Acute ulcerative gingivitis

Acute ulcerative gingivitis or Vincents disease is a complication of periodontal disease . It is

an acute gingivitis characterized by pain and halitosis (bad breath) . The affected gum
appears bright red with a covering layer of grey membrane where the gum marin has been
beed destroyed by bacterial action.The responsible bacteria are bacillus fusiformis , and
treponema vincenti.All the features of acute inflammation are present : red swollen painful
gums ; loss of function , because it is too painful to chew hard food ; and the patient often
has a raised temperature . It occurs mainly is areas already affected by chronic gingivitis ,
and also around erupting lower wisdom teeth. Penicillin or metronidazole are often given to
kill bacteria , administered internally in the form of tablets . Prior to the advent of penicillin
drugs commonly used for this purpose where chromic acid and hydrogen peroxide.But
whichever drugs are used to kill the bacteria , it is always necessary to scale the teeth
afterwards to prevent a recurrence.
4. Caries, causes, effects. Prevention and treatment
Tooth decay or caries is known to be probably the commonest disease of civilization. It is
due to the acid formation on the tooth surface, dissolving away the enamel and dentine to
produce a cavity. Acid is produced by the action of certain bacteria on food remaining on the
teeth after meals. The refined corbohydrates are reported to cause caries because it is the
only food which can be turned into acid by the bacteria. Refined carbohydrates are sugar
and white flour, so foods like cake, biscuits, bread can cause caries. The longer the
carbohydrates stay on the teeth the longer the duration of acid production. Thus sweet
fluids, such as tea with sugar which are washed by saliva are not a significant cause of
caries. Sticky carbohydrate is the major cause, because of its adherent nature it clings to the
teeth for a long period of time, during which it is being transformed into the acid. Coffee and
other sweets, cake, biscuits are among these type of carbohydrates.In our modern diet there
is a lot of refined carbohydrates, and our teeth are attacked by acid. It is evident that
excessive consumption of snacks or sweets between meals is one of the most important
causes of caries. Now, lets speak about effects of caries. At first, the pain lasts for a short
while and is brought only by contact with anything hot, cold or sweet. Later, as the cavity
approaches the pulp, toothache becomes more severe until there appears pulpitis. This
condition is caused by the irritant action of bacteria and their acid products in the cavity. It
is very painful and laeds to death of the pulp, followed by foration of alveolar abscess.
Pulpitis may be acute or chronic. It has many causes, apart from caries, but always ends in
pulp death. When pulpitis occurs, the pulp eventually dies as its blood supply is cut off by
inflammatory pressure. The dead pulp decomposes and infected materiales passes through
the apical foramen to the periodontal membrane and alveolar bone. These products give
rise to another inflammatory reaction which soon develops into pus formation and an acute
alveolar abscess. This is extremely painful condition. Frequently the whole side of the face is
involved in the inflammatory swelling and the patient may have a raised temperature. If an
acute abscess is not treated it eventually turns into a chronic abscess by draining of pus
through a sinus. It is clear that pulpitis is followed by pulp death, and this leads eventually to
an acute alveolar abscess, or to a chronic one. The prevention of caries can be achieved by:
1. Removal of carbohydrate debris to prevent acid forming 2)prevention of acquired
stagnation areas 3)making teeth more resistant to acid attack. If all carbohydrate is cleaned
off the teeth immediately after a meal, the source of acid formation is lost and caries will not
occur. Unfortunately, this cannot be done completely as no method of cleaning is absolutely
perfect. Howevere, it will ensure a considerable reduction in the incidence of caries. Teeth
can be cleaned by a tooth brush or detergent food like firm, fibrous fruits or
vegetables( apple, pear carrot cellery). The onject of treatment is to stop caries progressing
further and thereby prevent or cure pain. The type of treatment depends on the health of
pulp. If it is stiil vital, the tooth can be filled, but if it is inflamed, or already dead, treatment
is by extraction of root canal therapy. No drug can cure cariesand nothing can make the lost

tooth structure grow again. The best that can be achieved is the removal of all carious
enamel and dentine and replacement by a filling.
Causes of malocclusion
Almost all kinds of malocclusion are genetic in origin :very few are acquired.Causes of
malocclusion include abnormal jaw relationship , crowding , supernumerary teeth, missing
teeth, and sucking habits.
Normal jaw relationship is known as a class 1 occlusion . The abnormal relationships are
protruding upper incisors (class 2 occlusion) in which the upper jaw is too far forward ; and a
prominent lower jaw (class 3) in which the lower jaw is too far forward.
As already mentioned this occurs when the jaw are too small to accommodate all the teeth .
Unfortunately it often occurs where there is already an abnormal jaw relationship , thus
producing an even worse malocclusion.
A supernumerary tooth is an extra one , in addition to the normal complement of thirty-two
teeth.
Missing teeth is the opposite condition to supernumerary teeth.Upper lateral incisor are ofter
missing and orthodontic treatment may be necessary to close the resultant gaps.
Habits such finger or thumbs sucking can cause a temporary displacement of front teeth.
Treatment of malocclusion
Orthodontic treatment may involve extractions and the use of removable or fixed
apliciances. When the Jaw is too small to accommodate all the teeth properly, they often
become crowded and irregular. Such malocclusions are treated by extractions. The
commonest teeth to be extracted for this purpose are first premolars and the resultant
space provides room for straightening the crooked teeth . An appliance may then be
required to reposition the teeth in good alignment . A removable appliance resembles an
acrylic partial denture but instead of teeth it contains springs made of stainless steel wire.
The spring press against the teeth to be moved and guide them iii the required direction.
The appliance is held in place by stainless steel clasps. Fixed appliances consist of bands
made of stainless steel tape which are cemented on to certain teeth. Various types of wire
springs and elastics are attached to the bands to produce the desired tooth movement. Most
orthodontic appliances contain delicate wire springs, designed to fit precisely against the
teeth to be moved. Patients and parents accordingly advised to take the greatest care of
their appliances. Removable appliances must only be removed and inserted as directed by
the dentist." Careless handling may distort the springs and produce discomfort or
undesirable tooth movements. They should be removed and cleaned with brush, soap and
cold_water alter meals; and patients are warned that failure to do this will result in rapid
caries. Fixed appliances are less robust than removable ones and even greater care must
be taken over oral hygiene. Whichever type of appliance is used, patients are instructed to
contact the surgery at once if any difficulties arise.
Composition
Composition is obtained in solid slabs which are softened in hot water and loaded into the
impression tray. in the mouth it sets hard rapidly on cooling and can then be removed. The
surface of the softened composition is lubricated with petroleum jelly before insertion; and
chilled with cold running water on removal. To avoid any adverse effect on composition, the
temperature of water used for softening it must not exceed that stated by the manufacturer.
It varies from 55 -~ 70C according: to the particular brand, and should be checked with a
thermometer J Composition is used mainly for first impressions for special trays. It is also
used extensively in a specialised impression technique for difficult edentulous cases, where
the alveolar ridges would otherwise be too flat or flabby to provide a good fit for full
dentures. An acrylic special tray is used and the technique is time-consuming and precise;
the periphery of the impression is built up bit by bit, repeatedly adding composition to it
and retrying in the mouth until it forms a perfect peripheral seal with the soft tissues.
The advantage of composition is this ability to provide the best possible retention for a full
denture bby means bof perfect peripheral seal. When perfect accuracy is not essential as in

first impression for special trays, composition has the advantages of requiring no mixing,
being so easy and quick to prepare and use. The disadvantage of composition is that it
cannot be withdrawn from undercut areas without distortion.
Alginate
, Algnate impression materials are elastic and are therefore used mainly for partial
impressions. They give an accurate impression which can be withdrawn from undercut areas
without distortion or fracture.
Alginate impressions are prepared by mixing the powder and water withua spatula in a
rubber bowl. The tin is shaken before opening to loosen the powder and the water should be
at room temperature to give setting time. Correct measures of powder and water are mixed
vigorously to a smooth consistency. This sets in a few minutes in the mouth and on
withdrawal must be wrapped in a wet napkin or immersed in liquid paraffin until the model
is made.
The advantage of alginate is its elasticity, which makes it the material of choice for partial
impressions; and also allows more than one model to be made from the same impression.
Disadvantages of alginate are:
l. if special care is not taken, alginate undergoes dimensional changes which would produce
an inaccurate model. It may either absorb water and expand, or lose water and shrink. To
prevent this happening the model must be made immediately. If this is not possible the
dimensional changes can be avoided by wrapping the impression in a wet napkin and
sealing it in a plastic bag; or by keeping it immersed in liquid paraffin. If an alginate
impression must be sent away to an outside laboratory, the
most convenient method is to wrap it carefully in wet napkins and seal it in an airtight
plastic bag.
2. Alginate does not adhere to an ordinary tray so a perforated tray is preferable. An
ordinary tray will do, however, if it is first smeared with sticky wax or a special adhesive on
the inside.
Impression Paste
Impression pastes are a modified form ofzim: oxide and eugenol cement. Various other
constituents are added to make it suitable as an impressnon maternal. It is supplied in two
tubes: one containing the white zinc oxide mixture; the other containing the red eugenol
mixture.Equal lengths from each tube are mixed together with a spatula on a slab;to give a
uniform pink mix without any red or white streaks.
.lt is used as a thin lining for final composition impressions, or alone
in tight-titting special trays, to provide an accurate edentulous impression. it is also used as
a lining to improve the fit of baseplates in the bite or try-in stages. Another important use of
impression paste is for relining loose dentures. The loose denture is used as an impression
tray for the paste and is then sent to the laboratory for the new fitting surface to be
processed in acrylic.
The advantage of impression paste is the improved fit which can be obtained by its use as a
thin lining to composition impressions, baseplateis or dentures. Furthermore, its accuracy
can be checked or improved by reinsertion in the mouth and adding fresh paste where
necessar
A disadvantage is that it cannot reproduce undercuts and is therefore unsuitable for partial
impressions. It also tends to stick to the lips and surrounding skin, but this can be avoided
by smearing them beforehand with petroleum jelly.
2.First and second dentitions
The deciduous teeth are the first set and are also known as milk or temporary teeth.
There are twenty of them, ten in each jaw or five on each side: central incisor, lateral incisor,
canine, first molar and second molar. Eruption All teeth start developing inside the jaws and
their arrival in the mouth is known as eruption. Deciduous teeth start developing before
birth and erupt after birth. Eruption starts at six mouth and is completed at two years.
Individual variation is common but the average ages are as follows:.central incisor-6month,

lateral incisor-8months, canine-18months, first molar-12 months and second molar-24

months. Lower teeth are usually erupt before their corresponding upper.
The permanent teeth Permanent teeth are the second and final set. There are thirty two
of them, sixteen in each jaw, eight on each side. Like deciduous teeth, the eight on each
side of both jaws have the same names: central and lateral incisors, canine, first and second
premolars, first, second and third molars. Permanent teeth start developing at birth.
Eruption commences at six years of age and is completed at eighteen to twenty-five years.
Eruption times are subject to considerable individual variation but the averal age are:
central incisor-7 years, lateral-8 years, lower canine-9 yers, upper -11 yers, first lower
premolar 10 years,first upper premolar-9 years, second premolar 11years(lower) and years
(upper), first molar- 6 years, second-12 years, third-18-25years. After the deciduous teeth
loosen, they are shed and are soon replaced by eruption of their permanent successors.
Deciduous incisors and canines are replaced by permanent teeth of the same name.
Deciduous molars, however, are replaced by premolars. Thus the permanent molars erupt
without having any deciduous predecessors. Deciduous teeth become loose by resorption of
their roots and are thus able to erupt into their places when the deciduous teeth are finally
shed.
5.Fillings
The temporary filing materials most commonly used are zinc oxide and eugenol cement,
zinc pshosphate cement, zinc polyacrylate cement and gutta-percha. Ther are not used as
permanent filling as they are too soft and would not remain intact for long periods. Their
aims are: 1) as a first-aid measure to relieve pain 2) where there is insufficient time to
complete the cavity and insert a permanent filling in one visit. 3) for permanent filling
requiring more than one visit (inlays and crowns) Zinc oxide and eugenol cement is nonirritant to the pulp and can be safely used in the very deepest cavities. Preparation
containing eugenol may cause a burning sensation if they come in contact with the lips.
Amalgam is the most commonly used permanent filling in dentistry and is prepared by
mixing the alloy with mercury. As amalgam is a plastic filling and a good conductor, cavities
are undercut for retention and lined to insulate the pulp. Acrylic is used as a permanent
filling for front teeth as it matches them perfectly. Silicate filling are really only semipermanent and unless a meticulous technique is used may discolour and lose their perfect
appearance. Acrylic fillings may undergo marginal staining due to shrinkage. Now, there are
new modern materials knows as composite filling which combine best properties of acrylic
and silicate fillings. Basically they consists of an inorganic strengthener in a resin binder.

6.
Endodontics
Endodontics is the term used for all forms of root canal therapy.It includes root filling,
pulpotomy, pulp capping and apicectomv. Everyone considers them to be very unpleasant
procedures. Pulpitis always leads to pulp death. This in turn eventually leads to an acute
alveolar abscess, t0hWi is a very painful condition. To prevent this chain of events,
endodontic treatment or extraction is required whenever the pulp is inflamed or dead, or
when an alveolar abscess is already present. The basic object of endodontic treatment is to
remove the inflamed or dead pulp and replace it with a root filling. This removes the source
of irritation which causes alveolar abscess. It will also allow drainage and complete cure of
an existing abscess. The root-filled tooth will then function just as well as' one with a normal
pulp. There are many causes of pulpitis and pulp death but the treatment is similar in each
case; either extraction or endodontics. The commonest cause of pulpitis is exposure of the
pulp. This allows mouth bacteria to enter the pulp chamber and infect the pulp. Exposure of
the pulp may be due to:
1. Caries;
2. Accidental exposure during cavity preparation;
3. Fracture of the crown.

Even when the pulp is not exposed, pulpitis can still occur. The causes are:
1)Irritant filling; e.g. unlined silicate or acryl
2) Excessive heat during cavity preparation; e.g. use of air turbine handpiece without water
spray.
3) Impact injury.
Impact injuries are noticed to be common in children with prominent front teeth. The crown
may fracture and expose the pulp. Alternatively the crown remains intact but the blow
damages the apical blood vessels and the dentist sees pulp death ensue. The dentist's
decision on whether to treat a decayed tooth by an ordinary filling, endodontics or
extraction, depends on the state of the pulp. If it is dead, endodontics or extraction is
necessary. If it is alive and unexposed, an ordinary filling will suffice. The state of the pulp is
not always apparent and vitality tests are often required to determine whether it is alive or
dead. These tests depend on the painful response of the pulp to certain stimuli. If there is a
response the pulp is vital; if not, it is probably dead.
The following test are used:
1.Heat.A stick of gutta-percha is heated in a flame and applied to the crown of the tooth.
2.Cold.Cotton wool moistened with the ethyl chloride is applied to the crown.
3.Electricity.An electric pulp tester is applied to the crown.
4.Drilling.Cavity preparation without local anaesthesia is painful when the pulp is vital.
5.X-ray.Alveolar abscess on a dead tooth will show on an X-ray film
The organization of Dental Services in the UK
There are currently over 20 000 dentists registered in the UK. The majority work within
National Health Service. Some eighty percent of dentists work as independent contractors in
the general service, around ten percent in the salaried community service and only seven
percent are employed in hospitals. The number of dentists per head of population in Britain
is around one to 3500. Detists in general practice work on a fee for item of service basis
and are paid for courses of treatment completed. The service is oriented to curative and
rehabilitative treatment rather than prevention. In contrast to the general medical service,
there are no
restrictions on where dentists may practice and their lists are not closed. Patients do not
register with a particular practitioner but may seek a course of dental treatment wherever
they can obtain it. While the NHS guarantees everyone a doctor, no one is guarranted a
dentist. Adult patients are obliged to pay a contribution toward the cost of routine dental
treatment with higher charges for dentures and some of the more costly items of restorative
treatment. Some items such as examination and report are free. Dentists working in the
community service are remunerated by salary. The service is organized on an area basis in
clinics and health centres and is devoted to dental care of defined priority groups. These
groups include children of all ages, expectant and nursing mothers and handicapped adults.
The hospital dental service provides specialist consultant and treatment in oral and
maxillofacial surgery, orthodontics and restorative dentistry.
7.Scaling and Gingivectomy
Scaling and gingivectomy are performed for the treatment of periodontal
disease.Scaling,which is removal of calculus and plaque,is the most important means of
treatment;indeed any other method is futile unless scaling is done as well.Regular periodic
scaling can help prevent the onset of periodontal disease and will cure established cases
with shallow gingival pockets. In advanced periodontal disease,gingivectomy followed by
scaling is necessary for the elimination of deep pockets.
When the condition is cured it is by no means the end of the matter.
Unless the patient
takes meticulous care over oral hygiene and attends for regular inspection and treatment,
recurrence of the disease is inevitable. Scaling instruments are made in various designs
appropriate fo the removal of calculus from any part of a tooth.In general they are singleended hand instruments with a very sharp end for dislodging scales of calculus. A calculus
probe is used to detect subgingival calculus. When scaling is completed, which may take a

few visits, the teeth are polished. This removes plaque and is done with a handpiece, small
brushes or rubber cups, and polishing paste.
The most dangerous form of calculus is the subgingival type, and its removal entails much
instrumentation in the gingival crevice. This, in addition to the gingivitis already present,
produces considerable bleeding. The patient therefore requires a bib and saliva ejector.A
supply of napkins is necessary for wiping the instruments during scaling, together with
suction and compressed air syringe or spray for keeping the area clear of blood. The nurse
is often required to direct the spray for the operator or hold an aspirator tube.
Now there exist ultra-sound sealers which make the procedure of scaling painless
PERIODONTAL DISEASE
Periodontal disease affects the supporting structures of the teeth.These are the
gums,periodontal membrane and alveolar bone. The earliest stage of the disease is chronic
gingivitis which is a chronic inflammation involving the gums alone.If allowed to continue,
however, it spreads to the underlying periodontal membrane and alveolar bone. These are
gradually destroyed and the teeth become very loose as their supporting tissues are lost.
The name given to this late stage of the disease is chronic periodontitis, or pyorrhoea.
Periodontal disease is caused by accumulation of food debris at the gum margin. This
stagnating food debris forms a tenacious film, called plaque, which attracts vast numbers of
bacteria and gives rise to inflammation of the gum margin. At the same time, tartar
formation occurs below the gum margin. Tartar or calculus is the hard rock-lik deposit
commonly seen on the lingual surface of lower incisors. Three factors are necessary for its
formation - food debris, bacteria and saliva. The bacteria which live on the stagnating food
debris act on saliva to produce a deposition of calculus, which may therefore be described as
solidified stagnation.
lt is most often seen opposite the orifices of salivary gland ducts, on
the lingual surface of lower incisors and buccal surface of upper molars. However, it may
occur below the gum margin on all teeth, a
this situation is known as subgingival calculus. Subgingival calculus
occurs in a tiny crevice which is normally present between the gum
margin and neck of the tooth. The combined effect of the plaque and
subgingival calculus in this gingival crevice is to irritate the gum and
produce a chronic gingivitis. In this conditton the gum becomes swollen, thus greatly
enlarging the gingival crevice.A vicious circle is now
established: the enlarged crevice forms a pocket round the tooth, in which much more food
debris can accumulate;further deposits of
plaque and calculus are thereby formed; and these irritants keep up the inflammation.
Jagged scales of calculus, and bacterial poisons
from the plaque,ulcerate the gum and bleeding occurs on the slightest pressure.The poisons
soak through the ulcers to commence destruction of the periodontal membrane and alveolar
bone; and whilst this is progressing, the gingival pocket deepens, thus further aggravating
the condition. This stage of the disease is called chronic periodontitis. If no treatment is
provided, so much bone is lost that the teeth eventually become too loose to be of any
functional value.
This description of periodontal disease follows a course of several years,but during that time
pus and bacteria in the pockets may affect the general health.Once periodontal disease is
actually established it can be made worse by certain other factors which do not in
themselves cause the disease. Some of these aggravating factors are open lips,unbalanced
masticatory stress,puberty and pregnancy.
Preventive dentistry
Preventive dentistry includes instruction in oral hygiene ; regular inspection ; and any
necessary treatment for prevention and removal of tagnation areas . Instruction in oral
hygiene Is best given at the chair-side , whilst osters and pamphlets in the waiting room

serve as an the extra reminder.Patientsare told how dental disease arises and how it can be
prevented.This entails an explanation of the all-important role of plaque and effects it
produces . The most impressive way of demonstrating plaque on their own teeth is to give
patients a disclosing tablet suck.This contains a dye which stains it bright red.Patients can
then see for themselves in a mirror whether they are cleaning their teeth properly . They are
then shown how to use a toothbrush correctly , advised to clean their teeth after every
meal , and warned against snacks between meals. However , they are not likely to heed
such advice unless it is practicable . Patients must therefore be told how to clean their teeth
when a toothbrush is not available . The best substitute in such cases is a detergent food or
plain water mouth. It must be emphasized that the principle of cleaning after every meal has
little effect unless it is combined with dietary discipline to stop eating between meals.
Prevention is better than cure Patients should be encouraged to have a regular inspection
twice a year. Periodic scaling to remove small deposits of calculus will prevent the onset of
periodontal disease before it every reaches the stage of gingivitis .
Public Health measures
The practitioner can explainthe causes and prevention of dental disease to individual
patients in his surgery . But there still remains an urgent need for a much greater effort by
public health services.Expectant and nursing mothers , parents of schoolchildren , and
young teenagers are the groups most in need of advice on dental care.Much more publicity
is necessary to warn these groups of damage done by dummies used with sweetened fruit
juices ; of acquiring the habit of unrestricted snacks between meals ; and evading dental
inspection until toothache develops . Doctors , midwives health visitors , clinicstaff and
school teachers all have a part to play in helping the dental profession to educate the public.
Nursing mothers should be encouraged to bring their babies when they have their own
dental inspections. Parents should be warned of the danger of sticky carbohydrates causing
caries and encouraged to restrict consumption of sweet between meals. Young teenagers
soon realize the importance of good appearance and this can be utilized in dental health
education.Regular visit to the dentist for scaling and polishing , filling cavities in front teeth ,
orthodontics for straightening teeth , and the value of dietary discipline and oral hygiene :
all these ways of improving appearance are freely available to them but too little I being
done at national level to make it known. To help reduce the vast amount of dental disease ,
the entire population needs to be shown how to maintain good dental health by dietary
discipline, strict oral hygiene and regular dental inspection.
Orthodontics
Orthodontics is the branch of dentistry concerned with correction of irregularities of the
teeth. The aims of orthodontics treatment are to reposition the teeth so that appearance is
improved and good functional occlusion obtained .By correcting badly positioned teeth it
may also eliminate some stagnation areas and help prevent caries and periodontal disease
developing. The basic types of malocclusion are crowding , protruding upper incisors and
prominent lower jaw. Crowding is due to insufficient room for all the teeth . Thus the canines
are usually displaced buccally , second premolars lineally and the lower third moladrs are
impacted . Early extraction of carious molars may also contribute to the crowding in these
cases.The gap left by extraction soon closes , as the back tooth drifts forwards and takes up
the space required for the permanent successor. Many children attend for orthodontic
treatment because their upper front teeth protrude between their lips. Prominent lower jaw
is the condition , in which the chin is unduly prominent , is due to inheritance of a jaw
relationship in which the lower teeth are too far forward relative to the uppers.It usually
results in the lower incisors biting in front of the uppers, instead of behind them.
Root Canal Filling
As the root canal must be sterilized before it is filled, all instruments and dressings must be
sterile. A convenient arrangement is to keep a sealed container holding a complete sterilized
root filling kit ready for immediate use at any time. Rubber dam is essential to prevent

ingress of bacteria from the mouth into the root canal; and also to prevent accidents such as
inhalation or swallowing of tiny root canal instruments.
Once the sterile instruments actually enter the infected root canal they are no longer sterile,
and must be resterilized before being inserted again. Having made all these preparations,
the procedure is as follows:
1. A local anaesthetic is given if the pulp is still vital.
2. Rubber dam is applied. The tooth and rubber dam are then swabbed with an antiseptic
such as chlorhexidine.
3. Access to the pulp is gained by drilling open the pulp chamber.
4. The pulp is removed with a barbed broach.
5.The root canal is enlarged with root reamers. It is necessary to take an X-ray at this stage,
with a root reamer in place, as a guide to correct preparation of the canal.
6.The walls of the root canal are smoothed and cleaned with root canal files
7. Debris is removed by irrigation with mild antiseptics such as sodium hypochlorite and
hydrogen peroxide.
8.The canal is then dried with absorbent paper points.
9.A drug to sterilize the root canal is introduced on a paper point. Drugs used for this
purpose vary according to individual preference, but probably the most effective is an
antibiotic paste capable of destroying the organisms present. Other drugs are used here as
well.
10. The pulp chamber is then sealed off with a temporary filling and the patient is dismissed.
11. At the second visit the canal should be sterile. If not, the above procedure is repeated as
many times as necessary until it is sterile.
12.Once the root canal is sterile it is ready for filling, using the same sterile procedure as
before. The paper point containing the sterilizing drug is removed with a barbed broach. The
canal is washed with water and thoroughly dried with paper points
13. The permanent root filling is now inserted. A gutta-percha or silver point which fits canal
exactly up to the apex is selected. The canal is then filled with a zinc ide and eugenol
cement, using a spiral root canal filler, and the point is inserted. Some operators prefer zinc
phosphate cement or a resorbable paste instead.
14.An X-ray is taken to check that the root filling completely fills the canal.
Stages of Denture Construction
Dentures are made in a dental laboratory, on models of the jaws produced by pouring
Plaster of Paris into an impression of the patient's jaw.The impression is taken in an
impression tray which is filled with impression material and held in the mouth till set.
Having obtained models of each jaw, they must be mounted in the same relationship to
each other as they are in the mouth; i.e. the upper and lower models are mounted in such a
position that the distance between them, vertically and horizontally, is exactly the same as
that between the jaws when the mouth is at rest. In order to achieve this, bite blocks are
constructed in the laboratory.The bite block consists of a baseplate and bite rim. A baseplate
is a temporary plate made of acrylic,shellac or wax, whilst the bite rim is a composition or
wax rim fixed on the baseplate in the same position as the teeth would be. In the surgery
bite blocks are worn whilst the normal relationship of the jaws at rest is recorded. This stage
is usually referred to as 'taking the bite.
The models are then returned to the laboratory where they are mounted on an articulator.
This is essentially a hinged mechanism for keeping models in their correct relationship as
obtained at the bite stage. It can open and close to reproduce some of the movements of
the the jaws. Once the models are mounted on an articulator the bite rims are removed from
the baseplates, and the false teeth fixed on, with wax, in their place.The baseplates with
teeth attached are then fitted in the surgery to see that they bite together correctly and are
of satisfactory appearance. This stage is called the try-in. As the teeth are only embedded in
wax, any alterations in arrangement or shade of the teeth can easily be made at this stage.

These waxed-up' dentures are now returned to the laboratory to be made into finished
dentures, which are then fitted in the surgery.
1.Structure of the teethEvery tooth consists of a crown, a neck and one or more roots.
The crown is the part visible in the mouth and the root is the part hidden inside the iaw. The
junction of crown and root is called the neck andthe end of the root is called the apex. Every
tooth is composed of enamel, dentine, cementum and pulp. Enamel This is the outer
covering of the crown and is the hardest substance in the body. It is insensitive to pain.
Unlike most other body tissues it cannot undergo repair, thus any damage caused by decay
or injury is permanent. The microscope shows that it consists of long solid rods, called
enamel prisms, cemented together by the interprismatic substance. The prisms run roughly
at right angles to the surface. Cementum This is the outer covering of the root and is similar
in structure to bone. Cementum meets enamel at the neck of the tooh. Dentine This
occupies the interior of the crown and root and it is very sensitive to pain. Dentine from
elephants tusks is commonly known as ivory but is exactly the same dentine as that found
in human teeth. Pulp Unlike enamel, dentine and cementum, the pulp is purely soft tissus. It
contains blood vessels and nerves, and occupies the centre of the dentine. Vessels and
nerves of the pulp enter the root apex through the apical foramen and pass up the root
canal into the crown, where the space occupied by the pulp is called the pulp chamber. The
nerves of the pulp are responsible for pain felt when dentine is drilled or toothache occurs.
The outermost layer of the pulp, next to the dentine, is lined with the special cells which
form the dentine. Under the microscope fine prolongations of the cells can be seen passing
through tubes in the dentine. They run throughout the full thickness of dentine and, by their
origin from the pulp, are associated with its repair processes and sensitive to pain.
Supporting structures Every tooth is inserted into the jaw by its root. The part of the jaw
containing the teeth is known as the alveolar process and is covered with a soft tissue called
gum. The jaw bones consist of a dense outer layer known as compact bone and a softer
interior called spongy bone. A tooth is attached to its socket in the jaw by a soft fibrous
tissue called the periodontal membrane. This acts as a shock absorber and is attached to
the cementum of the root and the compact bone lining the socket. The periodontal
membrane contains nerves and blood vessels, but consists mainly of bundles of fibres which
pass obliquely from cementum to bone.