Diabetes education booklet

Introduction to diabetes
Approximately 1.4 million people in the UK have diabetes and it is suggested by Diabetes UK
that there could be another one million people with diabetes and are unaware they have it. The
majority of people with diabetes (85% - 90% will have Type 2 diabetes). The remainder will
have Type 1 diabetes.
Diabetes Mellitus is a condition in which the amount of sugar in the blood is too high. When
we eat a meal the starchy and sugary carbohydrates are changed into sugar (glucose ) during
dijestion and this sugar then passes into the bloodstream. When the pancreas senses that
there is a rising level of glucose in the blood it secretes a hormone called insulin. Insulin
changes glucose into energy which provides fuel for the body. Insulin is vital for life because
without it, the glucose could not be changed into energy and the body could not function
without energy. It is often said that insulin acts like a key – unlocking the cell to allow the
energy in. Obviously, like a car, we only need a certain amount of energy to provide for the
requirements of the body. If we eat more than we need this will be stored as fat.
Signs and symptoms of diabetes
· Excessive thirst
· Frequency in passing of urine
· Blurred vision
· Loss of weight
· Tiredness
· Mood changes
· Frequent infections e. boils, thrush etc
Types of diabetes
There are two main types of diabetes:
· Type 1 ( used to be called insulin dependent ) affecting children and young adults
mostly
· Type 2 diabetes ( used to be called non insulin dependent ) is commoner in the
over 40 year olds although children as young as sixteen and obese are
alsodeveloping Type2 diabetes
Main Aim of treatment
The main aim of treatment of both types of diabetes is to normalise blood glucose levels to
protect against long term damage to the eyes, kidneys, nerves,
heart and all the blood vessels. Some experts call diabetes “a blood vessel disease” because
preventing narrowing of the blood vessels is key to preventing complications.
Type 1 diabetes
The exact cause of Type 1 diabetes is unknown but thought to be due to a viral infection or
environmental factors. In type 1 diabetes there is total destruction of the cells in the pancreas
( beta cells ) that produce the insulin. The onset of type1 diabetes is acute, because as stated
earlier insulin changes glucose into energy but in the absence of insulin, glucose builds up in
the blood and is not turned into energy. In an effort to overcome the lack of fuel for the normal
functioning of the body, fats and proteins are broken down instead. This is why
patients are often underweight at diagnosis.
Once treatment with insulin is started the patient will begin to feel better quickly and will
regain the lost weight.
Treatment for type1 diabetes
People with Type 1 diabetes will need injections of insulin for the rest of their lives. Insulin is
destroyed by the gastric juices so cannot be taken in tablet form.
People with Type1 diabetes will need a minimum of two injections daily and often more. They
will also need to eat a healthy diet and take regular exercise and do regular self blood glucose
testing
If you have been diagnosed with Type 1 diabetes please ask your health professional for the
special section on “ Insulin Ttreatment” which will give you much more specific and detailed
information.
Type 2 diabetes
Type 2 diabetes occurs when the pancreas secretes less insulin than normal or when the
insulin secreted fails to work properly (called insulin resistance). People who are overweight
are five times more likely to develop Type 2 diabetes and four out of five people with Type 2
diabetes are overweight. Excess weight increases your body’s own glucose production and
thus your body’s need for insulin too. At the same time, this extra insulin increases fatty acids
stores and further increases insulin resistance. It becomes a vicious circle.
Type 2 diabetes is particularly associated with central excess weight ( apple shaped rather
than pear shaped). Health risks increase when waist circumference is greater than 37inches
(94cms) in men and 31.5 inches (80cms ) in women. Reducing calorie intake if you are
overweight will help your body use insulin better by reducing insulin resistance.
You will find a whole section of this book devoted to healthy eating, weight control and
exercise.
Type 2diabetes has a gradual onset. You may not feel any symptoms beyond a little tiredness
which is often mistakenly attributed to age and working hard. As Type2 diabetes progresses
you may become aware of some of the signs already mentioned or you may be diagnosed
whilst being investigated for something else. It is suggested by experts that most people have
had Type2 diabetes for at least five years before diagnosis.
The following people are at an increased risk of developing Type2 diabetes:
Family history of diabetes
Asian or Afro-Caribean origin
Women who have had gestational diabetes
Obese people
People who take little exercise
Older age
People on certain medications eg steroids, and some anti psychotic medications
Treatment for Type2 diabetes
People with Type2 diabetes will be encouraged to eat a healthy balanced diet and take regular
exercise. They will be treated with diet only for the first three months after diagnosis (unless
their blood glucose is very high and they are losing weight). If diet and exercise alone does
not control your blood glucose levels you may also need to take tablets.
Diabetes and Driving in UK
Having diabetes does not mean that you cannot drive as long as you doctor says you are safe
to do so – this is usually when your diabetes becomes stable and controlled. You will
however have to plan in advance before getting behind the wheel of your car if you are on
certain tablets for your diabetes and/or taking insulin.
You must by law inform the Driver and Vehicle Licensing Agency (DVLA) if
Your diabetes is treated with tablets or insulin
If your treatment changes from tablets to insulin or if insulin is added to the
tablets
If there are changes in your health or condition that may affect your ability to
drive safely
If you are applying for a licence for the first time, you must answer YES to the
question about diabetes.
People Treated with Insulin
After you have written to the DVLA informing them of your insulin treatment, you will be sent a
form (called “Diabetic 1”), asking for more information and for the name and address of your
GP/ Hospital Doctor. You will be asked to sign a consent form allowing the DVLA to contact
the doctor directly for more specific information on your diabetes control, eyesight and general
fitness to drive.
This does not mean that you will be refused a licence – it just ensures safety for you and
other drivers. Please answer all questions fully and honestly.
After you have informed the DVLA that you have diabetes, they will send you a letter
explaining your responsibility to re-notify them if you start having insulin or have
“hypos” (low blood sugar), or if you develop any of the complications of diabetes which could
affect your ability to drive.
They will not normally ask you any other questions at this stage and you will normally expect
to keep your “till to” licence.
No restrictions on driving and do not need to inform DVLA.
Restricted Licences
Insulin treated – a driving licence will be issued to you for one, two or three years if you are
treated with insulin. Just before expiry date, you will receive a reminder to renew your licence
and you will be asked to return your current licence. You will be sent another “Diabetic1” form
to confirm your medical condition. Renewals of restricted licences are free.
Tablets or diet treated – usually issued with a “till to” licence. When you reach 70 years of
age, you will be expected (like everyone else in UK) to renew it every one to three years. There
is a charge for this renewal.
Provisional licences – applies to insulin treated only – need to be renewed every one, two or
three years.
When renewing licences, it is always sensible to keep a copy of the old licence or to make a
note of the driver number, before sending to the DVLA. The process takes between six – eight
weeks unless there are complications.
If you drive a motorcycle the rules for informing the DVLA are the same as for a car.
Eyesight Problems
Obviously it is important to have good distance vision and good field of vision (what you can
see side to side when looking straight ahead). There are various tests that an ophthalmologist
can do to carry out to test these factors. Your licence may be revoked if you fail a field of
vision test, but you can appeal against it. There are different types of field of vision tests,
some people do better on one type versus another. The DVLA will accept the results of any
approved type of test.
Large Goods Vehicles (LGV) and Passenger Carrying Vehicles (PCV)
In 1991 the titles of HGV (heavy goods vehicle) changed to LGV
And PSV (public services vehicles) changed to PCV.
People treated with diet alone or diet and tablets are normally allowed to hold LGV and PCV
licences, provided they are otherwise in good health.
People treated on insulin are not allowed to hold these licences. If you currently hold such a
licence and start using insulin you must inform the DVLA and stop driving the vehicle
immediately.
In 1996, the regulation on larger vehicles was extended to include medium sized vehicles.
Anyone passing their driving test after 31 st December 1996 will only be given a licence to
drive vehicles up to 3.5 tonnes.
Vehicles weighing 3.5 tonnes – 7.5 tonnes (Category CI ) and mini buses (DI) are now treated
as Group 2 vehicles – normally there is a complete ban on insulin users obtaining a group 2
licence. However some CI licence holders can now apply for a medical assessment and can
regain ability to drive these vehicles whilst on insulin. Please write to the DVLA for more
information.
Taxis
The law does not bar insulin users from driving taxis, provided they are less than nine seats.
As local councils issue licences the policy may vary in different parts of the UK. Some taxi
authorities issue blanket restrictions. Please contact Diabetes UK and DVLC for more
information.
Diabetes in Pregnancy (Gestational Diabetes)
If you need to commence insulin in pregnancy, you should notify DVLA immediately.
You will normally be allowed to continue driving but are recommended to stop if your control
becomes unstable or if you do not have good warning signs of hypoglycaemia. You should re
notify the DVLA six weeks after delivery if you are still on insulin, as your licence will need to
be reassessed.
If you have problems relating to your driving licence, please discuss it with your diabetes
team, who will be able to advise you. DVLA wish to issue licences, not to take them away –
you can help by giving as much information as possible.
DO NOT DRIVE IF
· You have difficulty recognising early signs of hypoglycaemia (Section )
· You have started on insulin and your diabetes is not yet controlled.
· You have problems with eyesight not corrected by glasses
· You have numbness or weakness in your feet caused by nerve damage or circulation
(neuropathy or ischaemia)
· You have been drinking alcohol.
Precautions before Driving
Long journeys need careful planning, allowing for regular stops if you are on
specific tablets for diabetes and insulin.
Normally it is wise to have something to eat every two to three and half hours if you are on
insulin and not to miss meals and not to delay meals if you are on tablets and insulin.
Test your blood sugar before driving and regularly during a long drive or if at
work before you drive home at the end of the day or shift.
·Always carry quick acting glucose and slow release carbohydrate in the car at all
times if you are on insulin or specific diabetes tablets.
Always carry identification on your person and in the car stating your name, how
your diabetes is treated and the name of your GP.
At the first sign of Hypoglycaemia
· Stop driving as soon as it is safe to do so
· Remove ignition key and move into passenger seat.
· Immediately take glucose tablets or sugary drink (both may be required)
· Follow this with slow release carbohydrate i.e sandwich, crisps, biscuits etc.
· Wait for at least 15 – 20 minutes until you feel better, recheck blood if possible, if you
do not feel better, take more glucose and biscuits and wait a further 15 minutes.
· If you continue to feel unwell – call for help and do not drive – if considering using
motorway emergency assistance, please remember you may be unsteady on your feet, so
take extra glucose before walking.
Car Insurance
The main potential danger of diabetes and driving is the possibility of having a hypoglycaemic
episode which could impair your judgement and lead to an accident.
Since the Disability Discrimination Act came into effect at the end of 1996, insurers can only
refuse cover if they have evidence of increased risk.
It is virtually important to inform your motor insurance that you have diabetes.
Your motor insurance may become invalid if
· You fail to update them on changes to your treatment or physical condition
· You fail to notify the DVLA as mentioned previously
· You fail to comply with DVLA restrictions or recommendations
Diabetes UK Services has an exclusive service that will search through a panel of insurers for
the best quote, - freephone 0800 731 7431.
Life Assurance / Insurance
Some people experience difficulty getting life cover. It is important that you declare your
diabetes when applying for a new policy. Any life policy you hold at the time of diagnosis is
unaffected.
Any difficulties ring Diabetes UK Careline 0845 120 2960
Or write to Diabetes UK Careline, 10, Parkway, London, NW1 7AA (operates a translation
service also)
Travel Insurance
Many travel insurance policies exclude pre-existing medical conditions such as diabetes, you
must check carefully if your policy includes or excludes diabetes.
Some insurance companies charge an extra £10 - £15 to include diabetes. It is worth having a
letter to this effect from the insurers
Diabetes UK are continually expanding the service they offer. Please see relevant telephone
lists at the back of this booklet.
Diabetes and Employment
An employer cannot by law refuse to employ you or dismiss you purely because you have
diabetes, according to the Disability Discrimination Act (DDA1995).
Although most people with diabetes do not consider themselves to have a disability, diabetes
is covered by the Act.
Certain professions are exempt from the DDA and can refuse to employ someone with diabetes,
especially if they are treated with insulin, these include
· Air line crew
· Armed services
· Off shore workers
· Train drivers
· Any work requiring LGV and PCV
· Police force
However, if diabetes is diagnosed whilst in this employment, it may be possible to continue
with some negotiable changes in your duties.

How to Write a Research Proposal

Framework of the Research Proposal
A research proposal is a written document that includes the following information:
– Summary of prior literature.
– Identification of research topic and research questions.
– Specification of procedure to be followed to answer research questions.
The purpose of your proposal is to sell your idea by showing you have thought it through very
carefully and have planned a good research study.
There are three major sections of a research proposal, although the exact headings can vary:
I. Introduction
II. Method
III. Data Analysis
Two examples of Tables of Contents for a research proposal are shown in Table 4.1 (see your
textbook).
• Notice that the headings can vary.
• When you write a proposal, check with your committee or funding agency to determine
if they have a preferred layout of headings.
I. The introduction section of your proposal.
• The purpose of this section is to introduce your research idea, establish its importance
(i.e., you want to “sell” it to your reader), and explain its significance.
• Flow of the introduction:
– Start with a general introduction that
• defines the research topic.
• demonstrates its importance.
– Then review the relevant literature.
– This review should lead directly into a statement of the purpose of the study and your
research questions.
II. The method section of your proposal.
• This provides a written description of the specific actions, plan, or strategy you will
take to answer your research questions.
• It includes information about your proposed
– Research participants
– Design
– Apparatus or instruments, and
– Procedure.
Participants
The subsection of the method section entitled participants should provide a written
description of the individuals who will participate in your research study and how they will be
recruited.
Be sure to specify the following
Their demographic characteristics such as age and gender.
Inclusion and exclusion criteria you will use.
Any inducements for participation you plan to use.
Where they are located.
Design
In this subsection of the method section, entitled “Design, you present your plan or strategy
to be used to investigate your research questions.
• You must include a separate design section if your design is complicated; otherwise you
can put in your procedure section.
• The following is included in the design section:
– Type of design and design layout of your study (e.g., you might use a pretest-posttest
control-group design).
– Description of all the variables being examined in your study.
– Description of how your variables are to be combined.
– Description of the points of measurement and manipulation in the design.
Apparatus and/or Instruments
In this subsection of the method section you describe any apparatus and or instruments you
propose to use in your research study.
The following information should be included:
– General description of the apparatus or instruments.
– Variables measured by instruments.
– Reliability and validity of instruments.
– Why the instruments or apparatus are used.
– Reference indicating where apparatus or instruments can be obtained.
Procedure
In this subsection of the method section of your proposal, you carefully describe how your
study will be executed.
• The following information should be included in the procedure section:
– A description of the design if it was not previously described.
– A detailed step-by-step description of how the study will be executed.
The reader should know exactly what you intend to do after reading this description. It should
include enough information to tell the reader how to do the study if he or she wanted to
replicate it.
III. The data analysis section of your proposal describes exactly how you propose to analyze
the data you plan on collecting.
In a quantitative study, you will use some type of statistical analysis. You need to specify
those analyses.
In a qualitative study, there is no one or “right” way of analyzing the data. You must explain
the approach you propose to use and justify its use. In general, qualitative analysis will
involve coding and searching for relationships and patterns in qualitative data.
An abstract is required in completed research studies; it is an optional section in a research
proposal. You will need to determine if one is needed in your case.
The elements of the abstract will include the following:
Concise statement of research hypothesis or research questions.
Statement of expected number and characteristics of participants.
Brief summary of procedure or way data will be collected.
Brief statement of how will analyze results.
Abstract is optional in proposals.
Sample Research Proposal
Resident: John Smith, PGY2
Research Mentor: Jane Doe, MD, Section of General Internal Medicine
Date of Proposal: February 5, 2009
I. Title of Proposed Research Project Medical Students as Mediators of Change in Tobacco
Use  
II. Specific Aims
In conducting this study, we will accomplish the following specific aims:
Specific Aim 1. Compare the effectiveness of the stage specific smoking cessation
counseling intervention with the control intervention by evaluating the impact on the
following patient outcomes at 1, 3, 6 and 12 months: a) quit rate, b) stage of change, c)
desire to quit, d) motivation to quit, e) confidence in quitting (self-efficacy), and f) nicotine
dependence.
Hypothesis 1. Patients counseled by students initially trained in stage specific smoking
cessation counseling will have higher quit rates, improve their stage of change, increase
their desire to quit, be more motivated to quit, have higher confidence in quitting, and have
less nicotine dependence at 12 months.
Specific Aim 2. Compare the effectiveness of the stage specific smoking cessation
counseling intervention with the control intervention by evaluating the impact on the
following processes of care rated by patients at 1, 3, 6 and 12 months: a) satisfaction with
the quality of care in general, and b) satisfaction with the quality of care related to smoking
cessation counseling.
Hypothesis 2. Patients counseled by students initially trained in smoking-specific
behavioral counseling will have greater satisfaction with both measures of quality of care at
12 months.
III. Background
Tobacco is the only legally sold product known to cause death in one half of its regular
users.(1) Thus, of the estimated 1.3 billion people in the world who smoke, nearly 650
million will die prematurely as a consequence.(1) In the United States, approximately 25% of
men and 20% of women, or 46 million adults, smoke.(2) The financial toll of tobacco use in
the U.S. is substantial. Estimated costs include $75 billon per year in medical expenditures
and $80 billion from lost productivity.(3) The personal health risks of smoking are even
more significant with respect to morbidity and mortality. Although the role of physicians in
cessation efforts has been demonstrated, many physicians fail to counsel patients. The
most common reasons cited for lack of counseling include inadequate training and time
pressures. Our intervention will target medical students in the early stages of training. The
proposed intervention will provide a foundation for medical learners in stage specific
counseling and will aid physicians in primary practice to help their patients stop smoking.
The rationale for this program is that providing education early and allowing students to use
these skills with patients in the community can help: 1) future physicians with confidence in
smoking cessation counseling, 2) physicians in the community who may not have adequate
time to counsel patients, and 3) patients whose health may be at risk from smoking.
IV. Research Methods
Study Design : Randomized cross-over trial consisting of two smoking cessation
counseling interventions: 1) counseling intervention including patient education, written
material and follow-up by students who have been trained in stage specific tobacco
cessation techniques, and 2) counseling intervention that includes patient education, written
material and follow-up by students who have been trained in non-smoking cessation
techniques (exercise counseling).
Setting : Community practice sites in internal medicine, family medicine and pediatrics
throughout Connecticut where medial students attend weekly continuity sessions with
physician preceptors.
Study Subjects : 80 first-year medical students and 308-350 patients aged 16 years or
older in the students’ community practice sites who are seeing the students’ physician
preceptor for any reason and meet criteria of smoking one or more cigarette daily in the
previous week.
Randomization: Students will be randomized by the day they attend their Principles of
Clinical Medicine Course and trained in stage specific tobacco cessation counseling or
exercise counseling. After 6 months, students will receive training in the other behavioral
counseling technique.
Main Outcome Measures: patients’ quit rate, stage of change, desire to quit, motivation
to quit, confidence in quitting (self-efficacy), and nicotine dependence at 1, 3, 6, and 12
months.
Process Measures : patient satisfaction with the quality of care in general, and
satisfaction with the quality of care related to smoking cessation counseling.
Analyses: patient level analyses of main outcome and process measures comparing
patients who received counseling from students trained in smoking cessation counseling
and patients who received counseling from students trained in exercise counseling adjusting
for potential confounding factors. We will use logistic regression for dichotomous outcomes
and linear regression for continuous outcomes. We will use generalized estimating
equations (GEE) and random effects modeling to allow us to adjust for time-dependent
covariates
V. Timeline of Research Project
Month
Activity 1 2 3-4 5 6-9
10-12 13-14
Student randomization X
Train standardized patient X
Assess student behavioral counseling skills X
Train student in smoking or exercise counseling X
Assessment of office practice sites X
Train medical assistants to recruit patients X
Recruit patients X X
Patient counseling in-person
X X
Patient counseling by phone
X X
Data collection X X
Data analysis
X X
Prepare publication
(s) X
Present research at scientific
meetings X
VI. Literature Cited
1. World Health Organization Website: WHO tobacco Treaty set to become law, making
global public health history. WHO . 2005. 1-17-2005.
2. Cigarette smoking among adults--United States, 2001. MMWR Morb Mortal Wkly Rep
2003; 52(40):953-956.
3. Centers for Disease Control. Targeting Tobacco Use, the Nation's Leading Cause of Death
2004. CDC. 2005. 1-19-2005.

RUBBER DAM - Benifits for the patient and dentist, technique

Introduction
Most texts that discuss operative treatment for children advocate the use of rubber dam, but it
is used very little in practice despite many sound reasons for its adoption. In the United
Kingdom less than 2% of dentists use it routinely. It is perceived as a difficult technique that is
expensive in time and arduous for the patient.
In fact, once mastered, the technique makes dental care for children easier and a higher
standard of care can be achieved in less time than would otherwise be required. In addition, it
isolates the child from the operative field making treatment less invasive of their personal
space.
The benefits can be divided into three main categories as shown below.
Safety
Damage of soft tissues
The risks of operative treatment include damage to the soft tissues of the mouth from rotary
and hand instruments and the medicaments used in the provision of endodontic and other
care. Rubber dam will go a long way to preventing damage of this type.
Risk of swallowing or inhalation
There is also the risk that these items may be lost in the patient's mouth and swallowed or
even inhaled and there are reports in the literature to substantiate this risk.
Risk of cross-infection
In addition, there is considerable risk that the use of high-speed rotary instruments distribute
an aerosol of the patients' saliva around the operating room, putting the dentist and staff at
risk of infection. Again, a risk that has been substantiated in the literature.
Nitrous oxide sedation
If this is used it is quite likely that mouth breathing by the child will increase the level of the
gas in the environment, again putting dentist and staff at risk. The use of rubber dam in this
situation will make sure that exhaled gas is routed via the scavenging system attached to the
nose piece. Usually less nitrous oxide will be required for a sedative effect, increasing the
safety and effectiveness of the procedure.
Benefits to the child
Isolation
One of the reasons that dental treatment causes anxiety in patients is that the operative area
is very close to and involved with all the most vital functions of the body such as sight,
hearing, breathing, and swallowing. When operative treatment is being performed, all these
vital functions are put at risk and any sensible child would be concerned. It is useful to
discuss these fears with child patients and explain how the risks can be reduced or
eliminated.
Glasses should be used to protect the eyes and rubber dam to protect the airways and the
oesophagus. By doing this, and provided that good local analgesia has been obtained, the
child can feel themselves distanced from the operation. Sometimes it is even helpful to show
the child their isolated teeth in a mirror. The view is so different from what they normally see
in the mirror that they can divorce themselves from the reality of the situation.
Relaxation
The isolation of the operative area from the child will very often cause the child to become
considerably relaxed¾always provided that there is good pain control. It is common for both
adult and child patients to fall asleep while undergoing treatment involving the use of rubber
dam¾a situation that rarely occurs without. This is a function of the safety perceived by the
patient and the relaxed way in which the dental team can work with its assistance.
Shows rubber dam placed in the a child and with the comfort it provides it is not unusual for
children to fall asleep in the dental chair during treatment under rubber dam.
Benefits to the dentist
Reduced stress
As noted above, once rubber dam has been placed the child will be at less risk from the
procedures that will be used to restore their teeth. This reduces the effort required by the
operator to protect the soft tissues of the mouth and the airways. Treatment can be carried out
in a more relaxed and controlled manner, therefore lessening the stress of the procedure on
the dental team.
Retraction of tongue and cheeks
Correctly placed rubber dam will gently pull the cheeks and tongue away from the operative
area allowing the operator a better view of the area to be treated.
Retraction of gingival tissue
Rubber dam will gently pull the gingival tissues away from the cervical margin of the tooth,
making it much easier to see the extent of any caries close to the margin and often bringing
the cervical margin of a prepared cavity above the level of the gingival margin thus making
restoration considerably easier. Interdentally, this retraction should be assisted by placing a
wedge firmly between the adjacent teeth as soon as the dam has been placed. This wedge is
placed horizontally below the contact area and above the dam, thus compressing the
interdental gingivae against the underlying bone. Approximal cavities can then be prepared,
any damage from rotary instruments being inflicted on the wedge rather than the child's
gingival tissue.
Quite often it can be difficult and time consuming to take the rubber dam between the
contacts because of dental caries or broken restorations. It is possible to make life easier by
using a 'trough technique', which involves snipping the rubber dam between the punched
holes. All the benefits of rubber dam are retained except for the retraction and protection of
the gingival tissues.
Moisture control
As mentioned previously, silver amalgam is probably the only restorative material that has any
tolerance to being placed in a damp environment, and there is no doubt that it and all other
materials will perform much more satisfactorily if placed in a dry field. Rubber dam is the only
technique that readily ensures a dry field.
'Trough technique' of rubber dam placement.
Technique
Most texts on operative dentistry demonstrate techniques for the use of rubber dam. It is not
intended to duplicate this effort, but it would seem useful to point out features of the
technique that have made life easier for the authors when using rubber dam with children.
Analgesia
Placement of rubber dam can be uncomfortable especially if a clamp is needed to retain it.
Even if a clamp is not required the sharp cut edge of the dam can cause mild pain. Soft tissue
analgesia can be obtained using infiltration in the buccal sulcus followed by an interpapillary
injection. This will usually give sufficient analgesia to remove any discomfort from the dam.
However, more profound analgesia may be required for the particular operative procedure that
has to be performed.
Method of application
There are at least four different methods of placing the dam, but most authorities recommend a
method whereby the clamp is first placed on the tooth, the dam stretched over the clamp and
then over the remaining teeth that are to be isolated. Because of the risk of the patient
swallowing or inhaling a dropped or broken clamp before the dam is applied, it is imperative
that the clamp be restrained with a piece of floss tied or wrapped around the bow. This adds
considerable inconvenience to the technique and the authors favour a simpler method whereby
the clamp, dam, and frame are assembled together before application and taken to the tooth in
one movement. Because the clamp is always on the outside of the dam relative to the patient
there is no need to use floss to secure the clamp.
A 5-inch (about 12.5 cm) square of medium dam is stretched over an Ivory frame and a single
hole punched in the middle of the square. This hole is for the tooth on which the clamp is
going to be placed and further holes should be punched for any other teeth that need to be
isolated. A winged clamp is placed in the first hole and the whole assembly carried to the
tooth by the clamp forceps. The tooth that is going to be clamped can be seen through the
hole and the clamp applied to it. The dam is then teased off the wings using either the fingers
or a hand instrument. It can then be carried forward over the other teeth with the interdental
dam being 'knifed' through the contact areas. It may need to be stabilized at the front using
either floss, a small piece of rubber dam, a 'Wedjet', or a wooden wedge.

VIRTUAL ARTICULATORS :CHANGING TRENDS IN PROSTHODONTICS

INTRODUCTION:
The future of dental practice is closely linked to the utilization of computer-based technology,
specifically virtual reality, which allows the dental surgeon to simulate true life situations in
patients. In daily practice, mechanical articulators are used to diagnose and simulate the
functional effects of malocclusions and morphological alterations upon dental occlusion.
However, this mechanical scenario, so very different from the real life biological setting, poses
a series of problems.
In effect, the movements reproduced by the mechanical articulator follow the margins of the
structures that conform the mechanical joint, which remain invariable over time, and which
cannot simulate masticatory movements that are dependent upon the muscle patterns and
resilience of the soft tissues and joint disc. Moreover, tooth mobility cannot be simulated by
plaster models; as a result, the latter are unable to reproduce the real life dynamic conditions
of occlusion.

The virtual articulator offers the possibility of significantly reducing the limitations of
mechanical articulators , due to a series of advantages: full analysis can be made of static and
dynamic occlusion, of the inter-maxillary relationships, and of the joint conditions, thanks to
dynamic visualization in three dimensions (3D) of the mandible, the maxilla or both, and to the
possibility of selecting section planes allowing detailed observation of regions of interest such
as for example the temporomandibular joint. Combined with CAD/CAM technology, this tool
offers great potential in planning dental implants, since it affords greater precision and a
lesser duration of treatment.
MATHEMATICALLY SIMULATED
ADVENT OF VIRTUAL ARTICULATORS:
Szentpetery’s virtual articulator: It was introduced by Szentpetery in 1999. It is based on a
mathematical simulation of the articulator movements. It is a fully adjustable 3D virtual dental
articulator capable of reproducing the movement of an articulator. It offers possibilities that
are not offered by some of the mechanical articulators as curved Bennet angle movements
which make it more versatile than mechanical articulator.
Virtual articulator of Kordass and Gartner: It was introduced by Kordass and Gartner in 2003,
based on the exact registration of mandibular movement with the help of jaw movement
analyzer. This virtual articulator system requires digital 3D representation of the jaws as input
data generates an animation of the jaw movement and delivers a dynamic and tailored
visualization of the collision points.
Virtual articulator based on mechanical dental articulator: It was introduced by graphic design
and engineering project developments, the University of the Basque Country in 2009. The
project was focused on developing a different virtual articulator based on mechanical dental
articulator, knowing which setting parameters can be registered and transferred to the patient.
The main advantage of this approach is that the user can choose the most suitable articulator
to use in the simulation.
TYPES OF VIRTUAL ARTICULATOR:
Completely Adjustable Virtual Articulator
Mathematically Simulated Virtual Articulator
Completely Adjustable Virtual Articulator:
The ultrasonic measurement system, Jaw Motion Analyzer (Zebris, Germany) is used to
record and implement the movement pattern of the mandible Recording the reference plane
using special digitizing sensor.Three transmitters are attached to the lower sensor. Four
receivers are attached to a head gear opposite the lower sensor .Detection of all rotative and
translative components .A special digitizing sensor is used to determine the reference plane,
which is composed of the hinge axis infraorbital plane and special points of interest (eg, on
the occlusal surface).Movement data is calculated using digitized points. Silicon-based jaw
relation registrations are used to reproduce the best occlusion in the position of
intercuspidation. It is important that the registration remain attached to the upper teeth during
opening. The registration then should be stabilized with impression plaster on metal carrier
plate. The digitizing Sensor is attached to detect three main reference points on the rear of
this metal plate. These three points are used to combine movement data and the digitized
dental arches.
COMPLETELY ADJUSTABLE ARTICULATOR JAW MOTION ANALYSER
Silicon-based jaw relation registrations are used to reproduce the best occlusion in the
position of intercuspidation. It is important that the registration remain attached to the upper
teeth during opening. The registration then should be stabilized with impression plaster on
metal carrier plate. The digitizing Sensor is attached to detect three main reference points on
the rear of this metal plate.These three points are used to combine movement data and the
digitized dental arches. First, the impression of the upper teeth is digitized and then the
record material and the plaster of the lower teeth are scanned.Both dental arches are correctly
related to each other. The digitized impressions of the lower and upper jaw can be combined
with the scanned data from casts without losing the predefined jaw relationship. By defining
and calculating the same reference, both data sets, which come from three-dimensional
scanner and jaw movement recordings, were matched and presented in the virtual articulator.
The program detects the collision points of the teeth.
Mathematically simulated virtual articulator
The contact points are displayed using a different colour (e.g. red). It is able to calculate
and visualize static and kinematic occlusal collisions. It is further planned to integrate the
system into the design and correction of occlusal surfaces in CAD-systems.
Mathematically simulated virtual articulator:
It is a fully adjustable three-dimensional virtual articulator capable of reproducing the
movements of an mechanical articulator.It is simple ,adjustment free articulator.It is used as
average value articulator
NEED FOR A VIRTUAL ARTICULATOR:
In contrast to the conventional mechanical procedure, the VR tools enable three- dimensional
navigation through the occlusion based on every point of view while the mandible moves
along predefined pathways (as the mechanical articulator would do) or reproduce movement
patterns of mastication that never can be simulated in mechanical systems. The digitizing of
tooth surfaces opens possibilities in manipulation procedures to improve the occlusion. CAD/
CAM tools for a virtual set- up of the teeth could be linked.
Currently, the virtual articulator is concerned with better visualization of details and supports
the use of mechanical tools, but it will replace them in the future. Importantly, it would
influence the quality of the networking communication between dental practice and laboratory,
helping to produce the best- fitted occlusal restorations possible.
FUNCTIONING OF THE VIRTUAL ARTICULATORS:
Ideally, the virtual articulator is equipped with a device for registering the specific mandibular
movements of a given patient (such as the JMA), and can integrate the movements recorded
in the animation.
If no device is available for registering the mandibular movements, specific movements must
be defined by means of parameters, in a way similar to the practice used with mechanical
articulators. Some parameters of interest in these cases would be the following: protrusion,
retrusion, laterotrusion, and aperture / closure slope. After defining the movement parameters,
collision detection is required in order to identify the movement restrictions.
As an example, the software of the Dent-CAMvirtual articulator uses three main windows that
show the same movement pattern, distinguishing a series of aspects:
1. interpretation window: this shows both maxilla in dynamic occlusion and allows us to obtain
unusual points of view, e.g., observation from an occlusal surface of closing of the opposing
tooth during mastication;
2. occlusion window: this shows the points of contact that appear on the occlusal surfaces of
the upper and lower teeth as a function of time; and,
3. section window: this offers different frontal sections along the dental arch. This tool can be
used to analyze the degree of intercuspidation, as well as the height and functional angles of
the cuspids.
The latest software versions incorporate an orthodontic module allowing the creation of a
virtual setup. The program has also been equipped with the representation of the condylar
trajectories in the sagittal and horizontal planes. This tool allows us to observe the inter-
relationship between the incisal guide and the condylar guide, and the effects of joint mobility
upon occlusion.
One of the most recent new developments in the virtual articulators is the 3D virtual
articulation system (Zebris company, D-Isny).
This system requires the following:
1. an input unit in the form of a 3D scanner;
2. the software for prosthesis modeling and collision detection, based on a virtual articulator;
and,
3. the output module (a rapid prototyping system). With this system, and in addition to
mandibular movement, we can analyze masticatory movement – including force at the points
of contact and the frequency of contacts in relation to time.
PROGRAMMING:-
Pre requisite for visualization on screen is 3D scanning/digitizing of tooth surface or
restorations or denture models using 3D LASER SCANNER
TWO TYPES Of programming are:
1. Direct digitizing
2. Indirect digitizing
;
Direct digitizing
Indirect digitizing
VIRTUAL REALITY DENTCAM:
To demonstrate virtual tools in dental articulation, the VR DENT CAM was developed at
UNIVERSITY OF GREIFSWALD, GERMANY.It consists of three main windows, which show the
same movement movement of the teeth from different aspects
The slice window shows any frontal slice throughout the dental arch. This tool helps to
analyze the degree of intercuspidation and the height and functional angles of the cusps.
FUTURE MODULES OF VIRTUAL ARTICULATOR
1. In the latest version of DentCAM software, a special orthodontic CAD module was added to
simulate the therapeutic result by repositioning single teeth and reforming the dental arch
(virtual set-up).
2. Separating single teeth from the complete data set of the upper and lower jaw is a prerequisite
to the virtual set-up.
3. .DentCAM includes a pointer, which makes it possible to find the tooth-crown margin
automatically when positioned in the middle of the occlusal table of molars or premolars or
incisal rim or canine top.
4. Continuing tooth by tooth, the procedure results in single-tooth-based data sets that are
prepared for special software operations, such as simulation of orthodontic movements.
5. Based on the images from the virtual setup tool, an active protrusion splint is included in the
treatment plan
6. Detection of wear or bruxism, a module semiautomically analyses the teeth for the signs.
CONCLUSION:
Virtual reality enables new perspective in visualizing complex relationship in the diagnosis of
the occlusion and function. The new virtual articulator provides interesting modules for
presenting and analyzing the dynamic contact of the occlusal surface of the maxilla and
mandible and the relation to the condylar movement. To improve the functional occlusion, the
occlusal profile of the teeth can be designed with increased or decreased cusps to eliminate
occlusal interferences of the dynamic pattern. The data set of newly designed and improved
occlusal surfaces can be transferred to a milling machine, producing real crowns and fixed
restoration with that particular, optimized functional occlusion.
The virtual articulator is a basic tool that deals primarily with the functional aspects of the
occlusion; however, it also can be regarded as a core tool in many diagnostic and therapeutic
procedures and in the CAD-CAM manufacture dental restoration. The concept of Virtual
Articulator will change conventional ways of production and communication in dentistry and
begin to replace the mechanical tools.
REFERENCES:
1. The virtual articulator in dentistry :concept and development bekorda,christian
gartnerDCNA46(2002)493-506
2. Virtual Articulators in prosthodontics Gugwad.R.S, Basavakumar.M, Abhijeet.K, Arvind.M,
Sudhindra.M, Ramesh.C :International Journal Of Dental Clinics 2011:3(4):39-41
3. Virtual articulator for the analysis of dental occlusion: An update : Laura Maestre-Ferrín 1,
Javier Romero-Millán Med Oral Patol Oral Cir Bucal. 2012 Jan 1;17 (1):e160-3.

19 subjects… 4 years :D 1 year internship.. Doyou think you can read those again..!!

SUBJECT WISE BOOKS
19 subjects… 4 years :D 1 year internship.. Do
you think you can read those again..!! I doubt..at
least not without taking a break.. and the subject
wise books are going to help you out in covering
the topics in that 365 days… there are lot many..
the most imp books are mentioned here.
1) DENTAL PULSE
Surely… the name goes right. Its indeed a PULSE
OF THE MDS ENTRANCE SUCCESS. I am sure. This
would be the first book which all will buy at the
start of preparation of entrance.. It won’t be
surprising to see it in every students hand as soon as the student enters the internship.
The book consists most of the old questions, well-arranged and in a well retain-able manner.
Currently the 4th ed being marketed. It is available in two volumes. The basic and the clinical
one.. you will almost find all the old question of entrance papers with limited explanation
which surely is very easy to revise. In fact, this book is the one which needs to be read till
the last moment of exam..
Friends…so you finally brought the book and now have planned to read it.. but how??.. let me
help you out..
1st reading
Never read the synopsis at first… wonder why?? Hmmm. The most important factor for
preparation of entrance is the stress or tension… we are more efficient when our bottom is on
fire;) ..isn’t it? ..what’s the logic of reading synopsis and reading the questions.. obviously..
you will answer more in the first attempt. But.. if you read without the synopsis and try to
answer question then I am sure around 80% students will be able to answer only 60 out of 100
question.. and yeh.. you will also feel that you won’t be to crack the entrance.. but.. NO Fear..
it’s exactly this fear which is needed at the start… but not to quit!!!.. scoring at the first
attempt is not a criteria. WHAT MATTERS IS THE END!!! . The initial score gives you a baseline
on which you can compare your successive scores after revision. Hope you got my point:)
Never mark any question in 1st reading in the question section ... just mark important point in
the explanation. Why???.. I will tell you why a bit later.
The basic aim of reading a book for the first time is to get an idea about the type of topics
which is imp and to get an idea how different the entrance is from the UG theory preparation..
marking 100 question 100 does not mean you will get a rank for sure.. remember.. there are
around 10 books with around 10,000 questions which u need to remember and the question in
the next exam will have new one too.,.
2nd revision
When you start the 2nd reading make sure you read synopsis but don’t try more time in
remembering synopsis.. what’s imp in the initial reading is.. you need to enter the
competition. That’s only possible by remembering the old question.. you can gain knowledge
later.. start answering the questions more...read the explanation more rather than the
synopsis. Still don’t mark any question. Just mark the imp points in the explanation.
Successive revision.
When you finish around 4 revisions , then mark the questions which you always tend to
forget.. I believe that the human brain will surely will not able to store some questions no
matter how many times you read. .I am sure you will experience it.. this is mostly because
there are some questions which lacks logic, or no reference or completely different than what
we have read in our BDS days. Now mark those question and during successive revisions give
more imp for them.. why?? Believe me.. these are the questions which will be asked more in
exam and most of the time students go wrong here.
Now the imp question is how to remember those difficult question without any logic..you need
to find a word in that question and link it to the answer.so in next revisions whenever you
come to that marked question you will see that word and you need to remember what was the
answer.. I am sure..This helps :)
So basically this is how you need to read the Pulse..the marking part also applies to the other
books which I wont be repeating in the following matter.
One strange question which I have been asked by many student… SIR.. IS PULSE SUFFICIENT
FOR SECURING A RANK? OR FEW STUDENTS ALSO ASKED ME WHETHER PULSE AND PAST
DENTAL PAPERS ARE ENOUGH FOR EXAM?
I really don’t know what to answer.. but I would like to tell you one .. first of all.. nobody
knows how will be the exam or which type questions will come in to the exam. The pattern
changes every year.. but yes.. new question means.. its new for all.. so whats imp is you need
to remember all old questions and gain some extra knowledge.
Getting a rank is not imp.. Getting a top rank Is most imp . Getting a branch which you hate will
make you compromise for whole life..but also remember getting a seat also imp. I am just
telling you that when you have chance to get good rank then make a complete heart effort.
Work for success.. don’t ask for short cut..
But yes.. state exams are bit easy.. and it will be great if you don’t restrict it to only one book
and when you actually have more time and you can get a good rank by putting some more
effort.. YOU DON’T KNOW UNLESS YOU TRY!!
Although the explanation and well arranged matter surely needs a appraisal from any student
but I would also advise aspirants to gain some extra knowledge rather than just limiting your
self to it.
2) DENTEST BY Dr GOWRISHANKAR
Bible of Dentistry.. THE AUTHOR IS CONSIDERED AS A PIONEER IN THE FIELD OF MDS
ENTRANCE BOOKS. It has been around 16 years since the book is in market.. the book surely is
one of its kind.. Infact in many states students start reading from the DENTEST first..Why??..
no book will ever give you so clear explanation which is extremely important in order to
understand how to answer. Reading Dentest will clear your confusion and gives you extra
knowledge. Its almost equal to reading most of the regular books.. I have seen students
avoiding reading the explanation part..May be sometimes even I had done the same thing
during my preparation.. but it was after AIIMS I realized that the answers of new questions can
be found in the explanatory part. Yes the book is kind of big.. but if you are not reading theory
and planning for an awesome rank in State or Comed entrance or any Deemed university.. I
DOUBT. I might have been able to get rank in most of the exams.. but surely this book had
made a big contribution In getting me a 6th rank in state.
It was during my preparation when I made a list of correction in which I tried to compare the
answers from pulse and Dentest.. I found many mistakes. Recently I got chance to go through
it again... and it was surprising to know that some most controversial question answers were
rightly explained in the Dentest than the Pulse.. but yes.. surely the editing was not great that
time.. it had many mistakes. but. Recently the new 5th ed of Basic Volume has been released
and it is well arranged and colourful than the earlier. And regarding the Clinical
Edition..hoping to see it soon with new modification. And another imp point...the Dentest has
many new question and there is a good amount of chance that it will be asked in exam.
1ST READING.
Read everything.. GET TO THE DEPTH OF EXPLANATION.. UNDERSTAND IT.. FEEL THE
ANSWER!!!. Mark imp points from the explanation. Get to know what exactly the subject is
about..:)
Successive reading..
In the end of this blog I will surely try to give you a plan regarding the order of reading many
books…but after reading Pulse and Dentest at least 3 times , then you need to mark the new
questions which is absent in the Pulse. And do give more imp to them. Try to compare the
answer from Pulse and Dentest.. Weigh the logic between ..and then accept the answer.
3) BHATIA
During my time.. I had read Bhatia. I wont be able tell you much about this book as I had not
gone through it completely but yes.. the book surely had very good synopsis part which
according to my seniors.
4) RITU DUGGAL
Has some of the finest question specially for Ortho and Pedo.. but lacks references.. but guys..
during my time when I got 18th in PG,I the questions were lifted from the above subjects of
the book.
5) MANISHA PRABHAKAR
AIPG Perio questions are directly lifted from here.. and that to in order.. do read the Perio
part .



6) JATIN KARLA
Consists only of Oral Pathology question .. kind of similar to reading Shafer’s .. During my
time Oral path was lifted from here.. good question for ORAL PATHOLOGY
Friends. There are lot many other books.. but I guess when you are in internship you hardly
have time to read all the books. Or at least it was true in my case.
So I guess this much is enough for subject wise books.
BOOKS WITH YEAR WISE PAPERS
It is extremely important that you revise question in year
wise manner and not just in subject wise …WHY??
During my time.. when I read the Pulse and the Dentest 2-3
times.. there was a visual memory in my brain..and by the
time I came to the first question .. my brain already knew
what was the next question.. and basically because of this I never used to concentrate as
much as I used to concentrate at initial reading.. and because of this I used to make many
mistake..
One imp point which we need to remember is.. its easy to remember questions when its from
the same subject. But what’s important to know is.. in exams questions appear randomly.. and
YOU BRAIN NEEDS TO BE TRAINED IN SUCH A WAY THAT IT JUMPS FROM ANATOMY TO
PHYSIOLOGY IN 2 SEC, IT JUMPS FROM CONSERVATIVE TO ORAL SURGERY IN 2 SEC ,.. I hope
you got my point. That’s only possible when YOU solve the question in a year wise papers.
So here are the few important books which have entrance papers arranged year wise
1) DENTAL BYTES
You will never get a book having so many question papers .. NEVER!!!.. infact the book had
most of the papers from 1991 it self.. it almost has everything.. PGI, AIIMS,
AIPG,MAHRASHTRA , JIPMER, and lot lot lot. But yes.. The old edition had explanation only
for only recent papers. I had done the corrections of 8th ed.. and surely my seniors also made
a great contribution for its correction. It has been 3 years I have sent it thousands. Now it’s
the 10th ed. Me and my friend Gaurav have even contributed to it .. it also has references ..it
does have my corrections and of many too. The new edition has references and
explanation ..but you wont find old papers I guess before 2005 in the new edition.. anyway you
if you need then you can get it from the publisher.
I have been always told by many students that it has lot many mistakes even I was one time..
But the difference between me and them ?? when I got a seat.. I made an sincere effort to send
them to the author and many students. And infact those were the initial steps which gave me
some name in the field of entrance.
It’s a difficult task to obtain so many papers and the author had made a sincere effort to give
it to so many those are always looking for the early release of papers… atlest we need to
appreciate it rather than just complaining. I am sure a student who has read the subject wise
book properly, will easily identify such mistakes..Pls do send the correction to the respected
authors. Help others. Help you juniors. Help your friends. It makes a difference in your life.
It’s a must buy book.
2) DENTAL EXPLORER
It was a good book during my time. Indeed it was the only book which had recent BHU and
PGI questions papers and surely made a great contribution for many. In fact it was Dr Gaurav
Verma one of the author of Dental explorer.. Hope I am not wrong.. who started the community
of TIPS FOR MDS PREPARATION ON ORKUT. Which I continued later. Thanks for taking such a
great initiative. The book is now authored by Dr. Gyanander Attresh.
I really don’t have much idea about the recent edition. I am sure the new aspirants can always
through some light on it.
3) DENTAL QUEST
It was around March when me and my friend Dr Gaurav Ram Chandani came up with an idea of
writing a book. The Dental Quest has been appreciated by many which had AIPG,
MHCET,KCET,COMED 2011 paper and AIIMS NOV 2010 paper. The copies were sold rapidly.. but
soon we do found few mistakes which were mostly in AIPG paper and were due to editing part.
We did make an effort to send the correction to many. I have seen many students giving a
positive review regarding our book and also appreciated by many coaching institutes.. there
were some harsh comment like we being greedy of money. ;) its indeed strange to get such
comments about a book which gives 5 papers just 140/-.. in fact a movie costs more than the
book. Never mind we are always ready to take such comments in a positive way and out
heartfelt thanks to all those who loved it for sure.
I am sure many of you won’t find much explanation in Aipg 2011 paper as it consisted many
repeated questions. But I am sure the other papers will make a big difference in your entrance
as it has the explanation arranged in point to point wise from latest books and in fact the
exact references.. I am sure you won’t find such a good explanation in any other papers. It’s a
sincere effort by me and my friend which even today gets lot many hits on Facebook page.
Do request for the correction if you don’t have it yet.. we are always ready to send it to.
Apart from this.. There is
DENTAL INSIGHT
DENTAL UPDATE
And lot many !!!!!
MEDICAL BOOKS.
Now.. you must be wondering why the hell we
should read the medical papers!!!.. guys.. let’s all
accept one fact.. we are bit weak for the basic
subjects question of AIPG.. the questions are
really HI-FI.. but the good thing.. most of them
are repeated from the medical papers.. The guy
who aims AIPG , will surely read the medical
question papers.. Common guys.. it’s like you
already have your question papers in your hand.. be smart enough to do it before exam. In my
exam around 20 to 30 question were a direct lift from medical part.. Chromosome for Cat Eye
Syndrome?? Do you think you can answer that?? But it was lifted from recent AIPG medical
part.
SO there are lot many medical books.. but here are the once I read ,,and almost everybody
reads even today too.
1) MUDHIT KHANNA
Contains AIPG papers arranged year wise and subject wise too.. Hats off to authors.. the
amount of depth they have given in the books is surely appreciated by all.. but One fact you
all need to remember… We don’t have to dive so much.. but yes..at the end you have to
remember at least question and answers…
Now.. I know.. you all take the Mudhit khanna and read Anatomy, Physiology and all those
which we read in our BDS days.. But that’s not enough.. The examiners knows that you will
read that.. but the hard work counts more too.. The rank holders push themselves an extra
mile.. REMEMBER. . Pharmac question are there in Gynecology subject,.. syndrome question are
there in Pediatric too.. And believe me .. these are the question which will be asked in the
exam for sure.. and for those who don’t read those subject will surely feel the exam paper
really difficult.. it took me only 10 min to answer those repeated question.. I lost marks in the
dental part.. if you want to be in at least below 300 in those 8k students.. then ..U need to do
all the question.. but how??
Read all questions at first reading.. mark which are related ,, or if in case even if you think it
might be 60% related to us.. you don’t have to read lower limb questions.. that’s not related ..
but Parmac question can be always asked from any subject.. you cant say no to that.. BE
SMART!!!.. read it many times.. and make sure,, in the end you know at least know question
and answer. That’s A REASONABLE DEAL I GUESS
Regarding the explanation.. reading the explanation makes your basic strong.. .. you can also
get good charts for Pharmac in the book.. Community explained very nicely in the old
volumes.. READ THAT!!!
For exam sake.. you need to do at least last 5 years of Medical AIPG papers!!!
MAKE AN EFFORT TO TEST YOU SELF. DON’T LOOSE THE BATTLE SOON.. PUSH YOUR SELF TO
KNOW YOUR TRUE STRENGTH.
2) AIIMS PAPER
There is Amit Ashish. also you get lot many individual books for single papers like SPEED etc..
etc.. you need to do at least 3 years of AIIMS medical papers and also.
BELIEVE IN YOUR SELF..AND THAT BELIEF WILL MAKE IT
POSSIBLE!!!
KEEP READING :)

What is Digital Impression Taking & Why Should You Consider It?

What is Digital Impression Taking & Why Should You Consider It?
As a dentist that relies on conventional impression-taking, chances are you’re familiar with:
Cumbersome tasks such as selecting trays, preparing materials, disinfecting impressions and organizing
couriers;
Imprecision caused by drags, voids and bubbles in impression material;
Patients complaining about uncomfortable trays, gagging and retakes;
Lost productivity as ill-fitting restorations necessitate repeat appointments and remakes.
Indeed, predictable and accurate impressions and bite registrations have always been one of the more
difficult procedures to perform consistently. A host of variables present daily challenges, making conventional
impression-taking an inexact science.
Are you aware that
50% of conventional impressions do not show the entire preparation margin needed to fabricate a dental
prosthesis;
90% of conventional impressions have incomplete registration of finish lines;
And as a result, 36% of dentists retake impressions three or more times per month.
Digital dentistry, however, has arrived and is set to revolutionize your practice’s efficiency, flexibility and
overall patient experience.
So... what exactly does digital impression-taking involve?
An intra-oral scanning wand, connected to a computer processing unit, houses a camera and records oral
structures by capturing points of light.
Light is converted into digital data which is then rendered into a 3D on-screen, virtually articulated model of
your patient's mouth as scans of the prep, opposing and bite are stitched together.
A monitor enables you to complete an on-screen electronic prescription form as well as preview the prep and
review the impression with your patient chairside.
Wireless internet connectivity facilitates swift transmission of your digital impression to SCDL, meaning we
can provide immediate clinical advice, feedback and discuss case parameters.
SCDL's in-house digital workflow – whereby models and restorations are digitally produced at the one facility
– maximizes your practice's efficiency, marketability and bottom line.
Digital technology eliminates many chemical processes, meaning that error accumulation during both
treatment and the manufacturing cycle is minimized. With intra-oral scanners, we can say goodbye to:
Air bubbles, drags and voids
Tray displacement and movement
Insufficient/inadequate impression material or adhesive
Distortion from disinfecting procedures
Problems during transit

Clinical Features, Causes & Treatment of dry Socket / Alveolar Osteitis - Complete Management

What Is dry socket?- Postoperative complication causing moderate to
sever pain which develops on 3rd or 4th day after tooth extraction,
due to dislodgement of clot but it is not associated with an
infection.Socket bone get exposed and painful.
Occurrence-Rare (2%) after routine tooth extraction.
Frequent (20%) after removal of impacted mandibular 3rd molar.
Clinical appearence-
Tooth socket appears to be empty with a partially or completely lost
blood clot.
Some bony surface of socket is exposed which is sensitive and source
of pain
Area of socket has a bad odor.
Patient usually complains of foul taste.
Cause-
High level of fibrinolytic activity in and around extraction socket
Resulting in lysis of the blood clot
Causing exposure of bone surface.
Management:-
Give a nerve block or apply topical anesthesia if patient is in severe pain.
Tooth socket is gently irrigated with sterile saline
Socket is carefully suctioned of all excess saline and a small strip of iodoform gauze soaked with
medication is inserted into socket
Prescribe NSAID for relive of pain ( ibuprofen).
Medicated dressing contains-
Eugenol- obtundent
Benzocain- a topicl anesthetic
Balsum of peru- Carrying vehicle
This dressing is changed evry other day for the next 3-6 days depending on the severity of pain.
Note- Once patients pain decreases the dressing should not be changed repeatedly  because it acts as a
foreign body and prolongs the healing.
Who are at risk-
smoker
Poor oral hygiene
Wisdom teeth pulled
Have greater than usual trauma during the tooth extraction surgery
Use birth control pills
Have a history of dry socket after having teeth pulled

How to Become a Successful Dentist

In..today's changing world where most of the people are taking
career in dentistry as a nice paying profession It is normal to dream
to get successful. If you want to get successful as a dentist than you
must develop these three qualities :Be Good Clinician, Be Smart
Communicator ,Be Wise Businessman.
Missing any one of these 3 qualities will greatly affect your success
rate.I want to call this 'unfortunate' as we don't have any training
sessions to develop Later 2 qualities in our dental syllabus, these
qualities must be cultivated by own to become successful.
At this high time when thousands of dentists are coming out every
year and there is 'so called raising competition'  if you really want to
make difference then having a degree is not enough.You must have
something inside you for Dentistry!
I call it "Passion" you have to be passionate about dentistry.Ask
yourself - How much do you like Dentistry? How do you feel when
you solve problem of a patient?, Do you feel Good when you see your satisfied patients?
all answers should be positive to prove you passionate enough to be successful in your career.
Every morning when you wake up and get ready to go to your clinic you must feel energy and enthusiasm
to see and treat new patients.
Lets point out some Important qualities to become 1.Good Clinician and 2.Good Communicator: (I had
kept these points with me since long time, I copied it from some website but unfortunately I don't have
its link to give credits: Thanks to original author for 10 points)
Qualities you will develop to become Good Clinician and Good Communicator
1. Have a Good Manner: A great Dental professional has a good manner and makes patients feel
comfortable and at ease during exams and treatments.
2. Cultivate a Sense of Empathy: A great  Dental  professional has a strong sense of empathy and
understands what it is to feel pain and suffering. They are supportive and have a genuine interest in
improving a patient's well-being.
3. Develop Communication Skills: A great  Dental  professional has excellent communication skills. They
can explain complicated medical terminology in laymen's terms to the average patient. They also have
excellent listening skills and take the time to understand what a patient's needs are.
4. Learn Sharp Problem Solving Skills: A great  Dental  professional has excellent problem solving skills
and can quickly determine solutions to problems. Working in health care, by definition, involves solving
problems of the human body.
5. Be Always Very Thorough: A great  Dental  professional is always very thorough in their work. They
recognize that the smallest oversight can have grave consequences and therefore are sure to cover all
the bases in everything they do.
6. Offers Support for Patient Decisions: A great  Dental  professional acts as a partner with a patient in
treatment decisions and understands that ultimately, all decisions lie in the hands of the patient. They
offer full support of patient decisions after educating them properly about treatments.
7. Offers Adequate Time to Patients: A great Dental  professional spends adequate time with their
patients and never rushes through an exam during a busy day. They give each patient enough time to
make a proper diagnosis or to offer a thorough treatment.
8. Possesses Significant Knowledge: A great  Dental professional has extensive knowledge of the human
body and its ailments. They are not afraid to admit when they do not know something and will either
research it or refer a patient to someone better qualified.
9. Possesses Strong Sense of Ethics: A great Dental  professional has a strong sense of ethics and never
compromises their integrity, They suggest what is best for the patient, they do the best they can do for the
patients, They don't earn by cheating patients, They earn by treating large number for satisfied
patients.Work to increase your patient base.
10. Pursues Continuing Education: A great  Dental  professional recognizes that the dental field is full of
new research and developments, and they stay on top of everything new in the field. They read research
journals and take training classes to stay current.

Pin Retained Amalgam Restoration- Indications, Technique, Types, Advantages, Disadvantages.

Pin Retained Amalgam Preparations

Indicated for:
Too much tooth structure removed for normal retention features to be effective
To build up a badly destroyed tooth
Interim restoration during periodontal or endodontic treatment
Patients who cannot afford to have a crown
Elderly patients not capable of coming in for multiple appointments
Foundation for full coverage restorations

Not For:
Teeth with large pulp chambers
Teeth that are already sensitive
Non-vital teeth (more susceptible to fracture
Teeth inaccessible to pin drill
Anterior teeth

Advantages:
Fine, strong, long term restoration/build-up
Less expensive than a crown
Completed in one appointment
Conservsation of tooth structure

Disadvantages:
Drilling pin holes and placing pins à craze lines or fractures
Pins help retain amalgam, but the amalgam material is not as strong with pin
Remaining tooth structure not protected – fracture risk after placement
Pin may become a pulp irritant depending on placement
Pulp may be penetrated by incorrect angulation/depth of pin placement
Incorrect placement can lead to external tooth perforation
Why not bond amalgams if pins are bad? à Research has not proven that bonding is sufficient for
retention of amalgams. Therefore, retention features are still needed when using bonding agents.

Types of Pins
Cemented Pins à rarely used today
Pin hole usually larger
Cemented with zinc phosphate or polycarboxylate cement
Least retentive
3mm into tooth with 2mm post above tooth
Friction Lock Pins
Hole in tooth is smaller than cemented
Pin is tapped into place
More retentive than cemented
Rarely used
3mm into tooth structure and 3mm post above tooth surface
Self-Threading Pins
Use these in class
Hole in tooth slightly smaller than pin
Retained by threads on pin
More than twice as retentive as others
2mm into tooth, 2mm post above
Sizes (Thread Mate System)
Regular (largest)
Minim ß use this at Pacific (0.021” hole and 0.024” pin diameter)
Minikin
Minuta (smallest)

Placement
At the proximal line angles of molars
At the proximal line angles or cusp tips of premolars
Do not place in interproximals
Do not place in furcation areas
Do not place near root concavities (M of maxillary 1 st premolar)
Do not place in demineralized dentin
At least 0.5mm from DEJ (preferably 1.0mm) in the dentin
If below enamel on tooth, measure 1.0mm from edge of tooth

Drilling and Pin Issues
Use a depth limiting drill to get a depth of 2mm into dentin
2mm of pin should be visible above dentin
May need to bend the pin to get 1.5-2mm clearance for cusp build up (only use the TMS bending tool in
the pin kit)
Must have 3mm from gingival floor to opposing tooth (I have no idea what this means, but you may
want to memorize it anyway!)
Need flat, perpendicular floor for uniform drilling depth
Use one pin per missing cusp and you must have 5 mm between pins
Drill not penetrating:
Dull drill?
Drill flutes clogged?
Handpiece in reverse?
Drilling enamel instead of dentin?
Broken pin drill?!!!!
Dull drills may break
Stop rotating drill before removal à broken drill
Do not attempt drillectomy, leave it and place a new pin at least 1.5mm away from this site
Broken Pin? – Are you done breaking things yet?
Over tightened pin drill?
Aggressive bending = broken pin
Do not remove the pin! Pick a new spot to break something.
Loose Pin?
Pin hole is too large
Overturned pin causes stripping of dentin
If you got lucky and you have stripped dentin à remove the pin with 56 bur in a high speed (lightly
touching top of pin)
And if you can’t remove it, place a new one à the more the merrier, right?
Penetration of the pulp à Run away!!!
Remove pin or pin drill
Control bleeding
Peridex and cover with calcium hydroxide
Pick another location (I don’t know about this?!!!)
Inform patient (obvious)
Endodontic Treatment
Avoid Lawsuit (just kidding)
Penetrating External Tooth surface
Sense by loss of resistance, pin goes beyond 2mm, and blood
Turn out pin if possible
If above gumline, cut off excess and fill with amalgam or place crown margin below perforation
If below gumline, perio surgery and same as above
Pin Alternatives/Assistants
Circumferential Slots
33 ½ bur
Use only where needed
Carefully remove matrix
Amalgapins
330 bur
@ proximal line angles
1.5-2.0mm depth
0.8mm diameter hole
bevel at occlusal
Peripheral Shelves
2mm gingival floor
1mm axial height
Not circumfrential (only in parts where necessary)

Cause, Management & Prevention of Vasodepressor Shock or Syncope in Dental Clinic

'Faint' is a common situation in dental clinic, It's not a big deal but it's been included in Dental
emergency category and should be attended immediately. Most of the time fainting is due
to Vasodepressor Shock. It may happen to any patient healthy or compromised. Good news is that it is
harmless if managed properly and patients get there consciousness back after few minutes.
In this article ill discuss about- Causes, Clinical features, Pathophysiology, Prevention and Management
of Vasodepressor shock. Keep these points in mind and you can prevent or manage this kind of situation.
Causes of Fainting-
There are two root causes of Fainting 1.Psychogenic and non Psychogenic
1.Psychogenic cause- It is a response to fight or flight stimuli of body, if patient is sitting on dental chair
he can't do any muscular activity and in this condition Vasodepressor shock occurs which result in
transient loss of consciousness.Examples of situation:-
Anxiety
Sight of syringe or any surgical instruments
Fright
Stressed
Surprised with sudden pain.
After seeing blood.
2.Non Psychogenic factors- These factors result in pooling of blood in large vessels of leg resulting in
less supply to brain which eventually results in shock and fainting:-
Low levels of glucose due to skipping meals.
Long standing position.
Tired
Compromised physical condition
Crowded and Hot Environment
How can you prevent it-
1.Ask the patient to eat before they come for the appointments.
2.Monitor the vital signs before any surgery.
3.Keep the patient in supine or semi supine positions while treatments.
4.Keep an eye on the anxiety level and any concerns of dental patient, and manage it with Anxiety
reduction protocol.
5.Verbal and ensuring commands are needed in case of frightened patients.
avoid any surprises- inform the patients before performing the procedure which may elicit pain.
6.compromised physical condition will result in increased chance of fainting; so manage the case
sensitively.
7.keep the temperature of working cool with help of Air conditions or other means.
How to manage If patient Faints-
1.Stop any treatment and remove any kind of materials from mouth
of patient; clear the air way.
2.Place the patient in reverse trendelenburg position ie. Legs at
higher level then the heart and head- this will facilitate the
movement of blood from the legs toward heart and brain. hence
faster recovery.
3.Wait for few minutes sprinkle some cold water on patients face.
4.Let him come to normal state then decide to continue the
treatment or not.

Case Study : :Pyle's disease

A female patient aged about 17 years reported with complaint of pain in the
lower right molar region over 2–3 days. The pain was insidious in onset with
dull aching, moderate intensity, intermittent in nature and increasing with
chewing.
Past medical history was insignificant except for a history of fracture of her
lower right leg when she was 3 years of age. Her developmental milestones
were normal, as reported by her mother.
She had undergone oral prophylaxis and dental restorations 2 years previously.
Her family history was insignificant.
On general examination she appeared moderately built and nourished. The
right submandibular lymph node was enlarged, tender, soft and mobile. Mouth
opening was within normal limits.
Intraoral examination revealed areas of depapillation of the tongue. Several
permanent teeth were clinically missing (premolars in the right maxillary
quadrant, canine and premolars in the left mandibular quadrant and canine
and second premolar in the right mandibular quadrant). Multiple retained
deciduous teeth were present which contributed to the crowding of teeth in the
upper and lower arches.
Deep proximal caries was present on the mandibular left second permanent
molar (37), right first permanent molar (46), right second deciduous molar
(85) and all these teeth were tender to percussion. A working diagnosis of
apical periodontitis in relation to the mandibular right first permanent molar
was made.
Intraoral periapical radiographs revealed discontinuity of lamina dura and hazy
radiolucency in relation to periapex of teeth 46 and 37 . Fine trabeculation of
the alveolar bone was noted in both periapical radiographs. A panoramic
radiograph, taken because of the multiple missing teeth, revealed multiple
retained primary and unerupted permanent teeth as well as generalized
rarefaction of jaws, fine, scanty trabeculations, thinning of cortices of
mandible, wall of maxillary sinus and lamina dura and flared neck of the
condyle
radiographic differential diagnosis included metabolic bone disorders such as
rickets, hyperparathyroidism, renal osteodystrophy and hypophosphataemia.
However, the patient did not manifest clinical features of any of these disorders
and a complete haemogram, serum calcium and phosphorous, and alkaline
phosphatase values were within normal range.
The patient was referred to a general radiologist for a skeletal survey, which
revealed striking radiographic changes.
The metaphyses of the lower end of both femora showed widening and
thinning of cortices and ground glass opacity of osteoid matrix, giving rise to
“Erlenmeyer flask deformity”. Diaphyses appeared spaced.
Panoramic radiograph showing multiple retained primary teeth and unerupted
permanent teeth, and generalized rarefaction of the jaws, with fine, scanty
trabeculations
Whats ur Diagnosis?

Diagnosis:Pyle's disease
Pyle's disease (PD) is a rare skeletal dysplasia in which a defect in
metaphyseal remodelling leads to grossly widened metaphysis of long bones.
First described by Pyle in 1931.
Clinical signs and symptoms of PD are mild and the disease course is usually
benign.3Occasional abnormalities include muscle weakness, joint pain,
scoliosis, platyspondylia, fractures, carious and misplaced teeth, prognathism
and enlarged big toe.3Increased bone fragility is a well recognized but variable
component of Pyle disease.The lower extremity is more markedly affected than
the upper.
Concerns about the ability to withstand trauma to jaw bones and the nature of
healing in patients with this disease will naturally arise. The pathophysiology is
incompletely understood, but is apparently due to failure of subperiosteal
remodelling in the metaphyses; the cause of this is thought to be chronic
hyperaemia of the perichondral ring of osteoblasts. The hyperaemia may be
due to congenital hyperplasia of the perichondral ring arteries.
Bone softness and fragility are well documented in Pyle's disease, which may
have surgical implications.
Extractions and surgeries may have a favourable outcome in patients with
Pyle's disease. Minimum force should be used during dental procedures since
bone mineral density may be reduced in these patients.