and intense pain in the affected area.
Location: The pain is typically localized to the
mandible.
Neurological Symptoms:
Paresthesia or Anesthesia: Intermittent paresthesia
or anesthesia of the lower lip can occur, which helps differentiate
osteomyelitis from an alveolar abscess.
Facial Swelling:
Cellulitis: Patients may present with facial
cellulitis or indurated swelling, which is more confined to the
periosteal envelope and its contents.
Mechanisms:
Thrombosis of the inferior alveolar vasa nervorum.
Increased pressure from edema in the inferior alveolar canal.
Dental Symptoms: Affected teeth may be tender to
percussion and may appear loose.
Trismus:
Limited mouth opening due to muscle spasm or inflammation in the
area.
Pediatric Considerations
In children, osteomyelitis can present more severely and may be
characterized by:
Fulminating Course: Rapid onset and progression of
symptoms.
Severe Involvement: Both maxilla and mandible can
be affected.
Complications: The presence of unerupted developing
teeth buds can complicate the condition, as they may become necrotic and
act as foreign bodies, prolonging the disease process.
TMJ Involvement: Long-term involvement of the
temporomandibular joint (TMJ) can lead to ankylosis, affecting the
growth and development of facial structures.
Radiographic Changes
Timing of Changes: Radiographic changes typically occur
only after the initiation of the osteomyelitis process.
Bone Loss: Significant radiographic changes are noted
only after 30% to 60% of mineralized bone has been destroyed.
Delay in Detection: This degree of bone alteration
requires a minimum of 4 to 8 days after the onset of acute osteomyelitis for
changes to be visible on radiographs.
Early Childhood Caries (ECC) Classification
Conservative DentistryEarly Childhood Caries (ECC) Classification
Early Childhood Caries (ECC) is a significant public health concern
characterized by the presence of carious lesions in young children. It is
classified into three types based on severity, affected teeth, and underlying
causes. Understanding these classifications helps in diagnosing, preventing, and
managing ECC effectively.
Type I ECC (Mild to Moderate)
A. Characteristics
Affected Teeth: Carious lesions primarily involve the
molars and incisors.
Age Group: Typically observed in children aged 2
to 5 years.
B. Causes
Dietary Factors: The primary cause is usually a
combination of cariogenic semisolid or solid foods, such as sugary snacks
and beverages.
Oral Hygiene: Lack of proper oral hygiene practices
contributes significantly to the development of caries.
Progression: As the cariogenic challenge persists, the
number of affected teeth tends to increase.
C. Clinical Implications
Management: Emphasis on improving oral hygiene
practices and dietary modifications can help control and reverse early
carious lesions.
Type II ECC (Moderate to Severe)
A. Characteristics
Affected Teeth: Labio-lingual carious lesions primarily
affect the maxillary incisors, with or without molar caries, depending on
the child's age.
Age Group: Typically seen soon after the first tooth
erupts.
B. Causes
Feeding Practices: Common causes include inappropriate
use of feeding bottles, at-will breastfeeding, or a combination of both.
Oral Hygiene: Poor oral hygiene practices exacerbate
the condition.
Progression: If not controlled, Type II ECC can
progress to more advanced stages of caries.
C. Clinical Implications
Intervention: Early intervention is crucial, including
education on proper feeding practices and oral hygiene to prevent further
carious development.
Type III ECC (Severe)
A. Characteristics
Affected Teeth: Carious lesions involve almost all
teeth, including the mandibular incisors.
Age Group: Usually observed in children aged 3
to 5 years.
B. Causes
Multifactorial: The etiology is a combination of
various factors, including poor oral hygiene, dietary habits, and possibly
socio-economic factors.
Rampant Nature: This type of ECC is rampant and can
affect immune tooth surfaces, leading to extensive decay.
C. Clinical Implications
Management: Requires comprehensive dental treatment,
including restorative procedures and possibly extractions. Education on
preventive measures and regular dental visits are essential to manage and
prevent recurrence.
Onlay Preparation
Conservative DentistryOnlay Preparation
Onlay preparations are a type of indirect restoration used to restore teeth
that have significant loss of structure but still retain enough healthy tooth
structure to support a restoration. Onlays are designed to cover one or more
cusps of a tooth and are often used when a full crown is not necessary.
1. Definition of Onlay
A. Onlay
An onlay is a restoration that is
fabricated using an indirect procedure, covering one or more cusps of a
tooth. It is designed to restore the tooth's function and aesthetics while
preserving as much healthy tooth structure as possible.
2. Indications for Onlay Preparation
Extensive Caries: When a tooth has significant decay
that cannot be effectively treated with a filling but does not require a
full crown.
Fractured Teeth: For teeth that have fractured cusps or
significant structural loss.
Strengthening: To reinforce a tooth that has been
weakened by previous restorations or caries.
3. Onlay Preparation Procedure
A. Initial Assessment
Clinical Examination: Assess the extent of caries or
damage to determine if an onlay is appropriate.
Radiographic Evaluation: Use X-rays to evaluate the
tooth structure and surrounding tissues.
B. Tooth Preparation
Burs Used:
Commonly used burs include No. 169 L for initial cavity preparation
and No. 271 for refining the preparation.
Cavity Preparation:
Occlusal Entry: The initial occlusal entry should
be approximately 1.5 mm deep.
Divergence of Walls: All cavity walls should
diverge occlusally by 2-5 degrees:
2 degrees: For short vertical walls.
5 degrees: For long vertical walls.
Proximal Box Preparation:
The proximal box margins should clear adjacent teeth by 0.2-0.5 mm,
with 0.5 ± 0.2 mm being ideal.
C. Bevels and Flares
Facial and Lingual Flares:
Primary and secondary flares should be created on the facial and
lingual proximal walls to form the walls in two planes.
The secondary flare widens the proximal box, allowing for better
access and cleaning.
Gingival Bevels:
Should be 0.5-1 mm wide and blend with the secondary flare,
resulting in a marginal metal angle of 30 degrees.
Occlusal Bevels:
Present on the cavosurface margins of the cavity on the occlusal
surface, approximately 1/4th the depth of the respective wall, resulting
in a marginal metal angle of 40 degrees.
4. Dimensions for Onlay Preparation
A. Depth of Preparation
Occlusal Depth: Approximately 1.5 mm to ensure adequate
thickness of the restorative material.
Proximal Box Depth: Should be sufficient to accommodate
the onlay while maintaining the integrity of the tooth structure.
B. Marginal Angles
Facial and Lingual Margins: Should be prepared with a
30-degree angle for burnishability and strength.
Enamel Margins: Ideally, the enamel margins should be
blunted to a 140-degree angle to enhance strength.
C. Cusp Reduction
Cusp Coverage: Cusp reduction is indicated when more
than 1/2 of a cusp is involved, and mandatory when 2/3 or more is involved.
Uniform Metal Thickness: The reduction must provide for
a uniform metal thickness of approximately 1.5 mm over the reduced cusps.
Facial Cusp Reduction: For maxillary premolars and
first molars, the reduction of the facial cusp should be 0.75-1 mm for
esthetic reasons.
D. Reverse Bevel
Definition: A bevel on the margins of the reduced cusp,
extending beyond any occlusal contact with opposing teeth, resulting in a
marginal metal angle of 30 degrees.
5. Considerations for Onlay Preparation
Retention and Resistance: The preparation should be
designed to maximize retention and resistance form, which may include the
use of proximal retentive grooves and collar features.
Aesthetic Considerations: The preparation should
account for the esthetic requirements, especially in anterior teeth or
visible areas.
Material Selection: The choice of material (e.g., gold,
porcelain, composite) will influence the preparation design and dimensions.