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Payment For Dental Care Definitions

Capitation

It is defined as a fixed monthly/ yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment

Table of allowances

It is defined as a list of covered services that assigns to each service a sum that represents the total obligation of the plan to payment for such service but that does not necessarily represent a dentist’s full fee for that service

Payment For Dental Care Important Notes

1. Mechanism of payment

1. Private fee for service
   • Two party arrangement
   • The most efficient way and structurally acceptable
   • Only system under which some form of dental care is likely to be provided
   • The system is flexible
2. Post-payment plans
   • Under this, patient borrows the money from a bank or finance company to pay the dentist’s fees
   • Used by middle-class and low-income group
3. Private third-party prepayment
   • Payment for services is by some agencies such as insurance company
4. Deductible
   • The stipulated sum that the patient must pay toward the cost of treatment
5. Coinsurance
   • The patient pays a percentage of the total cost of treatment
6. Group insurance
   • Health insurance is offered to groups.

2. UCR fee

1. U- Usual fee
   • The fee usually charged for a given service by an individual dentist to private patients
2. C- Customary fee
   • A fee is customary when it is in the range of the usual fee charged by dentists of similar training & experience for the same service within a specific & limited geographic area
3. R- Reasonable fee
   • A fee is reasonable if it meets the above two criteria

3. Table of allowances

• It is defined as a list of covered services that assigns to each service a sum that represents the total obligation of the plan concerning payment for such service but that does not necessarily represent a dentist’s full fee for that service
• If the dentist’s fee becomes more than that assigned to that service by the carrier, the remainder will be collected by the dentist from the patient

Payment For Dental Care Long Essays

Question 1. Describe the payment plan for dental care.
Answer:

Dental care Private Fee For Service:

• It is a two-way arrangement of reimbursement of dental services
• Dentists prefer to practice under this arrangement
• It is the most efficient way of providing dental care
• It is an integral part of private practice

Dental care Advantages:

• Culturally acceptable
• Flexible
• Simple
• Provide dental care

Dental care Disadvantages:

• Not affordable to some patients
• Thus they are unable to receive dental care

Dental care Post-Payment Plans:

• Introduced in the late 1930s by local dental societies in Pennsylvania & Michigan
• Under this arrangement, the patient borrows money from a bank/ finance company to pay the dentist’s fee
• After the application is approved, the dentist is paid the entire fee
• The patient then repays the loan to the bank in the budgeted amount

Dental care Disadvantages:

• It was planned for low-income groups but was used by middle-income group
• Also, low-income patients find it difficult to accept the use of credit by lending institution

Dental care Private Third-Party Prepayment Plans:

Dental care Definition:

• It is defined as “payment for services by some agency rather than directly by the beneficiary of those services”

First Party: Dentist

Second Party: the patient

Third Party: finance

• Third-party refers to a private carrier such as an insurance company

Dental care Types:

• Deductible
• Co-insurance
• Group insurance

Dental care Plans:

• Commercial insurance companies
  • Can be more selective
  • Claim no obligation toward dental health
  • Provide specific cash payment reimbursement
  • Present an attractive total health package
  • Do not conduct a post-treatment dental examination

Dental care Advantage:

Payment is quicker & hassle-free

Dental care Disadvantage:

• Do not encourage the utilization of professional services
• Allow for the profit margin
• Nonprofit health service corporation
• Delta dental plans: ensures that
  • The care claimed & paid for has been provided
  • It is of acceptable quality
• Blue Cross/Blue Shield
  • These have adopted many of the cost control features pioneered by Delta plans
• Prepaid group practice
  • Provides dental services on a prepaid basis

Types of Dental care :

• General practice groups
• Single specialty groups
• Multi-specialty groups

Dental care Capitation plans:

It is defined as a fixed monthly/ yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment

Dental care Salary:

Dentists in some group practices, those in the armed forces & those employed by public agencies are salaried

Dental care Advantages:

• Dentists will be largely free of business concern
• Attractive fringe benefits

Dental care Disadvantages:

Lack of financial incentive

Dental Care Public Program:

• Aimed at fulfilling the needs of specific groups of the society
• Sponsored by the government

Dental care Includes:

• Medicare
• Medicaid
• National health insurance

Payment For Dental Care Short Essays

Question 1. Delta dental plans (or) Third party payments (or) Mechanism/method of payment for the rental car
Answer:

Delta dental plans

• It is a legally constituted non-profit organization incorporated on a state-by-state basis & sponsored by a constituent dental society to negotiate & administer contracts for dental care
• They are usually subjected to the insurance laws of the state in which they are constituted

Dental plans Members:

• Dentist’s elected from the state
• Members from the world of finance, insurance, labor & consumer groups

Dental plans  Activities:

• Ensure the quality of care provided
• Keep the program’s costs within its limit
• Ensures the care claimed & paid for has been provided
• Encourage the utilization of services
• Meet the demand for group purchase of dental care

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Dental plans  Advantages:

• Control of cost
• Quality assurance
• Wide support from dental practitioners
• The patients know they will not have to pay extra for their treatment
• Encourage all dentists to participate

Question 2. Medicare.
Answer:

Medicare

• Title XVIII of the Social Security Amendments of 1965 is the program known as Medicare
• It removes all financial barriers to hospital & physician services for all persons aged 65 & over, regardless of their financial means
• It was brought into being because the voluntary health insurance system was unable to provide adequately for persons over the age of 65
• Because the income of persons aged 65 & older is less, they have limited funds to spend on healthcare
• It is limited to those services requiring hospitalization for their treatment, usually a surgical treatment for fracture & cancer

Medicare Parts:

• Part A: Hospital insurance
• Part B: Supplemental medical insurance
• Both contain a highly complex series of service benefits available
• Both require some payment by the patient

Payment For Dental Care Short Question And Answers

Question 1. Capitation.
Answer:

Capitation Definition:

It is defined as a fixed monthly/ yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment

Significance Of Capitation:

• These plans are not purchased by specified groups but an individual can buy in
• Many of these plans offer only limited services
• Risk is low
• These plans are attractive where there is an oversupply of the dentist

Capitation Plans:

• Closed panel
  • For beneficiaries of plans using closed panels choice of dentist is limited to panel members & the dentist must accept any beneficiary as a patient
• Open panel
  • The beneficiary has a choice from among all licensed dentists & the dentist may accept/ reject any beneficiary

Question 2. Post payments.
Answer:

Post payments

• Introduced in the late 1930s by local dental societies in Pennsylvania & Michigan
• Under this arrangement, the patient borrows money from a bank/ finance company to pay the dentist’s fee
• After the application is approved, the dentist is paid the entire fee
• The patient then repays the loan to the bank in the budgeted amount
• Disadvantages
• It was planned for low-income groups but was used by middle-income group
• Also, low-income patients find it difficult to accept the use of credit by lending institution

Question 3. Fee for services.
Answer:

Fee for services

• It is the two-way arrangement of reimbursement of dental services
• Dentists prefer to practice under this arrangement
• It is the most efficient way of providing dental care
• It is an integral part of private practice

Fee for services Advantages:

• Culturally acceptable
• Flexible
• Simple
• Provide dental care

Fee for services Disadvantages:

• Not affordable to some patients
• Thus they are unable to receive dental care

Question 4. Table of allowances.
Answer:

Table of allowances

• It is defined as a list of covered services that assigns to each service a sum that represents the total obligation of the plan concerning payment for such service but that does not necessarily represent a dentist’s full fee for that service
• If the dentist’s fee becomes more than that assigned to that service by the carrier, the remainder will be collected by the dentist from the patient

Allowances Disadvantage:

Patients are often unaware that the plan may not cover them in full for dental care

Question 5. Blue Cross & Blue Shield.
Answer:

Blue Cross & Blue Shield

• These are non-profit health service corporation
• It is limited to services provided in a hospital
• It showed no enthusiasm for dental prepayment
• It has adopted many of the cost control features pioneered by Delta plans

Question 6. 90th percentile.
Answer:

90th percentile

• The percentiles of a set of data divide the total frequency into hundredth so that the 90th percentile is that value below which 90 percent of the observations lie
• When payment is made at the 90th percentile, it means that a payment of Rs 78 or their actual fee is paid to the participating dentists

Question 7. Medicaid.
Answer:

Medicaid

• It is the name given to title XIX of the United Social Security Amendments of 1965
• Its original intent was to provide funds to meet the healthcare needs of all indigent & medically indigent persons
• It is a joint federal-state program covering at least 3 basic services
  • Inpatient hospital care
  • Outpatient hospital care
  • Laboratory & x-ray services
  • Skilled nursing facilities
  • Home health services
  • Early & periodic screening, diagnosis & treatment (EPSDT) program
  • Family planning services
  • Physician services
• It is an extremely complex program
• Although the program has reached a large number of people, many needy persons are unable to receive dental care under it

Question 8. UCR fee. / Usual and customary fee
Answer:

U- Usual Fee:

The fee usually charged for a given service by an individual dentist to private patients

C- Customary Fee:

A fee is customary when it is in the range of the usual fee charged by dentists of similar training & experience for the same service within a specific & limited geographic area

R- Reasonable Fee:

A fee is reasonable if it meets the above two criteria

Question 9. Front-end payment.
Answer:

• It has connections to various card associations
• It supplies authorization and settlement services to the bank’s merchant

Payment For Dental Care Viva Voce

1. Fee for service is the traditional form of reimbursement for dental services
2. Potential patients not able to afford dental care the limited to private fees for service
3. The third party in the private third-party pre-payment plans is called the carrier
4. Front-end payment refers to deductible
5. A public program aimed at the benefit of those over 65 years is Medicare
6. A public program providing funds to meet the health care needs of all indigent and medically indigent people in Medicaid
7. Robinhood practice-price discrimination can be practiced in a private fee-for-service mode of payment

Health Care Delivery System Definitions

Primary health care

• Essential health care based on practical, scientifically sound & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation & at the cost that the community & the country can afford to maintain at every stage of their development in the spirit of self-determination

Voluntary health agencies

• It may be defined as an organization that is administered by an autonomous board, which holds meetings, collects funds for its support chiefly from private sources & expends money, whether with or without paid workers, in conducting a program directed primarily to furthering the public health by providing health services or health education, or by advancing research or legislation for health, or by a combination of these activities

Health Care Delivery System Important Notes

1. Components of alma ata declaration are:

1. Education about health problems and their preventive and controlling methods
2. Adequate supply of safe water and basic sanitation
3. Provision of essential drugs
4. Promotion of food supply and proper nutrition
5. Maternal and child health care including family planning
6. Immunization against infectious diseases
7. Prevention and control of endemic diseases
8. Appropriate treatment of common diseases and injuries

2. Principles of primary healthcare

• Equitable distribution
• Community participation
• Intersectorial coordination Appropriate technology
• Focus on prevention

3. Voluntary health agencies in India

• Agencies
  • Indian Red Cross Society
  • Hind Kusht Nivaran Sangh
  • Indian Council for Child Welfare
  • Tuberculosis Association of India

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• • Bharat Sewak Samaj
  • Central Social Welfare Board
  • Kasturba Memorial Funds
  • Family Planning Association

Health Care Delivery System Long Essays

Question 1. Describe existing dental health services in India
Answer:

Public Health Sector:

1. Primary Health Care:

Primary health centers:

• Each center covers a population of 1,00,000 & is spread over about 100 villages
• It acts as a referral unit for 6 sub-centers
• Functions
  • Medical care
  • Maternal & child health including family planning
  • Safe water supply & basic sanitation
  • Prevention & control of locally endemic disease
  • Collecting & reporting vital statistics
  • Education about health
  • National health programs
  • Referral services
  • Training of health workers, health guides, local dais & health assistants
  • Basic laboratory health services
• Sub-centers
  • It is the peripheral outpost of the existing health delivery system in rural areas
  • It covers a population of 5000 in general & 3000 in hilly, tribal & backward areas
  • One male & one female multipurpose health worker attends each sub-center
  • Each supervises the work of 6 health workers
  • Its function is limited to mother & child health care, family planning & immunization

2. Hospitals/Health Care:

• Community health care
  • It upgrades public healthcare
  • It covers an 80,000 to 1.2 lakh population with 30 beds & specialists who refer a patient directly to a state-level hospital
• Rural hospital
  • It upgrades the rural dispensaries to a public health center
• District hospital

3. Health Insurance Scheme:

• It is limited to industrial workers & their families
• They provide reasonable medical care plus some essential preventive & promotive health services
  • Employees state insurance
    • It provides medical care in cash & kind
• Central government health scheme
  • It provides comprehensive medical care to the central government employees

4. Others:

• Health care of railway employees
  • Provide health services to railway hospitals, health units & clinics
• Defense medical services
  • Under the banner “Armed Forces Medical Services”

Private Sector:

1. Privater Hospitals, Polyclinic, Nursing Homes & Dispensaries:

• Provide a large share of the health services

2. General Practitioners:

• Constitute 70% of the medical profession
• They provide mainly curative services

Indigenous Systems of Medicine:

• Provide bulk of medical care to the rural people

Voluntary Health Agencies:

• It may be defined as an organization that is administered by an autonomous board that holds meetings, collect funds for its support chiefly from private sources & expends money, whether with or without paid workers, in conducting a program directed primarily to furthering the public health by providing health services or health education, or by advancing research or legislation for health, or by a combination of these activities

National Health Programmes:

• National Malaria Eradication Programme
• National Filaria Control Programme
• National Tuberculosis Programme
• National Leprosy Eradication Programme
• Diarrhoeal Diseases Control Programme
• STD Control Programme
• National Programme for Control of Blindness
• Iodine Deficiency Disorder Programme
• Universal Immunization Programme
• National Family Welfare Programme

Question 3. Define Primary healthcare
Answer:

Primary Healthcare Definition:

• Essential health care based on practical, scientifically sound & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation & at the cost that the community & the country can afford to maintain at every stage of their development in the spirit of self-determination

Primary healthcare Principles:

• Equitable distribution
  • Health services must be shared equally by all people ( rich, poor, urban or rural residents)
  • Public health center aims to redress social injustice by shifting the center of gravity of the health care system from cities to rural areas
• Community participation
  • The community must be involved in the planning, implementation & maintenance of health services
  • The involvement of individuals, families & communities in the promotion of their health & welfare is an essential component of public health center
  • In China, community participation is in the form of bare-foot doctors
  • In India, village health guides & local dais provide public health care by overcoming cultural & communication barriers
• Intersectoral coordination
  • Planning with other sectors should be carried out to avoid unnecessary duplication of activities
  • For it, the administrative system of the country has to be reviewed, their resources reallocated & suitable legislation introduced
  • To improve oral health care more attention must be given to policies & strategies that require multi sec- toral cooperation & action
• Appropriate technology
  • It is defined as technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it & to those for whom it is used, and that can be maintained by the people themselves in keeping with the principles of self-reliance with the resources the community & country can afford
  • This applies to using costly equipment procedures & technology when cheaper, scientifically valid & ac- acceptable ones are available
• Focus on prevention
  • Health services should however not only be curative but should also promote health & healthy lifestyles with an emphasis on prevention

Health Care Delivery System Short Essays

Question 1. Primary health care.
Answer:

Primary health care Definition:

• Essential health care based on practical, scientifically sound & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation & at the cost that the community & the country can afford to maintain at every stage of their development in the spirit of self-determination

Primary health care Functions:

Medical care:

• Maternal & child health including family planning
• Safe water supply & basic sanitation
• Prevention & control of locally endemic disease
• Collecting & reporting vital statistics
• Education about health
• National health programs
• Referral services
• Training of health workers, health guides, local dais & health assistants
• Basic laboratory health services

Primary health care Principles:

Equitable distribution:

• Community participation
• Intersectoral coordination
• Appropriate technology
• Focus on prevention

Question 2. Bhore committee.
Answer:

Bhore committee

• Appointed in 1943 with Sir Joseph Bhore as its chairman
• It suggested one public health center for 40,000 population
• It aimed to provide integrated, curative & preventive health care to the rural population with an emphasis on preventive & promotive aspects
• It aimed to serve a population with 6 medical officers,
• Demonstration of public health nurses & other supporting staff

Bhore committee Synonyms:

• Health Survey & Development Committee
• Comprehensive Health Care
• Meaning the provision of integrated preventive, curative & promotional health services from “Womb to Tomb”.

Question 3. Village health guide.
Answer:

Village health guide

• It was introduced on 2nd October 1977
• A village health guide is a person mostly a woman with an aptitude for social service
• Characteristics: they should be
  • Permanent resident of the local community
  • Have a minimum formal education of at least up to VI standard
  • Acceptable to all sections of the community
  • Able to spare at least 2-3 hours every day for community health work
• After selection, they undergo training in the nearest primary health center for 200 hours spread over 3 months & receive Rs 200/- per month as a stipend
• On completion of training, they receive a working man- dual & a kit of simple medicines belonging to the modern & traditional systems of medicine
• Duties:
  • Treatment of simple ailments & activities in first aid
  • Mother & child health including family planning
  • Health education & sanitation
• The target is to have one village health guide for each village or 1000 rural population

Question 4. Voluntary health agencies in India.
Answer:

Voluntary health agencies in India

• It may be defined as an organization that is administered by an autonomous board that holds meetings, collects funds for its support chiefly from private sources & pends money, whether with or without paid workers, in conducting a program directed primarily to furthering the public health by providing health services or health education, or by advancing research or legislation for health, or by a combination of these activities

Functions:

• Supplementing the work of government agencies
• Education
• Demonstration
• Guarding the work of government Agencies
• Advancing Health Legislation

Question 5. World Health Organization.
Answer:

World health organization

• It is a specialized, largest, non-political most prominent, self-governing, influential, multilateral health agency of Strengthens training of various categories of oral health
• United Nations with headquarters in Geneva
• It came into force on 7th April 1948

Health organization Membership:

• It is open to all countries

Health organization Work:

• Prevention & control of specific diseases
  • Development of comprehensive health services
  • Family Health
  • Environmental Health
  • Health statistics
  • Bio-medical research
  • Health literature & information
  • Co-operation with other organizations

Health organization Structure:

• The World Health Assembly
  • The Executive Board
  • The Secretariat

Health organization Who Agenda:

• Promoting development
  • Fostering health security
  • Strengthening health systems
  • Harnessing research, information & evidence
  • Enhancing partnership
  • Improving performance

Health organization Who Journals:

• Bulletin of the World Health Organization
  • Weekly Epidemiological Record
  • WHO Drug Information

Question 6. Importance of national oral health policy.
Answer:

Importance of National Oral Health Policy

• It creates awareness about health problems & means to solve them
• It supplies safe drinking water & basic sanitation
• Concentrates on rural healthcare
• Supports health planning & health program implementation
• Provide support to health protection & promotion
• Act on widespread malnutrition
• Research healthcare delivery
• Creates greater coordination of different systems of medicine
• Resolves preventive & promotive oral health services
• Strengthens training of various categories of oral health care personnel care personnel
• Ensure statutory warning on the wrappers & advertisement of sweets, chocolates & other sugar retentive items
• Guide oral health research appropriate to the needs of the country.

Health Care Delivery System Short Question  And Answers

Question 1. International Red Cross.
Answer:

International red cross

• It is a non-political, non-official international humanitarian organization devoted to the service of mankind. In China, community participation is in the form of peace & war
• It was founded by Henry Dunant in 1859
• Dunant organized local people to bind the soldiers’ wounds & to feed & comfort them during the bloody battle in Solferino, Italy between the armies of imperial Austria & the Franco-Sardinian alliance
• Its emblem was a red cross on a white background

Principles:

• Humanity
• Impartiality
• Neutrality
• Independence
• Voluntary service
• Unity
• Universality

Question 2. Functions of primary health center.
Answer:

Functions of Primary Health Center

• Medical care
• Maternal & child health including family planning
• Safe water supply & basic sanitation
• Prevention & control of locally endemic disease
• Collecting & reporting vital statistics
• Education about health.

Question 3. Community participation.
Answer:

Community participation

• The community must be involved in the planning, implementation & maintenance of health services
• The involvement of individuals, families & communities in the promotion of their health & welfare is an essential component of public health center
• In China, community participation is in the form of bare-foot doctors
• In India, village health guides & local dais provide public health care by overcoming cultural & communication barriers

Question 4. Work of WHO.
Answer:

Work of WHO

• Prevention & control of specific diseases
• Development of comprehensive health services
• Family Health
• Environmental Health
• Health statistics
• Bio-medical research
• Health literature & information
• Co-operation with other organizations

Question 5. National health program.
Answer:

National health program

• National Malaria Eradication Programme
• National Filaria Control Programme
• National Tuberculosis Programme
• National Leprosy Eradication Programme
• Diarrhoeal Diseases Control Programme
• STD Control Programme
• National Programme for Control of Blindness
• Iodine Deficiency Disorder Programme
• Universal Immunization Programme
• National Family Welfare Programme

Question 6. Elements of primary health centers.
Answer:

Elements of Primary Health Centers

• The Alma Ata declaration has outlined 8 essential components of primary healthcare
• Education about prevailing health problems and meth- Co-operation with other organizations ods of preventing and controlling them
• Promotion of food supply and proper nutrition
• An adequate supply of safe water and basic sanitation
• Maternal and child health care including family planning
• Immunization against infectious diseases
• Prevention and control of endemic diseases
• Appropriate treatment of common diseases and injuries
• Provision of essential drugs

Question 7. Recommendations of the Bhore committee.
Answer:

Recommendations of the Bhore Committee

• Integration of preventive and curative services to all administrative levels
• Development of primary health centers in 2 stages
  1. As short-term measure
  2. As a long-term program
     • Major changes in medical education which includes 3 months of training in preventive and social medicine to prepare social physicians

Question 8. World health organization
Answer:

World health organization

• It is a specialized, largest, non-political most prominent, self-governing, influential, multilateral health agency of the United Nations with headquarters in Geneva
• It came into force on 7th April 1948

health organization Membership

• It is open to all countries

health organization Work

• Prevention & control of specific disease
• Development of comprehensive health services
• Family Health
• Environmental Health
• Bio-medical research
• Health literature & information
• Co-operation with other organizations

health organization Structure

• The World Health Assembly
• The executive board
• The Secretariat

Health Care Delivery System Viva Voce

1. Health care services to be shared equally by all people ensures the principle of equitable distribution.
2. The village health guide Scheme was introduced on 2nd October 1977
3. Kasturba Memorial Fund is raised with the main objective of improving women
4. Indian Red Cross Society was established in 1920.
5. The functioning of voluntary health agencies involves pioneering new procedures
6. Gram Sevikas are an integral component of the Kasturba Memorial fund
7. India falls into the WHO regional organization of Southeast Asia region
8. The International Red Cross was founded by Henry Dunant
9. The headquarters of the Family Planning Association of India is located in Bombay

Fluorides Definition

Water Fluoridation

It is defined as the upward adjustment of the concentration of fluoride ions in a public water supply in such a way that the concentration of fluoride ions in the water may be consistently maintained at one part per million by weight to prevent dental caries with minimum possibility of causing dental fluorosis

Topical Fluorides

It is used to describe those delivery systems that provide fluoride for a local chemical reaction to exposed surfaces of the erupted dentition

Defluoridation

Defluoridation is the process of removing excess naturally occurring fluoride from drinking water in order to reduce the prevalence & severity of dental fluorosis

Fluorides Important Notes

1. Fluoride Varnishes

• They maintain fluoride ions in intimate contact with enamel for longer periods
• Commonly used are
  • Duraphat – fluoride concentration is 22600 ppm
  • Fluor protector – fluoride concentration is 7000 ppm
• Duraphat is the first fluoride varnish
• Fluoride varnish was first developed in Europe by Schmidt
• Varnishes increase the time of contact between enamel surface and topical fluoride agents favoring the deposition of more permanently bound fluorapatite.

2. Fluoride Concentration

• In community water fluoridation – 0.7-1.2 ppm
• In-school water fluoridation – 3.5-4.5 ppm

3. Sodium Fluoride NaF

• NaF mouthrinses commonly used are
  • 0.2% NaF containing 99 ppm fluoride, for weekly use
  • 0.05% NaF containing 225 ppm of fluoride, for daily use
• When NaF is applied to the tooth surface, there is the formation of CaF
• This initial rapid reaction is followed by a drastic reduction in its rate and the phenomenon is called “choking off

3. APF (Acidulated Phosphate Fluoride)

• APF solution/ Brudevold’s solution is prepared by dissolving 20 gms of NaF in 1 liter of 0.1 M phosphoric acid and to this 50% hydrofluoric acid is added to adjust pH 3 and fluoride ion concentration at 1.23%
• APF gel is prepared by adding gelling agents like methylcellulose and hydroxyl ethyl cellulose and pH is adjusted between 4-5
• APF is most commonly used in dental clinics
• Thixotropic gels are another form of APF gel with identical properties of APF.

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• It denotes a solution that sets in a gel-like state
• On application of pressure, thixotropic gels behave like a solution
• They are more easily forced into the interproximal areas

4. Solution And Their Application

5. Snf

• So it requires fresh solutions to be prepared for each patient
• 8% SnF contains 19500 ppm of fluoride
• The pH of the freshly prepared solution is 2.5 and after that, it increases to 7.
• When SnF is applied in low concentration, tin-hydroxy-phosphate is formed, which gets dissolved in oral fluids and is responsible for the metallic taste after topical supplication of stannous fluoride
• At very high concentrations, calcium tri-fluoro-stannate gets formed along with tin-tri-fluorophosphate
• The tin-tri-fluorophosphate is responsible for making the tooth structure more stable and less susceptible to decay
• Calcium fluoride is the end product
• It reacts with hydroxyapatite and a small fraction of fluor hydroxyapatite also gets formed

6. Milk Fluoridation

• Introduced by Zeigler in the Swiss city of Winterthur in 1953
• In 1971, Dr. Edgar Borrow established Borrow Foundation for the use of milk fluoridation
• The first community-based milk fluoridation scheme was introduced in 19898, in Bulgaria

7. Salt Fluoridation

• Switzerland was the first country to adopt salt fluoridation
• Recommended level of fluoride to be added is 1.5 mg/5 gm of salt

8. Fluoride Toxicity

• In acute fluoride toxicity, orally soluble calcium in the form of milk or calcium gluconate or calcium lactate solution is given
• Crippling fluorosis is seen in several forms of dental and skeletal fluorosis when the water fluoride level is more than 8 ppm or more
• In it, the spine becomes rigid and joints stiffen, virtually immobilizing the patient

9. Fluoride Tablets

• Available in 0.55,1.1,2.2 mg tablets containing 0.25 mg, 0.5mg, 1 mg of fluoride
• Below 18 months of age, fluoride tablets are not given since the child cannot swallow

10. Nalgonda Technique

• It is defluoridation technique
• It was developed by National Environmental Engineering Research Institute at Nagpur in 1961.
• Useful in both domestic and community water supplies
• Involves the addition of aluminate or lime, bleaching powder, and filter alum to fluoride water
• Alumina is an important component

11. Daily recommended dose of fluoride

Fluorides Long Essays

Question 1. Describe the anticaries mechanism of fluoride on teeth, and discuss the self-applied fluoride.
(or) Acute fluoride toxicity.
Answer:

Anticaries Mechanism Of Fluoride:

1. Increased Enamel Resistance/ Reduction In Enamel Solubility

• Dental caries involves the dissolution of enamel by acid formation
• This dissolution is inhibited by fluoride as the fluoride forms fluorapatite which reduces enamel solubility
• Fluoride reduces enamel solubility also by promoting the precipitation of hydroxyapatite & phosphate mineral
• Fluoride inhibits demineralization by
• Reducing bacterial acid production
• Reducing equilibrium solubility of apatite
• By fluoridation of apatite crystal

2. Increased Rate of post-eruptive maturation

• Newly erupted teeth have hypomineralised areas & the enamel surface is also prone to dental caries
• Fluoride increases the rate of mineralization in these areas
• Organic material is also deposited over the enamel surface which increases its resistance to dental caries

3. Remineralization of incipient lesions

• Fluoride enhances remineralization by the deposition of minerals into the damaged areas
• This reduces enamel solubility through the growth of crystals which are more resistant to acid
• Fluoride enhances remineralization from calcium phosphate solution by the formation of calcium fluoride which prevents hydroxyapatite crystal growth

4. Interference With micro-organisms

• In two ways
• In high concentrations- bacteriocidal
• By reducing plaque
• In low concentrations- bacteriostatic
• Inhibits enzymes responsible for acid metabolism

5. Modification in tooth morphology

• If fluoride is ingested during tooth development it results in the formation of
• More caries-resistant tooth
• A tooth with smaller & shallow fissures
• Smaller diameter & cusp depth
• All these make them more self-cleansing

Anticaries Mechanism Of Fluoride Self-Applied Fluorides:

1. Dentrifices:

• Fluoride compounds in dentifrices
• Sodium fluoride
• Stannous fluoride
• Mono fluorophosphate
• Amine fluoride

Anticaries Mechanism Of Fluoride Indications:

• Dental caries prevention
• Caries risk patient
• Desensitization

Anticaries Mechanism Of Fluoride Mechanism:

• Monofluorophosphate gets deposited in the crystalline lattice & intra- crystalline transposition
• Fluoride is released
• This replaces the hydroxyl group to form fluorapatite
• Mono fluorophosphate may exchange with the phosphate group in apatite crystals

Recommendation:

Anticaries Mechanism Of Fluoride Adverse Effects:

• Detergents & flavoring agents
  • Irritate stomach
  • Cause vomiting
• Abrasive
  • Interfere with complete intestinal absorption of fluoride
• Regular ingestion of fluoride by children < 6 years
  • Dental fluorosis

2. Mouth Rinses:

Described by Bibby et al in 1946

Anticaries Mechanism Of Fluoride Contra-Indications:

• Children less than 6 years of age
• Persons with problems in oro-facial musculature due to which they cannot rinse

Sodium Fluoride Mouth Rinses:

• Formulated at
  • 0.2% concentration- for weekly use
  • 0.05% concentration- for daily use
• Preparation
  • Prepared by dissolving 200 mg sodium fluoride tablet in 5 teaspoons of fresh clean water
  • It can be used for 4 members (2 adults & 2 children)

Anticaries Mechanism Of Fluoride Mechanism:

• Fluoride forms fluorapatite from hydroxyapatite
• Fluoride inhibits bacterial metabolism & plaque acid formation

Anticaries Mechanism Of Fluoride Indications:

• If the concentration of fluoride in drinking water is 0.3 ppm or less
• Patients with increased caries risk
• School fluoride programs Advantages:
• 30-40% reduction in caries incidence

Anticaries Mechanism Of Fluoride Gels:

Anticaries Mechanism Of Fluoride Include:

• Neutral sodium fluoride & acidulated phosphate fluoride with a fluoride concentration of 5000 ppm
• Stannous fluoride with a concentration of 1000 ppm

Anticaries Mechanism Of Fluoride Method of Use:

• Brushing for 1 minute with the gel
• Placing several drops in each tray & held in contact with the teeth for 5 minutes

Anticaries Mechanism Of Fluoride Disadvantages:

• Violate the principle of delivering low concentrations of fluoride
• Cause fluoride toxicity
• Tedious to use

Question 2. Classify the various fluoride delivery methods in dentistry. Write in detail about the preparation, application & recommended age groups in Knutson’s technique.
(or) Knutson’s technique.
Answer:

Fluoride Delivery Methods:

• Topical fluoride
• Placed directly on the teeth
• Systemic fluoride
• Circulate through the bloodstream & are incorporated into developing teeth

Knutson’s Technique:

Knutson’s Technique Preparation:

• Prepared by dissolving 20 grams of sodium fluoride powder in one liter of distilled water
• It is stored in a plastic container as the fluoride may react with the silica of glass forming silicon fluoride, thus reducing the availability of free active fluoride

Knutson’s Technique Method Of Application:

• Initial appointment
  • Cleaning & polishing of teeth
  • Isolating with cotton rolls
  • Drying with compressed air
  • Using a cotton-tipped applicator stick, the 2% sodium fluoride solution is painted on dried teeth
  • Allow to dry the solution for 3-4 minutes
  • Repeat for each quadrant
  • Instruct patient to avoid eating, drinking, or rinsing for 30 minutes
  • 2nd, 3rd & 4th appointments are given at weekly appointments

Recommended Age:

Question 3. Define water fluoridation. Discuss the feasibility of community water fluoridation in India.
Answer:

Fluoridation in India Definition:

It is defined as the upward adjustment of the concentration of fluoride ions in a public water supply in such a way that the concentration of fluoride ions in the water may be consistently maintained at one part per million by weight to prevent dental caries with minimum possibility of causing dental fluorosis

Fluoridation in India Feasibility:

• The water fluoridation procedure is feasible only if
  • There is a municipal water supply reaching a reasonable number of homes
  • People drink this water rather than water from individual wells or tanks
  • Suitable equipment is present
  • Supply of fluoride is assured
  • Workers are available
  • Money should be available

Question 4. Describe the mechanism of action of fluoride. Add a note on the toxicity of fluoride.
Answer:

Toxicity Of Fluoride:

Toxicity Of Fluoride Acute Toxicity

• Results from rapid excessive ingestion of fluoride at one time
• Symptoms
  • Nausea, vomiting, diarrhea
  • Abdominal cramps
  • Increased salivation
  • Dehydration o Thirst
  • After 2-4 hours
    • Fatality
  • Death due to
    • Blockage of normal cellular metabolism
    • Cardiac failure
    • Respiratory paralysis
  • If a death has not occurred after 24 hours, the prognosis is good

Toxicity Of Fluoride Pathological Changes:

• Oral corrosive changes
  • Hemorrhagic stomach contents
  • Changes in intestine

Toxicity Of Fluoride Management:

• Administration of milk or egg
• Lime water
• Aluminum hydroxide gels
• Inducing vomiting

Toxicity Of Fluoride Dental Fluorosis:

Due to long-term ingestion of smaller amounts

Toxicity Of Fluoride Dental Fluorosis:

Toxicity Of Fluoride Mottled Enamel

• Presence of hypoplastic areas
• Mottled areas may stain yellow/ brown
• Fluoride occurs symmetrically within dental areas, commonly effecting premolars

Toxicity Of Fluoride Skeletal Fluorosis:

• Severe pain in
  • Backbones
  • Joints
  • Hips
• Stiffness in joints & spine
• Knock-knee syndrome
  • Outward bending of legs & hands
  • Damage to fetus
  • Blocking & calcification of blood vessels
  • Cripping fluorosis

Toxicity Of Fluoride Effect On Kidney:

Mav aggravates renal disease

Question 5. Define community water fluoridation & the requirements for community water fluoridation.
Answer:

Community Water fluoridation Requirements:

• The equipment must be adapted to local conditions & needs of the water network
• Equipment must be efficient, safe & precise
• Equipment should have well-defined precision limits
• It should be of standard type
• Equipment should be provided with the safety mechanism
• Adjustment of the distribution must be sufficient, easy & rapid
• The apparatus should operate between 20-80% of its total capacity
• In each fluoridation system, an antisiphon mechanism should be installed in the pipes
• Maintenance & control
  • The fluoridation system must be carefully maintained
  • A sufficient quantity of spare parts should be available
• Control at the water treatment plant
  • Regular monitoring of water supplies is essential
  • A uniform concentration of fluoride ions should be maintained
  • Analysis should be made several times in a day
• Control of the quality of analysis
  • The corresponding authority should send 3 “blind” samples each month for analysis & returned within 48 hours
• Control of the quality of water in the network
  • Samples are taken from the distribution network once a week & send for analysis
• Control of the quality of fluoride used
  • Samples should be analyzed every time the delivery of fluoride is received

Community Water fluoridation Equipment Used:

• Saturation system
• Dry feeder
• Solution feeder
• Venture fluoridator system
• Saturation-suspension cone

Community Water fluoridation Fluoride Used:

• Sodium fluoride
• Fluorspar
• Silicon fluoride
• Sodium silicofluoride
• Hydrofluosilicic acid
• Ammonium silicofluoride

Question 6. Define topical fluoride. Describe in detail the method of preparation, application, mechanism of action, and advantage & disadvantages of Mahler’s solution.
(or) Stannous fluoride.
Answer:

Topical Fluoride Definition:

It is used to describe those delivery systems which provide fluoride for a local chemical reaction to exposed surfaces of the erupted dentition

Topical Fluoride Definition Mahler’s Solution:

Topical Fluoride Definition Preparation:

• 0.8 grams of stannous fluoride is dissolved in 10 ml of distilled water in a plastic container
• The solution thus prepared is shaken briefly
• The solution is then applied immediately to the teeth

Topical Fluoride Definition Application:

• Cleaning & polishing of tooth surfaces
• Isolating the teeth with cotton rolls
• Drying with compressed air
• The freshly prepared solution is painted over the tooth surface
• The solution is allowed to dry for 4 minutes
• Repeat applications are made every 6 months or more

Topical Fluoride Definition Mechanism Of Action:

• At low concentration
  • Hydroxyphosphate is formed
  • This gets dissolved in oral fluids
• At very high concentration
  • Calcium tri-fluoro stannate gets formed along with tin tri-fluorophosphate
  • Tin tri-fluorophosphate makes the tooth structure more stable & less susceptible to decay
• Calcium fluoride is the end product of both
• It further reacts with hydroxyapatite & small amount of fluorhydroxyapatite also gets formed

Topical Fluoride Definition Advantages:

• Application required only once per year
• Conforms to the practicing dentist’s usual patient recall system

Topical Fluoride Definition Disadvantages:

• Material is not stable in aqueous solution
• Has to be prepared freshly every time
• Metallic taste
• Causes a reversible tissue irritation
• Causes pigmentation of teeth occasionally

Question 7. Define water fluoridation. Describe various methods of systemic administration of fluoride for the prevention of dental caries.
Answer:

Systemic Fluorides:

Systemic Fluorides Consist Of The:

1. Water Fluoridation:

• It is the most common form of systemic fluoride administration
• It constitutes of addition of fluoride to public water supplies.
• The optimal level of fluoride in water for protection against dental caries is approximately 1 ppm

Systemic Fluorides Equipment Used:

• Saturation system
• Dry feeder
• Solution feeder
• Venture fluoridator system
• Saturation-suspension cone

Systemic Fluorides Fluoride Used:

• Sodium fluoride
• Fluorspar
• Silicon fluoride
• Sodium silicofluoride
• Hydrofluosilicic acid
• Ammonium silicofluoride

2. Milk Fluoridation:

• Milk is an excellent source of calcium & phosphorous
• It contains all essentials for the development of bone & teeth
• Milk fluoridation was first mentioned by Ziegler in 1956

Systemic Fluorides Rationale:

• The nutritional value of milk has been well documented
• Provide a cost-effective & convenient vehicle
• All forms of milk products are suitable
• Can be targeted to those in greatest need
• The bioavailability of fluoride is not reduced by milk
• It keeps a permanently low level of ionized fluoride within the oral cavity promoting remineralization
• The confirmed dual action of fluoride: topical & systemic
• Greater preventive effect

Systemic Fluorides Advantages:

Staple food for children & infants

Systemic Fluorides Disadvantages:

• The cost would be considerably higher
• A centralized milk supply should exist
• Variation in intake & quantity of milk

3. Salt fluoridation:

Introduced in Switzerland in 1955

Systemic Fluorides Method of Preparation:

• Fluoride is added to salt by spraying concentrated solutions of sodium fluoride & potassium fluoride on salt on a conveyor belt
• Sodium fluoride & calcium fluoride are first mixed with slightly moist salt or mixed with a flow conditioner such as tri-calcium phosphate & this pre-mixed granule are added to the dry salt

Systemic Fluorides Advantages:

• Minimal fluorosis
• Safe
• Economic
• Freely available
• Easy to monitor
• Effective to supply
• Readily accepted

Systemic Fluorides Disadvantages:

• No precise control
• Sodium can cause hypertension

4. Fluoride Tablets/ Drops/ Lozenges:

Fluoride tablets/ drops/ lozenges may be prescribed to individual patients or may be part of a school or home-based public health preventive dentistry program

Systemic Fluorides Fluoride Used:

• Sodium fluoride
• APF
• Potassium fluoride
• Calcium fluoride

Systemic Fluorides Dosage:

Systemic Fluorides Age

• 6 months-3 years- 0.25 gms
• 3-6 years – 0.25-0.5 gms
• 6-16 years- 0.5-1 grams

Fluorides Short Essays

Question 1. APFgel.
Answer:

APFgel Method Of Preparation:

• It is prepared by dissolving 20 gms of sodium fluoride in 1 liter of 0.1 M phosphoric acid
• Followed by the addition of 50% hydrofluoric acid
• A gelling agent methylcellulose or hydroxyethyl cellulose is added to the solution

APFgel Application:

• Oral prophylaxis
• Isolate the teeth
• Dry the teeth
• Apply APF solution by loading in a tray
• Maintain it for 4 minutes

APFgel Frequency:

Twice a year

APFgel Mechanism Of Action:

• On applying APF gel it leads to dehydration & shrinkage in the volume of hydroxyapatite crystals
• Formation of dicalcium phosphate dehydrate
• Fluoride penetrates the crystals
• This leads to the formation of fluorapatite

Question 2. School water fluoridation.
Answer:

School water fluoridation

• Initiated as a pilot study in 1954 at St. Thomas Virgin Islands, United States
• It is used only if the surrounding areas from which the students come have a low fluoride content
• The concentration of fluoride in the school water is 4.5 ppm in contrast to 1 ppm of the community water supply
• This is to compensate for the reduced water intake

School Water Fluoridation Advantages:

• About 40% of reduction in DMFT was observed
• No effort is required by the recipient
• Effective public health measure
• Target population-school children
• Quite economical

School Water Fluoridation Limitations:

• Need for cooperation from school authorities
• Children may not attend all school days
• There is intermittent fluoride exposure
• Limited pre-eruptive benefits to primary teeth
• Possible confrontation by antifluoridation groups
• The cost of installation, supplies & maintenance compete with other needs of the school budget
• Custodial & backup personnel are required to be trained

Question 3. Topical fluoride.
Answer:

Topical Fluoride Definition:

It is used to describe those delivery systems that provide fluoride for a local chemical reaction to exposed surfaces of the erupted dentition

Topical Fluoride Indication:

• Caries active individual
• Children shortly after tooth eruption
• Those who take medication that reduces salivary flow
• After periodontal surgery
• Patients with fixed or removable prosthesis
• Patients with eating disorders
• Mentally & physically challenged individual

Classification Of Topical Fluoride:

• Professionally applied products
• Dispensed by a dental professional
• It includes
  • Sodium fluoride
    • Minimum 4 applications with 2% give caries reduction of about 30%
  • Stannous fluoride
  • Used as 8% concentration
  • Acidulated phosphate fluoride gel
  • Fluoride varnishes
    • Duraphat
    • floor protector
• Composition
  • It is a dichlorosilane-ethyl difluoro hydroxy silane
  • Fluoride content is 22.6 mg F/ ml
• Self-administered
  • Fluoride dentifrices
  • Sodium fluoride
  • Fluoride mouth rinses
  • Dentrifices containing monofluorophosphate

Question 4. Defluoridation.
Answer:

Defluoridation

Defluoridation is the process of removing excess naturally occurring fluoride from drinking water in order to reduce the prevalence & severity of dental fluorosis

Defluoridation Methods:

Defluoridation Ion Exchange Resins:

• Carbon
  • It is a cation exchange resin of good durability & can be used on sodium & hydrogen cycles
• Defluoron
  • A sulfonated sawdust impregnated with 2% alum solution
• Defluoron 2
  • It is a sulfonated coal using the aluminum solution as a regenerate

Defluoridation Nalgonda Technique:

• This technique was developed in India in 1975
• By National Environmental Engineering Research Institute
• It was constructed in the district of Nalgonda in Andhra Pradesh in the town of Kathri

Defluoridation Procedure:

• Raw water is collected in a tank
• Add alum solution to it
• Next, depending on alkalinity and lime
• Stir gently for 10 minutes
• Results in the formation of floes
• Allow it to settle

Defluoridation Advantages

• Can be used at domestic & community levels
• Manually operated
• Cost-effective
• It meets with standards laid down by the Bureau of Indian Standard

Question 5. Milk fluoridation.
Answer:

Milk fluoridation

• Milk is an excellent source of calcium & phosphorous
• It contains all the essentials for the development of bone & teeth
• Milk fluoridation was first mentioned by Ziegler in 1956

Milk Fluoridation Rationale:

• The nutritional value of milk has been well-documented
• Provide a cost-effective & convenient vehicle
• All forms of milk products are suitable
• Can be targeted to those in greatest need
• The bioavailability of fluoride is not reduced by milk
• It keeps a permanently low level of ionized fluoride within the oral cavity promoting remineralization
• The confirmed dual action of fluoride: topical & systemic
• Greater preventive effect

Milk Fluoridation Advantages:

Staple food for children & infants

Milk Fluoridation Disadvantages:

• The cost would be considerably higher
• A centralized milk supply should exist
• Variation in intake & quantity of milk

Question 6. Shoe leather survey.
Answer:

Shoe leather survey

• Conducted by Dr. H Trendley Dean
• It was conducted in 97 localities
• It was done with the help of questionnaires
• During this survey, Trendley Dean visited each & every house in that particular community
• He traced the dental status of 7000 children who drank naturally fluoridated water

Shoe Leather Survey AIM:

To find the level of fluoride at which the tooth starts to blemish

Shoe Leather Survey Report:

• In 1943, he reported that the ideal amount of fluoride was 1 ppm of water
• This concentration was demonstrated to result in healthy, attractive teeth that had l/3rd as many cavities as might otherwise be expected & no staining

Question 7. Fluoride varnishes.
Answer:

Fluoride Varnishes Commonly Used:

• Duraphat
• Fluorprotector

Fluoride Varnishes Composition:

• It is a dichlorosilane-ethyl difluoro hydroxy silane
• Fluoride content is 22.6 mg F/ ml

Fluoride Varnishes Application

• Oral prophylaxis
• Dry the teeth
• Apply varnish with a single tufted small brush first on the lower arch and then on upper
• Maintain it for 4 minutes
• Avoid rinsing, drinking, eating for 1 hour

Fluoride Varnishes Dose:

• 0.5 ml of dura phat containing 11.3 mg F fluoride
• 0.5 ml of floor protector containing 3.1 mg F fluoride

Fluoride Varnishes Mechanism Of Action:

• On application of varnish, results in a reservoir of fluoride ions around the enamel
• Results in deeper penetration of fluoride & formation of fluorapatite

Fluorides Short Answers

Question 1. Colorado Stains.
Answer:

Colorado Stains

• The history of fluoridation started with the contribution of Dr. Frederick McKay
• He arrived in Colorado Springs, Colorado, USA in 1901
• He noticed that many of his patients, particularly those who had lived in the area all their lives, had an apparently permanent stain on their teeth which was known to the local inhabitants as “Colorado Stains”
• He called the stain “mottled enamel” & said that it was characterized by minute white flecks or yellow or brown spots or areas, scattered irregularly
• Or streaked over the surface of a tooth or
• It may be a condition where the entire tooth surface is of a dead paper-white, like the color of a china dish

Question 2. Fluoridated Salt.
Answer:

Fluoridated Salt

Introduced in Switzerland in 1955

Fluoridated Salt Method Of Preparation:

• Fluoride is added to salt by spraying concentrated solutions of sodium fluoride & potassium fluoride on salt on a conveyor belt
• Sodium fluoride & calcium fluoride are first mixed with slightly moist salt or mixed with a flow conditioner such as tri-calcium phosphate & these pre-mixed granules are added to the dry salt

Fluoridated Salt Advantages:

• Minimal fluorosis
• Safe
• Economic
• Freely available
• Easy to monitor
• Effective to supply
• Readily accepted

Fluoridated Salt Disadvantages:

• No precise control
• Sodium can cause hypertension

Question 3. Nalgonda technique.
Answer:

Nalgonda technique

• Method of defluoridation
• This technique is developed in India in 1975
• By National Environmental Engineering Research Institute
• It was constructed in the district of Nalgonda in Andhra Pradesh in the town of Kathri

Nalgonda Technique Procedure:

• Raw water is collected in a tank
• Add alum solution to it
• Next, depending on alkalinity ad lime
• Stir gently for 10 minutes
• Results in the formation of floes
• Allow it to settle

Nalgonda Technique Advantages:

• Can be used at domestic & community levels
• Manually operated
• Cost-effective
• It meets with standards laid down by the Bureau of Indian Standard

Question 4. Optimum levels of fluoride.
Answer:

Optimum levels of fluoride

• The optimum level of fluoride in water in a temperate climate is 1 ppm
• For warmer & colder climates the amount can be adjusted from approximately 0.7 ppm to 1.2 ppm
• It is adapted according to the water consumed

Question 5. Chemical properties of fluoride.
Answer:

Chemical properties of fluoride

• Fluoride is a compound of fluorine with a metal
• It is an anion, the reduced form of fluorine
• It is a monovalent ion
• The solution of inorganic fluoride in water contains fluorine & fluorine ion
• Few inorganic fluorines are soluble in water
• Fluorides are more strongly solvated
• Fluoride is effective in preventing tooth decay
• Fluoride tends to be dangerous only in large doses

Question 6. Requirements of community water fluoridation.
Answer:

Requirements of community water fluoridation

• The equipment must be adapted to local conditions & needs of the water network
• Equipment must be efficient, safe & precise
• Equipment should have well-defined precision limits
• It should be of standard type
• Equipment should be provided with a safety mechanism
• Adjustment of the distribution must be sufficient, easy & rapid
• The apparatus should operate between 20-80% of its total capacity
• In each fluoridation system, an antisiphon mechanism should be installed in the pipes
• Maintenance & control
• The fluoridation system must be carefully maintained
• A sufficient quantity of spare parts should be available
• Control at the water treatment plant
• Regular monitoring of water supplies is essential
• A uniform concentration of fluoride ions should be maintained
• Analysis should be made several times in a day
• Control of the quality of analysis
• The corresponding authority should send 3 “blind” samples each month for analysis & returned within 48 hours
• Control of the quality of water in the network
• Samples are taken from the distribution network once a week & send for analysis
• Control of the quality of fluoride used
• Samples should be analyzed every time the delivery of

Question 7. Choking off effect.
Answer:

Choking off effect

• When NaF is applied to the tooth surface, there is the formation of CaF
• This initial rapid reaction is followed by a drastic reduction in its rate and the phenomenon is called “choking off

Fluorides Viva Voce

1. The relative atomic weight of fluorine is 19
2. The concentration of fluoride in human milk is 15-20 mg/1
3. Bone is a major route of fluoride absorption
4. Dr. McKay coined the term mottled enamel for fluorosis
5. Dental fluorosis was termed denti di chiaie by Dr J.M. Eager
6. The element fluoride was identified as a factor responsible for mottled enamel in 1931
7. 22 cities study conducted by Dr. Trendley H Dean determined the extent and severity of mottled enamel
8. The inverse relationship of dental caries and mottled enamel was given by Trendley H Dean
9. The world’s first artificial fluoridation plant was set up in Grand Rapids.
10. Dean proposed that fluoridating water supplies by 1 ppm of fluoride reduce dental caries by 60%
11. The kidney has the highest concentration of plasma fluoride level
12. The renal clearance of fluoride in the adult ranges from 30-60 ml/minute
13. Plasma fluoride concentration is lowest in the brain
14. Anti cariogenic effect of fluoride is rendered by interference with micro-organisms
15. The maximum loss of fluoride from tooth structure is due to tooth wear
16. Fluoride toothpaste is the best method for topical fluoridation in school children
17. Salt fluoridation is a method of choice if water fluoridation is not feasible
18. Fluoride toothpaste is recommended at night time because it is a fluoride reservoir
19. The maximum plasma concentration of fluoride after fluoride ingestion reaches upto 0.20 ppm
20. 8 ppm of fluoride causes skeletal fluorosis
21. Knutson’s technique for 3 years inhibits caries by about 35%
22. Fluoride acts on enolase enzyme to render anticaries effect
23. Fluoride remains on the tooth surface after dura phat application for up to 12 hours
24. The application of sodium fluoride solution is called Knutson’s technique
25. The aqueous solution of topical fluoride is continuously reapplied for 4 minutes
26. The amount of fluoride present in fluoride varnish is 22600 ppm
27. Fluoride varnishes are applied once in six months
28. Knutson’s technique is recommended for the age of 3, 7,11, and 13 years
29. APF solution is also known as Brudevold solution
30. Fluoride rendered by APF solution is 12300 ppm
31. 123% APF can reduce dental caries by about 66%
32. A 0.05% concentration of sodium fluoride mouth rinses is recommended for daily use
33. Children under six years of age are contraindicated for the use of fluoride rinses
34. Certainly, the lethal dose of fluoride is 32-64 mg of fluoride per kg of body weight
35. Safety tolerated dose of fluoride for a 70 kg adult is 8 16 mg F/kg body weight
36. Abdominal pain is the first sign of acute fluoride toxicity
37. The premolar is the most commonly affected tooth by fluorosis
38. A combination of fluoride, calcium, and vitamin D results in increased wall thickness of osteoblasts
39. Fluoride toothpaste is not safe for children of about 2-4 years of age
40. Fluoride toothpaste is recommended twice a day in mixed dentition period
41. Fluoride dentifrices can inhibit caries up to 35%
42. Water fluoridation is the most economical method for caries prevention in urban areas
43. The consumption of 1.5 ppm fluoridated water can result in fluorosis after 10-15 years
44. In fluoride toxicity drug of choice is calcium chloride
45. Cardiac failure is the cause of death in acute toxicity of fluoride
46. 4.5 to 6.3 ppm is recommended level for school water fluoridation
47. The second stage of the Nalgonda technique is flocculation
48. Ziegler introduced milk fluoridation
49. Permanent teeth have higher fluoride levels than primary teeth because of the long pre-eruptive maturation period
50. 30% of hydrogen peroxide is required to bleach fluorosis teeth
51. The Nalgonda technique is defluoridation technique
52. The use of fluoride varnishes reduces the number of patient’s visit
53. Post secretory phase and early mineralization phase is the critical period for fluorosis.

Miscellaneous Short Essays

Question 1. Odds ratio.
Answer:

Odds Ratio Definition:

It is a measure of the strength of the association between risk factors & outcome

Odds Ratio It Is Based On:

• The disease being investigated must be relatively rare. Example: Chronic disease
• The cases must be representative of those with the disease
• The controls must be representative of those without the disease

Odds Ratio Example:

If the odd’s ratio is 6.2- means the risk of oral cancer was 6.2 times greater in individuals in tobacco chewers than in non-chewers

Question 2. Tristan de Cunhan study.
Answer:

Tristan de Cunhan study

• It is a small remote island in the South Atlantic inhabited by people of European descent
• In the early 1960s volcanic eruption led to the evacuation of the entire community to England
• After a few years, an improvement occurred & the region become habitable
• Thus the people returned
• Modern industries developed & processed food became easily available
• Dental examination was carried out on an island in 1932, 1937 & 1953
• In England in 1962
• On an island in 1966
• Results obtained are

Question 3. Functional appliances.
Answer:

Functional Appliances Definition:

It is defined as loose fitting/ passive appliances which harness natural forces of oro-facial musculature that are transmitted to teeth & alveolar bone

Classification Of Functional Appliances:

• According to Tom Graber
• Group A: teeth supported
• Group B: teeth/ tissue supported
• Group C: vestibular positioned
• Based on use
• Removable
• Semi fixed
• Fixed

Functional Appliances Uses:

Intercept & treat jaw discrepancies

Functional Appliances Changes That Occur:

• Increase/ decrease jaw relationship
• Change spatial jaw relationship
• Changes direction of jaw growth
  Accelerates desired growth

Read And Learn More:  Percentive Communitive Dentistry Question And Answers

Question 4. Diet counseling.
Answer:

Diet counseling

• Steps
• Introduce diet dairy
• 24-hour diet record is prepared
• A daily diet of dairy is advised
• Analyse complete records
• Isolating the sugar factors
• Patients education
• Consumption of sugar substitutes

Diet counseling Visits:

Diet Counseling First Appointment:

• A diet diary of 6 consecutive days is prepared
• The form of particular food taken, its approximate amount along with snacks, candies, syrups, chewing gums consumption is recorded
• Identify the sugar-containing food items
• Mark such items with red Xs while others with blue Xs
• Explain to the patient the harmful effects of sugar-containing substances & explain to decrease the red Xs items while increasing the blue Xs items
• Teach him as a game
• Suggest sugar substitutes like peanuts

Diet Counseling Recall Visits:

• Recall appointments are carried out at regular intervals during the next months
• During these visits evaluate the patient’s progress & provide reinforcement

Question 5. Interceptive orthodontics.
Answer:

Interceptive Orthodontics Definition:

It is that phase of the science & art of orthodontics employed to recognize & eliminate potential irregularities & malpositions of the developing dentofacial complex

Interceptive Orthodontics Procedures:

• Serial Extraction
  • It is the planned extraction of certain deciduous teeth & later specific permanent teeth in orderly sequence & pre-determined pattern
  • Developing anterior crossbite
  • Treated to prevent minor orthodontic problems
• Interception Of Habits
  • Habits that are intercepted are
    • Thumb sucking
    • Tongue thrusting
    • Mouth breathing
• Space Regaining
• • Space lost by the mesial movement of the molar can be regained by distal movement of 1st molar
  • Muscular exercise
  • It helps to improve aberrant muscle function
  • Interception of skeletal Malrelation
  • To reduce the severity of the disease
  • Removal of soft tissues & bony barriers

Question 6. Exfoliative cytology.
Answer:

Exfoliative cytology

Refers to the removal of surface cells for cytological examination

Exfoliative Cytology Uses:

Exfoliative Cytology For Diagnosis:

Routine screening of patients with oral lesions & recurrent carcinoma

Exfoliative Cytology The stains Used Are:

Papanicolaon stain

Question 7. Four-handed dentistry
Answer:

Four-handed dentistry

It is the term given to the art of seating both the dentist & the dental assistant in such a way that both are within easy reach of the patient’s mouth

Four-handed Dentistry Process:

• The patient is in a fully supine position
• The assistant will hand the dentist the particular instrument he wants
• Assistant can also perform functions like retraction or aspiration

Four-handed Dentistry Advantages:

• Dentists can completely keep their eyes on the field of operation
• Less fatigue
• Greater efficiency
• Training Period Of Assistant:
• One or two years

Question 8. Orofacial signs of sexual abuse.
Answer:

Orofacial signs of sexual abuse

• Contusion
• Laceration of
  • Tongue
  • Buccal mucosa
  • Palate
  • Alveolar mucosa
  • Frenum
• Fractured, displaced, or avulsed teeth
• Facial bone & jaw fractures
• Burns
• Discolored teeth
• Pulpal necrosis
• Bruises
• Lichenification
• Scarring at the corners of the mouth

Question 9. Expert witness.
Answer:

Expert witness

• An expert witness is a witness who by education, training, skill or experience is believed to have expertise & specialized knowledge in a particular subject
• They are usually instructed to produce a joint statement detailing points of agreement & disagreement
• They charge a professional fee which is paid by the party
• They may be issued with a witness summon
• They must be qualified on the topic of testimony
• They may also deliver expert evidence

Expert Witness Expert Evidence:

• Fingerprints
• Blood analysis
• DNA fingerprinting

Question 10. Quarantine.
Answer:

Quarantine Definition:

A period of time during which a vehicle, person, or material suspected of carrying a contiguous disease is detained at a port of entry under enforced isolation to prevent the disease from entering a country

• It is used to separate & restrict the movement of good persons who may have been exposed to a communicable disease to see if they become ill
• It can apply to humans as well as animals
• Quarantine periods are very short

Quarantine Purpose:

• Prevent the spread of contamination
• To contain the contamination such that others are not put at risk

Question 11. Perjury.
Answer:

Perjury

A crime that occurs when an individual willfully makes a false statement during a judicial procedure after he/she has taken an oath to speak the truth

Perjury Basic Elements:

• A false statement is made under oath during a judicial proceeding
• The statement must be material or relevant to the proceeding
• The witness must have the specific intent to deceive

Perjury Punishment:

• Fine
• Imprisonment
• Both

Miscellaneous Short Question And Answers

Question 1. Positive health.
Answer:

Positive health

• It is the group of subjective, biological & functional that increase health & illness target
• Positive Health Indicator:
• It is one or a collection of questions that assess the presence of one / several aspects of health as more than the absence of disease or symptoms

Question 2. Sporadic.
Answer:

Sporadic

• It means scattered about
• The cases occur irregularly, haphazardly from time to time & generally infrequently

Question 3. Gingival physiotherapy.
Answer:

• Gingival physiotherapy Device used
  • Toothbrush
  • Rubber tip stimulator
  • Interdental cleaning device
• Gingival physiotherapy Effects
  • Epithelial thickening
  • Increased keratinization
  • Increased mitotic activity

Question 4. Soil, Seed & Sower.
Answer:

Soil, Seed & Sower

• It is one of the principles of health education
• According to it:
• The people are the soil
• Seeds: health facts- must be truthful
• Sower: transmitting media- should be attractive, palatable & acceptable

Question 5. Co-insurance.
Answer:

Co-insurance

• It is defined as ” an arrangement under which a carrier & the beneficiary are each liable for a share of the cost of the dental services provided”
• It means that the patient pays a percentage of the total cost of the treatment
• It helps to keep the premium down
• Example: The patient has to pay 20% of the cost of the treatment, and the remaining 80% will be paid by the insurance company

Question 6. Folk medicine.
Answer:

Folk medicine Definition:

It is the treatment of disease or injury based on tradition, especially on oral tradition, often utilizing indigenous plants as remedies

• It refers to healing practices & ideas of body physiology & health preservation known to a limited segment of the population in a culture
• It often coexists with formalized education based & institutionalized systems of healing
• Practices of folk medicine may be influenced by the formalized medical systems

Synonyms:

• Traditional medicine
• Alternative medicine

Question 7. Emporiatics.
Answer:

Emporiatics

• It is the specialty of travel medicine dealing with diseases that travelers can acquire especially in the tropics
• It deals with the prevention & management of health problems of international traveler
• Example: traveler’s diarrhea
• It comprises of
  • Prevention
  • Assistance
  • Wilderness medicine
  • Access to healthcare

Question 8. Standard of living.
Answer:

Standard of living

• It refers to the level of wealth, comfort, material goods & necessities available to a certain socioeconomic class
• It is inherent subjective

Standard of living Factors Effecting:

• Income
• Quality & availability of employment
• Poverty rate
• Housing
• Hours of work
• Quality health care
• Quality of education
• Life expectancy
• Incidence of disease
• Cost of services
• Environmental Quality

Question 9. Mores.
Answer:

Mores

• They are norms or customs which express fundamental values of society
• They are derived from the established practices of a society rather than from written laws
• They consist of shared understandings about the kinds of behavior likely to evoke approval, disapproval, toleration, or sanction, within particular contexts

Question 10. Need for dental care.
Answer:

Need for dental care Types:

• Normative need
  • It is the requirement for care as determined by expert opinion
• Felt need
  • It is the requirement of care as determined by the patient or public
• Expressed need
  • It arises out of attempts by members of the public to seek attention for their perceived needs

Need for dental care Approaches to Estimate Need:

• Surveys of dental health status
• Surveys of need for dental care using a questionnaire
• Analyses of service or treatment records

Question 11. Accretion.
Answer:

Accretion

It is a process where most of the fluoride is buried within the mineral crystallites during the period of crystal growth

Question 12. Census.
Answer:

Census

• It is the collection of information from all the individuals in a population
• It is the total process of collecting, completing & publishing demographic, economic & social data pertaining at a specified time or times to all persons in a community

Census Disadvantages:

• Expensive
• Time-consuming
• Less accurate

Question 13. Primordial prevention.
Answer:

Primordial prevention

• It is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared
• Primordial prevention is receiving special attention in the prevention of chronic diseases
• In it, efforts are directed toward discouraging children from adopting harmful lifestyles
• The main intervention in primordial prevention is through individual & mass education

Question 14. Hidden caries.
Answer:

Hidden caries

• It is a term used to describe occlusal dentin caries that is missed on visual examination but is large enough & demineralized enough to be detected radiographically
• The detection rate of such lesions will depend upon the prevalence of caries in the population
• Occlusal enamel appears sound or only minimally demineralized
• It is difficult to diagnosed

Question 15. Clinical manifestation of AIDS.
Answer:

Clinical manifestation of AIDS

• Unexplained diarrhea
• Fatigue
• Malaise
• Loss of body weight
• Fever
• Night sweat
• Oral thrush
• Generalized lymphadenopathy
• Enlarged spleen
• Opportunistic infections

Question 16. Deductible.
Answer:

Deductible

• It is stipulated flat sum that the patient must pay towards the cost of treatment before the benefits of the program go into effect
• It is sometimes called” front-end-payment”

Question 17. Space maintainers.
Answer:

Space maintainers Definition:

it is a device used to maintain the space created by the loss of deciduous teeth

Space Maintainer Requirements:

• Maintain the space created
• Restores function
• Prevent supra eruption of opposing teeth
• Simple to construct
• Withstand functional forces
• Do not exert excessive forces
• Maintain oral hygiene
• Allow growth of permanent teeth
• Should not interfere with oral function

Question 18. Geriatric dentistry.
Answer:

Geriatric dentistry

• It is the delivery of dental care to older adults involving the diagnosis, prevention & treatment of problems associated with normal aging & age-related disease as part of an interdisciplinary professionals
• In older individuals, dental disease is more common due to
• Decreased immunity
• Presence of systemic disease

Common Oral Problems Are:

• Periodontitis
• Attrition
• Root caries
• Early edentulism

Question 19. Epizootic.
Answer:

Epizootic

• An epidemic outbreak of the disease in an animal population often with the implication that it may extend to humans
• It can lead to an epidemic among humans who are exposed to disease animals
• It may be
• Restricted to a specific area/ local
• Genera
• It affects a large number of animals at the same time within a particular region

Question 20. Seasonal trends.
Answer:

Seasonal trends

• It is a prominent feature of infectious disease occurrence
• Example: Measles & varicella are usually found with their peak incidence during the early spring season
• Similarly, upper respiratory tract infections show an increase during the winter season & GIT infections have a seasonal rise during the summer months
• The seasonal variation in disease occurrence can be attributed to changes in environmental conditions like temperature, humidity, rainfall, overcrowding, etc.

Question 21. Critical pH.
Answer:

Critical pH

• It represents the demineralization-remineralization cycle
• At critical pH of 5.5 or below
  • Hydrogen ions (H+) react with the phosphate group present in the oral cavity
  • Results in the formation of hypophosphate
  • Due to this, hydroxyapatite crystals dissolve & are termed dimerization
• At neutral pH
  • With adequate presence of calcium & phosphorous, dissolution is inhibited

Question 22. Newburgh Kingston study.
Answer:

Newburgh Kingston study

• On May 2nd, 1945, sodium fluoride was added to the drinking water of Newburg on the Hudson River
• Kingston town was the control
• After 10 years of fluoridation, Ast et al in 1956 reported that the DMF rate had fallen from 23.5% to 13.9%
• It thus confirmed the caries inhibitory property of fluoride in drinking water

Question 23. Prevalence of HIV.
Answer:

Prevalence of HIV

• It refers to the percentage of people ages 15-49 who are infected with HIV
• It is the number of persons living with HIV at a given time regardless of the time of infection, whether the person has received a diagnosis or the stage of HIV disease
• The HIV prevalence rate in India is less than in numerous other countries
• During the 1990s, HIV infection rates rose like an epidemic affecting every Indian society
• A rise of 0.1% of the population adds more than half a million HIV patients
• The north-east & south of India has got high HIV rates

Question 24. Customs & habits.
Answer:

Customs:

• It refers to practices that have been repeated by a number of generations, practices that tend to be followed simply because they have been followed in the past
• They have a traditional, automatic, mass character

Customs Habits:

• It is defined as the tendency towards an act that has become a repeated performance, relatively fixed, consistent & easy to perform by an individual
• It is a purely personal affair, not entailing any obligation
• Example: Smoking a cigarette after dinner

Question 25. Blanket referral.
Answer:

Blanket referral

• It is an effective program in many schools
• It consists of the referral of all children to their family dentists
• In this program, all children are given referral cards to take home and subsequently to the dentist who signs the cards on completion of examination, treatment or both
• The signed cards are then returned to the school nurse or classroom teacher

Primary Preventive Services Definitions

Pit and fissure sealants

They are defined as ” a cement or a resin which is introduced into unprepared occlusal pit and fissures of caries susceptible teeth forming a mechanical & physical protective layer against the action of acid-producing bacteria & their substrates”

Primary Preventive Services Important Notes

1. Disclosing agents

• Erythrosine red dye – common disclosing agent
• Bismark brown – plaque component of the Ramjford index uses this solution
• Two-tone solution – Stains mature plaque as green and immature plaque as red
• Mercurochrome
• Malachite green

2. Pit and fissure sealants

• They mainly act by physical obstruction of pits and grooves
• This prevents the penetration of fermentable carbohydrates so the remaining bacteria cannot produce acid
• Types:

Indications:

• Presence of deep occlusal pits and fissures
• Presence of lingual pits or palatal pits in relation to upper lateral incisors and molars
• Presence of incipient lesion in pit and fissure
• Children and young people with medical, physical, and mental impairment with high caries risk
• Children and young people with signs of higher caries activity and coming from nonfluoride areas

Contraindications:

• Presence of shallow pits and fissures
• An open occlusal caries lesion with extension into the dentin
• Presence of large occlusal restoration
• Presence of interproximal lesions and rampant caries
• Partially erupted tooth where in isolation is a problem
• Uncooperative children

3. Interdental cleaning aids

It is selected depending on the relative size of the embrasure

4. Lactobacillus colony test

• It is the oldest and most widely used microbiological method for assessing the caries activity
• Measures the number of aciduric bacteria in the patient’s saliva

5. Swab test

• Developed by Grainger et al
• In it no collection of saliva is necessary
• It is valuable in evaluating caries in very young children

Procedure:

• Swab the buccal surfaces of the teeth with a cotton applicator
• Incubate the sample in a media
• The change in pH over 48 hours of incubation is noted on a pH meter.

Interpretation:

6. Snyder test 

• It measures the ability of the salivary microorganism to form organic acids from a carbohydrate media
• Media contains bromocresol green dye which changes color from green to yellow in the range of pH 5.4 to 3.8
• Color observations

7.Salivaiy reductase test (or) Salivary Reductase Test.

It measures the activity of the reductase enzyme present in salivary bacteria

8. Alban’s test

• It is a simplified substitute for the Snyder test
• Can be used for routine dental office use
• At the time of the test, the patient is asked to spit unstimulated saliva directly into the tube and it is incubated for 4 days.

Primary Preventive Services Short Essays

Question 1. Bisbiguanides/ Chlorhexidine.
Answer:

Bisbiguanides

Chlorhexidine gluconate & alexidine are the most effective biguanides

Bisbiguanides Chlorhexidine Gluconate:

Bisbiguanides Indications:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances

Read And Learn More:  Percentive Communitive Dentistry Question And Answers

• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Bisbiguanides Adverse Effects:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Bisbiguanides Mechanism:

• In low concentrations- bacteriostatic
  • Cationic molecules of chlorhexidine bind to the anionic molecules of bacterial cell wall
  • Interferes with membrane transport
  • Results in leakage of the substance
• In high concentrations- bacteriocidal
  • Penetration of chlorhexidine into the cell
  • Precipitation of cytoplasm

Bisbiguanides Effective Concentration:

10 ml of 0.2%

Question 2. Caries vaccine
(or) Describe the routes of immunization of dental caries vaccine.
Answer:

Caries vaccine

It is a suspension of an attenuated or killed microorganism administered for the prevention, amelioration or treatment of infectious diseases

Caries vaccine Mechanism Of Action:

• When the tooth erupts serum antibodies i.e. IgA stimulate opsonization & phagocytosis
• These antibodies have an inhibitory effect on glucosyl transferase & on acid production
• It results in the inhibition of the metabolic activity of S.mutans on teeth

Caries vaccine Route Of Administration:

• Oral route
  • Increases stimulation of IgA antibodies
• Systemic route
  • Subcutaneous administration of s.mutans led to an increase in IgG, IgM & IgA antibodies
  • Active gingival-salivary route
  • Localizes the immune response by using gingival crevicular fluid as a route
• Active immunization
  • Synthetic peptides
    • Derived from glucosyl transferase enzyme
• Coupling with cholera toxin subunits
  • Coupling of the protein with a nontoxic unit of cholera toxin suppresses colonization of S. mutans
• Fusing with avirulent strains of salmonella
  • Liposomes- increases IgA antibodies
• Passive immunization
  • External supplements are included
  • Bovine milk & whey
  • Egg yolk
  • Transgenic plants

Question 3. Preventive resin restoration.
Answer:

Preventive resin restoration

It utilizes the invasive & non-invasive treatment of borderline or questionable caries

Preventive resin restoration Indications:

• Deep pit & fissure
• Minimal/small carious lesion » Isolated carious lesion

Preventive resin restoration Advantages:

• Conservative technique
• Cessation of tooth destruction
• Can be replaced easily

Question 4. Chemical plaque control.
Answer:

Chemical plaque control Uses:

• As adjunct
• Prevents recurrence of disease
• It may involve the prevention of plaque formation
• Removal of existing plaque
• Inhibition of calcification of existing plaque
• Altering the pathogenicity of plaque

Classification of Chemical plaque control:

• First generation
  • Reduces plaque score by 20-50%
  • Example: Antibiotics
• Second generation
  • Reduces plaque score by 70-90%
  • Example: Bisbiguanides
• Third generation
  • Effective against specific organisms

Chemical plaque control Chemical Used:

• Antibiotics
• Erythromycin
• Penicillin
• Enzymes
• Lipase
• Amylase
• Quaternary ammonium compounds
• Benzalkonium chloride
• Bisbiguanide
• Chlorhexidine
• Metallic salts
• Copper
• Zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others
• Triclosan

Question 5. Anti caries mouth rinses.
Answer:

Anti-caries mouth rinses

• Formulated at
• 0.2% concentration- for weekly use
• 0.05% concentration- for daily use
• Preparation
• Prepared by dissolving 200 mg sodium fluoride tablet in 5 teaspoons of fresh clean water « It can be used for 4 members (2 adults & 2 children)
• Mechanism
• Fluoride forms fluorapatite from hydroxyapatite
• Fluoride inhibits bacterial metabolism & plaque acid formation
• Indications
• If the concentration of fluoride in drinking water is 0.3 ppm or less
• Patients with increased caries risk
• School fluoride programs
• Advantages
• 30-40% reduction in caries incidence

Question 6. Pit & fissure sealants
(or)Classify pit and fissure sealants. Write about indications and contra-indications.
Answer:

Pit & fissure sealants

They are defined as ” a cement or a resin which is introduced into unprepared occlusal pit and fissures of caries susceptible teeth forming a mechanical & physical protective layer against the action of acid-producing bacteria & their substrates”

Pit Indication:

• Children of less than 4 years of age
• Newly erupted teeth
• Stained pits & fissures

Pit Contraindication:

• Low carious risk patients
• Wide pit & fissure
• Partially erupted teeth

Pit Classification:

• Based on polymerization
• Self-activation
• Light activation
• Resin systems
  • BIS-GMA
  • Urethane acrylate
  • Clear or tinted

Pit Ideal Requisites:

• Easily flowable into the deep pit & fissure
• Easy & quick to apply & cure
• Should result in prolonged retention
• Must have cariostatic properties
• Must be nonirritant
• Should have wear resistance property

Procedure:

• Surface cleanliness of the tooth
• Dryness of the tooth surface
• Preparing the tooth for sealant application
• Application of the sealant

Question 7. Lactobacillus test.
Answer:

Lactobacillus test

Described by Hadley in 1933

Lactobacillus test Principle:

It estimates the number of acidogenic bacteria in a patient’s saliva by counting the number of colonies appearing on agar

Lactobacillus test Procedure:

• Collect paraffin-stimulated saliva (5-10 ml)
• Dilute to 1:10 dilution by pipetting 1 ml of saliva into a 9 ml tube of sterile saline solution
• Similar again to 1:100 dilution using a 1:10 diluted sample
• Mix thoroughly
• Spread 0.4 ml of each dilution over agar plates
• Incubate for 3-4 days at 37° C
• Count the number of colonies

Result:

Lactobacillus test Disadvantages:

• Inaccurate
• Require complex equipment
• Time-consuming
• Tedious

Question 8. Self-control of plaque.
Answer:

The self-control of plaque Measures:

The self-control of plaque Toothbrush:

• The self-control of plaque ADA’S specification
  • Tooth head should be
  • 1-11/4* inch in length
  • 5/16- 3/8 inches in width
  • 2-4 rows of bristles
  • 5-12 tufts per row
  • Soft- 0.007-0.009 rows
  • 80-86 bristles per tufts
• The self-control of plaque Types
  • Based on the diameter of the bristles
    • Soft- 0.007-0.009 inches
    • Medium- 0.010-0.012 inches
    • Hard- 0.013-0.014 inches
    • Extra hard- 0.015 inches
• The self-control of plaque Based on the use
• Frequency of brushing
  • Every 12 hours
• The self-control of plaque Frequency of change of brush
  • Every 3 months
  • Length of brushing time
    • Initially 10-20 minutes
    • Later 3-5 minutes
• The self-control of plaque Dentrifices
  • Used in the form of powder, paste, or gels
  • Interdental cleansing aids
  • Used in periodontally-involved patients
  • Used in open embrasures
  • Various aids
  • Dental floss o Interdental brushes
  • Wooden tips
  • Yams, gauze strips
  • The self-control of plaque Gingival massage
    • Device used
    • Toothbrush
    • Rubber tip stimulator
    • Interdental cleaning device
• The self-control of plaque  Effects
  • Epithelial thickening
  • Increased keratinization
  • Increased mitotic activity
• The self-control of plaque  Oral irrigation
  • Clean non
  • adherent bacteria debris
  • Disrupt & detoxify subgingival plaque
  • Delivers anti-microbial agents into the periodontal pocket

Question 9. Erythrosine dye.
Answer:

Erythrosine dye

It is a cherry-pink synthetic agent

Erythrosine dye Uses:

• Food coloring agent
• In printing inks
• Biological stain
• Disclosing agent
• Radiopaque medium
• Sensitizer
• Used in sweets, in cakes decorating gels

Erythrosine dye Concentration:

• For rinsing
  • Red no 3- 6.0 g
  • Water to make: 100 ml
  • For topical application
  • Erythrosine: 0.8 g
  • Distilled water-100 ml
  • Alcohol 95%-10 ml
  • Peppermint oil: 2 drops
• Erythrosine dye Tablets
  • Red no 3 -15 g
  • Sodium chloride- 0.747 %
  • Sodium sugary: 0.747 %
  • Calcium stearate: 0.995%
  • Soluble saccharin: 0.186%
  • White oil: 0.124%
  • Flavoring: 2.239%
  • Sorbitol

Erythrosine dye Purpose:

• Patient’s education
• Evaluate the effectiveness of the treatment
• Evaluate plaque indices
• Self-evaluation

Question 10. Toothbrush.
Answer:

Toothbrush Ada’s Specification:

• Tooth head should be
• 1-11/4^ inch in length
• 5/16-3/8 inches in width
• 2-4 rows of bristles
• 5-12 tufts per
• Soft- 0.007-0.009 rows
• 80-86 bristles per tufts

Toothbrush Types:

• Based on the diameter of the bristles
  • Soft- 0.007-0.009 inches
  • Medium- 0.010-0.012 inches
  • Hard-0.013-0.014 inches
  • Extra hard- 0.015 inches
• Based on use
  • Manual
  • Automatic
  • Sonic & ultrasonic
  • Ionic
• Frequency of brushing
  • Every 12 hours
• Frequency of change of brush
  • Every 3 months
• Length of brushing time
  • Initially 10-20 minutes
  • Later 3-5 minutes

Toothbrush Objectives Of Brushing:

• To clean teeth & interdental space
  • To prevent plaque formation
  • To remove plaque
  • To stimulate & massage gingival tissue
  • To clean tongue

Toothbrush Parts:

• Handle
  • Head
  • Tufts
  • Brushing plane
  • Shank

Question 11. Bass technique.
Answer:

Bass technique Synonym:

Sulcus cleaning method

Bass technique Indications:

• Open interproximal areas
• Routine technique
• Exposed root surfaces

Bass technique Technique:

• Place the bristles at a 45° angle to gingival
• Move in small circular motions
• Cover 3 teeth at a time
• Repeat around 20 strokes
• For occlusal surfaces
• Press the bristles firmly against pits & fissures
• Activate the bristles
• For lingual surfaces of the anterior place the brush vertically

Bass technique Advantages:

• Easy
• Effective
• Stimulate gingiva

Bass technique Disadvantages:

• Can cause gingival injury
• Time-consuming
• Require dexterity

Question 12. Classification of dental caries.
Answer:

Classification of dental caries Clinical:

• According to the stage of lesion progression
  • Non cavitated
  • Cavity
• According to the severity of the disease
  • Acute
  • Chronic
  • Stabilized
• According to clinical manifestation
  • White spot lesion
  • Superficial caries
  • Medium caries
  • Deep caries
  • Secondary caries

Classification of dental caries Anatomical:

• According to anatomical depth
  • Enamel caries « Dentinal caries
  • Cementum caries
• According to location
  • Coronal caries
  • Occlusal caries
  • Smooth surface caries
  • Approximal caries
  • Root caries

Question 13. Caries activity tests.
(or) Synder’s test
Answer:

1. Synder’s Test:

It is used for lactobacillus count

Caries activity tests Procedure:

1. Paraffin-stimulated saliva is collected in test tubes
2. It is inoculated into glucose & agar media
3. pH 4.7-5.0 is maintained along with color indicator bromocresol green
4. The color change indicates pH change & is compared to the standardized color chart & scored
5. Recordings are carried out at the end of 24 hours, 48 hours & 72 hours

Result:

2. Lactobacillus Test:

Described by Hadley in 1933

Caries activity tests Procedure:

• Collect paraffin-stimulated saliva [5-10 ml)
• Dilute to 1:10 dilution by pipetting 1 ml of saliva into a 9 ml tube of sterile saline solution
• Similar again to 1:100 dilution using a 1:10 diluted sample
• Mix thoroughly
• Spread 0.4 ml of each dilution over agar plates
• Incubate for 3-4 days at 37° C
• Count the number of colonies

3. Swab Test:

Caries activity tests Procedure:

• The oral flora is sampled by swabbing the buccal surfaces of the teeth with a cotton applicator
• It is subsequently incubated in the medium
• The change in pH following a 48-hour incubation period is read on a pH meter

Interpretation:

Question 14. Modified bass technique.
Answer:

Bass technique

• Placement of the head of the brush
  • 45° to the long axis of the teeth
  • Initial from most posterior teeth
• Method
  • Place the brush covering 3 most posterior teeth
  • Exert gentle pressure
  • Use short back & forth motions complete 20 strokes
  • Sweep the bristles occlusal
  • Repeat it for remaining teeth both buccally & lingually
  • For occlusal surfaces, press bristles into pits & fissures & exert strokes
  • For lingual surfaces of the anterior, place the brush vertically

Primary Preventive Services Short Question And Answers

Question 1. Interdental cleansing aids.
Answer:

Interdental cleansing aids Uses:

• Used in periodontally-involved patients
• Used in open embrasures
• Removes plaque & debris adherent
• Polishes the surfaces
• Massage the inter-dental papillae
• Reduces gingival bleeding
• Contribute to general oral sanitation
• Controls halitosis
• Various Aids:
• Dental floss
• Interdental brushes
• Wooden tips
• Yarns, gauze strips

Question 2. ADA’s specification of the toothbrush.
Answer:

ADA’s specification of the toothbrush

• Tooth head should be
  • 1-1 l/4th inch in length o 5/16-3/8 inches in width
  • 2-4 rows of bristles
  • 5-12 tufts per
  • Soft- 0.007-0.009 rows
  • 80-86 bristles per tufts

Question 3. Disclosing agents.
Answer:

Disclosing agents

• They are prepared in liquid, tablet, or lozenge form that contains a dye or other coloring agent
• It is used to identify bacterial plaque for instruction, evaluation & research

Disclosing agents Purpose:

• Patient’s education
  • Evaluate the effectiveness of the treatment
  • Evaluate plaque indices
  • Self-evaluation

Disclosing agents Requirements:

• Color should contrast with the normal color of the oral cavity
  • It should not rinse off immediately
  • It should not cause any irritation
  • It should be thin enough

Disclosing agents Agents

• Iodine containing preparation
  • Bismarck brown
  • Merbromin
  • Erythrosine
  • Fast green
  • Two-tone

Question 4. Synder’s test.
Answer:

Synder’s test

It is used for lactobacillus count

Synder’s test Procedure:

• Paraffin-stimulated saliva is collected in test tubes
• It is inoculated into glucose ft agar media
• pH 4.7-5.0 is maintained along with color indicator bro- mo cresol green
• The color change indicates pH change it is compared to the standardized color chart ft scored
• Recordings are carried out at the end of 24 hours, 48 hours & 72 hours

Question 5. Dental floss.
Answer:

Dental floss Types:

• Twisted or non-twisted
• Bonded or non bonded
• Waxed or unwaxed
• Thick or thin

Dental floss Technique:

• Wrap the dental floss around the fingers
• Stretch it between the forefinger ft thumb
• Pass interproximal through each contact area in the back ft forth motion
• Move the floss along the tooth apically upto sulus
• Repeat it

Dental floss Functions:

• Removal of adherent plaque ft debris interdentally
• Polish tooth surface
• Stimulate ft massage interdetnal papilla
• Help to locate
• Subgingival calculus
• Proximal caries
• Overhanging margins
• It is a vehicle to apply polishing / therapeutic agents

Question 6. Charter’s method.
Answer:

Charter’s method Method:

• Place the bristles 45° angle to the long axis of teeth pointing coronally
• Flexed against the gingiva
• Back ft forth vibratory motions are given

Charter’s method Indication:

After surgery

Charter’s method Effect:

• Gingival stimulation
• Interproximal cleansing

Question 7. Chlorhexidine.
Answer:

Chlorhexidine Indications:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Chlorhexidine Adverse Effect:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Chlorhexidine Mechanism:

• In low concentrations- bacteriostatic
  • Cationic molecules of chlorhexidine bind to the
  • ionic molecules of bacterial cell wall
  • Interferes with membrane transport
  • Results in leakage of the substance
• In high concentration-bacteriocidal
  • Penetration of chlorhexidine into a cell i
  • Precipitation of cytoplasm

Chlorhexidine Effective Concentration:

10 ml of 0.2%

Question 8. Active immunization for dental caries.
Answer:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Question 9. Roll on technique.
Answer:

Roll on technique Synonym:

• ADA method
• Sweep method

Roll-on technique Indications

• Preparatory for modified Stillman method
• Children
• Adults with limited dexterity

Roll on technique Technique:

• Place the bristles at a 45° angle to tooth surfaces
• Lightly roll over it occlusal

Roll on technique Advantage

Massage & stimulate gingiva

Roll-on technique Disadvantage:

• Lacerate alveolar mucosa
• Ineffective for the cervical third of the tooth & interproximal areas
• May produce punctuate lesions

Question 10. Dentrifices.
Answer:

Dentrifices

• It is a substance used with a toothbrush for the purpose of
• cleaning the accessible surfaces of teeth
• Used in the form of powder, paste, or gel

Dentrifices Functions:

• Minimize plaque build-up
• Anticaries action e Removal of stains
• Mouth freshener

Dentrifices Composition

• Abrasive
  • Calcium carbonate
  • Calcium phosphate
• Humectants
  • Maintains moisture
  • Glycerine, sorbitol
• Preservatives
  • Benzoic acid
• Thickening agents
  • Methylcellulose
• Foaming agents
  • Sodium lauryl sulfate
• Flavoring agents
• Mint
• Sweetening agents
  • Mannitol, saccharine
• Desensitizing agents
  • Sodium fluoride
• Anticalculus agent
  • Pyrophosphates

Question 11. Uses of chlorhexidine.
Answer:

Uses of chlorhexidine

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Question 12. Caries vaccine.
Answer:

Caries vaccine

It is a suspension of an attenuated or killed microorganism administered for the prevention, amelioration or treatment of infectious diseases

Caries vaccine Mechanism Of Action:

• When the tooth erupts serum antibodies i.e. IgA stimulate opsonization & phagocytosis
• These antibodies have an inhibitory effect on glucosyl transferase & on acid production
• It results in the inhibition of the metabolic activity of S.mutans on teeth

Question 13. Indications of a powered toothbrush.
Answer:

Indications of a powered toothbrush

• Young children
• Handicapped patients
• Individuals lacking manual dexterity
• Patients with prosthodontic or endosseous implants
• Orthodontic patients
• Institutionalized patients including the elderly who are dependent on care providers
• Patients on supportive periodontal therapy

Question 14. Salivary reductase test.
Answer:

Salivary reductase test Procedure:

• Paraffin-stimulated saliva is collected in a collection tube
• It is then mixed with the dye Diazo-resorcinol
• The caries conduciveness reading or color change is done after 15 minutes

Question 15. Spool method of flossing.
Answer:

Spool method of flossing

• About 12-18 inches long floss is taken and about 4 inches from each end is wound around the middle finger of each hand
• In both hands, the last three fingers are folded and closed and both hands are moved apart
• In this way, about 1-2 inches of floss is held tightly between the index fingers of both the hands

Primary Preventive Services Viva Voce

1. Fredick Tornberg was the first to design the powered toothbrush
2. The circular method of toothbrushing technique is called the Fones technique
3. The vertical method of brushing technique is called the Leonard method
4. Smith method is a physiological method of toothbrushing
5. The bristles in the bass method are placed at a 45-degree angle to the gingiva
6. Dental floss is indicated to remove plaque from type I gingival embrasure
7. Furcation areas are difficult to access with a dental floss
8. The spool method of flossing is used in adults with good manual dexterity
9. Waxed floss makes a squeaking noise when passed interproximal
10. Gingival physiotherapy results in better gingival health through increased blood flow
11. The bound chlorhexidine is slowly released in the active form for a period of 12-24 hours
12. Triclosan is a phenol derivative present as an antiplaque agent
13. Brown staining of chlorhexidine is due to the precipitation of salivary melanoidin’s
14. Humectant present in toothpaste helps in reducing loss of moisture
15. Sodium lauryl sulfate is the detergent present in toothpaste

Indices For Oral Disease Definitions

Index

A numerical value describing the relative status of a population on a graduated scale with definite upper & lower limits, which is designed to permit & facilitate comparison with other populations classified by the same criteria & methods

Indices For Oral Disease Important Notes

1. Gingival index scoring

2. Periodontal index scoring

3. Scoring System

4. Treatment needs scoring

5. Dean’s fluorosis index scoring
(or) A scoring pattern of Dean’s index.

6. Teeth examined in indices

7. HO modifications of DMF index

• All third molars are included
• Temporary restorations are considered D
• Only carious cavities are considered

8. Indicators of periodontal status used in CPI are

• Gingival bleeding
• Calculus
• Periodontal pockets

9. Periodontal index by Russell measures the presence/ absence of

• Gingival inflammation
• Pocket formation
• Masticatory function

10. Classification of index

• Based on the direction in which their scores can fluctuate
• Irreversible index
• Reversible index
• Depending upon the extent to which areas of the oral cavity are measured
• Full mouth index

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• Simplified index
• General categories
• Disease index
• Symptom index
• Treatment Index
• Special categories
• Simple index
• Cumulative index

11.Properties of index

• Clarity, simplicity, and objectivity
• Validity
• Reliability
• Quantifiability
• Sensitivity
• Acceptability

Indices For Oral Disease Long Essays

Question 1. Define indexes & classify them. Write about its ideal requisites.
(or) Classify various indices of the oral cavity. (or )Ideal requirements of index.
Answer:

Indexes Definition:

A numerical value describing the relative status of a population on a graduated scale with definite upper & lower limits, which is designed to permit & facilitate comparison with other populations classified by the same criteria & methods

Classification of Indexes :

• Based on the direction in which their scores can fluctuate
• Irreversible index
  • An index that measures conditions whose scores will not decrease on subsequent examination.
• Example: DMFT index
• Reversible index
  • An index that measures conditions that can increase or decrease on subsequent examination. Ex. Gingival index
• Depending upon the extent to which areas of the oral cavity are measured
• Full mouth index
  • Those indices measure the patient’s entire dentition. Example: PI
• Simplified index
  • These indices measure only a representative sample of the dental apparatus. Example: OH1-S
• General categories
  • Disease index
    • D- portion of DMFT index
• Symptom index
  • Measuring gingiva/sulcular bleeding
• Treatment Index
  • F portion of the DMFT index
• Special categories
  • Simple index
    • Measures the presence or absence of a condition
• Cumulative index
  • Measures all the evidence of a condition, past or present

Indexes Ideal Requisites:

1. Clarity, simplicity & objectivity:

• The examiner should remember the rules of the index clearly
• The index should be simple & easy to apply
• The criteria should be objective

2. Validity:

• The index should measure what it is intended to measure
• It should correspond to the clinical stages of the disease under study

3. Reliability:

The index should measure consistently at different times & under a variety of conditions

4. Quantifiability:

The index should be amenable to statistical analysis so that the status can be expressed by a number

5. Sensitivity:

The index should be able to detect small shifts in either direction

6. Acceptability:

The use of an index should not be painful or demeaning to the subject

Question 2. Define an index & describe the CPITN index
(or) Define index. Describe the CPITN with its objectives, scoring system, advantages & limitations.
Answer:

Index Cpitn Index

Index  Objectives:

• To survey & evaluate periodontal treatment needs
• identify actual & potential problems posed by periodontal diseases both in the community & in the individual

Index  Advantages:

• Simplicity
• Speed
• International uniformity

Index  Limitations:

• Does not record the position of the gingival margin
• Does not provide an assessment of past periodontal breakdown

Index  Procedure:

• The dentition is divided into sextants for assessment of periodontal treatment needs
• Each sextant is given a score

Index  Sextants:

Index  Probing Procedure:

• A tooth is probed to determine pocket depth & to detect subgingival calculus & bleeding response
• The probe is inserted between the tooth & the gingival, & the sulcus depth or pocket depth is noted against the color
• A tooth should be probed in at least 6 points, the mesiobuccal, distobuccal, and corresponding sites on lingual surfaces

Code & Criteria

Question 3. Classify them. Add a note on DMFT &. DMFS index &. on its limitations.
Answer:

Dmft Index:

Developed by Henry T Klein, Carole E Palmer & Knutson ] W in 1938

Dmft Index Components:

• D- used to describe decayed teeth
  • M- used to missing teeth due to decay
  • F- used to describe a number of teeth attacked by caries but which have been restored

Dmft Index Calculation:

• Individual DMFT= D+M+F
• Group average
  • Total DMF / total number of subjects examined

Dmft Index Limitations:

• Not related to the number of teeth at risk
• Invalid in an older individual
• Misleading in children
• Overestimate caries experience in teeth
• Little use in root caries
• Equates a disease state with a healthy state

Dmfs Index:

Dmft Index Components:

• D- used to describe decayed teeth surface
• M- used to missing teeth surface due to decay
• F- used to describe the number of teeth surfaces attacked by caries but which have been restored

Dmft Index Calculation:

• If 28 teeth are examined
• 16 posterior teeth[16*5)= 80 surfaces
• 12 anterior teeth( 12*4)= 48 surfaces
• Total= 128 surfaces
• If third molars are included (4*5)= 20 surfaces
• Total= 148 surfaces

Dmft Index Limitations:

• Time-consuming
  • Likely to produce inconsistencies in diagnosis
  • May require the use of a radiograph

Indices For Oral Disease Short Essays

Question 1. Dean’s fluorosis index.
Answer:

Dean’s fluorosis index

• Introduced by Trendley H dean in 1934
• It is an index for the assessment of dental fluorosis
• It is the most widely used fluorosis index since 1942

Question 2. Oral hygiene index.
Answer:

Oral hygiene index

Described by John C. Greene & Jack R. Vermillion in 1960

Oral hygiene index Methodology:

• Components
• Debris index
• Calculus index
• The dental arch is divided into three segments

The surface covered by debris & calculus is estimated

Scoring For Dl-S:

Scoring For Cl-S:

Interpretation For Dl-S & Cl-S:

Interpretation For OHI:

Question 3. Composite index.
Answer:

Composite index

The periodontal index is a composite index because it records both the reversible changes due to gingivitis & irreversible changes brought about by periodontal disease

Composite Index Method:

• Teeth examined
• All teeth present are assessed for gingival inflammation & periodontal involvement
• Scoring is given

Composite Index Calculation:

PI score per person= sum of individual score/number of teeth present

Question 4. Oral hygiene index-simplified.
Answer:

Oral hygiene index simplified

Described by John C.Greene & Jack R.Vermillion in 1964

Index-simplified Tooth Examined:

• 16/17,11,16/27
• 46/47,31,36/37

index-simplified Surfaces Examined:

• Facial surfaces of 16/17,11, 26/27, 31
• Lingual surfaces of 36/37,46/47

index-simplified Sites:

• DI-S- incisal third to gingival third
• CI-S – distal gingival crevice subgingivally from distal to mesial contact

Question 5. Loe & Sillness index.
Answer:

Stillness Index Teeth Examined:

All or selected teeth

Stillness Index Surfaces:

• Distal facial papillae
• Facial margin
• Mesial facial papillae
• Lingual margin

Scoring:

Stillness Index Calculation:

• For individual tooth
• Score / 4
• For individual person
• Total score/ total teeth examined

Interpretation:

Question 6. Caries index for primary dentition.
Answer:

Primary Dentition Def Index:

• Described by Gruebbel A.O. in 1944
  • d- decayed tooth e
  • e- extracted tooth e
  • f- filled tooth

Primary Dentition Examination Method:

• d- decayed teeth
• e-extracted teeth
  • Indicates those deciduous teeth which have been extracted due to caries or which have badly decayed that they are indicated for extraction
• f-filled teeth
  • Indicates the number of deciduous teeth that have been attacked by caries but which have been restored without any recurrent decay present

Primary dentition Calculation:

• For deciduous teeth 20 teeth are present
• For the def index maximum score is 20
• For deaths maximum score is 88, it is as follows
• 8 posterior teeth(8*5)= 40 surfaces
• 12 anterior teeth( 12*4)= 48 surfaces

Question 7. Define index. Write notes on DMFT and DMFS.
Answer:

Dmft Index:

Developed by Henry T Klein, Carole E palmer & Knutson J W in 1938

Dmft Index Components:

• D- used to describe decayed teeth
• M- used to missing teeth due to decay
• F- used to describe a number of teeth attacked by caries but which have been restored

Dmft Index Calculation:

• Individual DMFT= D+M+F
• Group average
• Total DMF / total number of subjects examined

Dmfs Index:

Components:

• D- used to describe decayed teeth surface
• M- used to missing teeth surface due to decay
• F- used to describe a number of teeth surfaces attacked by caries but which have been restored

Dmft Index Calculation:

• If 28 teeth are examined
• 16 posterior teeth(16*5)= 80 surfaces
• 12 anterior teeth( 12*4)= 48 surfaces
• Total= 128 surfaces
• If third molars are included (4*5)= 20 surfaces
• Total= 148 surfaces

Indices For Oral Disease Short Question And Answers

Question 1. DMF index.
Answer:

DMF index

Developed by Henry T Klein, Carole E palmer & Knutson J W in 1938

DMF index Components

• D- used to describe decayed teeth
• M- used to missing teeth due to decay
• F- used to describe the number of teeth attacked by caries but which have been restored

DMF index Limitations:

• Not related to the number of teeth at risk
• Invalid in an older individual
• Misleading in childer
• Overestimate carries experience in teeth
• Little use in root caries
• Equates a disease state with a healthy state

Question 2. Community fluorosis index.
Answer:

Community fluorosis index

• Devised by Trendley H. Dean in 1946
• It is to calculate the prevalence & severity of fluorosis in a group or community
• Index = nXw/N
• Where
  • n= number of individuals in each category
  • w= weighting for each category
  • N= total population

Question 3. Uses of PI.
Answer:

Uses of PI

• Estimate deeper periodontal disease
• Measure the presence or absence of gingival inflammation & its severity
• Pocket formation
• Masticatory function

Question 4. Validity of index.
Answer:

Validity of index

• The index should measure what it is intended to measure
• It should correspond to the clinical stages of the disease under study

Indices For Oral Disease Viva Voce

1. Def index measures dental caries in the primary dentition.
2. Cumulative indices measure all the evidence of past and present condition
3. The gingival index is also known as Loe and Silness and the Plaque index is also known as Silness and Loe index
4. The periodontal disease index is given by Ramfjord
5. Sulcus bleeding index and papillary bleeding index measure gingival bleeding
6. The weight of the CPITN probe is 5 grams
7. The length of the CPITN probe is 14 mm
8. In DMFT, decayed tooth includes
9. A tooth with caries below the existing restoration
10. A tooth with a temporary restoration
11. An index measuring the periodontal disease of an individual is classified under a composite index
12. Plaque index is an example of a reversible index
13. The plaque index measures the thickness of plaque at the gingival third
14. Russell periodontal index does not measures gingival recession

Atraumatic Restorative Treatment Definitions

Atraumatic restorative treatment

It is a procedure based on removing carious tooth tissues using hand instruments alone & restoring the cavity with an adhesive restorative material.

Atraumatic Restorative Treatment Short Essays

Question 1. Atraumatic restorative treatment.
Answer:

Atraumatic restorative treatment

It is a procedure based on removing carious tooth tissues using hand instruments alone & restoring the cavity with an adhesive restorative material

Atraumatic restorative treatment Principles:

• Removing carious tooth tissues using hand instruments
• Restoring the cavity with a restorative material that sticks to the tooth

Atraumatic restorative treatment Indication:

• Only in small cavities
• Accessible cavities
• Public health programs

Atraumatic restorative treatment Contra-Indications:

• Presence of swelling or fistula
• Exposed pulp
• Painful teeth with chronic inflammation of pulp ‘
• Carious cavity with inaccessible area

Atraumatic restorative treatment Advantages:

• Requires minimal cavity preparation
• Painless technique
• Simplifies infection control
• No electrical driven & expensive dental equipment required
• Simple
• Cost-effective
• Friendly procedure
• Accessible for all population groups

Atraumatic restorative treatment Procedure:

• Place cotton rolls alongside the tooth to be treated
• Remove plaque wet cotton pellet
• Diy the surface with a dry pellet
• Caries is removed by dental hatchet
• Next, the cavity is cleaned with wet cotton pellets
• Conditioning the cavity with dentin conditioner
• Mixing of GIC
• Restoring the cavity
• Rub a small amount of petroleum jelly & pressed firmly
• Remove excess material

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Atraumatic Restorative Treatment Viva Voce

1. Atraumatic restorative treatment [ART) follows the principle of removing carious tooth tissue using a hand instrument only
2. ART was a theme of World Health day theme in 1992
3. ART can be employed when a community cannot afford expensive dental equipment
4. ART was pioneered in the 1980s in Tanzania by Joe, Faencken, and Holmgren
5. ART can be employed when there is a clear occlusal cavity
6. ART is absolutely contraindicated in the presence of swelling or fistula near the carious tooth
7. GIC bonding in ART is chemical
8. Control of saliva is an important aspect of the success of ART
9. A small spoon excavator is used to clean the enamel dentin junction
10. A dental hatchet is used to widen the entrance to the cavity by removing unsupported enamel
11. Petroleum jelly is used to keep moisture away from GIC in ART
12. A plastic strip is used to contour the proximal surface of multiple surface restoration in ART
13. Poor adhesion is the result of over-mixing of GC material.

Behavioral Sciences Definitions

Sociology

It is defined as the study of human interactions & interrelations, their conditions & Consequences

Behavioral Sciences Important Notes

1. Social stratification

2. Intelligence Quotient (IQ)

Behavioral Sciences Short Question And Answers

Question 1. Nuclear family.
Answer:

Nuclear family

• It is universal in all human society
• Consists of
• Married couple & their children while they are still dependents

Question 2. Intelligence Quotient.
Answer:

Intelligence Quotient

• Obtained by
  • Dividing the mental age by chronological age
  • Then multiplying by 100
  • IQ=( Mental age / chronological age) 100

Question 3. Sociology-definition.
Answer:

Sociology-definition

• It is the science concerned with the organization/ structure of social groups
• It is defined as the study of human interactions & interrelations, their conditions and consequences
• It deals with human relationships & human behavior for a better understanding of the pattern of human life

Behavioral Sciences Viva Voce

1. Learned behavior that has been socially acquired is culture.
2. The term new families is implied to those under 10 years of duration.
3. A family in which parents have separated or where death has occurred of either parent is a broken family.

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Behavioural Management Definitions

Reinforcement

It means any consequences which increase the likelihood of a behavior being shown

Behavioral Management Important Notes

1. Home technique

• Indications
  • 3-6 years
  • A child who can understand simple verbal commands
  • Children displaying uncontrolled behaviour
  • Healthy children displaying uncontrolled behaviour
• Contraindications
  • Children under 3 years of age
  • Handicapped/ immature/ frightened child
  • Physical, mental, and emotional handicap.

2. Desensitization

• It is an effective method for reducing maladaptive behaviour
• It is accomplished by teaching the child a competing response such as relaxation and then introducing progressively more threatening stimuli.

3. Modelling

• It is based on the social learning principle allowing a patient to observe one or more models demonstrating positive behaviour in a situation
• It is brought about by
• Live models
• Filmed models
• Posters
• Audiovisual aids

4. Indications of tell show do the technique

• Children more than 3 years of age
• Fearful child
• First Visit

5. Behaviour-shaping techniques

• Desensitization
• Modelling
• Contingency management

6. Physical restraints can be

• Active – restraints performed by dentist or parents or staff
• Passive – with the aid of the restraining device

Behavioural Management Short Essays

Question 1. Management of children in the dental office.
Answer:

Management of children in the dental office Voice Control:

• The voice should be soft, gentle, modulated
• It is a controlled alteration of voice volume, tone or pace to influence a patient’s behaviour

Management of children in the dental office Non-Verbal Communication:

• Smiling face/ other facial expression
• Walking with the patient around
• Admiration, encouragement, friendliness

Management of children in the dental office Biofeedback:

It includes EMG activity

Management of children in the dental office Coping:

• Patient differs in coping with stress associated with painful experiences
• It includes distraction/ displacement of attention

Management of children in the dental office Humour:

It is to elevate the mood of the child

Management of children in the dental office Relaxation:

• Reduces stress
• Reduces reaction to pain
• Reduces anxiety present

Management of children in the dental office Audio-Analgesia:

• Diverts the attention of the patient
• This reduces stress & decreases reaction to pain

Management of children in the dental office Hypnosis:

• It includes
• Flattering of closed eyelid ° Deep breathing
• Progressive sense of relaxation

Management of children in the dental office Implosion Therapy:

Refers to the picturization of animated movies

Management of children in the dental office Aversive Conditioning:

• It includes
  • Physical restraints
    • Use of mouth props
    • Restraint of the patient by the dentist & assistant
• Home technique

Management of children in the dental office Drug Therapy:

• Used when basic techniques do not work
• Used in
  • Very young children
  • Very apprehensive children
  • Physically handicapped children
  • Mentally handicapped children
• Drugs used
  • Sedative & hypnotics
  • Anti-anxiety drugs
  • Narcotics

Question 2. Dental practice management.
Answer:

Practice management the Dental Office Setting:

• Selection of the location
• Locate where there are few dentists
• In town, surrounded by villages, near a bus stop
• In a city near the railway station, a shopping complex
• Close to government commercial offices, corporate & business houses
• Located in a place from where ladies can commute easily without fear

1. Selection of the building:

• Select the dental office in a new building
• It should be well-ventilated, with proper electrical, water & drainage system
• It should have a parking facility

2. Designing of the dental office:

• A spacious waiting room, work area, x-ray room, laboratory, resting place, toilet, etc
• Furniture must be durable, aesthetic & comfortable
• Placement of each electrical equipment & gadget required
• The exact position of the dental chair & unit, wash basin
• Autoclaving & sterilization done in a separate chamber
• The compressor & the generator should be kept as far away as possible

Management Of Dental Office:

• A dentist may appoint a full-time receptionist, a dental assistant
• Fair salaries & good benefits are necessary to avoid job dissatisfaction

Practice management Patient System:

• Dentists should have good communication with their patients
• He should be aware of the timings, weekly holidays, etc
• An appointment book should be maintained
• The clinic should be open at least 30 minutes before the first appointment
• Should have proper disposal of waste

Behavioural Management Short Question And Answers

Question 1. Home technique.
Answer:

Home technique

• Home: Hand Over Mouth Exercise
• It is an accepted technique for intercepting & managing demonstrably unsuitable behaviour

Home technique Procedure

• The dentist gently places his hand on the child’s mouth
• He then whispers in the child’s ear that if he cooperates, the hand will be removed
• Once the child cooperates complements the child for good behaviour
• Physical restraints are used only as a last resort

Question 2. Reinforcement.
Answer:

Reinforcement

It means any consequences which increase the likelihood of a behavior being shown

Reinforcement Types:

• Primary
• Based on primary biological needs
• Example: food, clothing
• Secondary
• Involves that are not intrinsically rewarding
• Example: praise
• Positive
• It is a pleasant reinforcement
• It increases the likelihood of behaviour
• Example: voice modulation, facial expression
• Negative
• It is an unpleasant event thus it can be avoided
• Example: threats of failing an examination

Question 3. Modeling in behavior management.
Answer:

Modelling in behavior management

Developed by Bandura in 1969

Behavior management requirements:

• Expended concentrated attention
• Presence of sufficient retention of desirable behaviour
• Must reproduce effectively the behaviour modeled
• The newly acquired behavior must be appropriately rewarded

Behavior management Uses:

• To achieve the attention of the child
• To alleviate anxiety
• To encourage preventive care at home
• Reduces uncertainty

Behavioural Management Viva Voce

1. Voice control is an effective communicative technique using sudden and firm commands to stop disruptive behavior and to get the child’s attention
2. HOME and physical restraints are methods of aversive conditioning
3. Behavior followed by termination of an aversive event is negative reinforcement
4. The show-do technique shapes the patient’s response to procedures through desensitization
5. Tell show-do technique uses verbal explanation, demonstration, and completion of the task
6. Modeling is an important component of social learning theory.

 

Cultural taboos Important Notes

1. Social norms

• They indicate the established and approved ways of doing things, of dress, of speech, and of appearance
• They are rules that a group uses for appropriate and inappropriate values, beliefs, attitudes, and behaviors
• Types: folkways, mores, and taboos

2. Folkways

They are the patterns of conventional behavior in society and norms that apply to everyday matters

3. Mores

• They are norms or lessons that express fundamental values of society
• They are derived from the established practices of society
• Some important mores are converted into laws to ensure implementations

4. Taboos

It is a strong social prohibition or ban against words, objects, actions, or discussions that are considered undesirable or offensive by a group, culture, society, or community

Cultural taboos Short Question And Answers

Question 1. Taboos related to dentistry in India.
Answer:

Taboos related to dentistry in India

• Some taboos may lead to severe penalties while others result in embarrassment, shame & rudeness
• Example:
  • Tooth avulsion
  • Lacquering and dyeing of teeth
  • Tattooing