FACULTATEA DE MEDICINA uTNTanA

DISCPLINA DE LIMBI MODERNE

pRocRAMA ANALrrrcA pENTRU LIMBA BNclnzA
ANUL tt-2014-2015
(1 semestru,28 ore)

1. Sistemul medical

si orsantarea serviciilor de slniitate

Physicians and Medical Specialities - 4h
Basic Hospital Vocabulary - 4h
Specialities in Dentisfiy, The Modern Concept of Endodontics
Orsanizarea cabinetului stomatolosic
o Dental Surgery Equipment - 2h

o
o
.

2.

2h

o Surgery-2h

3.

Echipamente si materiale
Materials in Dentistry -2h
4. Tipuri de dentitie
o Deciduous and Permanent Dentition
5. Lucriri dentare

2h

o Porcelain-2h

6.

Boli si tratamente stomatologice

. The Aetiology and Classification of Malocclusion

7.

Diagnosis and Treatment Planning

Chirurgie

o
.

l,ll -2h

Dental Implants - 2h
Grammar and Vocabulary Test (TOEFL)

- 2h

-2h

Bibliografie:
B.L, Medical Terminologt, J.B. Lippincott Company, Philadelphia, T994;
2. Glendining, E., Holmstrom,8., English in Medicine (A Course in Communication
Skills), Cambridge University Press, U.K., 1992;
3. Harty, E.J., Illustrated Dental Dictionary, WRIGHT - READ Educational &
Professional Ltd., 1999;
4. Isselhard, Brand, Anatomy of Orofaciol Structures, Mosby, 2003;
5. Marieb., E.N., Essentials of Human Anatomy and Physiologt, A. W. Longman,1997;
6. Soltesz Steiner, 5., Quick Medical Terminologt, Jolur Wilez & Sons, Inc. 2003;
7. Tiersky, E., Tiersky M., The Language of Medicine in Englisft, Prentice Hall Regents,
New Jersey,l992;
8. Vince M., Advanced Language Practice, Heinemann,1994;
9. *** American Journal of Dental Hygiene, Mosher and Linder.
1. Cohen,

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itlatch the con'ect definition witlt the person: radioiogy reci:nicians, phamracists, sociai irycrkersporters, consultanis, pediatricians, qpeech flrerapists, physioterapists, general practitioners. occupatioual
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l.They assist patients 'n'ho have difficuities speaking- 2. They mot'e patients on beds, n'oileys anil
n4reelchair-s. 3. They iook afier people's feet"4. They work out speciai meais and give adr.ice on the
most appropriate food. 5. They are responsibie for, prepare and dispe,::se meriicine. 6. These doctors'
speciality is chil<iren. 7- Senior medicai peopie lvho give expert advice and are responsible for final
decision making. 8. Tbey give fiu$sage and exercise io restore specific bodily functions. 9. Thev
operate on patients to repair skin darnage or improve a patient's appearance. 10. Their u,ol'll i-s
rehabilitation and assistance of people recovering from or suffering from iltness. i-i. They ojierate
equipment intlie X-ray deparhn ent. 12. They rvork together*,itir nredicai personnei in hospital a:rri u.y
to rieal wiflr a patient's probierns at home. 13. They clean and organtze bed linen. 14. These doctors
may refer their patients to hospital to see a specialist or to receive specialist care.
E THII{GS ON TIIE WAFS
It{arch each of the follov,ing descriptiotts tuitlt the con"ect wot'd: sheets, mafiress. cruicli, trolley.
curtar.n, drip stand, bedpaq tray, bedspread, observ-ations chatt, oxygen point, urine bottle, hoist.
u,heelchaie piilou,, call buttorl blanicet, basin, name band, monkeypole.

i. Tiris covers the beC to keep off the dust. 2. Something to rest one's head on. 3. Apaiiein conflned
to bed i^-ili have to use tids to urinate aud defecate. 4. Patienis use this v,,hen iiiey need ',o cali a nllrse.
5. For identificaiion, iltis is -uirorn bi,patients arou-nd their wrist. 5. A iralrou,beri used for iranspoi-tine
pratients. 7. l\rash -vour ha:rds here. 8. A mechan-ical device for lifting and moving patients. 9- Drau,n
aroturd a patient's bed to provide sorne privacy. 10. Two of these on the beri are strarghienecl regularJl,
and -washed every few days. 1 i. Meais are brought to Ure bed on this. 12. These keep the patient -\^/arin.
1;t. Male patieirts confine<i to bed use this to urinate. i4. Suspended above the bed, this cair be used
b-v the patieni to pull himself/herself up. 15. Patients lie on this, it's someiimes har-d aud sorletimes
sofrt 16. Lrtravenous fluidbags are suspended on'rhis. i7. Patients who can sit up coiliorlably can be
rraiisported in one of these. 18. A patient with a btoken leg v,,i11 need 2 cf tl:ese to get around. I 9. A
n:.ask and tube fiom iiris will suppiyoxygetrto the patient. 20-Thepatient's condition is recorded here.
E FE.OCEDURES
Thefollor,t,ing plrases are spoketz by a nurse can7tirxg out nasagasit ic iritubation. Tiiey cu-e all ntixed
tr1s. Pttt therri itr ilte correct order.
i . Nor,,, I'ii just check that we'r,e got it in tlie rigirt place, so I'm goi11g to pass jrist a iittle bir of ai.r urto
the tube and lisieir to it. Can you let rne listen to your stomach, please ?
2. OK, can you sit fr:nvard on your chair, please ? That's it ! Norv can you just lift your head a htile ?
Tliai's itne ! Nou, I'iri just' going to rnark the lenght of tube we need with titis iape. That's it.
3. }.'-es, that seeriis fiue. \4re1l done ! Now I'jj just put a little bit of iape ovei il:e tube io iroki it fu piace.
That's ii i Ail over- You can relax nou,4. Non, just a littie spray in youl left nosti-il. That's fine ! Nor.r, if you u,aitl uie to siop ar anli tiure-;usI
raise vor-ir-iranci. OIi ? Rigirt, rlov,, here corires the first bit. You're ooing 1ie11; 1:,;gll.
5 Helio il{rs. Tunrer'. f m An:yl.iathan.
6, liou,, can you just bend your head foi-warri a little anri I'd lihe you io taiie a sip of r+,atei tilor-rgh thts
stra\r,,. Fine !

'l'*r
'fi
:

ts

:,1.

,.li

7' Nor.'', )lou're going io irave an operation tomon-ou, and \.ve need to mai(e slu-e ihat your siomach
is
eiilpiy. Yrrhat I'C hke ic ric id stide Ethlir pla5ticrube=J:r-ougirjour1ose and dor.r,n llto
1,our sioptach.
8. You'le dcilg 1'el-1'r:eli. I'iow, take anorhor sirr. Thar's it- And nou, anorlier, Gooii. t,'e,re aimost
theie. lVeii rlone I
9' Don't wony, it rvori'r cause you anypain, but it will feel a bit uncor:-rA rtabie.Ii,s not the
most pieasani
of things but u,e'11 tal<e it carefuliy. Are 3,ou OK about this ?
E

LETTER GF R-EFERR,EJ

There Qre h'no letiers belov'- Atte is a leiterirotn a geteeytti practitioner to o- consulttuti nrrd
tlte oiher
oti'e tlze consultatzt's reply. Fill iru the ndssirzg words. Choose
f-om the lZ,llou,ing: discomfort, drip,
examutatton, findilgs, grateful, instance, nasal, obstruction, opinion, persist, persisteutly,
respond,
responris, response

Consultant: Dr Holger Bauer

Patient name: John Gardner

DOB: VlA7l80
a7iD5!A2
Dear Mr Bauer
J rvouid be (i) e1ateflll ifyou couid see th-is young
man who has had a(Z) ...blocked nose over the lasr
fe'uv inor:-ths. On two occasions I have noted po11ps. They (3)
... to asmalt degree to beciamethasone
(4) ... spray, but coutinue to (5) .... I wouid be gratefui for your
i6) . .
Yours sir:ce.i-eh,,
Aldrerv Connor

Drpartitleni of Otciaryngolog1,
hrera' i;atieni coltsliliatiol:: Jci::r Gardriei. IJ Otr i AlGj lg0
25/o6ic2
( Ch:ric lgia1iaz)
Dear Dr Comol
Thanle you for asking 1rre to see this 2 i -year-old telecommuriicatiols
esgineer.
l'reseffatlon and (7) .. :

He complains of iong-standing nasai (8) on both sides vvitir only partial

(9) ... to Beconase nasal
spray' iIe aiso savs
iris ears pop occasionaily and he geis some facial
]iiat
iiol , and post nasal (11)
" ' ' on (.1?-) "' today his nose shos'ed congested nasal mo.*u and pollpoid
middie tgrbinate and s,rall
middle meatai polyps.
impi-essicns aild pian:
hi ihe fri-st (13) .-., I have stai-led iirni on eccurse cf Nascriex
nasal spr ay r",'liicli is a more nlodei n
steroid tira:r Beconase. I shall see hiin agail jt: t*,o
months' time to see holr,, ire (14)
Yours sincerely
Iioiger Bauer
FIolget'Bauer
C onsuliant Otoiarymgo logist

E C*I{FUSTIIG

\liCR}S

CJtoose the cat'reci y,orC in ertch of

ihefoiloy,ittg.
1' She iietvously r','aiteo for tlte post to fi;iii out t,ireiirer sire irad
i:ast/passed ire;-fftia) nlit-siny
exat]lination. 2. lle seeil-s ic irave pui on a ioi oiy*eiehi/,i'ait in the jasi
4 r-^Y=- --' -l--.r-,.1
fefi, nroliits. i.? J-t
llU\'\' blYilL,'>]LC

'.,1ii''

.t

5r: the edge of the ci4, fu2" nou,

r2v \\' been
uvvLi 1i?!irt!i__19{_rj}9_llgv/J10sp_$e-i,_,{i.
fqUrrd_foi_ths_rrew_Losprtai. 4. .une
quaiity illat
aLl nJrses
that au
illrses lflu_st
One qEe[ry
tru_st
patiencerpaiieiits.
ha="e is
5: Shb is-v-ery coacel:re-d that her hair loss -wili resuit in her beconriug
bailedlbald- 6. Duriag the procedure shabegan to feel unu eil ald feii she was going to ienl/faint.
7
He has been experiencing pain in the lumbaviumbe: region bf the back. 8. The surgeon uses , to:r_n.
nurnber of slobs/sr.Bbs to mop up the bIood. 9_ Muicuiar dystrophl, is a disease u,here the r:ruscles
u'aist/ra'aste away- 10'He suffersfromamuscuiartic/tickinhisleft eye
11.1:rtheaccidenthesr-rffered
a major breai</brai<e to his nglit feraur. 12. After s"""rl"g
or coughing, some microbialpathogens r1av
be borir/bor':re on the wind, enlr.ancing tht spread of i#""tior.A B"f";" go*g off duty the
doctor
sirould'chequelcheck that all intravenous cannulae are working satisfacto rtty. M.The would
has been
Yery slo"in'to heel/hea7. 15. The doctor was called when the chiid began to
ra,ilh
eroury/lroan
pair. I 6
Ihe skin'ivas badly pited/pitied N'ith the scars of acne. 17. As the infection toot iroto trls iemperarlu.e
began to soar/sore.

fr I}ISEASIS
Mcttcit ihe conlt?lotl tuante-foy a cisense v,iih iis tned.icsl equ.ivalent.
"
Rfedical lrarre
alopecia
afierioscierosis
bursitis
candida
cerebr al pa1s1'
cel ebral inftrc.tion I bieedinE
dyspepsia
eruciation
flatulence
iraernon'hoids
halitosis
herpes simplex
heipes zoster
infectious moltoltricl eo sis
myo cardtai infarction
oerlenta
poiiornyelitis
plTosi-s
rr-rbe 1ia
rubecla; moibilii
tend.onitis
Llj-Iicatra
lrariceila
\/eIfLCae

Ccmmon irame
Gerrnari rneasles, polio. thrush. watls , ireart attack, heat spots /
n8etle rash, cold sore, sia,elling. (to be;
spastie, belching, glandular fever, ireartbum, baldness, chickenpox,
hardenilg ofthe a:teries. ileasles.
bad breath, indigestion, housemaid's knee, piles, shingles, ierlis elbow,
stroke, s,i1d.

lfaich ilrc defnitiotts wilh the folotuing ten?zs; siqns, sequeiae, difi,erentia] diag:rosis,
'
consultation, syndlome, aetioiogy, history- prognosis, abnonlali4,-. co::aplications,
prevlltion,
slntptoms, disease, examination, diagrosis.
L the ioirg-ienl results of an illless or treatment.
2. identifyi::g se'eral illnesses which the patie,I
may ha,e.
3 ' tirings \4/rong rvith the body rn'liich the patient
complains cf or experieilces.
4. a stuciy of the patient,s body.
5. the causes Ieariing to au iiiess.
6. an unusual feature whjch may be u,onying or dangerous.
7- a meeting betu,eeri patie't and doctor to discuss piobrerns.
E. tiie icientification of a paiticular-iliness.
9. a change in iire structure or function of the organs or tissue
of tlie bociy,.
I 0. tahi:l_s av,ral, the cause of illless or finiii,g ii earlr,.
1 1- a g:'oup of signs whicir are ciraracteristic
of a par-ticular iliiress.
12. aioiticnal prcblems io tire orighai illness.
I 3. like1y ouicome of an illuess.
i4. a paiteni's iledical backglound, problems. behaviour-and iifest-r4e.
I --5. 1yli31 the docioi can see of the illness.

E IHFtrCTIOUS DISEASES - WOy AY!.4i1:S__

Lise rl'te v,orrJs on the riglzr to JonaiTnounil;ifil;riiity r,-, tt* Otitrk spctce.

i. The .. of equipment

spores.
rvaste.
fluids.

is Decessary to kiil
STEzuLtr
2- Saiepractice includes the safe --- of
DISPOSE
3. Hands nrust be carefi.riiy ra,ashed after ... with body
CONTAMIN,ATE
4. A paiient w-ith a iiigt ly fufectious <iisease may have to be cared for in
EOLATE
5. Sonre disease organisms ffLay trlgger an iafhminatory ...in the
P.ESPON.D
6. The ... of influenza depends on the strain of virus causing
SEVERE
7. hi the case of mumps the period of ... is very
RJCUBATE
8. In mosi European counfries, ... agairst many chiidirood diseases is available. VACCIT{ATE
9. A long ... is often requiJed after glandular
CONVAIESCE
i0. Manyvirai diseases a1'e known to cause -.. of the
INFLAME.
11. A programme of .. , has made diplrtheria avery rare disease in
ne4UNE
72. Tetarnts is an .. . by the Closindiurn tetani
INTECT
13. Typhoid fever is spread by ... of food or drii:l< contaminated by bacillus &om infected faeces.

1ong.

it.

....
body.

fever.
tonsils.
bacillus.

14.

If plaque is not temoved fi'om teeth it rnay ieadto the ... ofthe

Britain.

enarnel.

I\GEST
DESTROY

B Prepos'itiotts

Fill in tlte nissing

prepositions in tlze setztettces below. Cizoose fi'otn the follou,iitg. Sotne of the
preposiiioTTs a?'e useti nzot'e thnn on.ce; about, agailrst, alo:rg, by, down, fi'oni, in, into. cf. oir, to. u{ih.
1. Disease can spread to auother person
1$_q_qg1, direct coatact
2. Infection may be cailied in ra,aier coniaminateri ... sewage.

witir tire patient.

of a mcsquito.
4- Toxir:s reieased ... the blood circulation may pro<iuce fever.
5. A rasl: is probably due ... a virai infection.
6. The severity of the disease depends ... the particular viral sirain.
7. A secondary infection can be treated ... the appropriate antibiotics.
8. Tirese are six patients suffering ... the flu.
9. Patients must be u,arrred . . . the dangers of sec.ondary infection.
3. ldalaria is transmitteC . .. ti:e trite

i 0. The measles rash appears . . . the forehead an<i then spreads .. . the body.
i 1. Tlie Gennar: measles rash consists ... pir:k macules,
i 2. Girls shouid be vaccinated . . . rubella if they have never had it.
13. Laryargeal spasm may cause difficulty . . . swalloin ing.
14. A:rtibiotics are effective ... the Borrieteila pertussis bacilius.

In the past many people died .. . smailpox

immunLed . .. polio, ra,irooping cough and other diseases.
i7. Typitoid fever is caused ... Saimoneila typlu.
18. Precautions mnsl be tahen to prerrent the spread ... infection.
19. Childr:en are often concer:red. .., a rasir on their siril..
20- You're coming ... fure. We'li have you home in no tirne!
2i, The baby is glou,ing quickly and putting ... rrueight.
22. She fainte<1 but quickly cailre . - 23 She's done something ... her bach- She's having diificulties moving
21. Try to keep . . . this diet for the next fou.r r,*,eeks.
15.

16. Childr-en are routinely

Specialties in Dentistry
Dentistry, which is a part of stomatology, is the branch of medicine that is involved in the
evaluation, diagnosis, prevention, and surgical or non-surgical treatment of diseases, disorders
and conditionr of th" oial cavity, maxillofacial area and the adjacent and associated structures and
their impact on the human body. Dentistry is widely considered necessary for complete overall
health. ihor" who practice dentistry are known as dentists. The dentist's supporting team aides in
providing oral heilth services, whieh includes dental assistants, dental hygienists, dental
technicians, and dental therapists.
Dentistry usually encompasses very important practices related to the oral cavity' Oral
diseases ur" *ujor public health problems due to their high incidence and prevalence across the
globe with the disadvantaged affected more than other socio-economic groups.
lltnougtr modern day dentat practice centres around prevention, many treatments or interventions
are stilineeded. The majority of dental treatments are carried out to prevent or treat the two most
common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease
or pyorrhea). Common treatments involve the restoration of teeth as a treatment for dental caries
(filiings), extraction or surgical removalof teeth which cannot be restored, scaling of teeth to treat
periodontal problems and endodontic root canal treatment to treat abscessed teeth.
All dentists train for around 4 or 5 years at university and qualifo as a 'dental surgeon'. By

of their general training they can carry out the majority of dental treatments such as
restorative (fillings, crowns, bridges), prosthetic (dentures), endodontic (root canal)
therapy,periodontai (gum) therapy, and exodontia (extraction of teeth), as well as performing
nature

radiographs (x-rays) and diagnosis. Dentists can also prescribe certain medications
"*uminuiions,
such as antibiotics, huorides, and sedatives but they are not able to prescribe the full range that
physicians can.
bentists need to take additional qualifications or training to carry oLrt more complex treatments
such as sedation, oral and maxillofacial surgery, and irnplants. Whilst the majority of oral
diseases are unique and self limiting, some can indicate poor general health,turnours,blood
dyscrasias and abnormalities including genetic problems. Dentists also encourage prevention of
dlntal caries through proper hygiene (tooth brushing and flossing), fluoride, and tooth polishing.

Dental sealants are piastic matirials applied to pne or more teeth, for the intended purpose of
preventing dental caries (cavities) or other forms of tooth decay.
Dental Specialities
Oral and maxillofacial surgery
Orthodontics
Prosthodontics
Periodontics
Endodontics
Pediatric Dentistry

OralPathology
Public Health Dentistry
Forensic Odontology
Oral and Maxillofacial Radiology
Esthetic Dentistry

Oral and maxillofacial surgery. This branch of dental practice deals with the diagnosis
and surgical treatment of any disease, injury, malformation, or deficiency of the jaws or
associated structures. An important aspect of oral surgery is the removal of teeth, which may be
complicated by their location, peculiar formation, or attachment to the jawbone. Teeth that are
embldded in the jawbone or soft tissue are said to be impacted. In such cases the surrounding
bone or tissue ntay have to be removed in orcier to reach the tooth.

badly aligned and

Orthodontics. This division of dentistry deals with the correction of
in
the mouth (cleft
cut
even a
prohuding teeth. If your child has habits like thumb sucking etc. or
will be able to guide and help you' It deals
;;il; oriipl or projecting lower jaw this.specialist
known as malocclusion'
with the detection, studylprev"niion, and torrection of the condition
and which can lead to
jaw
relationships
which involves irregularities in tooth position and
be an acquired defect
may
or
deformities of the jaws and face. Malocclusionrnuy b" hereditary
decay.
caused by faultyhibits or early loss of teeth as a result of
methods of providing artificial
various
with
the
deals
speciaf,y
Prosthodontics. This
of which ensures the even distribution
substitutes, or dentures, for missing teeth, the replacement
teeth as a result of undue
of the forces involved in chewinglnd thus prevents the loss, of other
supporting
of the remaining teeth and
stress. The nature of the replacem-ent dependi on the health
teeth. This type of replacement is
structures. If feasible, a fixed bridge is used to replace missing
which cover all or a large part of the-adjacent teeth' and

accomplished by constructing
".oinr,
made of gold. covered with
then by attaching the artific[l teeth to the crowns. A fixed bridge
readily removed' lf sufficient
porcelain or acrylic (a plastic material) is lifelike and cannot be
removable partial denture is
a
then
adjacent teeth do not iemain to support a fixed bridge,
occasionally with metal'
constructed. Full dentures are usually made of u"ryli., reinforced
periodontics. Gum disease is the major causl of tooth loss in the thirties. If you have
is concerned with the study
gums bleeding then this is the doctor to see. ihis branch of dentistry
the teeth' The gums' or
and treatment of the supporting structures and tissues surrounding
Calculus encrustations on the
gingivae, and the underlying boie are subject to many disorders'
the underlying tissues' Food
to
teeth, which form over urJ rnd", the gum, act as an irritant
cavities, malocclusions, or poorly
accumulating on the neck of the tooth and irrlgularities such as

imbalance of tooth-cusp
constructed dental appliances also act as irritants. In addition,
to irritants, such soft tissues
relationships may force'food particles into the guffrs. when subjected
bone rnay be destroyed' Thus' the
as the gingivae become inflamed, and eventua'ily the adjacent
around its roots'
tooth ultlmately becornes loosened because of the loss of bone
involved in tlre
procedures
therapeutic
Endodontics. This division deals with surgical and
pulp
ca"'ity u'hen
the
from
protection of tlre pulp (commonly known as the n-erve) or its removal
The
specialty'
this
in
is also included
diseased or injured, and ,oot canals. Bleaching of frontteeth
Canal Therapy'
treatment commonly done by these specialist is known as Root
pediatric Dentistry. Children have milk teeth and have specialproblems-and thus special
The field of pediatric
people take care of childien known as Pedodontist or pediatric dentist.
dentistry for patients
of
practice
general
dentistry (forrnerly called pedodontics) deals with the
wholly deciduous or^mixed dentitionunder 20 years of age and, in general, patients possessing
the use of such appliances
that is, both primary and perm"arent teeth. Suctr practice may include
of malocclusion' Another
as space maintainers and bite plates for the prevention or treatment
protect the chewing surfaces of a
pediatric procedure sometimes practiced is to apply a sealant to
to make them more porous
solution
with
a
fhild'. molars from bacteria. The teeth are first treated
to decay'
more
to the plastic resin that is then applied, makin-e them of oralresistant
its causes'
disease'
Oral Pathology. This fleld is conierned with the nature
of oral
Diagnosis
and structure.
processes, and effectl, together with the alterations of function
sputum, blood, and other body
disease is accomplished through the use of laboratory tests of
The oral pathologist' who
fluids, as well as through the microscopic examination of tissues'
only indirectly through
patient
the
usually works in the iaboratory of a hospital, serves
consultation with the general practitioner'
public Health bentistry. This field is concerned with the prevention and control of dental
community efforts' It relates to
diseases and the promotion oi dental health through organized
and clinical derrtistry' Each of
three basic career areas irt dentistry: dental public health, research,
these career areas may involve practice, teaching, or administration.

The Modern ConcePt of Endodontics

Endodontics (from the Greek endo "inside"; and odons "tooth") is one of the dental specialties which deals with
the tooth pulp and the tissues surrounding the root ofa tooth. Endodontists perform a variety ofprocedures including root
canal therapy, endodontic treatment, surgery, treating cracked teeth, and treating dental trauma. Root canal therapy is one
of the most common procedures. If the pulp (containing nerves, arterioles, venules, lymphatic tissue, and fibrous tissue)
becomes diseased or injured, endodontic treatment is required to save the tooth. Endodontic therapy is a sequence of
treafinent for the pulp of a tooth which results in the elimination of infection and protection of the decontaminated tooth
from future microbial invasion. This set of prog:dures is commonly referred to as a "root canal." Root canals and their
associated pulp chamber are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels
entities. Endodontic therapy involves the removal of these structures, the subsequent cleaning, shaping,
and other
"rttutur
and decontamination of the hollows with tiny files and irrigating solutions, and the obturation (filling) of the
decontaminated canals with an inert filling such as gutta percha.
During the last three decades, research in the field of endodontics has modified the approach to treatment. Lesions
of endodontici origin which appear radiographically as areas of radiolucency around the apices of lateral aspects of the
roots of teeth are, in majority of cases, sterile. The areas are caused by toxins produced by microorganisms lying within
the root canal system. This finding suggests that the remove of microorganisms from the root canal followed by root
filling is the first treatment of choice and the apicectomy with a retrograde filling can only be second best. Apicectomy
with a retrograde filling at the aplex is carried out in the hope of merely incarcerating microorganisms within the tooth,
but does noi tuk" into account the fact that approximately 50% of teeth have at least one lateral canal. The long term
success rate of apicectomy must inevitable be lower than orthograde root treatment.
Research into morphology of the pulp has shown the wide variety of shapes, and the occurrence of two or evell
three canals in a single root. There is a high incidence of fins which run longitudinally within the wall of the canal and a
network of communications between canals lying within the same root. The many nooks and crannies within the root
canal system make it impossible for any known technique, either chemical or mechanical, to render it sterile. Strong
intracanal medicarnents such as paraformaldehyde will not only fail to produce sterilization but may percolate into the
periradicular tissue and damage vital healthy tissue, thus delaying healing. The current feeling is to rely on mechanical
cleaning of the canalalone, or on the use of mild medicaments which do not damage tissue.
Oth". ur"ur of research have had the significant effect of changing the approacli to endodidontic treatment. The
hollow tube theory postulated that tissue fluids entering the root canai stagnated and formed toxic breakdown products
which then passed out into the periapical tissues. The theory, thet dead spaces within the body must be obturated, formed
the basis foi ttting root canals. However, more recently ,a variety of different studies have demonstrated that, on the
contrary, hollow tubes are tolerated by the body. As a result of this work there are currently two indications for filling a
root cairal: first. To prevent micro-organisms from entering the canal system from the oral cavity or via the blood stream
(anachoresis), and, secondly, to stop the ingress of tissue fluid which would provide a culture medium for any residual
bacteria within the tooth.
All root canal sealers are soluble and their only function is to fill the minute spaces between the wall of the root
canal and the root filling material. Their importance, judged by the number of products advertised in the dental press, has
been overemphasized. Despite much research, gutta percha remains the root filling of choice, although, it is recognized
that a biologically inert, insoluble and injectable paste would be better suited for obturation of the root canal, Most of the
new root canal filling techniques are concerned with methods of heating gutta-percha, which makes it softer and easier to
adapt to the iregular shape of the canal wall.
a. Root canal tissue cannot be damaged during cleaning.
b. Fluids which stagnate in the mouth may reach periapical tissues'
c. Empty tubes are never tolerated by the body.
d. Sealers can replace root canal filling.
e. Gutta percha is no longer used for canal filling.
In summary, the principles of modern endodontic treatment are:
Clean: remove microorganisrns and pulpal debris from the root canal system
Shape: produce a gradual smooth taper in the root canal with the widest part coronal and the narrowest part lmmshort of
the apex.
Fill: Obturate the canal system with an inert, insoluble filling material.

THE DENTAL SURGERY

The nature of dental practice determines a high degree of stress and tiredness for
dentists, which is why stresi should be reduced. The dentist must concentrate on his
work, to make sure that his services are of high quality. To all that other requirements are
added: to settle appointmentsigrnd to run the dental surgery. This is the reason why
modern stomatology-is based on the "four hands stomatology" concept, which means that
the assistant's hands are added to those of the dentist's to take care of the patient'
After the functional aspects of the surgery were included in the design, the
environment should be considired. Environment includes colours, the lighting, the
windows, the sound system, because both the patient and the dental professional team
of the "set". The stomatologist is obliged through
must benefit the psychological
-obstacle-free effect
place for invalid patients, even if the patient is in a
law to offer an
wheelchair. The idea that only one kind of equipment is favourable to "the four hands
stomatology" is a hazardous one, just like the idea that one type of car suits all drivers.
Nevertheleis, there are some design features which are essential to allow the team to
work in good conditions. Some necessary elements to endow a dental surgery arei a
dental chair, a dental unit, lockers for different instruments; an air-water syringe, an oral
inhalator, a special overhead lamp, an X-ray unit'
The center of activity for any manouevre is the stomatological chair' Its main
feature is that it offers access in the patient's oral cavity. An ideal chair should include at
least the following features: to allow the patient to lie down, to be comfortable for the
the
patient and dentisi to have the control buttons placed so that both the assistant and
itomatologist have easy access to them'
The dental unit is the control centre for the hand parts. Its main role is to control
the air and water flolv and to offer support for the team. Dental units vary through shape
and instruments configuration. Some of them contain besides the handparts elements like:
the oral inhalator, the air-water syringe, the optic fibre light'
The handparts are controlled through two buttons: one is fixed in the unit and
programmes which handpart will be used, and the other one, activated by foot, is used by
the dentist to establish the drill rotation speed.
The chair for the assistant must be chosen carefully the decisive factor being
comfort, but the shape and its positioning must contribute to visibility.
The instruments and the auxiliary materials in the lockers available contribute
to work efficacity. Only the materials that are frequently used must be kept at hand; all
the others should be kept in a storage space.

The cabinets have two kinds of lockers: some fixed; attached to the wali and
some mobile. The fixed lockers usually house the articles used for surgery, instruments
and instrument cases, as well as single use articles.
The mobile lockers can be moved all over the place and are used to store articles
necessary for treatment: gauze pads, cotton buffers, filling materials, special plates for
mixtures, drugs.
jet to rinse the
The air-wateisyringe can supply an air jet to dry preparations and a water
patient's mouth. The syringe has a pistol shape which allows easy handling'

The surgical and the saliva inhalator are instruments used to remove saliva and
debris from the oral cavity. The oral exhaust is the assistant's responsibility.
The X-ray device is essential for a dental surgery because it offers very important
information to establish diagnosis and saves time. Ii is possible, of course, to refer the
patient to a specialized surgery for X-ray.
The variety of instruments and materials in a dental surgery increases according to
the scientific development, hut should match the type of activities performed in the
surgery. Dental instruments are the tools that dental professionals use io provide dental
treatment. They include tools to examine, manipulate, restore and rembve teeth and
surrounding oral structures. Some instruments always found in the dental surgery are: the
drill, usually made of stainless metals or even diamond, used to cut the teeth-or brush the
oral structure surface; the dental mirrors used for indirect view; the dental probe, which
allows the dentist to feel the inegularities of the teeth surfaces; it also iemores the
material in excess and help shape the filling; the clip, used to place or remove small
objects from the oral cavity; polishing instruments, used to smoothen the filling surfaces;
surgical gloves, protective glasses (goggles) are the main physical obstacle between the
patient and the dental team against sfreading infection.
Standard instruments are the instruments used to examine, restore and extract
teeth and manipulate tissues. Examination instruments allow the dental professional to
manipulate tissues, to allow better visual access during treatment or during dental
examination. Dental mirrors are used by the dentist or dental auxiliary to view a mirror
image of the teeth in locations of the mouth where visibility is difficult or impossible.
They also are useful for reflecting light onto desired surfaces, and with retraction of soft
tissues to improve access or vision. used to check dental fillings.
Probes are divided into sickle probe or dental explorer, and periodontal probe.
Retractors are: cheek retractor, tongue retractor, and lip retiactor.
Dental drills. Dental handpieces come in many varying types which include:
High speed air driven; also known as an airotor), slow speed, friclion grip, surgical hand
piece, straight handpiece with a sharp bur.
Burs. Dental Burs cutting surface are either made of a multifluted tungsten
carbide, a diamond coated tip or a stainless steel multi fluted rosehead. Burs are also
classified by the type of shank. For instance a latch type, or right angle bur is only used
in
the slow speed handpiece with contra-angle attachment. Long shank or shaft is only
used
in the slow speed when the contra-angle is not in use, and nnaty a friction grip bur
which
is a small bur used only in the high-speed handpiece.
There are many bur shapes that are utilized in various specific procedures.
operative burs. Flat fissure, pear-shaped, football, round, tapered, flame,
chamfer, bevel, bud bur, steel, inverted cone, diamond.
Restorative instruments: Excavators-spoon excavator: which is used to remove
soft carious decay; half hollenbach used to test for overhangs orflash; Chisels: Straight bevels the cavosurface margin and used in 3,4 and 5 claisifications of cavities
on the
maxillary. Wedelstaedt - only used in the anterior for classes 3, 4 and 5 as well.
Bin
Angle - this is held in a pen grasp and used for class 2 maxillary only.
Burnishers can be flat plastic, ball burnisher, beavertail burnisher. cone
bumisher, J Burnisher, pear shaped burnisher.
Pluggers are also knov,zn as amalgam condensers.

The surgeon

In medicine, a surgeon is a person u,ho performs surgery. Surgery is a broad category of invasive
rnedical treatment that involves the cutting of a body, u,hether human or animal, for a specific reason such
to remove a diseased organ or to repair a tear or breakage. Surgeons may be physicians, ddntists,
podiatrists or veterinarians. In earlier times, they were also people trained solely in removing bladder
stones, but at the present day specialised practitioners would have first been trained in one of the
aforemention ed profess ions.

Minimally invasive procedures such as the procedures of interventional radiolog.v are sometimes
described as l'minimally invasive surgery." The field traditionally described as interventional
neuroradiolog-y, for instance, is increasingly ctlled neurointerventional surgery.
Some medical doctors u,ho are general practitioners or specialists in fainily medicine or emergency
medicine may perform limited ranges of minor, common, or emergency surgery. Anesthesia often
accompanies surgery, and anesthesiologists and nurse anesthetists may oversee this aspect of surgery. First
assistants, surgical nurses, surgical technologists and operating department practitioners are trained
professionals who suppoft surgeons.

Terminology
1. Excision surgery names often start with a name for the organ to be excised (cut out) and end in -

2.
3.
4-

5.
6.

ectomy.
Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting
through the abdominal wall to gain access to the abdominal cavity is a laparotomy.
Minirnally invasive procedures involving small incisions through which an endoscope is inserted
end in -oscopy. For example, such surgery in the abdominal cavity is called iaparoscopy.
Procedures for formation of a peilnanent or semi-permanent opening called a stoma in the body end
in -ostomy.
Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body paft to be
reconstructed and ends in -oplasty. Rhino is used as a prefix for "nose", so rhinoplasty is basically
reconstructive or cosmetic surgely for the nose.
Reparation of damageC or congenital abnormal structure ends in -rraphy. Hei'niorraphy is the
reparation of a hernia, whiie perineorraphy is the reparation of perineum.

Types ofsurgery

General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g.,
intestines including esophagus, stomach, small bowel, coion, liver, pancreas, gallbladder arid bile
ducts, and often the thyroid gland (depending on the availability of head and neck surgery
specialists). They also deal with diseases involving the skin, breast and hernias.
Cardiothoracic surgery is the field of medicine involved in sulgical treatment of diseases affecting
organs inside the thorax (the chest). Generally treatment of conditions of the hearl (heart disease)
and lungs (lung disease). Cardiac surgery (involving the healt and great vessels) and thoracic
surgery (involving the lungs and any other thoracic organ) are separate surgical specialties, except
in the USA, where they are frequently gr ouped together, so that a surgeon training in the
cardiothoracic specialty will receive a broader but less specialized experience in both fields'
Colorectal slo'gety is a field in medicine, dealing with disorders of the rectum or anus. The field is
also known as proctology, but the term is outdafed in the mor:e traditional areas of medicine. The
word proctology is derived from the Greek words Proktos, meaning anus or hindparts, and Logos
meaning scienie or study, Physicians specializing in this field of medicine are more commonly
called colorectal srrg"oni, or Iess commonly, plociologists. Colorectal'surgeons often rvork'olosely
u,ith urologists.
Pediatric sttrget)) (AE) or paediaf ic ,tlrget)) (BE) is a subspeciaity of surgerf involving the
Surgery of fetuses, infants,, childrerr, &dolescents, and ycring aCults. VIan1, pediatric sut'geons
practice at children's hospitals.

Plastic surgety is a medical specialty concerned u,ith the correction or restoration of form and
function. \\rhile famous for aesthetic surgeq,, plastic surgery also includes man)' types of
reconstructive surgery, hand surgery, microsurgery, and the treatment of burns. The u,ord "plastic"
derives from the Greek "plastikos" meaning to mould or to shape.
I/ascular surgery is a specialty of surgery in u,hich diseases of the vascular system, or atleries and
veins, are managed by medical ttrerapy, minimally-invasive catheter procedures, and surgical
reconsfluction. The specialty evolved from general and cardiac surgery. The vascular surgeon is
trained in the diagnosis and management of diseases affecting all parts of the vascular system
except that of the heart and brain. Cardiothoracic surgeons manage surgical disease of the heart and
its vessels. Neurosurgeons manage surgical disease of the vessels in the brain (e.g. intracranial
aneurysms)

Transplant sut"gety is the division of medicine that surgically replaces an organ that is no longer
functioning with an organ from a donor that does function. Organs are donated by living and
deceased donors in order to save the life of a recipient. Transplant surgeons may also care for the
patient prior to their transplant, and continue to care for the patient after transplant surgery. There
are many types of transplants in medicine, however, transplant surgery is the only division of
surgery that is concerned with organs. Other surgical specialties such as dentistry and orthopedics
will use human tissue to repair injuries and defects, but that is not considered "transplant surgery"
but the use ofa "tissue transplant".
Trauma surgery Trauma surgeons are physicians who have completed residency training in general
surgery and often fellowship training in fi'auma or surgical critical care. The trauma surgeon is
responsible for the initial resuscitation and stabilization of the patient, as well as ongoing
evaluation. The attending trauma surgeon also leads the trauma team, which typically includes
nurses, resident physicians, and support staff
Breast surgery is a form of surgery performed on the breast. Types include: breast reduction
surgety, augmentation mammoplasty, mastectomy, lumpectomy, breast-conserving surgery, a less
radical cancer surgely than mastectorny, mastopexy, or breast lift surgery.
Sw"gical oncologt is the branch of surgery which focuses on the surgical management of cancer.
The specialty of surgical oncology has evolved in steps sirnilar to medical oncology, which grew
out of heniatology, and radiation oncoiogy, rrvhich grew out of radiology.
Endocrine surgety is a surgicalprocedure that is performed to achieve a hormoiral or anti-hornlonai

effect

in the body. The commonest

operation

is thyroidectomy. Most thyroidectomies

are

performed through a 1.5-inch incision. This is called minimally invasive thyroid surgery. However,
orchiectomy remains a common approach for the hormonal management of prostate cancer because
bf tne simplicity of the procedure, its immediate effect, and the lack of side effects associated with
the drugs used to achieve the same hormonal suppression
Skin surgetl, Dermatology is the branch of medicine dealing with the skin and its diseases, a unique
specialty with both rnedical and surgical aspects. A dennatologist takes care of diseases, in the
widest sense, and some cosmetic problems ofthe skin, scalp, hair, and nails.

Otolaryngology ol ENT (ear, nose and throat) is the branch of medic.ine that specializes in the
diagnosis and treatment of ear, nose, throat, and head and neck disorders. The full name of the
specialty is otolaryngology-head and neck surgery. Practitioners are called otolarytrgologists-head
and neck surgeons, or sometimes otorhinolaryngologists (ORL). Otolaryngology is one of the rnost
competitive specialties to enter for physicians.
Oral and maxillofacial surgerT is surgery to correct a wide spectrum of diseases, injuries and
defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial
region. It is a recognized international surgical specialty.
Orthopaedic surgery or orthopedics (aiso spelled orthopaedics) is the branch of surgery
concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use botir
surgical and non-surgical rneans to treat musculoskeletal traurna, spr;rls injuries, degenerative
diseases, infbctions, turrors, and oongenital disorders, Nicholas Andry coined the u,ord
':orthopaedis5"i, derived fi'orn Greek u,ords fol ofihos ("correct", "straight") and paideion ("child").

room, the skin surface to be operated on is:'eleaned and'rprepared by applying an antiseptic such as
chlorhe>iidine gluconate or povidone-iodine to reduce the possibiliry of infection. If hair is present at the
, :surgical
site, itis clipped offprior to prep application.'Sterile drapes are used to cover all of the patient's
boJy except for the surgical site and the patient's head; the drapes are clipped to a pair of poles near the
head of'the bed to form an "ether screen". which separates the anesthetist/anesthesiologist's working area
(unsterile) from the surgical site (sterile).
Alesthesia is administered to prevent pain from incision, tissue manipulation and suturing. Based
on the procedure, anesthesia may be provided locally or as general anesthesia. Spinal anesthesia may be
used rvhen the surgical site is too large or deep for a local bloch but general anesthesia may not be
desirable. With loeal and spinal anesthesia, the surgical site is anesthetized, but the patient can remain
conscious or minimally sedated. In contras:, general anesthesia renders the patient unconscious and
paralyzed during surgery. The patient is intubated and is placed on a mechanical ventilator, and anesthesia
is produced by a combination of injected and inhaled agents.
An incision is made to access the surgical site. Blood vessels may be clamped to prevent bleeding,
and retractors may be used to expose the site or keep the incision open. The approach to the surgical site
may involve several layers of incision and dissection, as in abdominal surgery, where the incision rnust
traverse skin, subcutaneous tissue, three layers of muscle and then peritoneum. In certain cases, bone may
be cut to further access the interior of the body; for example, cutting the skull for brain surgery or cutting
the sternum for thoracic (chest) surgery to open.up the rib cage.
Work to correct the problem in body then proceeds. This work may involve:
excision - cuffing out an organ, tumor, or other tissue.
resection - partial removal of an organ or other bodily structure.
reconnection of organs, tissues, particularly if severed. Resection of organs such as intestines involves
reconnection. Intemal suturing or stapling may be used. Surgical connection between blood vessels or
other tubular or hollow structures such as loops of intestine is called anastomosis.
Iigation - tying off blood vessels, ducts, or "tubes".
giafts - *ay bl severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly
connected to the body but resewn for rearranging or restructuring of the area of the body in question.
Although grafting is often used in cosmetic surgery, it is also used in other surgery.
ifsertion of prortt.tic parts when needed. Pins or screws to set and hold bones may be used. Sec.tions of
bone may be replaced with prosthetic rods or other parts. Sometiure a plate is inserted io replace a
damaged area of skull. Artificial hip replacement has become more common. Heart pacemakers or valves
may be inserted. Many other types of prostheses are used'
creation of a stoma, a permanent or semi-permanent opening in the body
arthrodesis - surgical connection ofadjacent bones so the bones can grow together into one. Spinal fusion
is an example of adjacent vefiebrae connected allou,ing them to grow together into one piece.
repair of a fistula, hernia, or prolapse
- other procedures, including:
. clearing clogged ducts, blood or other vessels
. removal of calculi (stones)
o draining of accumulated fluids
. debridement- removal of dead, damaged, or diseased tissue
Blood or blood expanders may be administered to compensate for blood lost during surgely. Once the
procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the
anesthetic agents are stopped and/or reversed, and the patient is taken off ventilation and extubated (if
general anesthesia was administered).

After completion of surgery, the patient is transferred to the post anesthesia care unit and closell'

monitored. When the patient is judged to have recovered from the anesthesia, he/she is either transferred to
a surgical ward elseivhere in the hospital or discharged home. During the post-operative period, the
patient's general function is assessed, the outcome of the procedure is assessed, and the surgical site is
thecked lor signs of infection. Post-operative therapy may inclu<ie adjuvant treatment sucir as
chemotherapy, radiation therap1,, or administration of medication such as anti-rejection medication for
tansplants. Other follorv-up studies or rehabilitation may be prescribed dr"rring and after the recovery
per-iod

u'hen he published Orthopaedia: or the Art of Corecting and preventing Deformities in Children in
1741.
Neurosurgery is the surgery focused on treating structural diseases and spinal column, the central
nervous system, and peripheral nervous system amenable to surgical intervention. Neurosurgeons
treat all of ttre same problems that orthopedic spine surgeons ffeat. The differences in the two

specialists with regard to spine surgery have to do with the detailed micro-surgical approach
learned in a neurosurgical training program. Neurosurgery generally has the longest training period
of all the medical specialties; in America, the neurosugeon must complete the eight years of premedical and medical education, a one year-long surgical internship (where this is not a part of the
residency), and five to seven years of neurosurgery residency. Many neurosurgeons pursue an
additional one to three years of traidng in a subspecialty fellowship (like pediatric neurosurgery.
epilepsy, tremor, or stoke ("functional") neurosurgery, microneurosurgery, endovascular or open
vascular neurosurgery or neuro-oncological surgery).
Ophthalmology is a branch of medicine which deals with the diseases and surgery of the visual
pathways, including the eye, hairs, and areas surounding the eye, such as the lacrimal system and
eyelids. The term ophthalmologist is an eye specialist for medical and surgical problems. Since
ophthalmologists perform operations on eyes, they are considered to be both a surgical and medical
specialty. The word ophthahnolog"y comes from the Greek roots "ophthalmos" meaning eye and
"logos" meaning word, thought or discourse; ophthalmology literally means "the science of eyes".
Podiatric surgery is a branch of medicine devoted to the study, diagnosis and treatment of
disorders of the foot, ankle and lower leg. Within the field of podiatry, practitioners can focus on
many different specialty areas, including surgery, sports medicine, biornechanics, geriatrics,
pediatrics, orthopedics or prirnary care. In many English-speaking countries, the older title of
"chiropodist" may still be used by some clinicians but is gradually falling out of use. In many nonEnglish-speaking countries of Europe, the title used instead of podiatrist may be "podologist" or
"podolog". The level and scope of practice may vary in these countries as compared in the US.
Urology (fiom Greek oflt'on, "urine" and -logia "study of') is the surgical specialty that focuses on
the urinary tracts of males and females, and on the reproductive system of males. Medical
professionals specializing in the field of urology are called urologists and are trained to diagnose,
treat. and manage patients with urological disorders. Both Urologists and General Surgeons operate
on the adrenal glands. Urology combines management of medicil (i.e. non-surgical) pioblemi suclr
as urinary tract infections and benign prostatic hyperplasia, as well as surgical problems such as the
surgical management of cancers, the correction of congenital abnormalities, and corecting stress
incontinence. Urology is closely related to, and in some cases overlaps with, the medical fields of
oncology, nephrology, gynecology, andrology, pediatric surgety, gastroenterology, and
endocrinology.

Description of surgical procedure

At a hospital, modern surgery is often done in an operating theater using surgical instruments, an
operating table for the patient, and other equipment. The environment and procedures used in surgery are
governed by the principles of aseptic technique: the strict separation of "sterile" (fi.ee of microorganisms)
things from "unsterile" or "contaminated" things. All surgical instruments must be sterilized, and an
instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile
[tanner, ol al]owed to touch an unsterile surface). Operating room staff must wear sterile attire (scrubs, a
scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask). and they
must scrub hands and arms with an approved disinfectant agent before each procedure.
Prior to surgery, the patient is given a medical examination and certain pre-operative tests. If these
results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure
is expected to result in significant blood loss, an autologous blood donation may be made some weeks
prior to surgery. If the surgery involves the digestive system, the patient rnay be instructed to perform a
bowel prep by di'inking a solution of polyethylene glycol the nigirt before the procedure. Patients are also
instructeci to abstain frorn food or drink.
In the pre-operative holding area, the paiient changes out ofhis or her street clothes and is asked to
confin:r the details of his or her surgery. A set of vitai signs are recorded, a peripheral iV lirre is placed,
and pre-operative rnedications (aniibiotics, sedatives, etc) are given. When the patient enters the operating

Materials in Dentistry
ADA/FDA

or with an alloy'
An amalgam is any mixture or blending of mercury with another metal
also may be a
Amalgam
not.
are
Most metals are soluble in mercury, but somJ (such as iron)
are commonly used in dental
solution of metal-like ion comple*ei, such as ammonium' Amalgams
creating- dental fillings using
fillings. For some centuries, dentists have been cleaning out decay and
The renowned
niiirg material tu.t ut titne chips, resig cork, turpeniine, gum, lead and gold leaf' been in wide
have
Amalgams
ptyririun Ambroise Par6 (1510 - 1590) ised lead oi cork to fill teeth.
material'
use since the mid-l80bs, when ittty became the first true standard filling
and.more durable than
Amalgams are used in dentistry because they are cheap, easy to use,
controversy'
n9!.without
is
this
many alteitatives. They are generally regarded as safe, though
copper'
3'6Yo
silver'
69'4%
Modern low-copper u-utgutnt hu6 u po*der component com-posed of
weighrThe
45o/o mercury by
26.2%tin, and 0.8Yo zinc;and they have a liquid component of 42Yoto
inegular volume' and then
any
fill
1o
packed
amalgam remains soft for a short time so ii can be
the chinese in the 7th
were
forms a hard compound. The first people to use amalgam to fill cavities
silver coins and mercury' This
century. In 1816, ergutt. Taveau developed a dentafamalgam from
for the silver to dissolve at any
earty a*Agam was fZ* in mercury and irad to be heated in order
Current dental amalgams contain
appreciable rate. More modern dental amalgams are mixed cold'
alloy' The gamma-2 phase is
copper to eliminate the gamma-2 phase oi th" silver-mercury-tin
dental amalgam has superior
weaker than the other fhases, so a high-copper, low-gamma-2
fillings are,considered safe by
strength. Though *.r.ury itself is a potlnt niurotoxin, amalgam
of neurological harm associated
most dentists. Recent runio* clinical tiials have found no evidence
treatment'-Still, some worry
with their use in children, examining a period of 5-7 years following
neurological effects. They point
about the difficulties of conclusivety exituoing the possibility of

in the studies; may be larger in a

out that such effects may be delayed beyond tlie period examined
predisposed to mercury sensitivity;
vulnerable subset of fatients, ,u"h u, those who are genetically
concerns are especially significant
or may simply have been losi in the noise of measurement. These
Thus, while-the studies cited
considering the tremendous number of patients with amalgam fillings.
harm for most patients,
provide sting evidence that there is little risk of large sCale neurological
people'
of
number
large
even a risk small enough to be easily missed could affect a

Historical Overview of Mercury Use in Dentistry

mercury (Hg) to fill
As early as the 7th century, the Chinese used a "silver paste" containing
and Europe observed that this
decayed teeth. Throughout tt. tniiaOt. Ages, alchemists in China
would quickly disappear as
mysterious silvery tiqiiO, extracted from cinnabar ore, was volatile and
Hg appeared to
,upo. when mildly heated. Alchemists were fascinated that at room temperature
the use of a
1800's,
early
the
By
,'dissolve,,powders of other metals such as silver, tin, and copper.
and France and it was
Hg/silver paste as a tooth filling material was being popularized in England
practitioners expressed
eventually introduced into NoJh America in the 1b30s. Some early dental
fracturing the
frequently
setting,
after
concerns that the Hg/silver mixture (amalgam) expanded
jaw
Other
closure'
tooth or protruding u6or" the cavity pr.purition, and thereby prevented qrop:l
widely recognized that
dentists were concerned about 1n.r.uiiuf poisoning, because it was already
and loss of motor coordination'
Hg exposure resulted in many overt side effects, including dementia
Surgeons and several
of
n! tA+S, as a reflection of these concerns, the American Society Dental
not to use
uintiut.j regional dental societies aclopted a resolution that its members sign a pledge
society were suspended for
amalgam. consequently, during the next decade some members of the
prevailed and
the ialpractice of using amalgam. But the advocates ol amalgarn eventually
in 1856' ln
disband
it
to
fcrcing
membership in the American SoJiety of Dental Surgeons cleclined,
of
advocacy
the
on
its place arose the American Dental Association, founded in 1859, based
the
to
tin was added
;;;;r; as a safe and desirable tooth filling materia-I. Shortly thereafter,
formula'
amalgam
previous
the
Hg/silver paste to counteract the expansion properties of

There were compelling economic reasons for promoting dental amalgam as a replacement
for the other common filling materials of the day such as c.rnenl lead, gold, u-nO tinfoit. Amalgam,s
introduction meant that dental care would now be within the financialmians of a much wider sector
of the population, and because amalgam was simple and easy to use, dentists could readily be
trained to treat the anticipated large number of new patients. By 1895, the dental amalgam mixture
of metals had been modified further to control for expansion and contraction, and the basic formula
has remained essentially unchanged since then. Scientific concerns about amalgam safety
initially
surfaced in Germany during the 1920's, but eventually subsided without a cleai resolution. At
ttle
present time, based on 1992 dental $anufacturer specifications, amalgam (at mixing)
typically
contains approximately 50% metallic Hg, 35o/o silver, 9%o tin, 6Yo copper, and a trace of zinc.
Estimates of annual Hg usage by U.S. dentists range from approximately'tOO,OOO kg in the 1970's
to 70,000 kg today. Hg fillings continue to remain the materialpreferred by 92o/oof U.S. dentists for
restoring posterior teeth. More than 100 million Hg fillingi are placed each year in the U.S.
Presently, organized dentistry has countered the controversy surrounding the use tf Hg fillings
by
claiming that Hg reacts with the other amalgam metals to form a "biologically inactive substance"
and by observing that dentists have not reported any adverse side effects in paiients. Long-term
use
and popularity also continue to be offered as evidence of amalgam safety.

Current views on amalgam

Since the 1990s, FDA and other government agencies have reviewed the scientific literature
looking for links between dental amalgams and health problems. To date, the agencies have found
no scientific studies that demonstrate dental amalgams harm children or adults. but we continue
to
review the literature and ask experts their opinions on the safety of dental amalgam. In September
2006, an advisory panel to the FDA reviewed FDA's research and heard pres=entations from the
public about the benefits and risks of mercury and amalgam. This was a combined panel of the
Dental Products Panel from FDA's Center for Devices and Radiological Health and the peripheral
and Central Nervous System Drugs Advisory Committee from FDA's Center for Drug Evaluation
and Research' The panel Eenerally agreed that there is no evidence that dental urulgar, .uus"
health problems in the majority of the population. However, the panel did raise concerns about the
lack of knowledge concerning the effects of dental amalgam on specific groups, including pregnant
women, small children, and people who are especially sensitive to mercury. During thJ meJting,
FDA presented a draft white paper that reviewed the scientific literature from 1997 tolhe present o}
the safety of dental amalgam. FDA asked the panel for its opinion on this paper. ihe panel
recommended that the FDA reevaluate the literature. Specifically, they wanted to tnow if theri
was
additional information available regarding the effects of dental amalgam on pregnant women, small
children, and sensitive individuals, and on exposure levels during iritiut ptu.J*ent or removal of
amalgam fillings. Dental amalgam fillings are very strong and durable, they last longer than
most
other types of fillings, and they are relatively inexpensive. These advantages shoulJ be weighed
against the possibility that dental amalgam could pose health risks that aie not yet scientifiJally
known' FDA is examining its regulation of dental amalgam alloy, and pr.-.n.uprulated dental
amalgam. To reduce possible allergic reactions from restorative materiali, r'Da is proposing
in
labeling guidance that the product's labeling list the ingredients in descending order of weighl
by
percentage and include lot numbers, appropriate warnings and precautions, fiandling
instnitions
and expiration dating. The labeling guidance will be most useful with new restorative materials.
While research, regulatory changes, and educational efforts are underway, the use of dental
amalgams in the U.S. is declining. Pediatric dentists, in particular, are using resin (plastic) FDA
cleared tooth-colored materials that are bonded to the tooth. They may reliase fluoride and
are
mercury-free. Other reasons for the decline in amalgam use includi incieasing use of sealants
and
community fluoridation. an expanding selection of fluoride-containing dental products, irnproved
oral hygiene practices, and greater access to dental care. With the improvemenr of altemative
restorative materials over the past few years, dentists increased their use of these products.

4S,i'{

DECIDUOUS AND PER},IANENT DEI{TITION

Humans are dyphyodont, which means they have two sets of teeth, one that erupts quite soon
after birth, and another set that starts erupting around the age of 6; these sets are known as the
deciduous and the primary dentition. Thi deciduous dentition is also known as primary, baby,
milk or lactal dentition. The term deciduous means 'to fall off.
There are twenty deciduous teeth (ten on the maxilla and another ten on the mandible) that are
classified into three classes: incisors, canines and molars.Decidrrous teeth are marked A to J for the
upper ones and K through T for the lower ones as seen from in front. This notation is 'clockwise',
similar to the one for the permanent teeth.
The time the deciduous teeth are used is much shorter than the time a person uses the
permanent teeth. For example, a person aged 70 spends about 97o/o of their life eating with the help
of their permanent dentition, as compared to only 6Yo withthe deciduous dentition.
The role of the deciduous teeth is crucial for the person's overall health, although they are
replaced over time. They ensure the proper alignment, spacing, and occlusion of the permanent
teeth.
The time each type of milk tooth is used varies: the deciduous incisors are f,mctional for
approximately five years, while the deciduous molars are used for about 9 years. The premature
lois of the second deciduous molar can be extremely detrimental to the alignment of the permanent
teeth.
Formation and eruption of deciduous dentition. The process of calcification begins during
the fourth month of pregnancy and by the end of the 6th month every single deciduous tooth has
begun calcification; this fact emphasizes the importance of proper nutrition during pregnancy.
Interestingly, the first permanent molars have also begun calcit-rcation at the time of birth.
Scientists have noticed the existence of an eruption pattern , which can be described as follows:
teeth have the tendency to erupt in pairs;
the first to erupt are the lower deciduous teeth, more specifically the lower
deciduous central incisors.
The eruption of the deciduous second molars completes the deciduous dentition by
the age of 2-2%.
Eruption dates are not fixed, they vary according to many criteria, including race, sex and mother's
social standing. If the teeth appear unusually early or late, the paediatrician or the dentist should
inquire about the family features (parents or siblings), since it is well known that the timing of
eruption'runs in families'.
The complete order of eruption is presented in the different textbooks as follows:
upper 7 Yzmonths;
- central incisor: lower 6 % months;
upper 8 months;
- lateral incisor: lower 7 months;
upper 12116 months;
lower 12116 months'
- first molar:
upper 16-20 months;
- canine: lower 16-20 months;
upper 20-30 months.
- second rnolar: lower 20-30 months;

The transition from deciduous to permanent dentition begins with the eruption of the four
permanent molars (at the back, right behincl the last 'milk' molars) and the lower pernanent central
incisors replacing the lower deciduous central incisors. The first permanent molars are often called

the "six-yeat molars" and are among the !'extra" permanent teeth because they don't replace any
existing primary teeth. They are the most important teeth for the correct development of adult
dentition since they help detennine the shape of the lower face and affect the position and health of
other pernanent teeth. The mixed dentition exists from approximately 6 yeari of age to 12 years of
age. During this period all the primary teeth loosen and fall out while the permanent teeth come
through in their'place. Up to the age of 13 years 28 out of the 32 permanent teeth will have
appeared. The full dentition of adult lftrman teeth is completed much later. The 4 last adult teeth
("third molarsl'), one at the back of every side of each jaw will appear between 17 -21 years. Due to
their late eruption these pernanent teeth are also called wisdom teeth. Because their position in
the mouth, third molars often are not needed for chewing and are diffrcult to keep clean. Dentists
may sometimes recommend their removal to prevent potential complications when third molars are
erupted partially or are impacted.

Permanent denti-tion consists of 32 teeth (sixteen at the top and sixteen at the bottom jaw),
classified into four different teeth types
8 incisors
4 canines
8 premolars
12 molars.
The bones of the face grow during the period of tooth development. The jawbone normally grows
in size to accommodate the extra teeth. The jaws grow at a faster rate than the rest of the face, and
eventuaily measure up to 1i3 of the size of the face. This is a dramatic increase from the proportion
at birth. If the jaws do not grow sufficiently, the phenomenon of crowding or impacted teeth will
result. Crowding refers to the bunching together of teeth outside their normal alignment, causing
them to be irregular or crooked. This can affect the front or back teeth and can spoil facial
appear4nce and the smile, causing embarrassment and affecting the person's abilit_v to feed
normally and even to speak properly.
There are several causes for crowding, such as:

early loss of a deciduous tooth, that is, before the permanent replacement tooth is
ready to take its place, in which case an open space is left;
an adjacent tooth can drift into the open space, and cause an obstruction in the path
of the erupting permanent tooth; the latter one t will then be forced to grow and remain outside of
its normal position;
a mismatch of tooth and jaw size signi$ing that the teeth are too big for the
available space;
the development of supernrimerary teeth.

The frnal position of a tooth is determined by the action of the tongue, lips and cheeks. The tongue
exerts an outward pressure on the teeth, whereas the lips and cheeks provide a balancing inward force.
At the same time, teeth are prevented from growing longer by their contact with teeth in the opposite
jaw. Other influences are thumb-sucking and tongue-thrusting: the outward pressure of a thumbsucking habit pushes the upper front teeth and jaw forward and out of alignment, while the strong
forward thrust of the tongue can force teeth out of position. This happens when an adult continues the
swallowing patterns of childhood.

,E

PORCELAIN
Curs de Lb. Ensleza ptr Facultatea de Stomatologie
Porcelain is considered by many to bewilthptlt.peer as,a material
for restoring the crowns of
anterior teeth, and also for ttre ptrtions of bridgb porti"r
tissue. Highty
glazed porcelain is probably mo.e compatible riitfi
,han any other dental material and is
also one ofthe most esthetic in appearunr". '
"ruirisr.

*r,iJr,';ffi;;il;

d;#r

Porcelain is a ceramic material made by heating selected and

refrned materials, often
including clay, to high temperatures. TIre
materials
foipoicetain,
when mixed with water, form
raw
1-ilastic body that can be worked to a lequired st upe urroiJr"ing in a kiln at temperatures between
1200'C and 1400"cassociatid with porcelain includi Iow permeabrrity,-rugr, *rrgrir,
$onertigs
hardness, high durabifitr, whiteness,'translu"rrC", ,"ron*r.,
brittleniss, high resistance to the
passage of electricity, high resistance to chemical
ittack, high resistance to thermal shock and high
elasticity.
composition and characteristics of porcetain
Dental porcelain is made up of sev.rul-forns of silica notably kaolin (aluminum
silicate)
and feldspar (potasssius aluminum silicate) uto* ;6 r";;;; binders
and pigments or coloring
agents. The porcelain powder is combined with distilled water
to a puffylike consistency which is
applied to the platinum matrix.
When the matrix with its veneer of porcelain is fired in the furnace at a prescribed
temperature, a reaction occurs which fuses it into a very hard mass.
A notable characteristic of
porcelain is the fact that it shrinks as much as 40 per r"rt of its volume
when it is .,fired,, in the
filrnace. Unless this shrinkage is compensated for in the technique, the restoration
may be short at
the margins and there may be air spaces of voids in the fused porcelain.
This is one reason it is built up to contour gladually and fired several times in the process.
Good technique requires that the porcelain remains wet during its manipulation,
but after it has been
applied to the matrix as much water as possible must be remoied to insure hard
dense porcelain free
from voids.
To further remove moisture, the matrix with newly applied porcelain is allowed to set in
front of the oven for a few minutes before it is placed in the oven.
Another characteristic of porcelain is that it tends to crack or qaze if it is subjected to
a
sadden temperature change, For this reason it is never removed directly from the
oven and cooled to
room temperature. Instead the oven is cooled down to approximatety iOOO degrees
F at which point
the crown is removed and cooled under a Pyrex dish. This markediy slows tf,e rate
of cooling and
minimizes the possibility of crazing.
Types of Dental Porcelain
Porcelain is classified as low, medium, or high fusing based on the temperature required
to
fuse it' Low fusing (1600-2000 degrees F) is used mainly fir building up contacts and
modif,ing
the contours of porcelain pontics which
lave previously been completely fused. Medium nrsing
porcelain which fuses between 2000 an!2400
F, and high fusing poicelain above 2400 degrees F
are both used for the fabrication of crowns, inlays and Lridges. Because of the high temperature
required to fuse porcelain a special oven with extremely u""urut" temperature controls
is required.
Porcelain Glaze
- When porcelain is brought up to its fusing temperature it acquires a glazed translucent
surface. This highly glazed surface is often lost whin a porcelain tooth or facin! must
be ground.
When this happens ttre original highly glazed surface can be restored with a rp""iully manufactured
glaze, which is made for this specific purpose. The glaze is painted on witi a brush,
vibratecl to
eliminate the brush marks, and fired at the temperature recommended by the manufacturer.
Porcelain Stains.
Special stains are marketed which can be used to proiluce lifelike stains in porcelain crown.
They are available in a wide range of colors, from opaqui to black. The powders are blended with

{&:''-

effect. This is painted on th; crown

liquids provided by the manufacturer to produce the desired
temPerafure'
uft", its third or final bake, and fired in the furnase at the recornmended

rINE STRUCTURES

OF TIIE DENTAL

PILP

Curs de Lb- Engleza ptr Facultatea de Stomatologie

from the. connective tissue of

The dental pulp is the so& iissue qf the tooth, whic! develops
pulp
containing m! Aen?l .pulp It called the
the dental papilla. Within thg..crown, ,#;ilili
the apical foramen' The
tf,1.".n1o
chamber. The pulp contains blo"4,-r5t*is ,*a n9*""
lToogt'
Withii the root is th9 rldicular pulp.
prfp is wiihin the cr
teeth'
""[r"iEach person fr* a'toaf of,52 putp organt, 32. l the perm'anent and 20 in the primary
adult
is 038c1 and th9 mean vorume of a single
The total volumes
coronal pulp with three short
"frriri.T"**.firiletrr"organs shovel shaped
^has
human pulp is 0.02cc. Maxillari'centraii;t6iil
the longest pulp with ellipical
cuspid
horns on the coronal roof and triangular i, ,iorsr""tion,
pulp.
cross section. crowns of the teeth contain coronal
mesial, the buccal, the lingual and the
The coronat pii't;r ril<"rrrr;lri ir,, o"rtmul, th"
the pulp becomes smaller with age' This is not
floor. Because of continuous deposition oi a.ntin,
f."tt:t dl the floor than on the roof or side walls'
uniform throughout the ooronal pulp but p.ogr.tt.t
They
cervical region of the crown to the root apex'
Radicular pulp is that pulp extending to* it "
,"t atwayt straight but vary in shape , size and number'
"i" The radiculu.'ftrtion is continuous with the peiiapica-l tissues through the apical foramen or
radiculai purp into the periapical connective tissue'
foramina. Apical forimen is the openirg oitt"
a
U" two or m-ore foramina separated by
There
The average size i, O: to 0.4 mm in dilmeter.
"unMost infections spread through the apical
portion of dentin and cementum or by cementum onry.
pulp or from-the pulp 19 periapical.tissue' Accessory
foramen from the periapical tissue to the
prrp, exlerding iateialty-through the dentin to the
canals are pathways from the radicul..
of the root'
oeriodontal iissue seen especially in the apical third
' Iilt"rrelationship of nerves and blood vessels can be studied in the dental pulp with littleof
Pulp tissue contains numerous nerves and vessels
-urO
interference from oiher tissue elements.
ipu.rely cellular gelatinous matrix' Graf made a
varying size suspended in a fibrous
pulp cross
human dental pulp and reported that a
quantitative stuOy oi the types of nerves in the
and 10 in
I
between
separate nerve fibers, varying
section contains approximately one thousand
who
Provenza'
by
size-of anerioies in dentat pulp has been measured
-r;;ing
diameter. rn, **i*rm
and
up to- 100. The adveniitia of the arterioles' metaarterioles'
reported diameters
of nerve fibers and by the adjacent interstitial
precapillaries were obtiiera:ted-by dense bundres

titto"srooth

described by light microscopists

nerval innervation by autonomic fibers is generally
of the
on the surface or within the sarcoplasm
as a plexus of unmyelinated nerves that terminate
urinary
mammalian
in
and muscular elements
muscle fibers. connection between the nervous
with the electron microscope by Geaser. These
bladder and in the ureters were examined
muscle
contacts between the cytolemma of the smooth
neuromuscutar structures consisted of simple
was seen to be
Smooth muscre tissue in these preparations
and the lemnobrast of autonomic fibers.
of a syncytial arrangement'
and no evidence was obtained in support
".irru,Electrophysiologic and pharm*ofogi" Outu indi"uie the vas6motor rule of the autonomic
Uutit for the vasodilator and vasoconstrictor
fibres, but they Ao riot indicate th" ;#;h"t,ogi.
ti'is laboratory which indicates the presence of
mechanismr. putu- rrur"- i""n collected'in
the mandibular nen/e'
sympathetic vasoconstrictor fibers in
the
microscope for the study of slructures in
The present irr"rrGuti* utilizes the electron
of nerve
the blood vessel nerve complex. The fine strucfure
dental ptrlp and pu.ti*ru,"rv emphasizes
tone'
define the structures which mediate vasomotor
types was ,ru*rn"Ji, u, utt.mpt to

The aetiology and classification of malocclusion

:1 ,

^*,"{l,ii?{:{{ff1[!i[fi{]fi;

The development of ocilusion begins with the eruption of the primary teeth. Usually the first
teeth to erupt are the central incisors, with the mandibular teeth erupting slightly before the
maxillary. The eruplion of the Ialeral inci5ors, which occurs next, follows tte sameiequence.
At 16 months the primary mglars'erupt. The primary molars establish tle vertical height of
the primary occlusion. The developmetit:of the occlusion is further influenced by hereditary factors
such as congenitally missing teeth, impaCted teeth, or the size and shape of muscle and bone.
Conhollable factors that also affect occlusal development include the premature loss of deciduous
teeth, decayed teeth that where restored, and harmfulhabits.
Horizontal alignment.
After the teeth erupt into the oral cavity, the tongue acts as a huge internal force, pushing the
teeth toward the lip and cheeks. The bblance or reiative equilibrium between the tongue and the
facial muscles allows the teeth to be brought into proper afignment and to be maintained in their
proper positions once they have erupted. If the balance of forces is disturbed, a malocclusion or an
abnormal alignment of the teeth within the dental arches can result. The lip, tongue, and cheek
muscles and their relationship to one another are not the only factors that determine the alignment
of the teeth. The intercuspation of the teeth helps prevent tooth deviations in a buccal or lingual
direction. The maxillary posterior teeth have a buccal and a lingual cusp, and when the jaws are
closed, the buccal cusps of the mandibular posterior teeth are interlocked between the buccal and
lingual cusps of the maxillary teeth.

Vertical alignment.
The teeth are not positioned straight up and down in the mouth. The mandibular posterior
teeth have a tendency to tip their crowns straighter but with a slight buccal inclination, as well as a
Iingual inclination of the root. From a lateral view, all the teeth, maxillary and mandibular, anterior
and posterior, show a slight mesial inclination, with the possible exception of the maxillary third
molar. The anterior teeth have a slight labial protrusion, and from a frontal view their crowns seem
to incline laterally. In other words, the anterior teeth tip out to the side and toward the front.
1. The aetiology of malocclusion
There is still much to elucidate and understand about. At a basic level malocclusion can occur
as a result of genetically determined factors which are inherited, or environmental factors, or more
commonly a combination of both inherited and environmental factors acting together. For example,
failure of eruption of an upper central incisor may arise as a result of dilacerations following un
episode of trauma during the deciduous dentition which led to intrusion of the primary predecessorand an example of environmental aetiology. Failure of eruption of an upper central incisor can also
occur as a result of the presence of a supernumerary tooth-a scenario which upon questioning may
reveal also afflected the patient's parent, suggesting an inherited problem. However, if in the latter
example caries (an environmental factor) has led to early loss of many of the deciduous teeth, then
forward drift of the first permanent molar teeth may also led to superimposition of the additional
problem of crowding.
While it is relatively straightforward to trace the inheritance of syndromes such as cleft lip
and palate, it is more difficult to determinate the aetiology of features which are the essence part of
normal variation of the picture; it is further complicated by the compensatory mechanism that
exists. Evidence for the role of inherited factor in the aetiology of malocclusion has come from
studies of frmilies and twins. The facial similarity of members of a family, for example the
prognathic mandible of the Habsburg Royal Family can easily appreciated. However more direct
testimony is provided irr studies of twins and triplets which indicate that skeletal pattern and tooth
size and'irumber are largely genetically determined.

, &*".|

r:l.-..i; : Et'up.--let- 9f environmental influences include digit-sucking habits and premature loss
of
teeth can also influence tooth position' crowding ir
common in the caucasians, afitecting
applgximately a third of the population. As was mention"a
"*t ".i"ty
uior. the size of the jaws and teeth.are
malll genetically determined; however, environmental factors,
for example premature deciduous
loss canprecipitate or exacerbate crowding. In evolutionaryterms
{oth
both jaws size and tooth
size appear to be reducing. However, crowding iI much
moil prrrut"nt in
i', *T in p.rehistorical time. It has Leen postulated that this
is due to the introduction of a less
abrasive diet, so that less llterproximal tooth wear occurs
during the lifetime of an individual.
However this is not.the whole story,- as a change from
a rural-to an urban lifestyle can also
apparently lead to an increase in crowding after seviral generations.
Although this discussion may at first ieem rathi theoretical,
the aetiology of malocclusion
is a vigorously debated subject. Ttris is because if one u.ti"u"r
that the basis of malocclusion is
genetically determined, then it follows that orthodontics
is Iimited in what it can achieve. However
the. on-Rolite- view Pgint l.s that every individual has thl
fotential for ideal occlusion and that
orthodontic intervention is required to eliminate those eniironmental
factors that have Ied to a
particular malocclusion' Research suggests thatlor ttre
majority of malocclusions ttre aetiology is
multifactorial, and orthodontic treatnent can affect only limitid
skeletal
Therefore,
patient's skeletal and growth pattem is Iargely genetically
"il;;. treatment isastoa
deiermined, if orthodontic
be successful clinicians must recognize aidwJrk within
those parameters. of necessity, the above
is a brief summary, bul it.can be appreciated that the aetiology
of malocclusion is a complex
subject, much of which is still not fully understood. The reader
r.eking more information is advised
to consult the publications listed in the section of further reading.
2. C las s ify ing malo ccl us io n
The categorization of malocclusion by its salient features is helpful
for describing and
documenting a patient's occlusion. In addition, classifications
and indices allow the prevalence of a
malocclusion within a population to be recorded and also aid in
the assessment of need, difficulty
and success of orthodontic treatment.
Malocclusion can be recorded qualitatively and quantitatively. However
the large number of
classifications and indices which have been deviied are testimony
tt the problems inherent in both
these approaches. All have their limitations, and these should
Le borni in mind when they are

modern;;ilffi;#

applied.

Two terms are often mentioned in relation to indices:

o validity - can the index measure what it was designed to measure?
o Reproducibility - Does the index give the same result
when recorded on two
different occasions, and by different examiners?
a)QUALITATIVE ASSESSMENT oF MALOCCLUSION
-. Essentially,-a qualitative assessment is descriptive and therefore this category includes the
diagnostic classifications of malocclusion. The main drawback to qualitative'approach
a
is that
malocclusion is a continuous variable so that clear cut-offpoints betwe",
diff"r.rt categories do not
always exist. This can lead to problemt yh.l classifiing borderline
-utor.irlions. In addition,
although a qualitative classification is a helpful shonhandirethod
of describing the salient features
of a malocclusion, it does not provide any indication of the difficulty of treatm#t.
-historically
Qualitative evaluation of malocclylion was attempted
ilefore quantitative
analysis. One of the better known classifications was devised by
A;;i;
in--tsgq, but other
classifications are now widely used, for example the British Standards
Institite (1s93) classification
of incisor relationship
b)QUANTITATIVE AS SES SMENT OF MALOCCLUSION
In quantitative indices two differing approaches can be used:
-each feature of malocclusion is given a score and the sum total is
then recorded (e.g. The
PAR Index).
-the worst feature of malocclusion is recorded (e.g. The Index of Orthodontic
Treatment
Need).

Diagnosis and Treatment Planning

I
British Dental Journal

There are many causes of facial pain and the differential diagnosis can be both difficult and
demanding. All the:relevant information must be collected; this includes a case history and the
results of both a clinical examination and diagnostic tests. Only at this stage can the cause of the
problem be determined and thetreatment for the patient planned.
Case history
The purpose of a case history is to discoger whether the patient has any general or local condition
that might alter the normal course of treatnent. In addition, a description of the patient's symptoms
in his or her own words and a history of'relevant dental treatrnent should be noted.

Medieal

history

'

..

There are no medical conditions.which specifically contra-indicated endodontic treafinent

but there are several which require special care . If there is any doubt about the state of health of a
patien! hisiher general medical practitioner should be consulted before any endodontic treatment is

commenced. This also applies if the patient is on medication, such as corticosteroids or an

anticoagulant
Antibiotic cover is recommended for certain medical conditions, depending upon the
complexity of the procedure and the degree of bacteraemia expected, but the type of antibiotic and
the dosage are under continual review and dental practitioners should be aware of current
views..Patients who are predisposed to endocarditis and are given a prophylactic antibiotic should
be advised to report even a minor febrile illness which occurs up to 2 months following endodontic
treatment. Prior to endodontic surgery, it is useful to prescribe aqueous chlorhexidine (02%)
mouthwash.
Patient's complaints
Listening carefully to the patient's description of his/her symptoms can provide invaluable
about
information. It is quicker and more efficient to ask patients specific, but not leading, questions
*
their pain. Examples of the type of questions which may be asked are given below.
l. How long have you had the pain? 2. Do you know which tooth it is? 3. What initiates the
pain? 4. How would you describe the pain - sharp or dull/ throbbing/ mild or severe /
localized or radiating? 5. How long does the pain last? 6. When does it hurt most? During
the day or at night? 7. Does anytting relieve the pain?
It is usually possible to decide, as a result of questioning the patient, whether the pain is of
pulpal, periapical or periodontal origin, or, that it is non-dental in origin. It is not possible to
diagnose the histological state of the pulp from the clinical signs and symptoms. In cases ofpulpitis,
the decision the operator must make is whether the pulpal inflammation is reversible, in which case
it may be treated, or irreversible, in which case the pulp or tooth must be removed.
In early pulpitis the patient cannot localize the pain to a particular tooth or jaw because the pulp
does not contain any proprioceptive nerve endings. As the disease advances and the periapical
region becomes involved, the tooth will become tender and the proprioceptive nerve endings in the
periodontal ligament are stimulated.
Clinical examination A clinical examination of the patient is carried out after the case history has
been completed. The temptation to start treatment on a tooth without examining the remaining
dentition must be resisted. Problems must not be dealt with in isolation and any treatment plan
should take the entire mouth and the patient's general medical condition and attitude into
consideration.
Extra-oral examination The patient's face and neck are examined and any swelling, tender areas,
lymphadenopathy, or exta-oral sinuses noted.
Intra-oral examination An assessment of the patient's general dental state is made, noting in
particular aspects like: l. Standard of oral hygiene.2. Amount and quality of resiorativelvork. 3.
Prevalence of caries.4.Missing and unopposed teeth.5. General periodontal condition.6. Presence

rq.

of soft or hard swellings. 7. Presence of any sinus tracts. 8. Discolored teeth. 9. Tooth wear

'
,:

and

facets.

Diagnostic tests Most of the diagnostic tests used to assess ttre state of the pulp and periapical
tissues are relalvely crude and unreliable. No single tes! however positive the risuit, is suffrcienf to
,,,,{ake a firm diag4osis of reversible or irreversible pulpitis. There is a general rule that before
drilling'into a pulp chamber there should be two independent positive diagnostic tests. An example
wouIdbeatoothnon-vitaltotheelectricpulptesterandtendertopercussion.
Palpation The tissues overlying the apices of any suspect teeth are palpated to locate tender areas.
' The site and size of any soft or hard swellings are noted and examined for fluctuation and crepitus.
,, Percussion Gentle tapping with a finger 6oth laterally and vertically on a tooth is sufficient to elicit
any tenderness. It is not necessary to strike the tooth with a mirror handle, as this invites a false
positive reaction from the patient.
Mobility The mobility oi a tooth is tested by placing a finger on either side of the crown and
pushing with one furger while assessing any movement with the other. Mobility may be graded as:
l-slight (normal), 2-moderate, and 3- extensive movement in a lateral or mesiodistal direction
combined with a vertical displacement in the alveolus.
Radiography In all endodontic cases, a good inta-oral parallel radiograph of the root and
periapical region is mandatory. Radiography is the most reliable of all the diagnostic tests and
provides the most valuable information. A routine radiograph may be the first indication of the
presence of pathology. The disadvantage of radiography is that the early stages of pulpitis are not
normally evident on the radiograph.
If a sinus is present and patent, a small sized gutta-percha point should be inserted and
teased, by rolling gently between the fingers, as far along the sinus tract as possible. A radiograph
taken with the gutta-percha point in place will often show the cause of the problem.
Pulp testing The electric pulp tester is an instrument which uses gradations of electric current to
excite a response from the nervous tissue within the pulp. Both alternating and direct current pulp
testers are available, although there is little difference between them. Most pulp testers
manufactured today are monopolar
Pulp testers should only be used to assess vital or non-vital pulps; they do not quantiff
disease, nor do they measure health and should not be used to judge the degree of pulpal disease.
There are several disadvantages to electric pulp testing. No indication is given of the state of the
vascular supply which would indicate more accurately the degree of pulp vitality, false positive
readings occur due to stimulation of nerve fibres in the periodontium, and, finally, posterior teeth
may give misleading readings since a combination of vital and non-vital root canal pulps may be
present.

The use of gloves in the treatment of all dental patients has produced problems with electric
pulp testing. There is a lip electrode attachment available which may be used, but a simpler method
is to ask the patient to hold on to the metal handle of the pulp tester. The patient is asked to let go of
the handle if they feel a sensation in the tooth being tested.
Doubt has been cast on the efficacy of pulp testing the corresponding tooth on the other side
of the mid-line for comparison, and it is suggested that only the suspect teeth are tested. The teeth to
be tested are dried and isolated with coffon wool rolls. A conducting medium should be used; the
one most readily available is toothpaste. Pulp testers should not be used on patients with
pacemakers because of the possibility of electrical interference.
Teeth with full crowns present problems with pulp testing. A pulp tester is available with a
special point fitting which may be placed between tle crown and the gingival margin.
Thermal pulp testing involves applying either heat or cold to a tooth, but neither test is particularly
reliable and may produce either false positive or false negative results.
Overdenture Decoronated teeth retained in the arch to preserve alveolar bone must be root-treated.
Risk of exposure
Preparing teeth for crowning in order to align them in the dentai arch can risk traumalic
exposure. In some cases these teeth should be eiectively root-treated.

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Periodontal disease
In multi-rooted teeth there may be deep pocketing associated
with one root .The possibility
of elective devitalisation following thJ resection io a ,ooi'should
be considered.
Pulpal sclerosis following trauma
Review periapical radiographs should be taken following trauma.
If progressirc
the pulp space is ieen due tJ secondary dentine, elective
"uoo*ing
endodontics
may be considered
9f
while
ttre coronal portion of the root canal is stiil patent.'n ir *uy
occasionally apply after a pulpotomy
has been carried out.

Contra-indications to endodontics
Several medical conditions require special precautions prior to
endodontic treatrnent. They
can be classified-as general (like inadequatt ir"r.r, poor oral
hygiene, the paiient,s general medical
condition or his/her attitude) and local (like a tooth which is noirestoraute,
insumcient periodontal
support or root fractures).
Reroot treatment

One problem which confronts the general dental practitioner is

to

decide whether an

inadequate root treatment requires replacemint. The questions the

operator should consider are

given below
1. Is there any evidence that the old root filling has failed? A. Symptoms from the tooth. B.
Radiolucent area is still present or has increasid in size. C. presenci
of sinus tract.
2. Does the crown of the tooth need restoring?
3. Is there any obvious fault with the preseniroot filling which could lead to failure?
The final decision by the operator- on the treatment ptan for a patient will
be governed by the
level of his^rer own skill and knowledge.- General dentai practitioner
cannot become experts in all
fields of dentistry and should Ieam to be aware of their own limitations.
The treatment plan
proposed should be one which the operator is confident he/she can
carry out to a high standard.
Table I
Example of medical history questions for a patient's folder
Medical history
Rheumatic fever
If yes, is there any cardiac damage
Hypertension or cardiac disease
Allergies
Hepatitis
Pregnant
Upper resp. tract infections
Taking any drugs now: Anticoagulants; Steroids; Insulin; Tranquillizers;
other
Under treatment by GP or hospital
Serious illness in the past 3 years.

Further medical history

Table
Some medical conditions relevant to endodontic treatment and the precautions
which should be taken by the dentist

II

Medical condition

History

of

infective

endocarditis

Congenital

Precautions taken

Regarded as special high risk gro,

treatment Antibiotic cover required.

cardiac

abnormality

Rheumatic fever or

Consider antibiotic cover (Table III)

Consider antibiotic cover.

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Sydenham's chorea
Patient's cardiologist to advise antibiotic cover

Artificial heart valves

Prosthesis

for

total

replacement of ajoint

Consider antibiotic cover (advice from ordropedist varies)

Cardiovascular disease

GMP to advise alteration of drug therapy Non-surglcal endodontics preferred

Analgesics to reduce post-operative pain. Appointments not to exceed t hour

Hypertension

GMP to advise alterati*n of drug therapy. Non-surgica rOo n

Analgesics to reduce post-operative pain. Appointments not to exceed

Blood

disease

(haemophilia)

Patients

Root canal treatnent preferred to extraction. No local anesthetic

of devitahzrng pastes. Care taken not to lacerate gingivae.

hour.

if possible.

Use

on

GMP to advise.

on

200 mg oral 2 hours pre-operatively or double dose night before and on day of
operation.

anticoagulants

Patients
corticosteroids

(currently

or

during

past 12 months)
Diabetes

No general anesthetic if possible. Glucose kept in surgery. Healing will be

retarded Antibiotic cover if surgery intended or infection presents GMP to advise
any alteration of patient's drug therapy.
Hepatitis

Dangers:

1.
2.

Operator contracting disease.

Cross-infection via contaminated instruments. GMP to check if patient
is carrier.
Treat with caution:
i. Rubber gloves mask and giasses.
2. Low-speed instruments.
3. Dispose of instruments which may pick up microorganisms, eg files,

4.
5.

burs, etc

Wash down operating area with 2% glutaraldehyde solution and place

all instruments.etc, used on patient in the same solution for t hour
before sterilisation.
Treat at end of day.

Chronic renal failure

Take all precautions to prevent hepatitis cross-infection

if

patient on kidney

machine

Antibiotic cover if infection present. Possible corticosteroid supplement by GMP

Irnmunosuppressed

states: Patients

on

during and after endodontic treatment.

corticosteroids or
drugs to maintain
organ transplants

Radiotherapy

for

Any extractions necessary carried out before radioth erapy to prevent intractable

malignant disease

radionecrosis. Root canal treatment preferred to extraction after therapy.

Other

Patient could be sensitive to drugs: only prescribe drugs which patient has taken
previously

debilitating

i.e. asthma,
hay fever and skin
diseases,

rashes

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Dentalfmplants
AOe to,or;ii',

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'

Dental implants are artificial titanium fixtures, similar to those used in orthopedics, *fri"t, *i1'

, ' - placed surgically into the jaw bone to substitute for a missing tooth and its root: ,,,. '. Implants are very durable and will last many years. They can help restore ahno$ anyonels

smile even if natural teeth have been lost to injury or disease.

A very common reason why implants are beconiing more and more widely used is because a
, :-.i. .
-': -,:, sliding lower denture makes chewing and'talking difficult. hnplants can replace individual teetr and
.,,,' partial bridges in both the upper and lower jaws. Their success rate is remarkable:98 per cent for
lower implants and 91 per cent for upper implants.
The loss of one or several teeth generally tiggers various changes over time. The fust may be
that the person does not smile as much or as widely as they used to. Then they may realize that
chewing apples, crackers or other food is a thing of the past. Lastly, and normally noticed by the
dental professional rather than the patient, teeth begin to shift. When the whole tooth is lost
shrinkage of the jawbone may occur making th fage look older. Sometimes this is also associated
with muscle strain, the inability to speak clearly, and headaches.

Effects of tooth loss

The effect of tooth loss varies from person to person and depends on what exactly has been
lost. Losing the crown, for instance, mans losing the visible, outer part of the tooth, whereas losing
the root means losing the unseen, inner part of the tooth.
The root anchors the tooth in the jawbone, providing stable support for the crown. Without the
root, the bone around the lost tooth may gradually recede, rernaining teeth shift and chewing may
become more diff,rcult wittr time.
There is a variety of ways to replace tooth crowns. But for replacing the entire tooth - crown
and root - the most obvious option is the dental implant.
3

Short history
Quite interestingly, dental implants are not as new as we might think; they have been
perfonned for thousands of years. Egyptian mummies have been found with gold wire implants in
the jawbone. Pre-Columbian skeletal remains exhibit dental implants made of semi-precious stones.
Recently, a Roman soldier with an iron dental implant in his jawbone was unearthed in
Europe. Iri'tlie-Middle East; implants made of ivory have been discovered in skeletons from the
Middle Ages.
Modern implantology dates back at the beginning of the 20th century. However, it became
popular in the i980s with the increased success of the titanium cylinder. Since then many types of
implants, with minor variations, have been in use.
Advantages

of dental implants

Dental implants are said to have many advantages over other types of restorative work.
Firstly, they can be applied to anyone, irespective of age as long as there is enough bone available
in which to place the implants. Of course, the better the quality of the bone the greater the chance of
Iong-term success.

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Dental specialties
1. Oral medicine

a. involved in the assessment of dental health needs and

improving the dental health of populations rather than
individuals.

2.

of the dental pulp.

h. Root canal therapy and study of diseases

Special needs dentistrY

3. Periodontics

c. Extractions, implants, and facial surgery.

4. Pediatric dentistry

d. The straightening of teeth and modification of midface and

mandibular growth.

(Pedodontics)
5. Oral and rnaxillofacial
surgery

e. Study and treatment of diseases of the periodontium (nonsr-rrgical and surgical) as well as placement and maintenance

of dental implants.
6. Orthodontics

f. The branch of dentistry dealing with children from birth

thror-rgh adolescence.

Dental public health

8. Prosthodontics

g. T6e dental specialt,v pertaining to the diagnosis, treatment

planr-ring, rehabilitatior-r and maintenance of the oral function,
comfort. appearance and health of patients with clinical
copclitions associated .with missing or deficient teeth.

h. The specialty of dentistry that deals with the mallagement of

pain through the Lrse of advanced local and general anesthesia
techniqLles.

9. Dental anesthesiolog)'

10. Endodontics

i. The dental specialt,v placecl at the interface between medicine

and dentistry. is concerned w'ith clinical diagnosis and nonsurgical management of non-dental pathologies affecting the
oral and maxillofacial region.

j. A specialty of dentistry concerned with the oral health of

people who have intellectual disabilitl,-, or rvho are affected
by' other ntedical. ph),sical, or psychiatric issues.

al.
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1,

Match the terrns lYith the descriptions

a.

Dilaceration

::

l. A collection of pus that has accumulated in a caviqv

formed by the tissue in which the pus resides on the
basis of an infectious process or other foreign
materials

b. Scaling

2. Arare genetic disorder charac terizedby the

congenital absence of all primary or permanent teeth

c. Nightguard

3. Opening at the apex of the root of a tooth through

which the nerve and blood vessels that supply the
dental pulp pass

d. Inlay

4. Dental restoration used to replace a missing tooth by

joining permanently to adjacent teeth or dental

implants. Also known as fixed partial denture
e. Debridement

5 " A type of dental restoration rvhich cornpletely caps

or etlcircles a tooth or dental irnplant. Often used to
irnprove the strength or appearance of teeth

f. Crolvn

6. Medical removal of a patient's dead, damaged, or

inftcted tissue.io iiriprove the irbaiing potential of tire
rernaining healthy tissue. Removal may be surgical,
mechanical, chemical

g. Abscess

7.

h. Dental bridge

8. Indirect restoration (filling) consisting of a sotid

substance (as gold or porcelain) fitted to a cavity in a
tooth and cemented into place

i. Apical foramen

9. A protective device for the mouth that covers the

teeth and gums during the night to prevent and reduce
injury to the teeth, arches, lips and gums. It is used as
a treatment for bruxism.

j. Anodontia

10, The removal of plaQUe, calculus and stain frorn the

crown and root surfaces of teeth. It can be perfonned
with hand instruments or with an ultrasonic device

A developmental disturbance in shape of teeth. It

refers to an angulation, or a sharp bend or curve, in the
root or crown of a formed tooth

Dentpl instrumerlts

ll:Try

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A. Mouth milTor

F. Dental forceps

B. Scissors

G. Spatula

C. Periodontal probe

H. Scalpel

D.Tongue Retractors

I. Drill

E. Probe

J. Cheek retractor

DE]\TAL VOCABULARY
Match the terms witlt the definitions
l.abrasion
2.abscess

3.abutment

4,alveolar bone
5.analgesia
6.anesthesia
'7

.attrition

S.biopsy

9.bleaching
10. braces

devices used by orthodontists

alignment

to gradually reposition teeth to a more

favorable

a. loss of tooth structure caused by a hard toothbrush, poor brushing technique, or

bruxism (grinding or clenching the reeth).
e. a state of pain relief; an agent lessening pain

i. chemical or laser treatment of natural teeth for whitening effect

b. an infection of a tooth, soft tissue or bone
c. tooth or teeth that support a fixed or removable bridge
h. removal of a small piece of tissue for microscopic examination
d. the jaw bone that anchors the roots of teeth

g. loss of structure due to natural uiear

f.

partial or complete elimination of pain sensation; numbing a tooth is an example

local anesthesia, general anesthesia produces partial or complete unconsciousness

of