Acrylic Teeth Vs Porcelain Teeth

Property	Acrylic Teeth	Porcelain Teeth
Abrasion Resistance	Low	High
Adjustability	Easy	Difficult
Bonding	Chemical	Mechanical
Staining	Easily stained	Does not stain
Percolation	Absent when acrylic denture base is used	Present when acrylic denture base is used
Clicking Sound	Absent	Present
Ease of Fabrication	Easy	Difficult
Ease of rebasing	Difficult to remove acrylic teeth	Esay to remove porcelain teeth
Trauma to dental bearing area	Less	More

Anatomical Landmarks in Maxilla and Mandible for Complete Denture Fabrication

Anatomical Landmarks in Maxilla and Mandible for Complete Denture Fabrication

MAXILLA

Primary Stress bearing area	Residual alveolar ridge
Secondary stress bearing area	Rugae or anterior hard palate Maxillary Tuberosity
Tertiary stress bearing area and secondary retentive area	Posterolateral part of the hard palate
Relieving areas	Incisive papilla Mid palatine raphe Cuspid eminence Fovea palatinea
Primary retentive area	Posterior palatal seal area

MANDIBLE

Primary stress bearing area	Buccal shelf area
Secondary stress bearing area	Slopes of edentulous ridges
Primary retentive and primary peripheral seal area	Retromolar pad
Secondary peripheral seal area	Anterior lingual border
Relief areas	Crest of the residual ridge Mental foramen Mylohyoid ridge

Classification of Composites and their Properties

Type	Properties
Conventional Composite	Contain filler particle size of 8-12 micrometers It is the composite with largest filler size High strength and hardness Less water soprtion and Coefficient of thermal expansion Polishing is difficult and results in rough surface that tends to retain stains
Micro filled Composite	Contain smallest filler particles of size 0.04 - 0.4 micrometers Colloidal silica is used as a filler It has lowest filler content of 50% weight Lowest strength and hardness Highest thermal expansion coefficient and water sorption Excellent esthetics due to the increased smoothness
Small Particle	Contain filler particles of size 1 - 5 micrometers It has good surface smoothness like microfilled composites and improved physical properties like conventional composite It has the highest compressive strength of all composites
Hybrid Composite	It has filler particle size of 0.6 - 1 micrometer They have smooth finish and better esthetics than small particle but yet have similar physical properties.

Different Types of Pain : Anesthesia. Hyperaesthesia, Paraesthesia, Allodynia, etc.

TAXONOMY OF PAIN

Terminology	Description
Anesthesia dolorosa	It is a paradoxic pain in the region of sensory loss following an injury to a cranial nerve or a nerve root. It is seen most often after surgical treatment of the trigeminal ganglion or root for neuralgia.
Allodynia	Pain due to non painful stimulus that does not normally produce pain.
Hyperalgesia	Increased response to a stimulus that is usually painful
Hyperaesthesia	Increased sensitivity to stimulation and does not imply a painful sensation. Hyperalgesia is a special case of hyperaesthesia.
Hypoaesthesia	Decreased sensitivity to stimulation
Hypoalgesia	A special case of hypoaesthesia in which pain response to normally painful stimuli is diminished.
Paraesthesia	Abnormal (but not unpleasant) sensation
Dysesthesia	Unpleasant abnormal sensation
Hyperpathia	It is painful syndrome with increased reaction to a stimulus and an increased threshold; faulty identification and localization of stimulus; delayed and radiating sensations and after sensation may be present.
Causalgia	It is a syndrome of: Burning Pain, Allodynia, and Hyperpathia after a traumatic nerve lesion.
Phantom pain	Described as perceptions that an individual experiences relating to a limb or an organ that is not physically part of the body. For example, Limb loss as a result of either amputation following surgery or congenital absence of limb. Phantom limb pain is the feeling of pain in an absent limb or a portion of a limb.

Polishing Agents in Dentistry

Agent	Uses
Pumice	Smoothening dentures, polishing of artificial teeth
Zinc Oxide	Polishing of amalgam restorations
Rouge (Tin oxide)	Polishing of noble metal alloys
Zirconium Silicate	Prophylactic paste for polishing natural teeth
Chromic Oxide	Polishing Stainless steel
Corundum (White form of Al2O3)	Grinding of metal alloys

Most Common Sites of Some Important Pathologies : Oral Cancer, Cysts, Tumors etc.

Condition	Most Common Site
Enameloma	Bifurcation and trifurcation of maxillary posterior teeth
Composite compound odontoma Adenomatoid odontogenic tumor Squamous odontogenic tumor	Anterior maxilla
Composite Complex Odontoma	Posterior maxilla

MCQs on Biostatistics Part 1

# Which of the following correlates highest correlation between variables ?
A. r= + 0.25
B. r= + 0.5
C. r= - 0.75
D. r= + 2

# The arithmetical average of a number of observations is called :
A. Mean
B. Median
C. Range
D. All of the above

# Which of the following is not a measure of central tendency ?
A. Mean
B. Mode
C. Range
D. Median

# The levels of nicotine in 6 cigarettes were 13.0, 11.8, 15.4, 17.4, 31.2 and 24.3 mg. The mean of these values is:
A. 14.9
B. 15.9
C. 18.6
D. 8.4

# Father of Health Statistics is:
A. John Snow
B. John Graunt
C. Frederick Mc Kay
D. Pierre Fauchard

# Ranking students from the individual with the highest Grade points average (GPA) to the lowest is an example of:
A. Ordinal Scale
B. Nominal Scale
C. Interval Scale
D. Ratio Scale

# A random sample suggests that :
A. A person in a control group will not be a member of the experimental group
B. Any member of a group to be studied has an equal opportunity to be included in the study
C. Every nth name on a list is selected
D. Subjects are volunteers

# A stastistical test which indicates the chance or probability of an observed difference between two means occuring by chance is called:
A. Tests of significance
B. Means
C. Ratio
D. Normalcy

# Best measure for central tendency in a highly skewed distribution is :
A. Median
B. Mean
C. Mode
D. Range

# The graphic representation of frequency distribution with X and Y axis is :
A. Frequency polygon
B. Histogram
C. Pictograph
D. Pie diagram

> # A series may have all except :
A. No mode
B. One mode
C. Many modes
D. Negative mode

# The correlation coefficient can range from :
A. 0 to +1
B. 0 to -1
C. -1 to +1
D. 0 to 100

# As the sample size increases, standard deviation :
A. Decreases
B. Increases
C. Remains the same
D. May increase or decrease

# In a 3*3 table, the number of degrees of freedom is:
A. 4
B. 9
C. 3
D. 81

# Most of the values in data spread along the :
A. Mean
B. Mode
C. Median
D. Arithmatic mean

Local Anesthetic Techniques

Technique	Features
1. Infiltration	Also called as submucosal analgesia. Terminal branches or free nerve endings are anesthetized. Only that area into which the local anesthetic solution is infiltrated is anesthetized.
2. Field Block	Large Terminal Branches are anesthetized.
a) Paraperiosteal	Most commonly used technique. The solution is deposited alongside the periosteum. It is indicated widely in the porous maxilla than in the dense mandible.
b) Interosseous	Means injecting directly into the bone. Painful and dangerous procedure. It is not commonly used.
c) Interseptal	It is most effective in children and young adults. LA is injected into the thin porous interseptal bone.
d) Intraligamentary	Most effective for anesthetizing single tooth by injecting LA into the periodontal ligament under high pressure.
e) Intrapulpal	LA is injected into the pulp chamber. The needle should be wedged firmly.

Must know Facts about Local Anesthetics / LA

This table lists some unique properties of local anesthetic agents.

Properties	Local Anesthetic
Natural local anesthetic agent	Cocaine
Local anesthetic agent with intrinsic vasoconstriction property	Cocaine
LA which is most dilating of all	Procaine

List of Medical Syndromes and their Important Features

1. Developmental Disturbances

Syndrome	Important Features
Parry Romberg's Syndrome	Facial Hemiatrophy
Vander Woude's Syndrome	Pits of lower lip and cleft of palate
Ascher's Syndrome	Acquired double lip + Blepharochalasis + Non toxic thyroid enlargement
Oro Facial Digital Syndrome	Cleft tongue nd clefting of mandibular alveolar process
Median Cleft Face Syndrome	Hypertelorism + Median cleft of premaxilla, palate + Cranium bifidum occultum
Meischer's Syndrome	Cheilitis granulomatosa

Setting time of Dental Materials : Alginate setting time, GIC, ZOE, Impression plaster and Zinc Phosphate Setting Time

The Setting time of some of the dental materials is listed in the table below.

Material	Setting time
Fast setting alginates	1-2 minutes
Normal setting alginates	2.5 - 4 minutes
Alginate (Optimal)	3-4 minutes
Impression plaster	4 minutes

MCQs on Tooth Extraction (Exodontia) and Impactions

# All of the following statements about inhaled tooth fragment are true except:
A. It usually enters in the right bronchus
B. It may cause lung abscess
C. It may cause bronchiectasis
D. It will be coughed out spontaneously, no treatment is necessary

# Rotatory movement is used for the extraction of the :
A. Mandibular canine
B. Maxillary central incisor
C. Maxillary lateral incisor
D. All of the above

Important Signs in Clinical Medicine and their Significance : Murphy's Sign, Auspitz's sign, Trousseau's Sign, etc.

Important Signs and their significance

Sign	Significance
Nikolsky's sign	➤ Seen in Pemphigus, familial benign chronic pemphigus and recessive form of epidermolysis bullosa ➤ Loss of epithelium due to rubbing resulting in raw, sensitive surface
Auspitz's sign	➤ Seen in Psoriasis ➤ If the deep scales are removed, one or more tiny bleeding points are disclosed

Treatment of Acute Necrotising Ulcerative Gingivitis (ANUG)

Treatment of ANUG

First Visit	➥Removal of pseudomembrane and non attached debris after the application of a topical anesthetic ➥Patient is advised to rinse with 3% H2O2 (hydrogen peroxide) in equal dilution with warm water every two hours ➥Patients with systemic symptoms and local lymphadenopathy are placed on Amoxicillin 250 or 500 mg QID and Metronidazole 250 or 500 mg TID

G.V. Black's Classification of Tooth Preparations / Cavity Preparations

Based on anatomical location of carious lesion, Greene Vardiman Black (G.V. Black) classified tooth preparations into five different classes. Later an additional class, class VI was also added. Class I refers to pit and fissure lesions, whereas all other classes are smooth surface lesions.

G.V. Black's Classification of Tooth Preparations

Class I	All pit and fissure preparations. It Includes: ➤ occlusal surfaces of premolars and molars, ➤ occlusal two-thirds of the facial and lingual surfaces of molars, and ➤lingual surfaces of maxillary incisors
Class II	Preparations involving the proximal surfaces of posterior teeth  (i.e. Premolars and Molars)

Dentist

Who is a Dentist / Dental Surgeon ?

A dentist is a person who is licensed by the nation or state's licensing body to practice dentistry independently. He can either run a private practice or work as a government employee or an employee in other's clinic. A dentist can examine and diagnose the disease of your oral cavity, perform restorations, rectify maloccluded teeth by the use of removable and fixed orthodontic appliances, extract your tooth, provide partial or complete / removable dental prostheses, etc. The dentist deals not only with the teeth, the rest of the soft tissues like tongue, palate, buccal and labial mucosa are also dealt by the dentist. Extra-oral lesions, swellings, and tumors of the head and neck region too come to the attention of the dentist first. Some facial reconstruction surgeries, surgical correction of cleft lips and palates, implants,etc. all come under the duties of a dentist or dental surgeon.

MCQs on Oral Histology - Salivary Glands Part 2

# Myoepithelial cells are present in:
A. Striated duct
B. Intercalated duct and terminal duct
C. Serous cells
D. Mucous cells

# Carmalt's glands are:
A. Major salivary glands
B. Minor salivary glands(Retromolar)
C. Minor salivary glands (lingual)
D. Taste buds

MCQs on Oral Histology - Salivary Glands Part 1

# The normal pH of saliva is about:
A. 5.5
B. 9.5
C. 7.5
D. 8.5

# Of the total amount of saliva secreted by all the salivary glands, about 60% is secreted by :
A. Parotid glands
B. Sublingual glands
C. Submandibular glands
D. None of the above

What is Depression? How can we help?

The theme for this year's world health day is depression, with a slogan- Depression: Let's Talk. Depression is aptly chosen as this year's theme because it is taking pandemic proportions in today's competitive world. More and more young generations are diagnosed as having depressions every day attributing to failures in relationships, academics, careers, finances and many other seemingly inconsequential reasons. As per the WHO's definition of health, health is a state of complete physical, mental and social well-being but not merely the absence of disease or infirmity. Yes, a person may seem well from others' perspective but he may be having troublesome issues within himself. He may not feel healthy mentally. Some unknown fear, apathy, anxiety may be lurking in his psyche and he may not know to whom he should consult. It is a global necessity that every one of us understands the fact that nobody is immune to mental illness and we should not attach a stigma to those having mental disorders.

What is depression?
Normally we all feel sad, lethargic, heartbroken and uninterested in any activities during stressful situations or after we face some major losses in life. These mild depressive symptoms are normal as we acknowledge the fact that it's not our day every day. The saying "Everyday is not Sunday" also reminds us that ups and downs in life are inevitable. Depression becomes a disorder when the symptoms become so severe that they interfere with normal functioning, and when they continue for weeks at a time. The sadness of depression is differently both quantitatively as well as qualitatively as compared to normal sadness. The most important feature is the sadness of mood or loss of interest and/or pleasure in almost all activities (pervasive sadness), present throughout the day (persistent sadness). 


Depression is so common that the life-time risk of depression in males is 8-12% and in females is 20-26%. Sadness is usually associated with pessimism and the person suffers from three common types of depressive ideas :
hopelessness (nothing is going to be good in future) ,
helplessness (nobody can help me to become better) and
worthlessness (I cannot do anything in my life, better if I end my life!! )

The person doesn't like to get involved in social interactions and is not excited about things he used to enjoy before. His appetite is decreased and keeps on thinking about some particular events repeatedly and becomes pessimistic. Some other physical manifestations (somatic syndrome) can also be seen as listed in the table below.

The suicidal tendency is seen increased in some of the risk groups. Suicidal risk is much more in the presence of following factors:
a. Presence of marked hopelessness
b. Males over 40 years age; unmarried, divorced/widowed
c. Written/verbal communication of suicidal intent and/or plan
d. Early stages of depression
e. Recovering from depression (At the peak of depression, the patient is usually either too depressed or too retarded to commit suicide)
f. Period of 3 months from recovery.

So, extra attention should be given to those persons. We should give them company, keep them engaged and occupied. We should never give them a chance to be overcomed by their depressive emotions.

How can we help ?
Depression is a disease and as every other disease it can be treated. The depressed person feels better even if we listen to his problems and show some sympathy. We should not mock or ridicule them saying things like, " You are talking nonsense, You're out of your wits, You crazy moron, What makes you so retarded? , Grow up man don't talk sissy, You got to be strong, etc.". That's not going to help.
We need to assure them that they can have their previous happy life back once again if they become aware of their condition. Regular psychiatric consultations should be made and medications should be taken as per the psychiatrist's pescription.

Let's talk about Depression..!!!

MCQs on Oral Histology - Salivary Glands

# The normal pH of saliva is about:
A. 5.5
B. 9.5
C. 7.5
D. 8.5

# Of the total amount of saliva secreted by all the salivary glands, about 60% is secreted by :
A. Parotid glands
B. Sublingual glands
C. Submandibular glands
D. None of the above

# The basket cells are also known as :
A. Myoepithelial cells
B. Endothelial cells
C. Parenchymal cells
D. None of the above

# The three bilaterally paired major salivary glands are located :
A. Extraorally
B. Intraorally
C. In tongue
D. In neck

# The parotid glands open through the :
A. Stensen's duct
B. Wharton's duct
C. Bartholin's duct
D. Blandin's duct

# The saliva is neutralised due to:
A. Mucin
B. Ammonia
C. Amino acids
D. Bicarbonates

# Among various glands, salivary gland secretion is unique in that, its secretions are controlled by:
A. Hormones
B. Nerves
C. Chemicals
D. All of the above

# The content of saliva include all except:
A. Amylase
B. Urea
C. Lysoenzyme
D. Lipase

# The ducts of glands opening into the floor of the mouth are :
A. Submandibular and sublingual
B. Submandibular and parotid
C. Sublingual and parotid
D. Von Ebner


# Sublingual gland is a :
A. Mixed gland
B. Serous gland
C. Mucous gland
D. Present in root of tongue

# Bartholin's duct is the name of:
A. Parotid duct
B. Submandibular duct
C. Sublingual duct
D. Lacrimal duct

# The glands of Blandin and Nuhn are:
A. the posterior lingual glands
B. the anterior lingual glands located near the apex of the tongue
C. the glossopalatine glands
D. the palatine glands

# A purine which is found in saliva is :
A. Uric acid
B. Thymine
C. Adenosine
D. Hypolithinium

# Which of the folowing is not found in saliva?
A. Lysozyme
B. Phosphate
C. Bicarbonate
D. Trypsin

# Mucin in mucous cells are usually demonstrated by:
A. PAP stain
B. H and E stain
C. Mucicarmine stain
D. Mallory stain

# The functions of myoepithelial cells may be:
A. Initiating contraction
B. Support for the end piece during active secretion of saliva
C. Provide signals to the acinar secretory cells for structural reorganization
D. All of the above

# Myoepithelial cells are present in:
A. Striated duct
B. Intercalated duct and terminal duct
C. Serous cells
D. Mucous cells

# Carmalt's glands are:
A. Major salivary glands
B. Minor salivary glands(Retromolar)
C. Minor salivary glands (lingual)
D. Taste buds


# On passing from acini to ductal orifices after ductal modifications, saliva becomes _________ as compared to plasma.
A. Hypertonic sometimes
B. Hypotonic
C. Isotonic
D. Hypertonic always

# Tuft cells are receptors seen on:
A. Cell rich zone
B. Lining of maxillary sinus
C. Salivary duct
D. TMJ capsule

# The parotid gland opens:
A. on the floor of the mouth
B. at the side of the lingual frenum
C. at the caruncula
D. on the buccal mucosa opposite the maxillary second molar

# Which of the following is purely serous in nature?
A. parotid and Von ebner's glands
B. Palatine glands only
C. Glossopalatine glands
D. Lingual glands

# The total volume of saliva secreted daily is :
A. 750 ml
B. 1.5 liters
C. 2 liters
D. 3 liters

# Largest amount of saliva is produced by :
A. Submandibular glands
B. Sublingual Glands
C. Parotid glands
D. Von ebner Glands

# The immunoglobulin present in saliva is:
A. IgG
B. IgA
C. IgM
D. IgE

# Salivary glands are not found in:
A. Anterior part of the hard palate
B. Posterior part of the hard palate
C. In mandible posterior to the 3rd molar
D. Nasopalatine canal

# Which of the following is purely mucous?
A. Palatine glands
B. Glossopalatine glands
C. Posterior lingual mucous glands
D. All of the above

# The minor salivary glands begin their development in fetal life during :
A. 1st month
B. 2nd month
C. 3rd month
D. 4th month

# Salivary flow is reduced in:
A. Sjogren's syndrome
B. Xerostomia
C. Inflammation of glands
D. All of the above

# The severance of duct of minor salivary glands and pooling of saliva in the tissues is called as:
A. Ranula
B. Congenital Epulis
C. Mucocele
D. Sialadenitis

# The pH of whole saliva is :
A. 1.2 - 2.4
B. 3.0 - 5.6
C. 6.7 - 7.4
D. 7.0 - 8.2

Management of Hospital waste in BPKIHS

B.P. Koirala Institute of Health Sciences (BPKIHS) is a tertiary health care center and referral center in eastern development region. Thousands of patients come here every day seeking outpatient medical care. It also has got a 700-bedded inpatient ward and the largest (in terms of manpower) emergency unit in the nation. There is also a separate College of Dental Surgery(CODS) for dental facilities which consist of nine different departments. So, a large amount of general waste and biomedical waste is produced from the hospital every day.  General waste includes paper and plastic packages of medicine, wrappers of junk foods, kitchen waste from hospital kitchen, etc. and biomedical waste includes used gloves, cotton dressings and gauges, used syringes and medicine bottles, excised body parts, etc. These waste materials must be suitably disposed of immediately lest they putrefy, emit foul smells, act as a source of infection and disease, and become a public health hazard. It is the responsibility of the healthcare institute producing those wastes for the proper management of health care waste, not the government or local governing unit.

In BPKIHS too, there is a provision of proper waste disposal, which, however, is not the best protocol to follow. Juniormost staffs are responsible for the collection and disposal of the waste. For the workers’ health and safety, Health welfare scheme/Treatment facility is provided by the institution. The workers are vaccinated and Personal protective equipment (PPE) viz. Long boots, gloves, face mask, Cap and plastic apron are also provided for the employees. The materials used for the collection of the wastes are:

-Plastic bags (Black)

-Cartons (Red/Orange/Green colored)

- Plastic buckets

-Wheel big plastic bins (Red/Orange/Green)

Trolley

The wastes are segregated by using different color coded containers for different types of wastes.

The Nepal Health Research Council (NHRC) guidelines are followed as listed below:

Green Box (Non- Infectious): Non-infected stuffs/General waste

Orange box / Red box (Infectious): Infected Stuffs – Gauze/ bandage/cannula/urobag/blood/bodyfluid contaminated stuffs

Sharp Box: Needle/syringe/surgical blade/infected sharp materials

The collection and transportation of infectious wastes from wards to the incinerator is done in two shifts per day. And the residual sterile waste is disposed of to the dumping site. This is done by the attendants posted at the incinerator.

Similarly, the non-infectious waste is collected in two shifts from the wards to the bay/Collection container by ward attendants. Then, it is transported to the dumping site by sanitary workers in three shifts. 

Though the waste segregation system has been applied, it’s not properly followed due to unawareness. Also, The spread of infection from the open dumping site and direct contact transmission of disease to those poverty struck rag-pickers from the dumping site is always a risk which may cause a serious health hazard. Besides, A clean hospital and good housekeeping have a direct effect on the health, comfort and morale of patients, visitors and hospital personnel alike. Cleanliness radiates cheer and a well-kept hospital would give the public a feeling of confidence. So, due care has to be given in proper management of wastes and adequate budget should be allocated for that purpose.