The document discusses isolation techniques in dentistry, focusing on the use of rubber dams. It describes the goals of isolation as moisture control, retraction and access, and harm prevention. Rubber dams provide a dry, clean operating field and help maintain the properties of dental materials. Direct isolation methods discussed include rubber dams, fluid absorbents, saliva ejectors, and retraction cords. Indirect methods include patient positioning, local anesthesia, and pharmacological muscle relaxation. The document provides detailed information on rubber dam materials, frames, punches, clamps, templates, forceps, and placement techniques. It notes alternatives when rubber dams cannot be used and discusses recent advances.
This presentation specifically deals with the maxillary and mandibular Major connectors used in a cast partial denture. it also mentions the uses, advantages and disadvantages of each,
this presentation has all the techniques in impression making in the fabrication of an RPD.
The presentation is available on request. Mail me at apurvathampi@gmail.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.
This presentation specifically deals with the maxillary and mandibular Major connectors used in a cast partial denture. it also mentions the uses, advantages and disadvantages of each,
this presentation has all the techniques in impression making in the fabrication of an RPD.
The presentation is available on request. Mail me at apurvathampi@gmail.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.
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
Isolation of operating field/ orthodontic course by indian dental academyIndian 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.
Success of any dental procedure is determined by a good isolation. Here is a seminar on how to isolate the oral cavity from fluids and maintain a good dry field while working on a patient
For those who want to seek simple and thorough understanding about the placement and application of the rubber dam and other isolation materials.
TARGET AUDIENCE : DENTAL STUDENTS.
REFRENCES : sturdevant and grossman
In dentistry, separation of a tooth or group of teeth from oral tissues and saliva by use of a dental dam, cotton rolls, or other means to improve access, visibility, and control moisture contamination while restorative or operative dental procedures are performed.
Restorative procedures require adequate isolation of the operating field for best results.
A clean and dry field is comfortable both for the patient and the operator.
It provides better access and visibility, improving the efficiency of the operator.
The properties of many dental materials are improved in the absence of moisture.
Isolation collects the materials from operating site and also prevents their aspiration.
Isolation also often permits the dentist to carry out extended operations if desired.
Goals of isolation:
Moisture control
Retraction and access
Harm prevention . Safe and aseptic operating field
Prevent accidental swallowing of restorative materials and instruments
Isolation of dental field/ orthodontic course by indian dental academyIndian 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.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
3. 3
Oral environment needs to be
adequately controlled to prevent it
from interfering with the execution
of any dental procedure.
4. 4
Goals of Isolation
Moisture control:- To exclude sulcular fluid,
saliva, gingival bleeding in the operating field and to
prevent the hand piece spray and restorative debris.
Retraction and Access:- used to retract
the tongue, maintains mouth opening, lips and cheek.
Harm Prevention:- to prevent swallowing of
instruments , restorative debris and prevents soft tissue
injury
5. 5
Need for Isolation in Pediatric Dentistry
Increased salivation
Excessive tongue movements
Better visibility
Protection from swallowing or aspiration
of foreign elements.
Aids in behavior management
6. 6
Various means of isolation
DIRECT METHOD
Rubber dam
Fluid Absorbents
Saliva Ejectors
Retraction Cord
Mouth Prop
Cotton Holders and Rolls
INDIRECT METHOD
Patient Position
Local Anaesthesia
Pharmacological
Muscle Relaxation
7. 7
Rubber Dam
Developed by S.C.Barnum in 1864
Usually a latex Rubber
Used to define the Operating field by
isolating one or more teeth from the oral
environment
It eliminates saliva from the operating
site and retracts the soft tissues.
8. 8
Rationale (Isolation )
Dry , Clean Operating field.
Access & Visibility .
Maintaining(Improved) properties of Dental
Materials.
Reduced patient conversation
Tissue retraction
Operating Efficiency.
Reduces risk of Cross Contamination
especially to the Root Canal System
9. 9
Protection of the Patient and Operator
Prevents accidental ingestion of
files/reamers
Prevents injury to soft tissue
Prevents patient from putting the tongue
into the cavity
Prevents the irrigating fluid coming in
contact with oral soft tissues
10. 10
Contraindications
• Child with upper respiratory tract infection,
congestion of nasal passage or other nasal
obstruction.
• Takes considerable time to be applied.
• Fixed orthodontic appliances
• Recently erupted tooth
• Allergy to latex
11. 11
Certain condition which Precludes
the use of rubber dam
Erupting teeth with insufficient support for
retainer
Clamp must not impinge on the gingiva nor
traumatize the adjacent teeth.
Allergy to latex
Extremely malposition of teeth
Asthmatic Patient
Mouth breathers
12. 12
Rubber Dam : Material &
Instrument
Rubber dam sheet
Rubber dam frame
Rubber dam punch
Rubber dam retainer forceps
Waxed dental floss
Rubber dam napkin
Lubricant
Clamps
scissors
14. 14
Rubber Dam
sheet
Rubber Dam Material Various
thickness
Thin (0.006” or 0.5mm)
Medium (0.008” or 0.20mm)
Heavy (0.010” or 0.25mm)
Extra heavy (0.012” or 0.30mm)
Special Heavy (0.014”)
Thicker material resists tear and thinner ones
passes through tight proximal contact easily.
15. 15
Various colors
Light / dark colors – contrast
Shiny / dull side
Dull surface should face the occlusal aspect as
it reflects less light
Available in various sizes
Rolls or prefabricated
5 x 5” (12.5 X 12.5cms)- PEDIATRIC
6 x 6” (15 X 15cms)- ADULT
19. 19
Lubricants
Water soluble lubricants are applied in the
area of punched holes for easier placement
of the dam.
Easy placement in the tight proximal
regions
e.g.:- Vaseline or soap slurry
20. 20
Rubber Dam clamps
Rubber dam Retainer
/clamp
Shiny or dull stainless
steel
Consists of a bow and jaws
Aid in anchoring the dam
to the tooth and soft tissue
retraction.
Commonly used for
pediatric dentistry are
#2, #4, #8A and #14A.
26. 26
Need to Ligate the Clamp
All retainers applied before the rubber dam in place
must be ligated.
A 12” or 18” piece of floss should be attached to
the retainer and threaded through both holes
Prevents accidentally swallowing the clamp.
Prevents injury to the dental team from flying
debris caused by an improper seat of the clamp.
35. 35
Method 2
Simultaneously placement of retainer &
dam
Advantage :-
Reduce risk of retainer being swallowed or
aspirated before dam is placed
Reduces difficulty of trying to pass the dam
over a previously placed retainer.
36. 36
Clamp used :- winged clamp
Disadvantage :- interfere with procedure
due to limited vision .
Indication : 3rd molars
37. 37
Method 3
Placement of clamp after dam placement
Use : is restricted to anterior area or till
premolar area
38. 38
Rubber Dam removal
Thoroughly cleanse area.
Cut/remove interproximal ligatures.
Stretch rubber dam facially and cut
each interproximal septum with
scissors.
Remove clamp with clamp forceps.
39. 39
Remove dam and examine it for any
missing pieces.
Examine site for remaining rubber;
remove with floss or explorer.
Rinse oral cavity, wipe off patient’s lips.
40. 40
Selection of rubber dam
Heavy and extra heavy rubber dams are used
for restorative procedures, while medium is
considered ideal for endodontic purposes since
it
- Retracts the tissues better than thin type
- Easier to place than heavier type
41. 41
RECENT ADVANCES IN RUBBER DAM
Hat Dam:- it is clear plastic form shaped like a hat
without a top.
It is trimmed and fitted around a clinical crown that
cannot be clamped and it is cemented with glass ionomer
cement.
Cushioning metal clamp jaw:- Ferrite-N is a
material that can be pressed in embrasure area and
material is light cured over which clamp is seated.
Fiber optic clamps:- These are used for high intensity
light transilluminates pulp chamber and canal orifices.
43. 43
Liquid dam:-
Resinous material is applied on gingival aspect of
tooth surface prior to power bleaching and sand
blasting.
Kool Dam is the 1st heatless liquid dam
44. 44
Fluid absorbents
Used for short periods when absolute
dryness is not required.
During examination, polishing, fluoride
application
Various materials that can be used for
this purpose are:-
- cotton rolls
- gauze or throat shields
- absorbent paper
Cellulose
45. 45
Cotton rolls
Available in different diameters variant lengths
Have plain or woven surfaces
Cotton rolls provide the advantage of slightly retracting
the cheeks aiding in visibility and access
They may adhere to dry tissues
46. 46
These are stabilized and held sublingually with specific
holders or with an anchoring rubber dam clamp.
They can be applied without holders, over or lateral to
salivary gland orifices.
47. 47
Disadvantages:-
It doesn’t provide proper isolation.
It doesn’t protect the patient from debris getting
into the mouth.
It is difficult to use in children's with gag reflex
If removed improperly, a dry cotton roll may stick
to the oral mucosa and results in cotton roll
stomatitis
48. 48
Gauze or throat shields
A gauze sponge is unfolded and spread over the tongue
and the posterior part of the mouth.
Used in pieces of 2”X 2” or larger
Indicated when there is danger of aspirating or
swallowing small objects.
Important when treated maxillary arch
50. 50
Saliva ejectors and high
volume evacuating equipment
Saliva ejector prevent pooling of saliva in the floor
of mouth
High volume evacuating equipment removes solid
debris along with water unlike the saliva ejectors
51. 51
Saliva ejectors and high volume
evacuating equipment
Types
- Metallic –
Autoclavable and have rubber tip to
avoid irritating the
delicate tissues on the floor of the mouth
- Plastic – Disposable and Inexpensive
52. 52
Saliva ejectors and high volume
evacuating equipment
Precautions:-
- Care should be taken to avoid cross
contamination. Thus,
Should be disinfected after each use
Disposable tips are preferred
Child patient is cautioned not to close his
mouth to hold the tip since it may cause
backflow of contaminated solutions into his
mouth as a result of pressure changes
53. 53
Saliva ejectors and high
volume evacuating equipment
Requirements
- Floor of the mouth under the tip should be
covered with gauze to prevent injury to soft tissue
- Should not traumatize the lip or cheek mucosa
- Should not interfere with instrumentation
- Needs to be used with other adjuncts like Cotton
Rolls and Gauze
54. 54
Other alternative aids
Retraction cord
Insert cord after anaesthetizing the area
- usually used for cervical lesions
Mirror and evacuator tip
- help in retraction of oral soft tissues, specially in
absence of rubber dam
56. 56
Mouth prop
- benefits both operator and the
patient
- maintain mouth opening
during various procedures
- prevent muscle fatigue in
patients
Cheek and lip retractor
57. 57
Drugs
Anti sialagogues can be used to decrease
excessive salivation
e.g:- atropine
Local anesthesia decreases pain in addition to the
vasoconstrictor it bring about a reduction in
salivation.
58. 58
REFRENCES
Olatosi OO, Nzomiwu CL, Erinoso OA, Oladunjoye AA.
Undergraduate dental students' perception, educational satisfaction,
and attitude regarding the use of rubber dam. J Clin Sci
2018;15:13-7.
Damle SG. Textbook of pediatric dentistry. 5th edition.
Ahmad. IA. Rubber dam usage for endodontic treatment: a review.
International Endodontic Journal, 2009; 42: 963–972.
Nikhil Marwah. Textbook of pediatric dentistry. 3rd edition.
Gilbert. GH. et al. Rubber dam use during routine operative
dentistry procedures. Operative Dentistry; 2010: (35-5)491-499.
59. 59
Roger J. Smales, Thomas L. Berekally. Long-term Survival of
direct and indirect restorations placed for the treatment of
advanced tooth wear. Eur. J. Prosthodont. Rest. Dent; 2007 :15
(1);2-6.
BM Owens. Alternative rubber dam isolation technique for the
restoration of class V cervical lesions. Operative Dentistry; 2006,
31:2, 277-280.
Marlus Cajazeira et al. Influence of the operatory field isolation
technique on tooth-coloured direct dental restorations. Am J Dent.
2014; 27(3):155-159.
Arnalod Casterllucci. Tooth Isolation: the Rubber Dam.