Dentin hypersensitivity is a common condition characterized by short, sharp pains in response to stimuli like hot, cold, sweet or acidic foods. It affects 14-98% of adults and is caused by exposure of dentin, usually due to gum recession. The hydrodynamic theory is the most accepted explanation, where stimuli cause rapid fluid movement in dentinal tubules, stimulating nerve fibers. Treatment focuses on blocking tubules with agents like potassium nitrate, strontium chloride or oxalate. Placement of restorations or periodontal procedures may also help. Patients are advised on controlling factors that exacerbate sensitivity.
Tooth hypersensitivity is a common problem encountered in everyday life and clinical practice. This presentation clearly shows causes, methods of prevention and treatment in such cases.
Tooth hypersensitivity is a common problem encountered in everyday life and clinical practice. This presentation clearly shows causes, methods of prevention and treatment in such cases.
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
A short slideshow covering the basics of Intrusive luxation and total avulsion, from an endodontic point of view.. Highlight are the photographs chosen with care to explain the points well. Ideal for under-graduate and Post-graduate students. Based on Grossman's Endodontic Practice, 13th Edition.
Teeth don’t possess regenerative ability found in most other tissues. Therefore, once enamel & dentin are lost as a result of caries, trauma or wear, restorative material must be used, to reestablish form & function.
Teeth require preparation to receive restoration & these preparations must be based on fundamental principles, which are discussed in this presentation, from which basic criteria can be developed to help predict the success of prosthodontic treatment.
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
A short slideshow covering the basics of Intrusive luxation and total avulsion, from an endodontic point of view.. Highlight are the photographs chosen with care to explain the points well. Ideal for under-graduate and Post-graduate students. Based on Grossman's Endodontic Practice, 13th Edition.
Teeth don’t possess regenerative ability found in most other tissues. Therefore, once enamel & dentin are lost as a result of caries, trauma or wear, restorative material must be used, to reestablish form & function.
Teeth require preparation to receive restoration & these preparations must be based on fundamental principles, which are discussed in this presentation, from which basic criteria can be developed to help predict the success of prosthodontic treatment.
Tooth hypersensitivity | by: Dr Muneera GhaithanDenTeach
Tooth hypersensitivity - learn about why teeth are sensitive to cold and other stimulus including (sensitivity theories - causes and factors causing the teeth to be sensitive)
حساسية الاسنان - تعرف لماذا الاسنان حساسة للبرودة وللمؤثرات الاخرى هذا الموضوع يتضمن (نظريات حساسية الاسنان - الاسباب التي تجعل الاسنان اكثر حساسية)
Prepared by: Dr Muneera Ghaithan
A comparative evaluation of 0.33% Sodium Fluoride (Iontophoresis) and Novamin...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. Dentin Hypersensitivity is “characterized by
short, sharp pain arising from exposed dentin
in response to stimuli typically thermal,
evaporative, tactile, osmotic or chemical
stimuli and which cannot be ascribed to any
other form of dental defect or pathology.”
The international Workshop on Dentin
Hypersensitivity(1983)
Manifests as a pain induced by cold or hot
food, citrus fruits, sweets, dental instruments,
contact with brush
3. PREVALANCE
14.3% of all dental patients.
Periodontal patients - upto to 72-98%
Adults in age group of 20-50 yrs ( Peaks in
30- 40 years)
More common in cervical area of facial surface
of permanent teeth ( Canines and Premolars
commonly involved )
4. ETIOLOGY
Scaling and root planing in periodontal
therapy
Dietary factors: fruit, juice, yoghurt & wines.
Acid in dental plaque, gastric reflux
Agents in toothpaste like abrasive and
surfactant
Psychological disorder (bruxism, abnormal
clenching habits)
5. Pathological conditions that cause dentinal
hypersensitivity
Cracked teeth / chipped tooth
Leaky restoration margin
Gingival recession and Periodontal disease
Deep Dentinal Caries
Root caries
Trauma from occlusion
pulpitis
6. Mechanism of pain transmission – theories of
dentin hypersensitivity
Direct neural stimulation theory
Fluid/hydrodynamic theory (most accepted)
Transduction theory
7. Direct innervation theory
According to this theory , ‘ nerve fibers
present within the dentinal tubules initiates
impulses when they are injured and this
causes dentinal hypersensitivity’ .
8. Transduction theory
This theory suggests that the odontoblasts or
their processes are damaged when external
stimuli are applied to exposed dentin. As a
result of this they conduct impulses to the
nerves in the predentin and underlying pulp
from where they proceed to the CNS.
9. Hydrodynamic Theory
Proposed by Brannstrom M
Most accepted theory
Dentin has over 30,000 dentinal tubules /mm2
These are filled with dentinal fluid which is the
intracellular fluid of the pulpal connective
tissue .
Whenever exposed dentin is stimulated by
tactile , chemical, thermal or osmotic stimuli
there is rapid movement of the dentinal fluid
either towards the pulp or outward.
10. This can cause:
Direct stimulation of the low threshold A-delta
nerve fibers in the pulp.
Indirect stimulation of A- delta nerve fibers in
the pulp by displacing the odontoblastic cell
bodies.
Such rapid displacement of the dentinal fluid
in thousands of dentinal tubules at the same
time produces a cumulative effect and this
causes hypersensitivity .
13. Symptoms
Initial : sharp pain of rapid onset and
disappears once the stimulus is removed
Severe: long standing –shorter or longer
periods of lingering, dull aching pain may be
provoked
Even a minimal contact with the toothbrush
may elicit intense pain
14. Diagnosis
History of nature, intensity, duration and
frequency of pain
History- periodontal treatment, dietary habits.
History of pain during brushing, h/o of trauma,
diurnal variation of pain.
physical findings of tooth/teeth are essential to
rule out caries, cracked tooth, pulpitis, non
vital tooth
Rule out any other cause of sharp pain.
15. Clinical examination
Patient often directs the operator toward
the hypersensitive area may be located by
gentle exploration with probe or cold air
(due to root surface exposure)
Tender on percussion
Clinical findings like attrition, fractured
cusp
Gingival recession/loss of attachment
Thermal test
Electrical test
Radiography
16. Methods of measuring dental
hypersensitivity
• Subjective Assessment
1. Verbal rating scale is a simple descriptive pain
scale which includes the following:
• 0 – No discomfort
• 1 – Mild discomfort
• 2 – Marked discomfort
• 3 – Marked discomfort that lasted for more than
10 seconds
Gillam and new Man (1993)
18. MANAGEMENT
behavior
Stepwise approach:
1. First Step: confirmation of diagnosis.
2. Second Step: consider etiology and
3. Third Step: management strategies.
Two major groups of products are used to treat
dentinal hypersensitivity:
1)those that block and occlude dentinal tubules
2)those that interfere with the transmission of
neural impulses.
19. Treatment strategies for dentinal
hypersensitivity
1. Nerve desensitization
Potassium nitrate
2. Anti-inflammatory agents
Corticosteroids
3 Cover or plugging dentinal tubules
a. Plugging (sclerosing) dentinal tubules
b. Dentine sealers
c. Periodontal soft tissue grafting
d. Crown placement/restorative material
e. Lasers
22. Dietary advice: citrus fruits, apple or any other
food or drink that acidic in nature should be
avoided .
Plaque control
Severe symptoms: use those agents which
block the tubular opening.
In very severe case, remedy is achieved by
pulpectomy or root canal filling.
23. Information to patient
• Possibility of root hypersensitivity before
treatment is undertaken
• How to cope with the problem:
1. Hypersensitivity is inevitable if calculus and
plaque buried in the root is to be removed.
2. Disappears slowly over a few weeks.
3. Plaque control is important for its reduction.
4. Desensitizing agent should be used
continuously for at least 2 weeks.
24. Desensitizing agent
• Can be applied :
1.By the patient at home
2.By the dentist or hygienist in the dental office.
Clinical evaluation of different agent is difficult
because
Measuring and comparing pain between different
persons is difficult.
Hypersensitivity disappears by itself after a time and,
Desensitizing agents usually take a few weeks to act.
25. Agent used at home
Desensitizing toothpastes/dentifrices:
The following dentifrices have been approved
by the American Dental Association for
desensitizing purposes:
I) Sensodyne II)Thermodent
which contain strontium chloride.
Denquel, and Promise, which contain potassium
nitrate.
Protect which contains sodium citrate
26.
27. ACTIONS
Potassium nitrate 5%-Blocks sensory nerve
activity at pulpal end of tubules by altering the
excitability of nerves
Strontium chloride 0.4%-combines with
phosphate in dentinal fluid, strontium phosphate
crystals then binds to tubular matrix thus leading
gradual reduction of tubular radius and finally
leads to closure.
sodium citrate : Act by precipitation of crystalline
salt on dentinal surface → block the dentinal
tubule
28. Agents used at dental office
1)Topically applied desensitizing agents:-
Fluoride( sod.fluoride, stannous fluoride) :-
possibly by precipitation of insoluble calcium
fluoride within the tubules. Which blocks fluid
movement within the dentin
Potassium nitrate:- potassium ions do reduce nerve
excitability
29. permeability and
Oxalate:- Oxalate products
occlude
reduce
tubules
dentin
more
consistently
Currently , potassium and ferric oxalate solutions
are the preferred agents. They form insoluble
calcium oxalate crystals that occlude the
dentinal tubules and prevent fluid movement.
ferric oxalate under the name Sensodyne
Sealant.
Calcium phosphates:- Calcium phosphates
occlude dentinal tubules in vitro and decrease
in vitro dentin permeability by 85%
30. 2)Placement of restorations:
Glass ionomer or a composite resin restoration may
be placed to replace the lost tooth structure and
seal the exposed dentin .
3) Ionto-phoresis
• This procedure uses electricity to enhance
diffusion of ions into the tissues.
• Dental iontophoresis is used most often in
conjunction with fluoride pastes or solutions
(2% sodium fluoride)
31. • A 2% sodium fluoride is applied on the exposed
dentin and this is transferred deep into the dentin
on activation of the unit.
32. improve
treatment
4)Lasers
• Recently , attempts have been made to
the success and longevity of these
using lasers.
• Low- level laser “melting” of the dentin
surface appears to seal dentinal tubules without
damage to the pulp.
• Finally , in a combined treatment modality, the
Nd:YAG laser has been used to congeal fluoride
varnish on root surfaces.
33. This in vitro study demonstrated
that the laser treated fluoride
varnish resisted removal by
electric tooth-brushing,
with 90% of tubules remaining
blocked while in the controls
(no laser treatment) the fluoride
varnish was almost completely
brushed away.
Further research is still on
progression.
34. Suggestions for patients:
Avoid using large amounts of dentifrice or
reapplying it during brushing.
Avoid medium- or hard-bristle toothbrushes.
Avoid brushing teeth immediately after
ingesting acidic foods.
Avoid over brushing with excessive pressure
or for an extended period of time.
Avoid excessive flossing or improper use of
other interproximal cleaning devices.
Avoid “picking” or scratching at the gumline or
using toothpicks inappropriately.
35. Suggestions for professionals:
Avoid over instrumenting the root surfaces during
scaling and root planing, particularly in the cervical
area of the tooth.
Avoid over polishing exposed dentin during stain
removal.
Avoid violating the biologic width when placing
crown margins causing subsequent recession.
Avoid burning the gingival tissues during in-office
tooth whitening or bleaching procedures.