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.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
Design considerations for a distal extension rpd/prosthodontic 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
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
Design considerations for a distal extension rpd/prosthodontic 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
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.
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
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One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
Indications contraindications and classification of bridges/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
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.
Impression procedures for compromised ridges/cosmetic dentistry 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
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.
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.
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
One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
Indications contraindications and classification of bridges/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
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.
Impression procedures for compromised ridges/cosmetic dentistry 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
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.
Diagnosis and treatment planning is the foremost protocol in the fabrication of complete denture.
The steps involved in the diag and treat planning are mentioned in the same
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
an any other group age
Poor oral hygiene among older people has traditionally been manifest in high level of tooth loss, dental caries, and periodontal disease as well as xerostomia and oral cancer
1- Bone:
= Increasing age is associated with progressive reduction in bone mass resulting in osteoporosis
= atrophy of alveolar bone is related mainly to tooth loss and increase by age that resulting in:
- Absence of denture
- Loss of facial height
- Upward and forward posturing of mandible
= loss of alveolar bone occurs more rapidly in mandible than maxilla
= level of cyclo-oxygenase 2(cox2) enzyme, which play essential role in bone repair, decline dramatically with age, this explain the delayed bone healing in older age
2- T M J:
= The main age changes related to remodeling of the articular surface and disc in response to functional changes following tooth loss
= remodeling may result in disc displacement, particularly anterior displacement
= the retrodiscal tissue may show decreased vascularity and cellularity and increased density of collagen
= in severe cases displacement may lead to perforation of the disc resulting in progressive damage
3- Nerve and musculature:
= continued muscle function in a major requirement for the maintenance of speech and mastication, in all patient with advancing age, there is reduction in total muscle mass which occurs through a reduction in the number of muscle fiber rather than a major reduction in muscle fiber size
= by age there is a loss of motor unit specially over 60 age
= manifestations:
- Reduced masticatory force
- Reduce muscle strength
- Lengthening of chewing process
- Changes in chewing behavior
4- Oral mucosa:
= the clinical appearance of the oral mucosa in older patients is indistinguishable from younger one, however changes by time as:
- Mucosal trauma
- Mucosal disease
- Salivary gland hypo-function
Can alter the clinical features and character of oral tissues
= the stratified squamous epithelium become thinner, loss of elasticity and atrophies with age with increased oral disorders
5- Sensory changes:
= it is known that taste and smell sensitives changes throughout life and often decline with aging
= these changes can make the foods become tasteless resulting in reduction in appetite
= diminution of taste results from degeneration of taste buds and reduction of their total numbers
= elderly people cannot detect the pleasantness of food compared with younger people, this can lead to the older people to added more ingredients such as sugar or salts to food stuff that can lead to adverse health effect
6- Salivary glands:
Dry mouth –xerostomia and diminished salivary glands output are common in older age, some cases have decreased salivary output due to high intake of drugs as:
- Anti-depressant
- Anti-hypertensive
- Cytotoxic and anti-parkinsonism
Some cases with neck cancer may exposed to irradiation which cause:
- Severe and permanent salivary hypo-function
- Xerostomia
Some disease as: Diabe
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
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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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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.
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.
- 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
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Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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
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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
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Patient education
1. PATIENT EDUCATION RELATED TO COMPLETE
DENTURE PROSTHODONTICS
Patient education is the prosthodontic service that refers to giving
complete information and instructions to a complete denture patient in the
use, care and maintenance of the prosthesis. Communication is the basic
medium of education and can be encouraged by establishing a feeling of
trust between the doctor and his patients. By careful listening and observing,
the dentist learns about the patients problems and expectations regarding
denture, his emotional and physical conditions, the health and adequacy of
his oral tissues and associated structures, and whether the present dentures
are fulfilling the needs of this patient.
According to Webster’s New Collegiate Dictionary to educate is to
provide with training or knowledge for a specific purpose. To motivate is to
provide with a motive to impel, to incite.
A willingness to instruct the patient in the care and use of his
dentures and an understanding of his desires are essential to assure a
successful prognosis. An informed patient will realize when his dentures
require attention and will seek treatment before an ill-fitting denture
damages the oral tissues. Skill in mechanics is only one fact of denture
service. The dentist must also know anatomy, physiology and psychology so
1
2. that he can correctly evaluate normal and abnormal situation. One of the
primary objectives of dentures is to preserve the supporting tissues within
physiologic limits. The preservation of the supporting tissues is essential to
continuous successful use of dentures. Therefore, a patient should be
educated to understand his responsibility in denture service.
Understanding the patient
The dentist must know human psychology because, the ability to
understand the patient’s mental attitude is frequently the difference between
acceptance and rejection of the denture. M.H. House classified the mental
attitude of patients as philosophical, exacting, indifferent and skeptical
patient.
Philosophical patient
The best mental attitude for denture acceptance is the philosophical
type. He is calm, rational, his motivation is generalized, as he desires
dentures for the maintenance of health and appearance.
Exacting patient
This type of patient requires extreme care, effort and patience on the
part of the dentist. This patient is methodical, precise and accurate and at
times makes severe demands. He likes each step in the procedure to be
explained in detail.
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3. Indifferent patient
The indifferent patient presents a questionable or unfavourable
prognosis. He evidences little if any concern; he is apathetic and
uninterested and lacks motivation. He pays no attention to instructions will
not cooperate and is prone to blame the dentist for poor dental health.
Skeptical patient
This type of patient is an old denture wearer with negative past
experience regarding his complete denture treatment. Such a person requires
genuine concern and patience on part of the dentist.
The success of the treatment will depend upon the willingness of the
patient to accept his responsibility in the treatment, the use and care of the
dentures, and the post-insertion procedures. Complete dentures must be
constituted in harmony with the maxillofacial structures and the
stomatognathic functions of mastication, swallowing, phonation and speech.
All objectives may be attained, but, because no two mouths are exactly alike
and because some vary greatly from the ideal, it is sometimes necessary to
compromise one objective to favour a more important one.
Information and instructions related to complete dentures
a) Limitations of usefulness of complete dentures
The loss of natural teeth is a misfortune which the artificial teeth can
reduce but never fully remove. Problems created by loss of natural teeth will
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4. not be over by just having dentures. It is not within the law of nature to
compress the vulnerable tissues with dentures whose impression surface is
akin to a sandpaper. Even the slightest pressure can impede the circulation
and decrease the nutrition to the tissues. Moreover, the efficiency of natural
teeth and dentures has no comparison with a ratio of 10:1 in favour of
natural teeth.
Due to the wide range of movments of the lower jaw and because the
force of mastication is exerted by it, the lower denture presents the greatest
problem in learning to use complete dentures. Limits of functions of oral
tissues have to be re-established and extreme non-functional movements
cannot be performed. Learning to master the movements of the mandible is a
gradual process. Patient should develop neuromotor skills to be able to hold
the dentures. The length of time required depends on the ability, the
perseverance and the determination of the patient.
The patient should be made aware of the shortcomings of the
prosthesis, and should not be promised too much in the future use of
dentures. The treatment requires continuous follow-up, check up which
includes occlusal corrections, relining or rebasing.
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5. b) Understanding the nature of denture foundations
Placement of dentures in the mouth provides an unnatural
environment to the oral tissues and bone. The vulnerable mucosa is
compressed between the bone and denture base. Pressure or compression is
excess of physiological limits of tissue tolerance causes loss of alveolar
bony support, overgrowth of soft tissue and excessive denture movements.
Good health and improved nutrition in addition to scientific methods
of treatment will reduce the problems of tissue abuse. An adequate protein
intake with dietary supplements help to maintain a balance in oral health.
c) Oral and general conditions complicating use of complete dentures
Educating a prospective denture patient about his oral status and
systemic conditions as they apply to him are absolutely necessary.
Diabetes mellitus: Diabetes patiets show an abnormally high rate of bone
resorption together with decreased tissue tolerance and delayed wound
healing. Such patients should be told that they will require frequent oral
examinations, denture adjustments and relines along with effective oral
hygiene.
Arthritis: These patients should be made aware that occlusal relationship
may change as a result of their disease and that limited jaw function may
follow.
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6. Anemia’s: Mucosites, glossitis and angular cheilitis decrease the tolerance
to a foreign body in the mouth. They should be counseled about the diet and
pharmacotherapy.
Neuromuscular disorders: Lack of neuromotor skill and control can result
in instability of the denture base. The use of a denture adhesive may be
advised in some patients.
Menopause: Post menopausal osteoporosis results in excessive alveolar
bone resorption and chronic tenderness of oral tissues.
The condition requires physicians consulting diet, pharamacotherapy
and use of soft liner.
Patients who have problems where surgery is either contraindicated
or surgery cannot be performed can complicate the use of dentures. Patients
who cannot control tongue and jaw movements due to wasting or muscular
incoordination. Macroglossia or microglossia can result in loss of peripheral
seal and loss of retention and stability.
Patients who do not accept their responsibility inspite of excellent
prosthodontic treatment.
Patients with adverse mental attitude and lack of mental capacity to
adjust to the treatment.
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7. d) Educational factors related to impression and jaw relation
recording procedures.
Considerable instruction may accompany impression making and
brief concise explanation of the impression technique should be give with
proper emphasis on the role of the patient in that procedure. The patient
must understand clearly that he is expected to co-operate fully during the
impression making procedures.
Dental education should include a discussion on the harmony and
beauty of the human face. Diagnostic casts, facial measurements, old and
recent photographs, profile records and the patients old dentures if available
can be employed to illustrate the discussion.
Effects of excess and reduced vertical dimension should be explained
to the patient while the necessity for accurate jaw records pointed out.
Should the jaw movements be abnormal, the dentist should explain that
compromises may have to be made in the selection of posterior teeth with a
possible loss in chewing function.
e) Patient education at the try-in
At the try in the dentist should instruct the patient carefully that
denture teeth should be shaded and have embrasures and diastemas to
simulate natural appearance. We should explain that the denture will seem to
be bulky at the try in. the patient should be given a mirror and instructed to
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8. speak and count. Each patient should be accompanied by a close friend or
relative at the try in. It is absolutely necessary to obtain the complete consent
and satisfaction of the patient before proceeding with the construction of the
dentures.
f) Patient education at the time of placement of dentures
During the initial insertion, the patient must be educated and prepared to
receive the denture.
i) Appearance
The appearance and nervous denture patient has a strained facial
expression because he has not been prepared psychologically for the
denture. The facial expression may seem slightly altered and it takes time for
the muscles and lips to relax and assume their natural position around the
dentures.
ii) Speaking with dentures
At first there is a feeling of full mouth and a crowding of the tongue
because the dentures have altered the shape of the mouth. Patient will be
conscious of something in the mouth, that was not there before and he/she
will have to learn to speak. However as soon as the lips, tongue and cheeks
have been accustomed to the dentures and new muscle habits are formed,
this difficulty is overcome easily.
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9. A good way to learn to speak is by reading aloud before a mirror and
carefully enunciating each syllable. Practice and patience resolves all
difficulties.
iii) Salivary flow
Soon after the insertion of dentures, salivary flow is stimulated which
declines after 2-3 days unless something is physically wrong with the
dentures which can cause irritation. Simply swallowing more often is the
best remedy and in a few days, the salivary glands will adjust themselves to
the presence of dentures and resume normal function. Patient should be
made aware of these problems in advance of the treatment, otherwise patient
will not trust the clinician and the quality of service. He should not carryout
any adjustments to overcome these inconveniences.
iv) Patient should be told about feeling of fullness and crowding of
the tongue. He should be told to rest the tongue in the floor of the mouth.
Lips and cheeks should be relaxed and not tensed.
Learning to eat with dentures takes time and requires positive effort
from the patient. At first the patient should cut soft foods that require little
chewing. Then he should try and place the bolus of food on both sides
simultaneously and chew with controlled vertical movements.
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10. Successful efficient use of dentures is a learned process and patient
has to train his musculature in holding the dentures.
v) Tenderness
The patient will experience some tenderness and discomfort from the
dentures during the first few weeks. The reason is that the mucous
membrane of the mouth is vulnerable and not evolve to bear stresses placed
upon them by the dentures.
New dentures will require some adjustment. The patient should be
told to wear the denture continuously for the first 24 hours and then
immediately report to the dentist. Any irritations or impingements can be
detected easily and corrected.
Later he should be instructed to only wear the dentures at daytime
without using them for eating. After 1-2 weeks he can start with soft chewy
foods and then, as the ridges get accustomed to pressures he can resume his
daily diet. Parafunctional habits such as clenching and grinding should be
avoided.
g) Rest to the supporting tissues
It is desirable that oral tissues should not remain under continuous
stress and therefore it is important to provide rest and natural ventilation by
removing the dentures from the mouth at night, during sleeping hours. This
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11. will allow tissues to recover from effect of stress. Those patients who suffer
discomfort and loss of sleep after removed of dentures, may provide short
periods of rest to oral tissues during the day.
h) Denture hygiene and maintenance
It is important to know that successful use of dentures also depends
on the maintenance of oral and denture hygiene. Mouth should be rinsed
after food and dentures should be cleansed with a small hand brush using
soap and cold water. Gritty or abrasive powders or paste should never be
used as they remove the gloss and cause scratches which mar the surfaces
and destroy the fit of the dentures.
While cleaning, the dentures should be held over a basin of water to
prevent breakage in case of accidental from the hands. If should be slipping
held in the palm of the hand while clenching the hand against the side of the
denture. Commercial denture cleanses are available in tablet and powder
forms. They are dissolved in water, the dentures are soaked overmight and
brushed in the morning.
If the dentures are left out of the mouth for any length of time, they
should be placed in a saturated selection of salt and baking soda or a boric
acid solution. This affords them safe and effective storage. The dentures
should not be allowed to dry out as moisture is relaxed and they get warped.
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12. i) Recall visits and their importance
Objective of recall visit is to offer continuing health service by
ensuring the status of supporting tissues. Thorough recall visits one can
observe the development of undesirable situations before more damage
occurs. Recall visit may be fixed every fine to six months or one year.
j) Importance of Good Diet
Enquiry into the diet of the patient and his food habits will reveal or
bring out useful information on the nutritional intake of the patient. The diet
should be evaluated by a nutritionist and the deficiencies noted. A well
balanced diet containing a high percentage of proteins, vitamins and
essential minerals and a low percentage of carbohydrates is necessary to
keep the supporting tissues of the dentures in good condition.
Close co-operation between the patient dentist and the physician will
result in greater service to the patient.
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