Public Health-Mas

Informed consent
Informed is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. In the communications process, you, as the physician discuss with your patient:
patient's diagnosis, if known nature and purpose of a proposed treatment risks and benefits of a proposed treatment Alternatives treatment risks and benefits of the alternative treatment or procedure The risks and benefits of not receiving or undergoing a treatment or procedure

patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

Komplikasi pencabutan gigi

Intra operasi Fraktur mahkota/akar Fraktur tlg alveolar dan tuberositas maksilaris Fraktur mandibular Trauma pd jaringan lunak dan sekitarnya Pendarahan primer Displacement gigi dan fragmennya Fistula oroantral Dislokasi tmj Emphysema Traima pd saraf Sinkop dan syok anafilaktik Post operasi Dry soket pendarahan sekunder Infeksi dan penyembuhan lambat Nekrosis jaringan lunak Pembengkakan dan trismus Sakit yg menetap

Instruksi pasca pencabutan

Gigit tampon 1- jam Jgn sering berkumur Jgn sering meludah Jgn mempermainkan bekas luka dgn lidah Jgn menghisap luka Jgn merokok Mkn pada sisi berlawanan Jgn mkn /minum yg panas Kontrol segera jika ada keluhan atau alergi obat

Conservative Dentistry-Tjin, Niro

Blacks Classification

Class Iocclusal areas and buccal or lingual pits Class IIposterior interproximal Class IIIanterior interproximal Class IVanterior interproximal including the incisal corner Class Vgingival at facial or lingual (Class VIcusp tip)

Cement Base
Choose a cold large slab Put a scoop of powder on the slab &divide it into 6 Two drops of liquid Mix powder to one drop of liquid. Adding more powder if needed or liquid to the mixture Mix in a large circular motion and folding motion

Definition of Class II Amalgam Restoration

Amalgam restoration that restore one or both of the proximal surface of a posterior teeth

Matrix Placement
Observe the video for better understanding http://www.youtube.com/watch?v=an5hdF8Rl8&feature=related
AND DOC AYUs SLIDES

Instrumentation for amalgam placement

1. Tofflemaire Matrix Retainer 2. Wedge (made of wood if got, if not made from plastic) 3. Matrix Band (normal straight band) 4. Burnisher

Burnisher

Steps in Matrix Placement

Try the wedge. Burnish the matrix band. Place the matrix band into the retainer. Fit the matrix onto the tooth. Place the wedge. Tighten the matrix band around the tooth

Class II Restoration (Focused)

The wedge placement
For MO : wedge will be placed at the mesial side of the teeth from palatal/lingual to buccal For DO : Wedge will be placed at the distal side of the teeth from the buccal to palatal/lingual For MOD: wedge placed on both mesial and distal of the teeth like above

Remember
The open end of the U-shaped head must be always face the gingiva The long knob and short knob end should be facing out of the mouth.

LOCAL ANESTHESIA-Diyana
Pre-injection procedures Fisher technique Plus+ Maxillary injection tech Mandibular injection tech
http://www.nysora.com/peripheral_nerve_blo cks/head_and_neck_block/3062oral_maxillofacial_regional_anesthesia.html

Sila chekkidout

Wash hands

Open syringe package drop on sterilized tray

Clean ampule with alcohol place on sterilized tray

Break ampule

Wear gloves

Wash hands

Wear mask

Fill syringe with anestetikum

Recap syringe

Oles betadine on mucosal tissue to be injected

Fisher Technique
1ST POSITION Locate linea obliqua externa geser median to locate linea obliqua interna (melalui trigonum retromolar) Punggung jari menyentuh buccoocclusal gigi terakhir Syringe at premolar region Tengah2 lengkung kuku penetrate until contact with bone 2ND POSITION Syringe now sejajar dataran occlusal Penetrate 6mm, ASPIRATE Aspiration ve, 0.5cc N.Lingualis 3RD POSITION Syringe now at canine region Penetrate 10-15mm until contact with bone hilang ASPIRATE, -ve, 1cc N. Alveolarius Inferior

MAXILLA
Nasopatine nerve

Greater palatine nerve

Supraperiosteal Blok N. Palatinus Mayus Blok N. Nasopalatinus Infiltrasi palatum

Lesser palatine nerve

Supraperiosteal/ local infiltration Tarik pipi n bibir sehingga jaringan tegang Tusuk pada lipatan mukobukal Jarum tusuk ke arah apeks . Jarum dimasukkan sampai ujung jarum di daerah apeks gigi Aspirate, 0.6-1cc slowly (20sec)

Blok N. Palatinus Mayus Baal sampai canine Foramen at distal 2nd molar (pertemuan palatum durum n processus alveolaris) Jarum tusuk slowly 0.5mm 0.5cc-0.75cc

Blok N. Nasopalatinus Jarum inserted thru papila nasopalatinus sampai jalan masuk canalis incisivum Contact dgn tulang jarum keluarkan lagi 0.5-1mm, anestetikum 0.1cc-0.2cc slowly

Infiltrasi palatum Tujuan: jaringan gusi 5-10mm dr gingival margin Jarum 45degree Anestetikum 0.20.3cc

MANDIBLE
Fisher blok Buccal Nerve Block

Buccal Nerve Block Dilakukan pd coronoid notch (median frm linea obliqua . Mukosa bukal ditarik.) Jarum tusuk lateral and distal gigi geraham terakhir setinggi oklusal 2-3mm, aspirate, 0.5cc

Microbe-Fit

Hand Washing Technique

To wash hands properly, rub all parts of the hands and wrists with soap and water or an alcohol-based hand rub. Wash hands for at least 15 seconds or more. Pay special attention to fingertips, between fingers, backs of hands and base of the thumbs. Keep nails short Wash wrists and forearms if they are likely to have Remove watches, rings and bracelets been contaminated Do not use artificial nails Make sure that sleeves are rolled up and do not get Avoid chipped nail varnish wet during washing

Wearing Glove Technique

Putting on Gloves: 1. Wash hands with soap and water, and dry thoroughly- removing jewelry prior to washing hands is highly recommended. 2. Staff wearing jewelry must wear larger sized gloves to ensure proper fit. 3. Before putting gloves on, be sure to examine for dirt or damage (tears or holes). Replace gloves if necessary. 4. Replace gloves before dealing with another patient or if they become heavily soiled.

Removing Gloves: 1. Remove gloves carefully to prevent splattering. Grab the outside wrist of one glove with your other hand. Turn glove inside out as you remove it. 2. Drop the inverted glove into the other hand and slide your bare finger under the second glove to invert it and trap the first glove inside. 3. Wash hands after removing gloves.

ORTHODONTIC
Hani

MEASURE OVERBITE AND OVERJET

OVERBITE

OVERBITE

NORMAL

HOW TO MEASURE?
Mark a short line on labial surface of lower incisor with

sharpened pencil
Distance from incisive edges

to the mark is measured with

Boiley gauge

OVERJET

Normal

MALE
FEMALE

2,2 mm + 0,8 mm
2,5 mm + 1,1 mm

Edge to edge/ cusp to cusp

Overjet

HOW TO MEASURE?
Measure horizontal distance from

maxillary incisal tip with the labial

surface of mandibular incisor during centric occlusion Big overjet : >3mm Instrument : Boiley Gauge

ANGLES CLASSIFICATION
The classifications are based on the relationship of the

MESIOBUCCAL CUSP OF THE MAXILLARY FIRST MOLAR and the

BUCCAL GROOVE OF THE MANDIBULAR FIRST MOLAR

Deweys modification: Type 1-crowded maxillary anterior teeth Type 2-proclined or

labioversion of maxillary
incisors

A normal molar relationship

exists but there is crowding, misalignment of the teeth, cross bites etc

Type 3-linguoversion of
maxillary incisors Type 4-incisors and canines normally positioned Type 5-mesioversion of molars

Class II division I when the maxillary anterior teeth are proclined and a large overjet is present Class II division II Molar relationship shows the

where the maxillary

anterior teeth are retroclined and a deep overbite exists

buccal groove of the mandibular

first molar distally positioned when in occlusion with the mesiobuccal cusp of the maxillary first molar

Molar relationship shows the buccal groove of the mandibular

first molar mesially positioned to the mesiobuccal cusp of the

maxillary first molar when the teeth are in occlusion

Deweys modification:
Type 1- well-aligned teeth and dental arches Type 2- Crowded mandibular incisors Type 3- Crowded maxillary incisors

CEPHALOMETRIC LANDMARK

Nasion (N) point where

frontonasal and internasal sutures meet in midline Sella (S) centre of pituitary fossa or sella turcica Basion (Ba) most posterior and inferior point in sagital

plane on the anterior rim of

foramen magnum

A (subspinale) deepest
point between ANS and inferior most point in maxillary alveolar process B (supramentale) deepest point between pogonion and superior most point in

mandibular alveolar process

Pogonion (Pog) anterior most point in contour of lateral shadow of chin Gnathion (Gn) most anterior and inferior point on lateral

shadow of chin, mid point

between pogonion and menton Menton (Me) inferior most point in contour of chin

Gonion (Go) most

posterior and inferior point

at the angle of mandible Porion (Po) superior most point of external auditory meatus Orbitale (O)- lowest point on outline of bony orbit

MODEL ANALYSIS

ANALISIS BOLTON
TOOTH SIZE DISCREPANCY (TSD)

OBJECTIVE
Evaluates maxillary and mandibular teeth for tooth size discrepancies

According to Bolton, there is a relation between combined

width of mandibular and maxillary teeth

Comparing the size of the maxillary teeth the size of the mandibular dentition

There are two measurements: - The ratio of anterior (6 anterior teeth) - The ratio of total (12 teeth)

Rasio Anterior dan Rasio Total

STAGES
Stage 1: Measure and record all the mesio-distal tooth size in mm (such as analysis ALD) - 6 anterior teeth RA (13-23) - RB 6 anterior teeth (33-43) - 12 teeth RA (16-26)

- 12 teeth RB (36-46)

RATIO ANTERIOR

TOTAL RATIO

 Stage 2:
Calculations with Boltons formula

How to calculations using theformula of Bolton:

ANTERIOR RATIO:

mand. 6 x 100 = % maks. 6

(mean = 77.2; SD = 1.65) (Normal = 75.55 to 78.85)

How to calculations using theformula of Bolton:

TOTAL RATIO: mand. 12 maks. 12 x 100 = %

(MEAN = 91,3 ; SD = 1,91) (NORMAL : 89,39 - 93.21)

STAGE 3 IF, anterior ratio> 77,2% total ratio> 91,3%

Then the true size of the maxillary teeth and themandible is too large than it should

-Use the correct size of the maxillary teeth is to see the size of the teeth mandible should be on the Boltons table. -Measure the mandibular teeth of the patient -Reduce the size of the mandibular teeth of the table -The results of this reduction is the difference between mandibular tooth size excess

If,

anterior ratio < 77,2% total ratio < 91,3 %

Then the true size of the mandibular teeth, the size of the maxillary teeth are too big than it should

Use the true size of mandibular teeth to measure the size of maxillary teeth that should be in Boltons table Measure the maxillary teeth on patient Reduce the size of maxillary teeth from the table Result of reduction is the excess of maxillary tooth

TABEL BOLTON (TSD)

TABEL PENGHITUNGAN ANALISIS BOLTON (TSD)

Seharusnya (Tabel) ------ mm ------- mm ------ mm ------- mm
------ mm ------- mm ------ mm ------- mm

Pasien

Selisih
------ mm

Mand 6

Maks 6
Mand 12 Maks 12

------ mm
------ mm ------ mm

CONTOH KASUS
Ukuran 12 gigi RB = 90 mm Ukuran 12 gigi RA = 95 mm Menurut Rumus Bolton : 90 ---- x 100 = 94,7% 95 94,7% kesimpulan geligi madibula yang salah (ukurannya terlalu besar dibandingkan seharusnya) dan gigi maksila yang benar. Lihat di tabel Bolton angka 95 untuk ukuran gigi maksila yang benar, maka ditemukan ukuran gigi mandibula seharusnya 86,7 mm. Maka ukuran 12 gigi mandibula berlebih sebanyak = 90 86,7= 3,3 mm.

Isi Tabel yang Tersedia di Status

Pasien
Mand 6 ------ mm

Seharusnya (Tabel)
------mm

Selisih
------ mm

Maks 6
Mand 12

------ mm
90 mm

-------

mm

------ mm
3,3 mm

86,7 mm

Maks 12

95 mm

mm

mm

Kemungkinan Rencana Perawatan

Agar oklusinya baik maka perawatan dapat dilakukan dengan memajukan (ekspansi) gigi anterior maksila ke anterior sebanyak 1,65 mm atau slicing gigi mandibula sebanyak 3,3 mm (?) atau cara lainnya

Analisis Howes

Analisis Howes
State of dental crowding (crowding) is not only due to the size of the teeth that are too big but can also be caused by the curved jaw bone is too small.

Notes : only for maxilla

Used as a benchmark measure:

1. Dental arch length = Number of mesiodistal tooth size of 16 to26 teeth 2. Arch width / Width Base Apical = distance between the deepest point canine fossa, measured from the point at the tip apex of tooth 14 to tooth 24 3. Dental arch width = distance between the tip of buccal teeth 14 to 24

Dental arch length = Number of mesiodistal tooth size of 16 to26 teeth

Arch width / Width Base Apical = distance between the deepest point canine fossa, measured from the point at the tip apex of tooth 14 to tooth 24

Dental arch width = distance between the tip of buccal teeth 14 to 24

Howes Formula
1. 100 X Apical base ________________ Total Mesiodistal 16 26 100 X .. mm = ______________ mm = .%

2. Dental arch width (buccal tip14-24) = .........mm dental arch width (apical base) = .........mm ________________ reduction = mm

ANALYSIS RESULT
1. 44% = INDICATES THAT THE APICAL BASE WIDE ENOUGH FOR ALL TEETH FROM 6 TO 6
2. < 37% =ARCH CURVE IS SMALL UNTIL EXTRACTION NEEDED 3. 37 %-44 % = DOUBTFUL CATEGORY BETWEEN EXTRACTION OR EXPANSION 4. > 44% = JAW ARCH WIDTH> DENTAL ARCH WIDTH UNTIL P1 SO EXPANSION CAN DONE SAFELY

Analisis PONT

The rationale is: greater mesiodistal widths 4 incisive maxillary teeth, the greater the width dental arch between P1 and M1 so that no crowding

1. Mesiodistal width 12 11 21 22

2. Distance of central fossa 1424 (patient)= ..mm

3. Distance of central fossa 1626 (patient)=mm

a. Ponts index formula for 14 24

Total mesiodistal 12 11 21 22 80

x 100 =... mm

b. Ponts index formula for 16 26

Total mesiodistal 12 11 21 22 x 100 =. mm 64

Ponts table
PATIENT 14 -24 16-26 .. mm ..mm PONT ..mm ..mm DIFFERENCE ..mm ..mm

If the result is - (negative) contraction occur If the result is + (positive) distractions occur

Oral Surgery-Alyana
-Choose the right tang for extraction -Show extraction procedure -Write prescription for a case (extraction) -Prescribe: mefenamic acid and amoxicillin

Maxillary forceps
The S, I, and Z shaped forceps are used on the maxillary arch.

Maxillary forceps no. 150

maxillary incisors, canine teeth, and premolar teeth

 For maxillary premolar

Forcep No. 150A (Slight variation from 150 for maxillary premolar only)

to extract maxillary first and second molars Smooth, concave surface for the palatal root Pointed design that will fit into the buccal bifurcation on the buccal beak.

Based on doc endangs slide

Maxillary: lurus mostly Only for molars: right and left different
Buccal part yang lancip

Mandibular forceps
Forceps which are C and L shaped are used on the mandibular arch Bentuk paruh

Forceps No. 151

for single-rooted teeth the incisors, canines, and premolars

 For mandibular premolar

forceps No. 17
lower molar forceps beaks have bilateral pointed tips in the center to adapt into the bifurcation of the molar teeth. the beak adapts well to the bifurcation.

HAWKBILL-TYPE FORCEPS
Mead #MD3 forceps
For mandibular anteriors and bicuspids

#13 forceps
For mandibular bicuspids

#22 forceps
For mandibular first, second, and third molars.

Based on doc endangs slide

mandibular: bentuk paruh mostly Right left same for all

How to extract
Anamneses Extra oral and intra oral exam Explain what you are going to do Informed consent!!! Inject local anesthetic. Separate the gum from the tooth. Loosen the tooth - baine Take out the tooth.
Right hand: pgg tang Left hand: fix gigi

Stop the bleeding gigit tampon hrs Suture is must depending on the surgical area Explain to the person what to do at home to look after the wound.

Put baine at mesiobuccal of tooth that wanted to be extracted

Maxillary region 1 and 2 Extraction

Operator at the right of patient Operator shoulder length Patients face facing to operator if needed exp: upper left posterior

Way to extract maxillary

Incisor: luxate then rotate Canine: luxate then rotate Premolars: luxate Molars: luxate

Mandibular region 3 and 4(ant only) Extraction

Operator at patients right side Elbow length

Ways to extract mandibular

Incisor: luxate Canine: luxate Premolars: luxate then rotate Molars: luxate

Mandibular region 4 posterior

Operator at patients behind on the right

Use of Cryer Elevator

Here to prescribe (adults)

Patients name: Date: R/ Amoksicillin 500mg caps No XII S3 dd1 caps pc Patients name: Date: R/ As Mefanamat 500mg caps No X S3 dd1 caps pc ah

docs sign

docs sign

Here to prescribe (child)

Patients name: Date: R/ Amoksicillin syr F1 1 S3 dd2 cth Patients name: (< 10yrs) Date: R/ paracetamol 500 mg tab V S3 dd tab

docs sign

docs sign

Pedodontics-Fuzah

Question 1
Anak laki-laki, 5 thun, dtg rsgm bersama ibu Gigi kanan atas sakit, ingin dirawat Intraoral exam. : caries profunda gigi 55

Diagnosis Pulpitis irreversible

Cara mendiagnosis

Rencana perawatan

Visual showing a deep Pulpotomy + SSC cavity involving the pulp, confirmed using a probe. If the probe is sent deep into the pulp, both pain and hemorrhage would be seen. Radiograph It may show exposure of the pulp and deep cavity. The periapical area usually is normal, with some widening of the periodontal ligament sometimes. Percussion Exudate in the pulpal cavity increases the intrapulpal pressure, which leads to tenderness on percussion of the tooth. Vitality test

Question 2
Anak laki-laki, 7 tahun gigi kiri atas(64) berbau (halitosis) Makan/minum dingin : xde rasa ape2

Diagnosis Necrosis pulpa

Cara mendiagnosis Inspection radiograph Palpation Percussion

Rencana perawatan Pulpectomy + SS crown

 Anak perempuan, 4 tahun Mengeluh sakit berdenyut hebat pada 54, menangis dan tak boleh tidur Ada pembengkakan pada 54 smpi bwh mata kanan

Diagnosis Abses et cause necrotic pulp

Cara mendiagnosis Inspection Palpation Percussion Vitality test

Rencana perawatan 1) Incision and extraction of 54. *adequate drainage is almost impossible to achieved in primary tooth. 2) Space maintainer OR Mummifikasi (DSP6 punyer slides by dr inne n dr yetty)

 Anak perempuan, 6 tahun Mengeluh sakit gigi kanan bawah (85) bile minum/mkn dingin Pt ingin ditambal

Diagnosis Pulpitis reversible

Cara mendiagnosis Inspection Radiograph Palpation Percussion

Rencana perawatan Tambalan amalgam/composite

 Ini sgt instant. Kalau ade yg salah or nk tmbh, mangga di benerin nyak!

 Ref:
Slides doc indri Slides doc inne n doc yetty Dentistry for child and adolescent (ebook DSP 9)

Radio-Fieka
Radiology Periapical : Bi-centric technique

Communication
Bila patient masuk : Greet patients with salam and senyum mesra Suruh patient duduk Read status and confirm with patient : nama, alamat pendek, case Explain risk secara overview, eg Explain procedure to patient

Preparation (1)
Operator : wear baju kebal, mask and glove Patient : position on chair Maxilla tegak 90* Mandible sudut mulut to tragus // lantai Film positions principles : White surface faces teeth The dot faces occlusal

Note :

1) film @ palatal/lingual gigi only 2) Maxilla : patient pegang dengan thumb Mandible : patient pegang dengan jari tunjuk 3) Anterior : film vertical 4) Posterior : film horizontal

Preparation (2)
Adjust angles and timer based on case

Set voltage to 6V (standard) Note : ada juga yang kata 5-6 so tak tau le

Shoot
Confirm angles based on case Check patients head and film positions Turn the machine on Shoot.

Yam

 Class I : Bilateral edentulous areas located posterior to the natural teeth (bilateral free end)

 Class II : A Unilateral edentulous area located posterior to the remaining natural teeth (unilateral berujung bebas (free end unilateral))

 Class III : A Unilateral edentulous area with natural teeth remaining both anterior and posterior to it (gigi bersandaran ganda)

 Class IV : A single but bilateral (crossing the midline), edentulous area located anterior to the remaining natural teeth

Applegates rule
Klasifikasi dibuat setelah semua extraction selesai dilakukan Bila M3 hilang dan tidak diganti, so tak masuk klasifikasi Bila M3 ada dan akan digunakan sebagai gigi penahan, so masuk dalam klasifikasi. Bila M2 dah hilang dan tak akan diganti, so tak masuk dalam

klasifikasi.
Bagian tak bergigi paling posterior selalu menentukan kelas

utama dlam klasifikasi.

 Daerah tak bergigi yang tak masuk dalam klasifikasi, disebut modifikasi. Jumlah gigi yang hilang tak dipersoalkan; yang dipersoalkan adalah jumlah ruangan gigi yang hilang (untuk dimasukkan sebagai klasifikasi atau modifikasi) Tidak ada modifikasi untuk kelas IV

Cuba test!

Klasifikasi Soelarko
Kelas I: berujung bebas Kelas II: bersandaran ganda Kelas III: gabungan berujung bebas dan bersandaran ganda Aturan divisi Divisi 1: satu sisi Divisi 2: dua sisi Divisi 3: meliputi garis median

SURVEYING

 Survey model menggunakan surveyor. Surveyor adalah alat yang dipakai untuk meninjau kesejajaran dari 2 permukaan gigi atau lebih, atau bagian lain dari model. Surveyor The Ney Kegunaan Surveyor: Menentukan arah pemasangan Menentukan garis survey Menentukan daerah gerong (undercut) Menentukan guiding plane Menentukan penempatan cangkolan Menutup daerah gerong yang tak diperlukan.

 Garis survey merupakan garis singgung yang menunjukkan kontur terbesar suatu permukaan (gigi, alv ridge) pada arah pemasangan tertentu. Letak model atas meja model dgn zero tilting cari undercut kalau dapat undercut dgn baik, maka arah pemasangan sejajar oklusal then buat garis survey pada semua permukaan ggi sandaran dgn carbon marker kalau tak dapat, tilting ke arah ant/ post/ kiri/kanan kalau dpat undercut yg baik, kunci meja model then buat gari survey sebelum melepas model, buat tripoding (untuk mencari ulang posisi terakhir survey)

Design Full Denture

Retensi Stabilisasi Estetik Arah pemasangan Support

(ni semua baca dekat slide dr. rasmi)

Design partial denture

RETENTION STABILITY AESTHETIC EXTENSION PATH OF INSERTION / REMOVAL ORAL HEALTH (SOFT & HARD TISUE)

(baca dekat slide dr. taufiq) Aku bukan malas ehhhhhhhhhhhhhhhhCuma nanti I copy paste jugak hahahaha

Desain
Retensi: kemampuan GT bertahan terhadap gaya yang melepaskan (DARI ARAH VERTIKAL) . (retensi untuk GTSL dari cangkolan (retainer) pada gigi sandaran) Stabilisasi: kemampuan GT agar tidak goncang/bergeser pada pemakaian. (dari arah horizontal). (stabilisasi terutama berhubungan dengan dukungan/support (dari gigi/mukosa) dan dari oklusi Estetika: keindahan yang sesuai dgn keperibadian Support: kemampuan GT utk menahan tkanan dari arah apikal Arah pemasangan

 Tentukan gigi sandaran surveying buat garis survey tentukan arah pemasangan (dri surveying) tentukan perluasan landasan

Cangkolan
Cangkolan adalah bagian dari GTSL yang biasanya dibuat dari kawat khusus (kawat klamer) atau dari logam cor. Melingkari dan menyentuh sebagian besar, keliling gigi, memberi retensi, stabilisasi dan suport bagi GTSL tersebut. Cangkolan C, Cangkolan bukal, Cangkolan E atau Cangkolan Bola (Ball clasp)

Syarat2 Cangkolan
1/3-1/2 ujung lengan retentif berada di daerah gerong dan ujungnya 1-2 mm diatas tepi gusi. 1/3 awal lengan retentif harus berada di daerah non gerong Kontak cangkolan dgn permukaan gigi harus kontak berkesinambungan. Cangkolan harus beradaptasi dan tidak menekan gigi. Bila memakai oklusal rest tidak boleh mengganggu oklusi Ujung lengan dibuat sepanjang mungkin Ujung lengan dibentuk sehingga tidak tersangkutnya sisa makanan, bibir, pipi serta lidah Cangkolan tak boleh cacat bekas tang Utk tangan cangkolan yg panjang (misal pd ggi molar) gunakan kawat klamer 0.8 mm.

Mengukur
Yang nak ukur linggir, daerah x bergigi semua tuI honestly x tau sgt punkat buku xde,,secara teorinyaso, I rase basically ape yg kita buat dalam labmain point is pakai pembaris besi yang mula dari nol tu. Nak ukur dari mesial ke distal ke ape keI kurang tahumaaf ya teman2kalau ade yg tau.,,nanti kongsi2 kayyy Love u alllawhhhhh gewdixxx Raaawwrrrrrrr..

DMT-nina
Alginate Model cast

 Baca case carefully, and understand the needs..

Nak impression ke, nak casting ke..etc What region.. wear gloves!

alginate

alat2
Sendok cetak/tray: berlubang, ruang 4-6mm dari gigi. RA: sampai daerah AH-line RB: sampai molar terakhir/retromolar pads. Tak cukup: tambah lilin dgn retensi.

alginate

metode
Cetakan mukostatis Tekanan minimal Bahan cetak hidrokoloid Indikasi: gigi goyang, byk undercut & diastema

alginate

persiapan
Mulut: bahu & siku operator Instruksi pasien nafas ikut hidung. Oklusal rahang sejajar lantai. Pasien kumur dahulu.

Operator bersih + wear gloves. Cetak Rahang Bawah dulu! Posisi cetak: -RA diri depan kanan, masukkan sendok cetak, fix, pindah ke kanan belakang. -RB depan kanan.

alginate

persediaan
RA: 2.5 scoop alginate, 1 sukatan air RB: 2 scoop alginate, sukatan air Guna air dingin lengthen working time Masuk air dalam bowl Shake powder dalam beg ambil, ratakan pakai spatula If ada kertas disediakan -> tempat letak powder. Bubuk -> air Sediakan another bowl of air utk ratakan impression

alginate

pengadukan
Aduk sampai semua terbasahi 1 minit/ 45-60 saat Menekan ke dinding bowl alginat larut, buang udara, homogen Isi sendok posterior ke anterior Ratakan pakai jari basah. Work quickly before color changed.

alginate

mencetak
- RB dulu! -telunjuk kiri tarik sudut mulut pasien - kanan sendok cetak masuk dulu -posisikan segaris midline -tekan sendok posterior anterior

RB instruct patient utk gerakkan lidah ke atas dan ke depan. -kalau ada yg belum tertutup (vestibulum), tambah alginat. -hold in place for atleast 2mins -cek kekerasan dgn excess di bowl
-buka seal dengan retracting cheek to allow air inside - RA: tarik tangkai ke atas, lepaskan posterior dulu, sejajar tooth axis - RB: tekan tangkai ke bawah, lepaskan posterior dulu.

alginate

Hasil cetakan
Semua anatomi tercetak (muccobuccal fold, frenulum, etc) Hopefully takde: Bubbles yang besar Vestibule tak tercetak sebab tak cukup tinggi Penyimpangan midline Decreased/increased depth

Rinse with water to remove saliva & blood Remove excess water..done! Cor gips within 15-30mins..kalau lebih, moisten alginate with damp tissue

Cast model

Plaster Gips ; study model 50-60cc:100gr Stone Gips; work model 30cc:100gr
RA: 100 gr RB: 80 gr Letak powder on paper or alas if ada.

Cast model

mixing
Isi air dlm bowl Tuang powder (15s) Tekan2 with spatula until all wet (15s) Aduk until homogen (60s) Use vibrator or ketuk2 atas meja with the upper side of bowl tertutup, until bubbles xde (1.5mins).

Cast model

loading
Place posterior part higher Tgn kiri pgg handle, tgn kanan load Masuk dari satu arah shj! Ketuk2 kat meja to let it flow until cervical Tutup semua tapi jgn terlebih nnt susah buka Tunggu smpi gips hilang shine and cool down. Buat retensi

Cast model

removing
Minimum 30 mins, maksimum 60 mins Buang excess dulu Under running water
If gips chalky because: Impression not clean Ada air on impression Remove too early/too late Low w/p ratio

ORAL MEDICINEsuga

Anamnesis

Chief Complaint Location of the lesion Time Course Quality of pain Factors that reliefs the pain Factor that triggers the pain Whether been treated before What wants to be done

Blood Pressure Measure

 Patient is rested and relaxed. Check with the patient as to which arm is usually used for the cuff (preference as a result of existing medical conditions or previous procedures). Ensure that the arm to be used is supported at the same level as the heart. The elbow needs to be extended, to allow the best detection of the brachial artery in the elbow joint.

 Palpate the brachial pulse, this is where the stethoscope will be placed when listening for the Korotkoff sounds. Size the cuff correctly, the bladder portion must extend at least 80% around the arm. Apply the cuff to the upper arm, the centre of the bladder in line with the brachial artery. The cuff needs to be positioned to allow the stethoscope diaphragm clear access to the brachial artery (not too tight or loose). Should be no trapped clothing beneath the cuff: reading error, due to a pressure point.

 Find the radial pulse and keep monitoring this. Close the control valve (arrowed) on the sphygmomanometer. Gently pump the bulb until radial pulse cannot be felt. Continue to inflate adding 30 mmHg. Then, gently open the valve for a slow controlled release of air from the cuff with 2mm Hg per second. Listen carefully for the first beat: REAL SYSTOLIC PRESSURE.

 At some point, you will not be able to detect the beat. This is the: DIASTOLIC PRESSURE. Open the air valve fully, to rapidly deflate the cuff. Release the patient from the equipment. Record your readings, Systolic over Diastolic.

SUMMARY:

Topical Medication

Needed Items
Pinset Topical Medication (gel/ointment) Gloves Cotton pellet Glass lab Gauze

 Wash your hands and wear the gloves. Place the gel or ointment on the glass lab. Use gauze to dry the mucosal tissue completely. Prevent using cotton roll to dry the tissue that can cause the wools stick onto the lesion.

 Use the cotton pellet to apply a small amount of the medication onto the lesion and a bit of the surrounding. Leave the area untouched for 5 min for a full absorption. If the lesions is on the palate, use folded gauze and ask the patient to bite it for 5 min.

Periodontology-githa, ashley

1. Structure of healthy gingiva

Color: coral pink Size: depends on vascular supply Contour: marginal gingiva (collar like/scalloped) Shape: interdental gingiva (anterior: pyramidal shape, posterior: flattened) Consistency: firm, resilient Surface texture: stippled- on attach gingiva Position: gingival margin

2. Basic instruments
Explorer Mouth mirror Pinset Probe

3. Examination

Anamnesis Medical history Bad habits Intraoral Drifting of teeth Tooth mobility Attrition Sensivity

- Abrasion - Pain - Gingival bleeding(spontaneous/ non-spontaneous) - Stillmans Cleft (dry mouth and severe gingivitis)

4.Types of periodontal disease Gingival disease - plaque induced - non plaque induced acute / aggressive periodontitis - localized/ generalized Chronic periodontitis - localized/ generalized

5. Brushing method Vertical :disadvantage - cause gum recession Horizontal :disadvantage- interdental not cleaned, abrasion, recession Roll : for patient with healthy gingiva & brush placed above free gingiva and bristles towards apices Circular / Strokes: For children Vibratory 450 into gingival sulcus & mainly for periodontitis patient

Choosing the right tooth brush

Round ended Soft bristles Flat surfaces Small head Straight head