Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
There have been several changes since inception in the field of dental ceramics. Need for newer materials with improved aesthetics, flexural strength and optical properties made it necessary for introduction of advanced technology in fabrication of dental ceramics.
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
There have been several changes since inception in the field of dental ceramics. Need for newer materials with improved aesthetics, flexural strength and optical properties made it necessary for introduction of advanced technology in fabrication of dental ceramics.
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
DENTIN HYPERSENSITIVITY - ETIOLOGY, DIAGNOSIS AND TREATMENTDr.Shraddha Kode
Dentinal Hypersensitivity is a common clinical condition which is sharp in character and of short duration in response to stimuli. It is associated with exposed dentin surfaces. This presentation provides a brief overview - its etiology, diagnosis and treatment.
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
DENTIN HYPERSENSITIVITY - ETIOLOGY, DIAGNOSIS AND TREATMENTDr.Shraddha Kode
Dentinal Hypersensitivity is a common clinical condition which is sharp in character and of short duration in response to stimuli. It is associated with exposed dentin surfaces. This presentation provides a brief overview - its etiology, diagnosis and treatment.
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
Recent advances in gic final /certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
microleakage in restorative dentistry/rotary endodontic courses by indian den...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Topical Fluorides- Professionally applied & Self appliedDrSusmita Shah
An overview of Topical Fluorides. Includes mechanism of action of topical application of fluorides- professionally and self applied. Recommendations of use of Fluorides in pediatric dentistry.
Fluoride is: natural mineral that helps build strong teeth and prevent cavities
Fluoride treatment; is typically professional treatment containing high concentration of fluoride that dentist or hygienist will apply to a person’s teeth to improve health and reduce the risk of cavities
Benefits of fluoride treatment:
1- Slow or reverse the development of cavities by harming bacteria that cause cavities.
2- Join into tooth structure when tooth develop to strengthen the enamel surface
3- Helps body, better use mineral such as Ca and phosphate, the teeth reabsorb these mineral to repair weak tooth enamel
Side effect of fluoride:
1- Tooth discoloration
2- Allergies or irritation
3- Toxic effect: if person apply it incorrectly or at high doses: nausea, diarrhea, excessive sweating
Common source of dietary fluoride:
Tea, water, sea food, fish eaten with their bones
Grape juice, food cooked in water.
Optimal fluoride intake:
Birth to 3 years: ---- 0.1 to 1.5 mg
4 years of age: ------1 to 2,5mg
7 years of age: ------ 1.5 to 2.5mg
Adolescent and adult: --- 1.5 to 4mg
History:
1802: Sir James Crichton Browne, the 1st hint of possible connection of fluoride and dental health
1901: Fredrek Mckay: present in permanent stains on teeth known as mottled enamel
1902: J.M Eager: stains on teeth
1916: Green Vardmin Black: support the Mckay work with histologic evidence, reported as endemic imperfection of enamel
Fluoride application procedures:
1- Fluoride prophylaxis pastes:
The use of cleaning and polishing pastes (pumic, zircate) and other comparable abrasive pastes before cementing orthodontic bands may lead to removal of significant amount of surface enamel which has more resistant layer and provide a significant amount of fluoride to support enamel surface.
2- Topical fluoride solution:
The most commonly used topical solutions are;
Sodium fluoride –2% neutral
Acidulated sodium fluoride at PH3 and 1.2 fluoride
8% --10% stannous fluoride.
3- Fluoride gel:
Are available in; sodium fluoride, acidulated sodium fluoride, stannous fluoride
4- Fluoride mouth rinse
5- Fluoride tablets:
Fluoride administration as pills or tablets (0.5 ---1mg/day) according to age show caries reduction in permanent teeth of 20 --- 40% when started at 6 –9 years of age
6- Fluoride dentifrices:
There are large number of dentifrices in market as, sodium fluoride, stannous fluoride, amine fluoride
Sodium monofluorophosphate
The regular use of fluoride dentifrices should be recommended to all patients undergoing orthodontic treatment in addition to other forms of fluoride administration
7- Fluoride cements:
Silicate cements restoration slowly release fluorides and protect surrounding enamel from secondary caries
8- Fluoride varnish:
Topical application of fluoride predisposes to the formation of readily soluble Ca fluoride crystals on the enamel surface
9- Other methods: as elastic containing 10% sodium fluoride.
Some studies:
1- Good oral hygiene was the only
It is generally accepted that a low level of fluorine in mains water 0.4 to 1 mg -¢ L – 1 depending on the climate of the country concerned promotes the formation of tooth enamel and protects teeth from decay. On the other hand, too much fluorine will destroy this enamel and cause a range of endemic type disorders that are generally called “fluoroses- malformed teeth, staining of the enamel, decalcification, tendon mineralisation, digestive and nervous disorders, etc. These problems can appear in individuals for widely variable quantities of the product. Water must be discharged or treated as soon as it contains more than 1 to 1.5 mg -¢ L – 1 of F – . Some natural waters contain more than 10 mg -¢ L – 1 of fluorine. This concentration has to be reduced to approximately 1 mg -¢ L – 1 the acceptable concentration falling as the average annual temperature rises the European standard has set 1.5 mg -¢ L – 1. Many studies have been carried out to address the issue however little success has been reported up to date. Layered double hydroxides LDHs which readily undergo anion exchange reactions have been used as a suitable candidate for defluorination. Also there is regeneration of the material after removal of fluoride ions without releasing flouride ions back in to the water cycle. F elimination using a nanofiltration NF operation will solve problems for large scale pilot plants in the future.Many defluorination projects have significant effectiveness on the prevention of endemic fluorosis. The concentrations of water fluoride were below 1 mg L. Advanced on site methods, such as under sink reserve osmosis units, can remove fluoride but are too expensive for developing areas. Calcium carbonate as a cost effective sorbent for an onsite defluorination drinking water system. Batch and column experiments have been performed to characterize F removal properties. The present review discusses various techniques of defluorination of water. Dr. Atul Kumar Sharma | Dr. Harsukh Ram Chharang "Defluorination of Drinking Water" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd46324.pdf Paper URL: https://www.ijtsrd.com/chemistry/other/46324/defluorination-of-drinking-water/dr-atul-kumar-sharma
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
HISTORY & MECHANISM OF ACTION SYSTEMIC FLUORIDES.pptxRUCHIKA BAGARIA
EVERYTHING YOU NEED TO KNOW ABOUT SYSTEMIC FLUORIDES.
HISTORY, MECHANISM OF ACTION, METABOLISM, DIETARY SUPPLEMENTS AND RECENT ADVANCES.
LETS STUDY SYSTEMIC FLUORIDE TOGETHER.
LETS LEARN AND SHARE OUR KNOWLEDGE.
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
2.Case Discussions
3.with hundreds of pictures.
4.Demo on Models
5.Demo on Patients
6. subtitles in your own language
12 months unlimited access and support @350 USD only.
For Demo please visit :www.idalectures.com/preview/
For more details visit: www.idalectures.com
Please contact us for any clarifications:
idalectures@gmail.com
indiandentalacademy@gmail.com
Thanks & Regards
Indian Dental Academy
--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
- 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
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Fluoride releasing
1. INTRODUCTION
In the 1940s, dentists observed that secondary caries was rarely
associated with silicate cement restorations.
The fact that fluoride was inherent in the composition of the material
relieved much attention.
This heralded the development and increasing use of “CONTROLLED-
RELEASE THERAPEUTIC MATERIALS” in dentistry.
By the mid-1970s some fluoride releasing amalgams and luting cements
were commercially available in Europe.
By the mid-1980s, a wide variety of fluoride-releasing dental restorative
materials were available to dentists and dental consumers.
Also, the cariostatic effect of fluoride ions on enamel caries had been
demonstrated in many studies.
The effect of fluoride-releasing restorative materials on dentin also began to
receive attention.
In fact researchers have found deeper penetration depths of fluoride in
dentin than enamel on cavity walls adjacent to a variety of fluoride
containing restorative materials.
Addition of fluoride can be achieved by 1) physically incorporating
soluble fluoride salt within the bulk material. 2) by adding virtually insoluble
fluoride-containing minerals as fillers. 3) Another alternative for fluoride
release is chemical in nature and uses monomers with fluorine as the matrix
1
2. former. These monomers release fluorine ions by means of ion exchange in
which hydroxy groups replace fluorine ions that have been released.
A brief not on the anticariogenic action of fluoride:
Fluoride contributes to caries inhibition in the oral environment by
means of both:
1) Physico-chemical mechanism.
2) Biologic mechanism.
Physico Chemical Mechanism – Here, fluoride inhibits demineralization
through the formation of an acid resistant phase. Thereby, enhances
remineralization of carious enamel (non-cavitated).
i.e. fluoride, ions released from the restorative materials become
incorporated in hydroxyapatite crystals of adjacent tooth structure to form a
structure that is slightly more resistant to acid attack “Flourapatite”.
Biologic-Mechanism fluoride interferes with the carbohydrate metabolism
of the acidogenic plaque flora.
In fact, it has been shown that bacterial species fail to thrive in the presence
of fluoride, particularly “streptococcus mutans”.
The fluoride also enters the microorganisms and accumulates
intracellularly. The fluoride ions then induce enzyme inhibition, leading to a
slower rate of acid production.
2
3. Meanwhile, the fluoride increases cell permeability and it can rapidly
diffuse out of the bacterium, contributing again to the fluoride content within
the plaque matrix.
Another way by which fluoride inhibits caries is by reducing the surface
energy of the tooth surface, thereby making the adherence of dental plaque to
tooth surface more difficult.
Coming to individual fluoride materials:
AMALGAM
Fluoride containing amalgams have been shown to have anticaries
properties that is sufficient to inhibit the development of caries in cavity walls.
Studies have shown that the concentration of fluoride in the saliva by
fluoride-releasing amalgams is sufficient to enhance remineralization.
Therefore, fluoride releasing amalgam restorations may have a
favourable effect on initial demineralization in the mouth.
Tviet and Lindh (1980) found that the greatest concentration of fluoride i.e.
about 4000µg/mL in enamel surfaces exposed to fluoride-containing amalgams
were found in the outer 0.05µm of the tissue.
In dentin, the greatest concentrations, i.e. about 9000µg/ml were found
at a depth of 11.5µm.
Most of the fluoride-releasing amalgams like other fluoride containing
dental restorative materials show an initial release that is significant. However,
this release of fluoride decreases to minor amounts after 1 week.
3
4. One study found salivary fluoride concentrations at more than 20 times
baseline concentration for the first few days after placement of restorations.
The release declined exponentially to baseline levels after 30 days. One In-
vivo study has shown that fluoride released from amalgams loaded with soluble
fluoride salts was detectable within the first month and thereafter fluorable was
not released in measurable amounts. Another in vitro study showed fluoride
release can continue as long as 2 years (but at a much lower rate than that for
GIC).
Disadvantage – The leaching of fluoride makes the amalgam more susceptible
corrosion.
GLASS IONOMER CEMENT
Glass ionomer cements are perhaps the best known fluoride-releasing
restorative materials.
Like silicates they have been shown to have anticariogenic properties due to
their significant release of fluoride.
The fluoride which is an essential component of glass ionomers imports the
following functions:
1) It lowers the temperature of fusion.
2) Improves working characteristics.
3) Increases the strength of the set cement.
4) In moderate amounts enhances radiolucency.
5) Contributes to the therapeutic value of the cement.
4
5. These cements have also shown the uptake of fluoride in cavity walls,
enamel and plaque.
FORSTEN (1977) found glass ionomers to release significantly more fluoride
than silicate cement and amalgams (1990).
But studies by Tviet and Gjerdet (1981) showed fluoride-release from
silicate cements was about 5 times greater than from glass ionomers.
The presence of fluoride in GICs has shown to inhibit plaque formation.
Glass Ionomer cermets (sintered silver particles to glass ionomer
powder) and metal powder admix materials have demonstrated fluoride release
and caries inhibition at enamel and dentin restoration margins in vitro.
However, less fluoride is released from cermet than from Admix.
This is because the metal filler particles are not bonded to the cement
matrix. Thus, the filler cement interface become pathways for fluid exchange
this greatly increases the surface area available for leaching of fluoride.
The fluoride release levels of Resin-Modified GICs are comparable to those
of conventional GICs.
Both Resin-Modified GICs and conventional GICs may have “Synergistic
effects” when used with extrinsic fluorides.
The mechanism of this syndergy is thought to be or recharging effect, where
extrinsic fluoride is deposited back into the ionomer. Thus, resupplying the
release from the ionomer into the surrounding environment.
5
6. As in the case with other fluoride-releasing materials, all glass-ionomers
have been shown to have a “Burst-effect”.
Studies by De Schepper and others have shown that commercially
available GICs release the greatest proportion of their total fluoride in the first
24 hours after mixing.
This fluoride-release however, stabilizes after 2 weeks to comparable low
release levels. [i.e., 0.16µg/mm2
to 0.42µg/mm2
].
Forsten (1977) found the “Burst Effect” to be true over a period of several days
to 2 weeks.
In a more recent study he found that for all GICs, the fluoride release
eventually reached a constant level of approximately 0.5µg/ml to 1.0µm/ml
(other than cermet) during the 2nd
year.
Another study Koch and coworkers (1990) found the fluoride
concentration in unstimulated saliva to decrease by 35% after 3 weeks and
another 30% after 6 weeks.
After 6 weeks, however, the fluoride level in saliva was still 10 times the
baseline concentration.
Fluoride release rates have not been found to be proportional to fluoride
concentrations in Glass ionomer products.
Commercially available cements vary in the amounts of fluoride-
released fluoride release from a silver cermet was found to be significantly
less than the release from a standard GIC throughout a 12 month –period.
The cariostatic effect (in vitro) of the cermet was also significantly less.
6
7. The steady fluoride-release was approximately 1.5µm/mL for standard GICs
and 0.5µg/mL for the cermet.
Both the materials however, had significantly higher in vitro caries
inhibition than composite and amalgam.
This indicated that caries inhibition was fluoride dose dependent even at
these low release levels.
Other factors that may influence the release rates of fluoride in GICs may be:
1. Handling.
2. Powder : Liquid ratio.
3. Maturity of the cement matrix.
4. Application of varnish.
1) Handling Hand-mixed GICs have been shown to release
significantly less fluoride than mechanically triturated GICs (Miller and
Others, 1995).
2) Powder:Liquid Ratio : Studies have shown that cements with
lower powder to liquid ratios demonstrated greater fluoride release.
McKnight-Hanes and Whitford (1992) also found that the release rate of
fluoride in a GIC was inversely proportional to the powder to liquid ratio.
This finding is probably due to the composition, amount and maturity of the
reaction matrix forming within the cement.
7
8. 3) Apply of Varnish : Studies showed that the varnishing of disks
made from GIC (greatly) sharply reduced fluoride release.
However, the finishing of the varnished disks produced a significant
increase in the fluoride release of one GIC product.
Likewise, another study found a significant reduction in fluoride release
from GIC restorations covered with a sealant.
Preliminary in vitro research has confirmed that GIC (along with
composites) retain fluoride delivered by dentifrices or topical fluoride
treatments at the material surface and then release this fluoride slowly.
Hence, these mateials act as: “Flouride Reservoirs”.
Table : This table shows the fluoride-release from various glass ionomer
formulations.
Mg – F
14 days 30 days
Type II Glass ionomer
Cermet
Silver alloy admix
Type I Glass ionomer
Glass ionomer liners:
- Conventional
- Light wred
440
200
3350
470
1000
1200
650
800
4040
700
1300
1600
COMPOMERS : A relatively new class of fluoride-releasing restorative
materials has been introduced. These are combinations of glass ionomer glass
powder with polymerizable acidified monomer.
8
9. A study on the compomer “Dyract” showed the initial release of fluoride to
be 25µg/mL.
This release rate after 28 days was maintained at 6µg/mL.
However, there is little clinical evidence to support a claim for caries
inhibition.
Composites : Composite resins have also been formulated to release fluoride.
As early as 1970s, some composite resins incorporated fluorides and were
shown to release fluorides.
The release of fluoride from composite resins demonstrated a reduction in
2° caries initiation and even remineralization of adjacent demineralized enamel
when examined in vitro. Studies have detected a fluoride release of 200-
300µg/mm2
from composites to completely inhibit in situ secondary caries.
Donly and Gomez (1994) have also demonstrated the remineralizing effects
of a fluoride-releasing composite.
Although fluoride-releasing composites have consistently demonstrated
recurrent caries inhibition at enamel margins, there are still conflicting results
regarding caries inhibition at dentin margins (Donly 1994).
As with GICs, there may be a “Synergistic effect” between fluoride-
releasing composites and fluoride rinses or fluoridated dentifrices.
i.e when exposed to external fluoride, the materials surface undergoes an
increase in fluoride, which is subsequently released.
9
10. ADHESIVE PRIMERS
Kerber and Donly (1993) studied the effect of adding ammonium fluoride to
two different dentin primers.
Results showed that primers containing fluoride demonstrates significantly
less demineralization from the dentin margins than the primers without
fluoride.
Pit and Fissure Sealant
In 1984, Roberts, Shern and Kennedy evaluated an autopolymerizing pit and
fissure sealant as a vehicle for the slow release of fluoride.
Sodium fluoride was added to the sealant at several concentration (upto
concentrations of 2.5%).
The fluoride release was measured to be 0.3µg/mL for a period from 31
days to 90 days at the highest concentration (i.e. 2.5%).
However, when the authors considered the dilution factor due to average
salivary flow, they concluded that this level of release would be below any
known level of physiologic significance.
In the late 1980s, a fluoride-containing sealant was introduced to the dental
materials market place. The product was evaluate in vitro. It was found to
release fluoride over a 7 day evaluation period, beginning at a level of
3.5µg/mL on the 1st
day and declining to a level by 0.41µg/mL on the last 2
days.
This same product was clinically compared to a conventional glass-ionomer
sealant.
10
11. It was found that retention of the fluoride releasing resin was much higher
and caries incidence was much lower than the glass ionomer (Rock and others,
1996).
What could not be resolved in this study was whether this lower incidence
of caries was due to fluoride release or the greater retention of the resin.
In another, in vitro study (Jensen et al, 1990) a fluoride releasing pit and
fissure sealant was found to reduce the amount of enamel demineralization
adjacent to the material, compared with conventional pit and fissure sealants.
Seppa and Forss (1991) found that fissures sealed with a glass ionomer
sealant were more resistant to demineralization than were unsealed controls.
They suggested that the result may be the combined effect of fluoride
release and residual materials in the bottom of the fissures.
11
12. LINERS /BASES AND CAVITY VARNISHES
There are currently half dozen or more fluoride releasing liners on the
market.
Some have been found to significantly reduce lesion areas under amalgam
restorations.
Most of these liners / bases have been found to have a “Burst effect” in the
release of fluoride.
Most studies have shown that the largest proportion of total fluoride release
occurs during the first days or weeks, followed by dramatic reductions in the
rate of release.
Long term release of fluoride varied over a range of 0µg/mL to 7 µg/mL.
Glass ionomer cements have also been used as a liner material under
amalgam restorations.
They have been shown to continue releasing measurable amount of fluoride
in the range of 0.3µg/mL to 1.1µg/mL after 1 year.
Certain in vitro studies have also shown glass ionomer cements to reduce
recurrent caries when placed under amalgam.
A light cured and a chemically cured glass ionomer cement liner were found
to have a similar effect in inhibiting demineralization.
Both demonstrated significantly less demineralization than a non-
fluoride-releasing control liner (Souto and Donly, 1994).
12
13. ZINC POLYCARBOXYLATE CEMENT
The powder of zinc polycarboxylate cements contains small quantities
of stannous fluoride.
The stannous fluoride :
1) Modifies the setting time
2) Enhances manipulative properties.
3) Increases strength.
However, the fluoride released from this cement is only a fraction (15-20%)
of the amount released from (zinc silicophosphate) and glass ionomer cements.
There are not many studies done further regarding the amount/rate of
fluoride release for these cements.
CONCLUSION
From the above, it can be concluded that:
1) All fluoride-containing materials release fluoride in an initial burst and
then reduce exponentially to a much lower steady-state level of release.
2) The steady state release of fluoride is reached after approximately 30
days for most materials.
3) Caries inhibition and remineralization potential have been shown in
vitro by all of these materials when release levels have been equal to or
exceeding approx. 1µg/mL/
13
14. There are few clinical studies that appear to support the proposition that
low levels of fluoride release can inhibit in vivo demineralization and caries
formation.
The ultimate goal of correlating fluoride release with actual caries
inhibition reduction is an objective than can be met by completing clinical
studies on materials that release fluoride.
14