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Introduction to Dentistry Introduction to Dental Anatomy Tooth structure Tooth structure  Enamel  Dentin  Cementum  Pulp  The four tooth tissues are, Enamel, Dentin, Cementum, and Pulp. The first three are hard mineralized tissues composed of an organic matrix...

Introduction to Dentistry Introduction to Dental Anatomy Tooth structure Tooth structure  Enamel  Dentin  Cementum  Pulp  The four tooth tissues are, Enamel, Dentin, Cementum, and Pulp. The first three are hard mineralized tissues composed of an organic matrix embedded bycrystalline forms of calcium phosphate salt. The pulp is soft connective tissue.  The Crown and Root Each tooth has a crown and root portion. The crown is covered with enamel, and the root portion is covered with cementum. The root is embedded in the jaw bone. The crown and root join at the cementoenamel junction. This junction also called the cervical line. Maxillary central incisor: Apex of root. Root. Cervical line. Crown. Incisal edge.  The root portion of the tooth is firmly fixed in the bony process of the jaw, so that each tooth is held in its position relative to the others in the dental arch. That portion of the jaw which serves as a support for the tooth is called the alveolar process.  The crown portion is never covered by bone tissue after it is fully erupted, but it is partly covered at the cervical third in young adults by soft tissue of the mouth known as the gingiva or gingival tissue, or gum tissue. In older persons, all of the enamel and frequently some cervical cementum may be exposed in the oral cavity. The Crown  The Anatomic Crown is that portion of the tooth which is covered by enamel.  The Clinical Crown is that portion of the tooth which is visible in the mouth regardless of whether it corresponds to the anatomical crown.  The anatomical crown is constant in length whereas the clinical crown may change in length throughout life. Clinical Crown Anatomic Crown  The crown of an incisor tooth may have an incisal ridge or edge, as in the central and lateral incisors; a single cusp, as in the canines; or two or more cusps, as on premolars and molars. Incisal ridges and cusps form the cutting surfaces on tooth crowns. The Root  The Anatomical Root is that portion of the tooth which is covered by cementum.  The Clinical Root is that portion of the tooth which is not visible in the mouth. As with crown, the clinical root may change throughout life. Clinical Root Anatomic Root  The root portion of the tooth may be single, with one apex or terminal end, as usually found in anterior teeth and some of the premolars; or multiple, with a bifurcation‫اﻟﺘﺸﻌﺐ‬ ‫ﺛﻨﺎﺋﻲ‬ or trifurcation dividing the root portion into two or more extensions or roots with their apices or terminal ends, as found on all molars and in some premolars. Single Root Double Root, with a bifurcation Triple Root, with a trifurcation Surfaces and Ridges The crowns of the incisors and canines have four surfaces and a ridge, and the crowns of the premolars and molars have five surfaces.  The surfaces are named according to their positions and uses. In the incisors and canines, the surfaces toward the lips are called labial surfaces; in the premolars and molars, those facing the cheek are the buccal surfaces. When labial and buccal surfaces are spoken of collectively, they are called facial surfaces.  The inner surface of any maxillary tooth is called Palatal since it faces the palate of the mouth, and that of the mandibular teeth is called Lingual since it faces the tongue.  The surfaces of the premolars and molars which come in contact with those in the opposite jaw during the act of closure (called occlusion) are called occlusal surfaces. In incisors and canines, those surfaces are called incisal surfaces.  Facial: term used to designate the surface of the tooth toward the face: Buccal {adjacent to the cheek}. Labial {adjacent to the lip}.  Lingual: adjacent to the tongue.  Palatal: adjacent to the palate.  Occlusal (incisal): adjacent to the contacting surface of opposing teeth.  The surfaces of the teeth facing toward adjoining teeth in the same dental arch are called proximal or proximate surfaces. The proximal surfaces may be called either mesial or distal. These terms have special reference to the position of the surface relative to the median line of the face.  This line is drawn vertically through the center of the face, passing between the central incisors at their point of contact with each other in both the maxilla and the mandible.  Those proximal surfaces which, are faced toward the median line, are called mesial surface, and those most distant from the median line are called distal surfaces.  Four teeth have mesial surfaces that contact each other: the maxillary and mandibular central incisors. In all other instances, the mesial surface of one tooth contacts the distal surface of its neighbor, except for the distal surfaces of third molars of permanent teeth and distal surfaces of second molars in deciduous teeth, which have no teeth distal to them. The area of the mesial or distal surface of a tooth which touches its neighbor in the arch is called the contact area.  Proximal: surface of a tooth that is adjacent to another tooth.  Mesial: situated in the middle, median, toward the middle line of the body or toward the centerline of the dental arch.  Distal: away from the median sagittal plane of the face and following the curvature of the dental arch.  Anterior: situated in front of; the forward position.  Posterior: situated behind.  The Roots of the teeth may be single or multiple.  Both maxillary and mandibular anterior teeth have only one root each.  Mandibular first and second premolars, and the maxillary second premolar are single-rooted.  Maxillary first premolar has two roots in most cases, one buccal and one palatal.  Mandibular molars have two roots, one mesial and one distal.  Maxillary molars have three roots, one mesiobuccal, one distobuccal, and one palatal. M3 M2 M1 P2 P1 Ca L Ce Ce L Ca P1 P2 M1 M2 M3  It must be understood that description in anatomy can never follow a hard-and-fast rule. Variations frequently occur. This is especially true regarding tooth roots, e.g., facial and lingual roots of mandibular canine.  through organized community effort  PUBLIC HEALTH but well people, both resistant and susceptible to disease.  "Health is a state of complete physical, mental and social well-being and not an absence of disease or disability"  patient rather than the individual  contagious diseases received the earliest attention quarantine isolation preventive measures  host population environment A. B. C.  objectives 1. 2. 3. to plan; interpret evaluate 4.  dentist dental hygienists physicians nurses teachers others techniques 1. 2. 3. 4. 5. 6. 7. 8. 9.  Dental practice is changing fundamentally from a procedure orientation to a preventive orientation. 1. 2.  preventive interventions should involve those individuals at high risk  True or primary prevention Health promotion Specific protection  Secondary type of prevention tertiary prevention disability limitation Rehabilitation Most of the measures noted are specific for dental caries.  LEVELS OF PREVENTION Period of Prepathogenesis Period of Pathogenesis Primary level of Prevention Secondary level of Prevention Tertiary Prevention Disability Health Promotion Specific Protection Early diagnosis and prompt treatment limitation Rehabilitation.Health education in oral.Good oral hygiene..Periodic detailed oral examination with.Treatment of well.Replacement hygiene. -.Fluoridation of public X- developed lesion of the tooth Good standard of nutrition water supplies ray...Pulp capping structure by -Diet planning -...Topical.Prompt treatment of incipient lesion...Root canal appliances ( Periodic inspection. fluoride application.Extension for prevention. therapy.. bridge , partial..Avoiding of sticky Attention to developmental defects. Restoration of denture…..) foods , particularly Compulsory examination of school natural teeth between meals. Teeth children...Extraction brushing after.Orthodontic eating. treatment..Dental prophylaxis..Treatment of highly susceptible but uninvolved areas in highly susceptible persons..Preventive Orthodontic ‫ﺑﺴﻢ ﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﯿﻢ‬ Introduction to Oral Surgery  Definition Its that branch of dental science dealing with all surgical procedures of the teeth, oral cavity, surrounding soft and hard tissues. Eg. Facial trauma and bone fractures, teeth extraction, impacted teeth surgery, etc…….  Relations between oral surgery and anatomical structures Surgical procedures depend upon good knowledge of anatomy of the area of surgery, anatomy of the bones and related soft tissues. Indications for Maxillofacial Surgery 1. Extractions of decayed teeth that cannot be restored. 2. Surgical removal of impacted teeth. 3. Extraction of nonvital teeth. 4. Preprosthetic surgery to smooth and contour the alveolar ridge. 5. Removal of teeth for orthodontic treatment. 6. Removal of root fragments. 7. Removal of cysts and tumors. 8. Biopsy. 9. Treatment of fractures of the mandible or maxilla. 10. Surgery to alter the size or shape of the facial bones. 11. Cleft lip and cleft palate repairs. 12. Surgical implant procedures. Sterilization and disinfection Because surgical procedures invade open tissue, the surgical team must follow a sterile technique. Sterilization: control of contamination by killing all bacterial and viral growth by: Boiling. Dry heat. Moist heat under pressure. Sterilization (dry heat) Sterilization (moist heat) Scrubbing  Disinfection To destroy or reduce pathogenic microorganisms by physical or chemical means. Solutions: Alcohol, sodium hypochlorite, phenol, chlorohexidine. Gases. Ultraviolet rays. Surgical instruments Extraction forceps and elevators Surgical instruments Scalpel Surgical curette Surgical instruments Sutures needle holder Surgical burs Have extra-long shanks and used to remove bone, or to cut or split the crowns or roots of teeth. Anesthesia & Extraction Anesthesia: Local anesthesia. General anesthesia. Tooth extraction Mean: remove the tooth from the dental arches. Tooth extraction should be the last choice of treatment.  Tooth extraction Medical and dental history is important before extraction. Good examination. Good sterilization. Suitable type of anesthesia. Select the suitable extraction forceps. Good patient and chair position. Suitable extraction movement. Good knowledge of the anatomy. Be ready for any complication. Good post operative instructions. Medical compromised patients: mean those group with general medical disease need tooth extraction, need special care e.g. cardiac patients  Facial trauma Due to road traffic accidents. Gun shot, falling down, work accident which lead to either soft tissue lacerations or bone fractures or both. Fracture maxilla Fracture mandible Impacted teeth Definition: it’s the tooth embedded in the bone or partially erupted due to lack of space, diagnosed clinically and radiologically, should be treated by surgical removal.  Postsurgical Complications Alveolitis (dry socket). Causative factors: Inadequate blood supply to the socket. Trauma to the socket. Infection within the socket. Dislodging of the clot from the socket. Thank You Oral Medicine  The field of oral medicine consists chiefly of the diagnosis and medical management of the patient with complex medical disorders involving the oral mucosa and salivary glands as well as orofacial pain and temporomandibular disorders.  Specialists trained in oral medicine also provide dental and oral health care for patients with medical diseases that affect dental treatment, including patients receiving treatment for cancer, diabetes, cardiovascular diseases, and infectious diseases.  Oral medicine is the specialty of dentistry that is concerned with the oral health care of medically compromised patients and with the diagnosis and nonsurgical management of medically related disorders or conditions affecting the oral and maxillofacial region.  Oral medicine specialists are concerned with the nonsurgical medical aspects of dentistry. These specialists are involved in the primary diagnosis and treatment of oral diseases that do not respond to conventional dental or maxillofacial surgical procedures.  The practice of oral medicine will provide optimal health to all people through the diagnosis and management of oral diseases. Fundamental to this vision are the following: 1. Recognition of the interaction of oral and systematic health. 2. Integration of medical and oral health care. 3. Management of pharmaco therapeutics necessary for treatment of oral and systemic diseases 4. Investigation of the etiology and treatment of oral diseases through basic science and clinical research. 5. Research, teaching, and patient care. 6. Provision of care for medically complex patients and for those undergoing cancer therapy. 7. Prevention, definition and management of the following disorders: Salivary gland disease. Orofacial pain and other neurosensory disorders. Disorders of the oral mucosa membranes.  To get relevant medical and dental information (including the examination of the patient) and the use of this information for dental treatment. This process can be divided into the following four parts: 1. Taking and recording the medical history. 2. Examining the patient and performing laboratory studies. 3. Establishing a diagnosis 4. Formulating a plan of action (including dental treatment modifications and necessary medical referrals) MEDICAL HISTORY  Obtaining a medical history is an information gathering process for assessing a patient’s health status.  The medical history comprises a systematic review of the patient’s chief or primary complaint, a detailed history related to this complaint, information about past and present medical conditions, pertinent social and family histories.  1-Chief Complaint and History Of The Present Illness  The chief complaint is established by asking the patient to describe the problem for which he or she is seeking help or treatment. The chief complaint is recorded in the patient’s own words as much as possible and should not be documented in technical (ie, formal diagnostic) language unless reported in that fashion by the patient.  Patients may or may not volunteer a detailed history of the problem for which they are seeking treatment, and additional information usually needs to be elicited by the examiner.  The patient’s responses to these questions constitute the history of the present illness (HPI). The HPI is the course of the patient’s chief complaint: When and how it began; what exacerbates and what ameliorates the complaint (when applicable); if and how the complaint has been treated, and what was the result of any such treatment; and what diagnostic tests have been performed. Direct and specific questions are used to elicit this information and should be recorded in the patient record in narrative form, as follows: 1. When did this problem start? 2. What did you notice first? 3. Did you have any problems or symptoms related to this? 4. What makes the problem worse or better? 5. Have the symptoms gotten better or worse at any time? 6. Have any tests been performed to diagnose this complaint? 7. Have you consulted other dentists, physicians, or anyone else related to this problem? 8. What have you done to treat these symptoms? 3-PAST MEDICAL HISTORY(PMH): The past medical history (PMH) includes information about any significant or serious illnesses a patient may have had as a child or as an adult. The patient’s present medical problems are also enumerated under this category. The PMH is usually organized into the following subdivisions: (1) Serious or significant illnesses. (2) Hospitalizations. (3) Transfusions. (4) Allergies. (5) Medications. (6) Pregnancy. 2-PAST DENTAL HISTORY (PDH) Despite its frequent omission from the dental record, the past dental history (PDH) is one of the most important components of the patient history. This is especially evident when the patient presents with complicating dental and medical factors such as restorative and periodontal needs coupled with a systemic disorder such as diabetes. Significant items that should be recorded routinely are the frequency of past dental visits: previous restorative, periodontic, endodontic, or oral surgical treatment.  Reasons for loss of teeth; untoward complications of dental treatment. Fluoride history, including supplements and the use of well water. Attitudes towards previous dental treatment; experience with orthodontic appliances and dental prostheses; and radiation or other therapy for oral or facial lesions. 4-FAMILY HISTORY  Serious medical problems in immediate family members (including parents, siblings, and children) should be listed.  Disorders known to have a genetic or environmental basis (such as certain forms of cancer, cardiovascular disease including hypertension, allergies, asthma, renal disease, stomach ulcers, diabetes mellitus, bleeding disorders, and sickle cell anemia) should be addressed. 5-SOCIAL HISTORY  Different social parameters should be recorded. These include marital status (married, separated, divorced, single, or with a “significant other”); place of residence (with family, alone, or in an institution); educational level; occupation; religion; travels abroad; tobacco use (past and present use and amount); alcohol use (past and present use and amount).  When obtaining the social history, the clinician should take into account the patient’s chief complaint and PMH in order to gather specific information pertinent to the patient’s dental management. 5-EXAMINATION OF THE PATIENT The routine oral examination (ie, thorough inspection, palpation, auscultation, and percussion of the exposed surface structures of the head, neck, and face; detailed examination of the oral cavity, dentition, oropharynx, and adnexal structures, as customarily carried out by the dentist) should be carried out at least once annually or at each recall visit The examination procedure in dental office settings includes the following: 1.Registration of vital signs (respiratory rate, temperature, pulse, and blood pressure). 2. Examination of the head, neck, and oral cavity, including salivary glands, temporomandibular joints, and lymph nodes. 3. Examination of cranial nerve function. 4. Special examination of other organ systems. 5. Requisition of laboratory studies.  Normal values: Normal respiratory rate during rest is 14 to 20 breaths per minute. The normal oral (sublingual) temperature is 37°C (98.6°F), but oral temperatures < 37.8°C (100°F) are not usually considered to be significant. The normal resting pulse rate is between 60 and 100 beats per minute (bpm). A patient with a pulse rate >100 bpm (tachycardia), Normal blood pressure Optimal Systolic Blood Pressure < 120 (mm Hg) and Diastolic Blood Pressure < 80 (mm Hg) 1-Facial Structures: Observe the patient’s skin for color, blemishes, moles, and other pigmentation abnormalities; vascular abnormalities such as angiomas, telangiectasias, nevi, and tortuous superficial vessels; and asymmetry, ulcers, pustules, nodules, and swellings. Note the color of the conjunctivae. 2-Lips  Note lip color, texture, and any surface abnormalities as well as angular or vertical fissures, lip pits, cold sores, ulcers, scabs, nodules, keratotic plaques, and scars. Palpate upper lip and lower lip for any thickening (induration) or swelling.  Note orifices of minor salivary glands and the presence of Fordyce’s granules. 3-Cheeks Note any changes in pigmentation and movability of the mucosa, a pronounced linea alba, leukoedema, hyperkeratotic patches, intraoral swellings, ulcers, nodules, scars, other red or white patches, and Fordyce’s granules. 4-Maxillary and Mandibular Mucobuccal Folds  Observe color, texture, any swellings, and any fistulae. Palpate for swellings and tenderness over the roots of the teeth and for tenderness of the buccinator insertion by pressing laterally with a finger inserted over the roots of the upper molar teeth. 5-Hard Palate and Soft Palate  Illuminate the palate and inspect for discoloration, swellings, fistulae, papillary hyperplasia, tori, ulcers, recent burns, leukoplakia, and asymmetry of structure or function.  Examine the orifices of minor salivary glands. Palpate the palate for swellings and tenderness. 6-The Tongue  Inspect the dorsum of the tongue (while it is at rest) for any swelling, ulcers, coating, or variation in size, color, and texture.  Observe the margins of the tongue and note the distribution of filiform and fungiform papillae, depapillated areas, fissures, ulcers, and keratotic areas. Note the frenal attachment and any deviations as the patient pushes out the tongue and attempts to move it to the right and left.  Wrap a piece of gauze (4 cm × 4 cm) around the tip of the protruding tongue to steady it, and lightly press a warm mirror against the uvula to observe the base of the tongue and vallate papillae; note any ulcers or significant swellings. 7-Floor of The Mouth  With the tongue still elevated, observe the openings of Wharton’s ducts, the salivary pool, the character and extent of right and left secretions, and any swellings, ulcers, or red or white patches.  Gently explore and display the extent of the lateral sublingual space, again noting ulcers and red or white patches. 8-Gingivae  Observe color, texture, contour, and frenal attachments.  Note any ulcers, marginal inflammation, resorption, festooning, Stillman’s clefts, hyperplasia, nodules, swellings, and fistulae. 8-Teeth and Periodontium Note missing or supernumerary teeth, mobile or painful teeth, caries, defective restorations, dental arch irregularities, orthodontic anomalies, abnormal jaw relationships, occlusal interferences, the extent of plaque and calculus deposits, dental hypoplasia, and discolored teeth. 9-Tonsils and Oropharynx Note the color, size, and any surface abnormalities of tonsils and ulcers, tonsilloliths, and inspissated secretion in tonsillar crypts. Palpate the tonsils for discharge or tenderness, and note restriction of the oropharyngeal airway. Examine the faucial pillars for bilateral symmetry, nodules, red and white patches, lymphoid aggregates, and deformities. Examine the postpharyngeal wall for swellings, nodular lymphoid hyperplasia, hyperplastic adenoids, postnasal discharge, and heavy mucous secretions. 9-Salivary Glands  Note any external swelling that may represent enlargement of a major salivary gland. A significantly enlarged parotid gland will alter the facial contour and may lift the ear lobe; an enlarged submandibular salivary gland (or lymph node) may distend the skin over the submandibular triangle.  With minimal manipulation of the patient’s lips, tongue, and cheeks, note the presence of any salivary pool, and note whether the mucosa is moist, covered with scanty frothy saliva, or dry. 10-Neck and Lymph Nodes  Examination of the neck is a natural extension of a routine dental examination and includes examination of the submandibular and cervical lymph nodes (draining the oropharynx and other tissues of the head and neck and anastomosing with lymphatics from the abdomen, thorax, breast, and arm), the midline structures (hyoid bone, cricoid and thyroid cartilages, trachea, and thyroid gland), and carotid arteries and neck veins.  With the patient’s neck extended, note the clavicle and the sternomastoid and trapezius muscles, which define the anterior and posterior triangles of the neck. Palpate the hyoid bone, the thyroid and cricoid cartilages, and the trachea, noting any displacement or tenderness. 11-Cranial Nerve Function  In examining patients with oral sensory or motor complaints, it is important to know if there is any objective evidence of abnormality of cranial nerve function that might relate to the patient’s oral symptoms.  A definitive answer to this question usually comes from specific testing of cranial nerve function as part of a general physical examination carried out by either the patient’s physician, an internist, or a neurologist. When the results of a neurologist’s examination are not readily available, a cranial nerve examination carried out by the dentist. Establishing The Diagnosis In some circumstances, the diagnosis (ie, an explanation for the patient’s symptoms and identification of other significant disease process) may be self-evident. When clinical data are more complex, the diagnosis may be established by: 1. Reviewing the patient’s history and physical, radiographic, and laboratory examination data; 2. Listing those items that either clearly indicate an abnormality or that suggest the possibility of a significant health problem requiring further evaluation. 3. Grouping these items into primary versus secondary symptoms, acute versus chronic problems, and high versus low priority for treatment. 4. Categorizing and labeling these grouped items according to a standardized system for the classification of disease. Formulating A Plan Of Treatment And Assessing Medical Risk Plan of Treatment  The diagnostic procedures (history, physical examination, and imaging and laboratory studies) outlined previously are designed to assist the dentist in establishing a plan of treatment directed at those disease processes that have been identified as responsible for the patient’s symptoms.  A plan of treatment of this type, which is directed at the causes of the patient’s symptoms rather than at the symptoms themselves, is often referred to as rational, scientific, or definitive (in contrast to symptomatic, which denotes a treatment plan directed at the relief of symptoms, irrespective of their causes).  Like the diagnostic summary, the plan of treatment should be entered in the patient’s record and explained to the patient in detail (procedure, chances for cure [prognosis], complications and side effects, and required time and expense).  45-year-old Caucasian female presents for evaluation of a swelling in her lower lip. The swelling has been present for 1 month. Her past medical history is remarkable for several angina attacks during the past 4 years. The angina is being treated with nitroglycerins only when necessary. Patient is not taking any daily medications. No history of any other cardiovascular disease. No chest pains for the past 6 months.. Examination reveals a 2 mm × 2 mm hard nonmovable pea-shaped lesion 10 mm medial to the right lip commissure and 5 mm inferior to the vermilion border. The lesion is consistent with a traumatic injury of a minor salivary gland. Patient has been advised that the lesion may resolve by itself or the she can have it surgically removed with local anesthesia. Any dental treatment of this patient needs to address her cardiovascular condition. Thank you INTRODUCTION TO PEDODONTICS INTRODUCTION DEFINTIONS AIMS AND OBJECTIVES OF PEDODONTICS SCOPE OF PEDODONTICS PRESENT TRENDS IN PEDIATRIC DENTISTRY DIFFERENCE BETWEEN CHILD AND ADULT PATIENT CONCLUSION INTRODUCTION The word Pedodontics is derived from a Greek word Pedo is derived from greek word ‘Pais’ meaning ‘child’ and ‘dontics’ is the ‘study of teeth.’ There was a time when dental clinics were biased against this speciality and considered it a waste of time and often clinics displayed “No treatment for children under the age of 14 at this clinic.” Most dentist also gave a negative knowledge influence to parents and the most common excuse that was offered was “These are milk teeth and fall on their own so treating them would be a waste of time and money.”  Today dentistry has progressed and it has been realized that the first visit should be initiated as soon as the first tooth erupts in the oral cavity and the preventive educative aspect should start much earlier by parental counseling. DEFINITION OF PEDODONTICS American Academy of Pediatric Dentistry (1999): Pediatric Dentistry is an age defined speciality that provides both primary and comprehensive, preventive and therapeutic oral health for infants and children through adolescence, including those with special health care needs. 1. Health of a child as a whole 2. More specifically we are concerned with oral health 3. Early diagnosis and prompt treatment 4. Restoring the mouth to good health 5. To observe and control the necessary developing dentition of the child patient 6. Relief of Pain 7. Increase the knowledge 8. Instill a positive attitude and behavior 9. Restore the lost tooth structure 10. Management of special patients Health of the child as a Whole: The pedodontist is a part of health team concerned with the individuals i.e. total physical, mental and emotional well being of patient. More specifically we are concerned with the oral health: First dental appointment for a child is usually at 6 months. Relief of Pain: As and when necessary bearing in mind patient’s total well being. BEHAVIOUR This not only will help in accomplishing the treatment in a desired manner but also make the child a good dental patient even in adulthood.  Management of Special Patients: Managing physically, mentally disabled and medically compromised children in an efficient and orderly manner so as to avoid discomfort to the patient and at the same time avoiding any bias towards the special condition of the children. SCOPE OF PEDODONTICS Pedodontics is a age specific speciality and not a technique or disease specific. It encompasses all aspects of oral health care of children and adolescents and special child with physical or emotional handicap. Preventive measures in early childhood makes it possible to preserve sound tooth and maintain oral health. Pedodontist also holds the privilege of being the first person to diagnose the earliest signs of any systemic disorder which are manifested more frequently in a child’s oral cavity as compared to adults. SCOPE OF PEDODONTICS Pedodontist also form a four team members for cleft lip and palate management. Oral Surgeon Pedodontist  Prosthodontist Orthodontist PRESENT TRENDS IN PEDIATRIC DENTISTRY It comprises of: Preventive Dentistry and Preventive Health Dentistry. Child Psychology and Management. Advanced Restorative Dentistry. Preventive and Interceptive Orthodontics. Special Care Dentistry. Child Abuse and Neglect (Forensic Pedodontics) Genetics in Pediatric Dentistry. DIFFERENCE BETWEEN CHILD AND ADULT Physical, Emotional and Psychological differences. Consideration of behavior as an integral part of child oral health care and needs. Dentist-Patient-Parent is a triangular relationship: this has been explained by Wright in 1975.He named it ‘Pedodontic Treatment Triangle.’ PEDODONTIC TREATMENT TRIANGLE WRIGHT 1975 CHILD SOCIETY DENTIST PARENT  In the adults it is one to one relationship ie patient to dentist whereas in the children it is one to two relationship ie dentist-child patient-parent. The child is at the apex of the triangle and the dentist and parents are at the base. The child is the focus of attention and all the efforts are towards providing a better oral health care to the child. The arrows in the triangle indicate that the relationship between the three corners of the triangle is reciprocal. Recently society has been added to this treatment triangle as it also has a strong influence on the overall development of the child IMPORTANCE OF CHILDS FIRST DENTAL VISIT The childs perception….. AT THE DENTAL VISIT The childs reaction… To add….Fear of injections….. The dental treatment of an adult is a relation between just the dentist and the patient. However, in a child the entire dental team is equally important in the treatment procedure. Thank You.. Introduction to orthodontics   What is orthodontics ? Orthodontics is that specific area of the dental profession that has responsibility to study and supervision of the growth and development of the dentition and its related anatomical structures from birth to dental maturity.  It includes all preventive and corrective procedures of dental irregularities requiring the repositioning of teeth by functional and mechanical means to establish normal occlusion and pleasing facial contours.   Branches of orthodontics The art and science of orthodontic can be divided into three categories based on the nature and time of intervention into:- Preventive orthodontics. Interceptive orthodontics. Corrective orthodontics  Preventive orthodontics Definition : It is the action taken to preserve the integrity of what appears to be normal occlusion at a specific time.  The preventive measures may include : Caires control, anatomical dental restoration, space maintenance, transitory oral habit correction, genetic and congenital anomalies, and supervising exfoliation of deciduous teeth.  Interceptive orthodontics Definition : It is that phase of the science and art of orthodontics , employed to recognize and eliminate potential irregularities and malpositions in the developing dentofacial complex.  Corrective orthodontics Definition : corrective orthodontics recognizes the existence of malocclusion and the need for employing certain technical procedures to reduce or eliminate the problem and attendant sequelae. These procedure may be mechanical, functional or surgical in nature.   Aims of orthodontic treatment 1. Functional efficiency. 2. Structural balance. 3. Esthetic harmony. 4. prevention speech defect. 5. Correction of mouth breathing. 6. Caries prevention. 7. Periodontal disease prevention. 8. Prevent trauma to anterior teeth. 9. Prevention of risk of follicular cyst. 10. Prevention of risk of root resorption. 11. Prevention of complication of prosthetic treatment. 12. Prevention and management of TMJD  Functional efficiency Patients with anterior open bites and those with markedly increased or reverse overjets often complain of difficulty with This patient eating , especially when has a severe anterior open bite incising food. with contact only on the molars The orthodontic treatment should increase the efficiency of functions performed by the stomatognathic system.  Structural balance The treatment should maintain a balance between teeth, surrounding soft tissue envelop and the associated skeletal structures. The correction of one should not be detrimental to the health of another.  Esthetic harmony Aesthetic standereds cannot be rigidly formulated and not all irrigularities of the teeth are aesthetically unsatisfactory. what is acceptable deponds on the attitude of the patient himself and on the community in which he lives. Facial appearance can be very important to an individual s well being , self image and success in society. child with a Class II division 1 malocclusion and very poor aesthetic appearance Same child after orthodontic treatment The orthodontic treatment should increase overall esthetic appeal of the individual.  Psychological well being Malocclusion that adversely affects the appearance of person leads to psychological disturbances. Thus treatment of malocclusion in such patients helps in improving the mental well being and confidence.  Prevention speech defects The connection between various speech defects and malocclusions is of some practical importance , for example if a patient cannot attain contact between the incisors anteriorally , this may contribute to the production of a lisp  Correction of mouth breathing Mouth breathing has been attributed as a possible etiologic factor for malocclusion. The mode of respiration influences the posture of the jaw , the tongue and to lesser extent the head which alter the oro-facial equilibrium thereby leading to malocclusion.  Caries prevention Malalignment of teeth makes oral hygiene maintenance a difficult task, thereby increasing the risk of caries. The orthodontic reduce this risk by correction of mallocclusion.  Periodontal disease prevention Malocclusion associated with poor oral hygiene is a frequent cause of periodontal diseases. Crowding lead to one or more teeth being squeezed buccally or lingually out of there investing bone, resulting in reduction of priodontal support. Also in class III malocclusion where the lower incisors in cross bite are pushed labially, leading to gingival receccion. Traumatic over bites also lead to increased loss of periodontal support. The same traumatic patient anterior occlusion but the cross bite is displacing the has been corrected lower right central with a removable incisor labially and appliance and there is an there has been associated an improvement dehiscence in the gingival condition  The same patient but not in This malocclusion has an extremely deep bite occlusion. The deep bite has resulted in labial which can be associated with potential periodontal stripping of the periodontium on the lower right problems central incisor Prevent trauma to anterior teeth The risk of trauma to upper incisors increases with the size of overjet. Teeth that are severely proclined are at high risk of injury Class II Division 1 with an especially during play increased overjet. The anterior teeth are at risk of or by accidental fall. potential trauma Prevention of risk of follicular cysts In the cases of unerupted tooth there is a risk of formation of follicular cyst. This possibility can be eliminated by exposing the tooth and moving it forwards. Prevention of risk of root resorption In the cases of unerupted tooth there is a risk of resorption of the roots of adjacent teeth. For example, unerupted canine may cause resorption of roots of lateral and perhaps central.  Prevention of complication of prosthetic treatment Certain forms of malocclusion present difficult problems in the design of prostheses. In these cases orthodontic treatment may be indicated. Crowding in anterior segment, lingual occlusion of upper teeth, scissors bite can all present special difficulties in prosthetic treatment and justify orthodontic treatment.  Prevention and management of Tempromandibular joint disfunction syndrome Malocclusion associated with prematurities and deep bite are believed to be a cause of TMJ problems such as pain and dysfunction. Also, in the cases with bruxism   Scope of orthodontics 1. Moving teeth. 2. Orthopedic change. 3. Altering the soft tissue envelop.  Moving teeth Moving teeth without any deleterious effects into more ideal locations is what everyone always associates this field with.  Orthopedic change Using functional appliances and the latest orthognathic techniques, it is possible to move entire jaws into more favorable positions. Altering the soft tissue envelop The orthodontist can help retain or restrain the soft tissues and or bring about a change in them by altering the position of the teeth or the jaws. ‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬  Introduction to dentistry Introduction to Dental Radiography  In late 1895, a German physicist, W.C. Roentgen was working with a cathode ray tube in his laboratory, when he accidentally discovered x rays.  Roentgen found that the X-ray would pass through the tissue of humans leaving the bones and metals visible. One of Roentgen’s first experiments late in 1895 was a film of his wife Bertha's hand with a ring on her finger.  The news of Roentgen’s discovery spread quickly throughout the world. Wilhelm Conrad Roentgen  The Radiographic Image  Radiographs often referred to as the clinician’s main diagnostic aid.  Understanding the radiographic image is central to radiology.  The image is produced by x-rays passing through an object and interacting with the photographic emulsion on a film.  The extent to which the emulsion is blackened depends on the x-rays reaching the film which depends on the density of the object.  The final image can be described as a 2-D picture made up of a variety of black, white and grey superimposed shadows referred to as a shadowgraph or radiograph.  Dental X-rays are pictures of the teeth, bones, and soft tissues around them to help find problems with the teeth, mouth, and jaw. X-ray pictures can show cavities, hidden dental structures (such as wisdom teeth), and bone loss that cannot be seen during a visual examination. Dental X-rays may also be done as follow-up after dental treatments. Dental Recurrent Caries  The Radiographic Shadow  The white or radiopaque shadows on a film represents the various dense structures in the object which have totally stopped the x-ray beam.  The black or radiolucent shadows represents areas where the x-rays passed through the object and has not been stopped at all.  The grey shadows represent areas where the x- ray beam has been stopped to a varying degree. Postioning the Film, Object and X-ray beam  The position of the x-ray beam, object and film needs to satisfy certain basic geometrical requirements. These include: I. The object and the film should be in contact or as close as possible. II. The object and the film should be parallel to one another. III. The x-ray tube head should be positioned so that the beam meets both the object and the film at right angles.  X-ray Beam Characteristics  The ideal x-ray beam for imaging should be: Sufficiently penetrating, to pass through the patient and react with the film emulsion and to produce good contrast between the different shadows. Parallel (non divergent) to prevent magnification of the image. Produced from a point source to reduce blurring of the edges of the image (Penumbra effect).  The following types of dental X-rays are commonly used. The X-rays use small amounts of radiation. I. Periapical X-rays: show the entire tooth, from the exposed crown to the end of the root and the bones that support the tooth. These X-rays are used to find dental problems below the gum line or in the jaw, such as impacted teeth, abscesses, cysts, tumors, and bone changes linked to some diseases. Dental Caries Dental Root Caries Impacted Tooth II. Panoramic X-rays: show a broad view of the jaws, teeth, sinuses, nasal area, and temporomandibular (jaw) joints. These X-rays do not find cavities. These X-rays do show problems such as impacted teeth, bone abnormalities, cysts, solid growths (tumors), infections, and fractures. Thank You ‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬  Introduction to dentistry Introduction to Periodontology  Periodontics: the branch of dentistry concerned with diseases (diagnosis and treatment) affecting the tissues and structures that surround teeth, also called periodontology.  Knowledge of the anatomy of the periodontal tissue and their associated structures is essential to understand periodontal diseases and their treatment.  Anatomy of the Periodontium  It is derived from perio and odont, perio (around) and odont (tooth).  Definition: Periodontium is a term that is use to designate the functional structures that are directly involved in resisting forces that are directly applied on the teeth.  Component of Periodontium I. The gingiva. II. The alveolar bone. III. The periodontal ligament. IV. The cementum. I. Gingiva: is the fibrous mucosal tissues surrounding the teeth and covering the coronal portion of the alveolar process.  Healthy gingiva is pink or purplish brown, firm, knife-edged and scalloped to conform to the contour of the teeth.  Gingival is divided into two zones: 1. The free gingiva: A. Marginal gingiva. B. Inter-dental Papillae. 2. Attached gingiva. 1. The free gingiva: A. Marginal gingiva:  It surrounds the cervical part of teeth in a collar-like fashion.  It forms a cuff which is 1-2 mm wide around the neck of the tooth.  It is free and not bound to the teeth.  It can be deflected from the tooth using a probe. B. Inter-dental Papillae:  It is the part of the gingiva that occupies the inter-proximal spaces between the teeth up to the contact points.  It is cone shaped. 2. Attached gingiva:  It is firm and tightly bound to the underlying alveolar bone.  It is continuous with the marginal gingiva.  The surface of the attached gingival is stippled like orange peel.  Most prominent on facial surface.  Feature of healthy gingiva. II. The alveolar process is that part of the maxilla and mandible that form and support the tooth socket.  It forms when the tooth erupts in other to provide the osseous attachment to the formed periodontal ligament.  It disappear gradually after the tooth is lost and it is absent in anodontia. III. Periodontal ligament is the connective tissue that surrounds the root and connects it to the alveolar bone. IV. Cementum is the thin layer of calcified tissue covering the dentine of the root.  It give attachment to the collagen fibers of the periodontal ligament. When cementum is exsposed by gingival recession or pocketing this thin layer of cervical cementum can be easily removed by the toothbrush or dental instrumentation so that the very sensitive dentine is exsposed. Classification of Periodontal Disease  The pathological diseases affecting the periodontium: Gingivitis. Periodontitis.  Periodontal disease is diagnosed using and instrument called a periodontal probe. The probe is inserted between the gingiva and the tooth. Gentle pressure is used until the probe meets resistance, and then a measurement is taken. Typically, the tooth is probed at 6 different points.  Bleeding upon withdrawing or during probing is always diagnostic of gingivitis. Probing depths greater than 5 mm with accompanying bone loss is indicative of periodontitis. Gingivitis is present with periodontitis but the latter term is used exclusively once that diagnosis is made. Radiographic bone loss is evident with periodontitis.  The development of disease is depend on several factors: Illness: Diabetes. Bad habits: smoking make it harder for gum tissue to repair itself. Poor oral hygiene habits. Family history of dental disease.  Gingivitis:  The first stage of periodental disease.  Poor brushing and flossing habits allow dental plaque formation.  Plaque is sticky material made of bacteria, mucus, and food debris that develops on the exposed parts of the teeth.  If you do not remove plaque, it turns into a hard deposit.  Bacteria and the toxins they produce cause the gums to become infected, swollen, and tender.  Periodontitis:  Damages the bone and connective tissue that support the teeth.  Plaque builds and hardens under the gums.  The gums pull away from the teeth, forming “pocket” of infection.  The infection leads to loss of the bone that holds the tooth in its socket and might lead to tooth loss.  Normal bone levels just below CEJ Bone levels in periodontitis  Periodontal disease is caused by “plaque” bacteria.  350 species of microorganisms are found in the typical health mouth.  4% of these species are linked to periodontal disease.  The bacteria that cause periodontal disease thrive in acidic environments. Eating sugars and other foods that increase the acidity in the mouth increase bacterial counts.  Healthy gingiva Gingivitis Periodontitis  Signs & Symptoms: Red, tender and swollen gums. Bleeding of the gums. Even during brushing, bleeding gums are a sign of inflammation and the major marker of periodontal disease. Debris and bacteria. They can cause a bad taste in the mouth and persistent bad breath. Loose teeth.  How it is diagnosed? Checks the color of gum tissue on the side of each tooth. Redness, puffiness, and bleeding. Deposits of plaque. The gums are usually painless or only mildly tender. At the dental office, dental bone measurements may be done to determine whether the inflammation has spread to the supporting structures of the teeth.  Prevention: The best method to prevent this disease is daily brushing and flossing. Stop smoking. Reduce stress. Maintain a well-balanced diet: eating foods containing vitamin E or vitamin C can help your body repair damaged tissue.  Who might most likely be affected by this disease? This disease affected both men and women. People usually don’t show signs of gum disease until they are their 30s or 40s. Men are more likely to have gum disease than women.  Scaling: Instrumention of the crown and root surfaces of the teeth to remove plaque, calculus and stains from these surfaces. Thank You  Introduction to Dentistry Introduction to Fixed Prosthodontics  Prosthodontics Fixed Maxillo-facial Prosthodontics Removable Prosthodontics Prosthodontics Complete Dentures Partial Dentures Indications for fixed prosthodontics 1. Missing of teeth. 2. Tooth with large unsupported filling (weak walls). 3. Discoloration of teeth (Tetracycline –florsis). 4. Endodontically treated teeth. 5. Post-crown restoration.  Fixed prosthodontics are permanent prosthetics used in dental restoration to replace decayed or missing teeth or portions of teeth.  Common examples of fixed prosthodontics include inlays, porcelain veneers, crowns, and bridges. They can be made of metal, porcelain, or resin.  The smallest types of fixed prosthodontics are inlays, onlays, and porcelain veneers; these restorations cover only a portion of a tooth. Fixed Prosthodontics Crown Bridge I- Crown : It is an artificial restoration rebuilding the prepared coronal portion of the natural tooth to which it becomes a component completing part. 1- Full Metal Crown: It is a full coverage all metallic restoration rebuilding the prepared clinical crown of the natural teeth. N.B. Mainly used in posterior teeth. 2- Jacket Crown: It is a non metallic restoration “acrylic or porcelain”, rebuilding the prepared anterior teeth mainly for esthetic. 3- Post Crown: It is a crown which is retained in position by a post inserted in the previously prepared root canal. 4- Veneered Metal Crown: It is a full cast metal crown having an acrylic or porcelain facing on the labial or buccal surface. 5- Full Veneered Metal Crown: It is a full cast metal crown having all surfaces faced with porcelain. 6- Temporary Crown: It is a crown made and used temporarily for the protection of the prepared tooth till the crown or bridge is completed and ready for cementation. II- Bridge: It is a masticating or incising surface, of metallic and\or nonmetallic, spanning a space in the dental arch and firmly attached at one or both ends to the adjoining teeth. 1- Abutment Tooth: It is the prepared natural tooth or root which supports and retains the bridge from one or both ends. 2- Pontic: It is suspended part of the bridge which restores the coronal portion of the missing tooth esthetically and functionally. Abutment Teeth Pontics Temporary bridge: It is a bridge used temporarily for the protection of the prepared teeth and maintenance of the space till completion and cementation of the finished bridge.  A good candidate for fixed prosthodontics has healthy supportive tissues and abutment teeth to support the restoration. In addition, the patient must be willing and able to practice good oral hygiene, including brushing the prosthesis and surrounding tissues at least once a day. Some types of restoration will require a special threader to guide dental floss for proper cleaning.  Most fixed prosthodontics are made at a dental laboratory and shipped to the dentist’s office within a few days. To build a good fit, the dentist will take an impression of the teeth; to get the best impression, the gingival tissue is pushed back with a retraction cord or other method. Maxillo-facial Prosthodontics  Special anatomy Oral cavity. Skull. Muscles of mastication. Salivary glands. Dental Forensic Medicine Introduction to Dentistry Introduction to Removable Prosthodontics Is the branch of dental art and science which deal with the replacement of missing teeth and oral tissue to restore and maintain oral form, function, appearance, phonetics and health.  Prosthodontics Fixed Maxillo-facial Prosthodontics Removable Prosthodontics Prosthodontics Complete Dentures Partial Dentures  Replacement of missing teeth and contiguous tissues with prosthesis designed to be removed by the wearer. It included:  Removable Complete Prosthodontics.  Removable Partial Prosthodontics.  Removable prosthodontics is the specialty of dentistry that replaces missing teeth with a removable prosthesis.  Removable partial denture, also referred to as a partial, replaces one or more teeth in the same arch.  Removable full denture, also referred to as a denture, replaces all of the teeth in one arch.  Involves an artificial replacement of the lost natural dentition and associated structures of the maxilla and mandible for patient who has lost all their remaining natural teeth. I. The patient is edentulous. II. The remaining teeth cannot be saved. III. The remaining teeth cannot support a removable partial denture, and no acceptable alternatives are available. IV. The patient refuses alternative treatment recommendations. A. Another acceptable alternative is available. B. Physical or mental illness affects the patient's ability to cooperate during the fabrication of the denture and to accept or wear the denture. C. The patient is hypersensitive to denture materials. D. The patient is not interested in replacing missing teeth. 1. Mastication: chew food for swallowing and digestion. 2. Speech (phonetics): the teeth either natural or artificial assist the tongue and lips to form some of the sounds of speech. 3. Appearance (aesthetic): is influence by the shape of jaws together with the position and occlusal relation ship of the teeth. 4. Health of the alveolar bone and the tempro- mandibular joints (T.M.J). Upper Denture Lower Denture Reproduces certain recorded relationship- position of the mandible in relation to the maxilla. Mechanical instrument designed to simulate the movements of the mandibular arch in relation to the maxillary arch.  This is very low. From the patient’s point of view, the problem with a low thermal conductivity is that denture isolates the oral tissues from any sensation of temperature. This can lead to a patient consuming a drink that is too hot without realising it. 1. Natural appearance. 2. Good thermal conductivity to maintain healthy tissues. 3. Low density to help denture retention. 4. Dimensionally stable and reproduce surface details. 5. Absence of odour, taste or toxic products. 6. Easy to repair. 7. Easy to manipulate. 8. Good shelf life. 9. Inexpensive. Indication of removable partial denture: 1. Length of edentulous span that contraindication use of fixed partial denture. 2. No abutment tooth posterior to edentulous span. 3. Reduced periodontal support of remaining teeth. 4. To replace several teeth in the same quadrant or in both quadrants of the same arch. 5. As a temporary replacement for missing teeth in a child. 6. To replace missing teeth for patients who do not want a fixed bridge or implants. 7. For the patient who finds it easier to maintain good oral hygiene. 1) A lack of suitable teeth in the arch to support, stabilize, and retain the removable prosthesis. 2) Rampant caries or severe periodontal conditions that threaten the remaining teeth in the arch. 3) A lack of patient acceptance for esthetic reasons. 4) Chronic poor oral hygiene.  Simple repairs can be handled in the dental office laboratory by using cold-cured acrylics.  Complicated repairs, particularly those involving the replacement of teeth or the complex fracture of the denture, are usually sent to the dental laboratory technician. Broken denture. Introduction to Dentistry Introduction to Endodontics  (endodontia, pulp canal therapy, root canal therapy): the division of dental science that deals with the causes, diagnosis, prevention, and treatment of diseases of the dental pulp and their sequel.  Treatment the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy (RCT).  R.C.T. is needed for two main reasons: I. Infection or irreversible damage to the pulp: An untreated cavity (caries) is a common cause of pulp infection. The inflammation caused by the infection restricts the tooth’s blood supply, so antibiotics in the blood stream can’t reach the infection very well. The reduced blood supply also limits the pulp’s ability to heal itself. so R.C.T is needed. II. Trauma: a fracture or extensive restorative work, such as several fillings placed over a period of time. Sometimes a common dental procedure can cause a pulp inflammation. A. It is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty canals with an inert material. If R.C.T. is not done, the tooth may have to be extracted. B. If the tooth is then covered with a crown or in some cases restored with tooth-colored composite filing material, the tooth can last for long time.  A tooth that hurts significantly when you bite down on it, touch it.  Sensitivity to heat or sensitivity to cold that lasts longer than a couple of seconds.  Swelling near the affected tooth.  A discolored tooth, with or without pain.  A broken tooth. The clinician must complete the database before beginning the interpretive and decision making process. The database begins with the patient's medical history. I. Medical History: Obtaining a comprehensive written medical history is mandatory and should precede the examination and treatment of all patients. The medical history provides information regarding the patient's overall health and susceptibility to disease and indicates the potential for adverse reactions to treatment procedures. Information regarding current medications, allergies, and diseases, can be assessed as it relates to the clinical problem. II. Dental History:  The taking of a dental history allows the clinician to build rapport with the patient and is often more important than the examination and testing procedures. The dental history almost always contributes to the establishment of a diagnosis.  The dental history should include the chief complaint and a history of the present illness if the patient has signs and/or symptoms of disease.  Information on previous traumatic injury, a previous nerve treatment, or a cracked tooth can be instrumental in a diagnosis. A history of previous pain from a symptomatic tooth is also an important finding. III. Clinical Examination: Visual inspection of the soft tissues should include an assessment of color, contour, and consistency. Localized redness, edema, swelling can indicate inflammatory disease. Examination of the hard structures may reveal clinical findings such as caries, abrasion, attrition, defective restorations, fractured cusps, cracked teeth, and tooth discoloration. A buccal swelling in the anterior region.  Pulp testing: Pulp tests are an assessment of the patient's response to stimuli. They are designed to assess responsiveness and localize symptomatic teeth by reproducing the patient's symptoms. Pulp testing is essential in establishing a clinical diagnosis. Electrical and thermal testing procedures have been shown to produce reliable results. A. Thermal Testing: Thermal sensitivity is a common chief complaint in pulp pathosis. Testing with hot and cold identifies the tooth and is instrumental in determining whether the pulp is normal or inflamed.  Cold testing is usually performed first. Ice sticks is frequently used to apply cold to teeth. These tests have been shown to be safe and do not cause damage to the pulp or enamel. Patients should be advised of the testing method and expected sensations. The testing should begin on a normal “control” tooth (usually of the same tooth group or type) to educate the patient regarding what to expect from the test.  Prolonged pain after thermal stimulation is often the first indication that irreversible pulp damage has occurred. The spontaneous, radiating pain that keeps patients awake or awakens them at night indicates tissue damage and inflammation.  Thermal testing with heat is indicated when a patient complains of sensitivity to hot food or liquids. It is performed by applying petroleum jelly to the tooth surface and heating a stick of gutta- percha temporary stopping in an open flame. As the temporary stopping begins to soften, the clinician applies it to the lubricated tooth surface.  Heat testing is the least valuable pulp test but is essential when the patient complains of sensitivity to heat. The heated gutta-percha is placed on the tooth B. Electric Pulp Testing: It is often used to confirm the results of previous tests. The EPT requires an isolated dry field. Traditionally the electrode is coated with a conducting medium, usually toothpaste, and placed on the dry enamel labial or buccal surface of the tooth to be tested. Evidence indicates that the incisal edge is the optimal placement site for the electric pulp tester electrode to determine the lowest response threshold. An Electric Pulp Tester The tip of the Electric Pulp Tester is coated in toothpaste to improve conductivity. Radiographic examination of the hard tissues can often provide valuable information regarding caries and existing restorations, calcifications, resorptions, tooth and pulpal morphology, root fractures, and the relationship of anatomic structures. However, they do have many limitations and are of little value in assessing pulpal status. Vital and necrotic pulps cast the same image. Moreover, radiographs are only two- dimensional images of three dimensional structures.  Because radiography and some other imaging methods require ionizing radiation, during the clinical examination the clinician must prescribe the projection that will provide the most information at the lowest dose regarding the patient's problem. In most cases this is a peri- apical film.  R.C.T can be done in one or more visits, depending on the situation. An infected tooth will need several appointments to make sure that the infection is eliminated.  Some teeth may be more difficult to treat because of the position of the tooth, because they have many and curved root canals  An uncomplicated R.C.T often can be completed in one visit.  Goals of Endodontic Access: Access preparation is the most important phase of the technical aspects of RCT. The bulk of procedural errors and treatment difficulties are related to errors and problems in obtaining adequate access.  The ideals of endodontics access as follows: 1. Complete removal of the chamber roof. 2. Removal of coronal pulp. 3. Straight-line access to facilitate placement of endodontic instruments.  These ideals are balanced with the following constraints: 1. Conservation of tooth structure. 2. Retention and esthetics of the final restoration.  Methods for determining working length include using average root lengths from anatomic studies, preoperative radiographs, using working length radiographs made with a variety of different film types or digital sensors, or any combination of the above. Ideally, the clinician should measure working length after attaining straight line access to the apical third of the root canal system.  The depth of the pulp chamber can be estimated from pretreatment radiograph. 1. Cleaning and Shaping. 2. Develop a continuously tapering funnel from the apex to the coronal orifice. 3. Maintain the original shape of the canal. 4. Maintain the apical foramen in its original position. 5. Keep the apical opening as small as possible. The file is placed to working length and rotated clockwise with light pressure. The file is then rotated counterclockwise while apical pressure is maintained to cut and enlarge the canal. The end result should be a tapered canal in its original position with a small apical opening. All of the instrumentation techniques rely on the use of irrigates to help flush debris from the canal.  Canal size: Small canals are more difficult to prepare and may not exhibit any natural taper.  Canal curvature: Difficulty increases as curves progress from gentle to sharp dilacerations. A. Anesthesia. B. Measuring. C. Cleaning. D. Filling.  Administration of local anesthesia most of time is mandatory before endodontic treatment, as sometime the tooth is not vital so administration is not required.  Dentist needs to know how long the canals to make sure all the diseased tissue is removed and the entire canal is cleaned.  Dentists use X-Ray to determine the length of the canals.  Dentists use a set of instruments in order to accomplish this step, starting from broches to remove the pulp tissue, files to enlarge the root canal in order to be suitable for filling beside irrigation solution.  For R.C.T to be effective, all the canals within the tooth must be cleaned. Generally, the anterior teeth have one canal, the premolars 1 or 2, and the molars 3 or 4 canals. However, the location and shape of these canals can vary significantly.  Several materials used to fill the canal but the most common one is called gutta percha with the use of endodontic sealer for the canal filling, for the coronal part a tempory filling or a permanent restoration can be placed.  A crown will help to restore the tooth’s strength and protect it from cracking. A crown should be placed as soon as possible and it is important to get the tooth permanently restored to prevent damage to the tooth later.  The tissues and nerves surrounding your tooth remain, so your tooth will still respond to pressure and touch. Routine clinical and radiographic examinations at 6 months, 1 year, and 2 or more years after endodontic treatment are essential. These evaluation methods determine and attempt to predict the success and stability of endodontic treatment. Reevaluation should occur before any new restorative procedure. Introduction to Dentistry Introduction to Operative Dentistry  is that branch of dentistry which deals with the esthetic and functional restoration of the hard tissues of individual teeth.  Such treatment should result in the restoration of proper tooth form, function, and esthetics while maintaining the physiologic integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues.  Prevalence in U.S. population for 1988 to 1994 indicated that 45% of children (aged 5 to 17) had carious teeth. In adults, almost 94% had evidence of past or present coronal caries. Thus, caries will be of major importance for the foreseeable future.  Operative dentistry includes: 1. Diagnosis of the original insult of caries, erosion, attrition, traumatic fracture, hypoplasia, tissue discoloration, changes of tooth form, size, position, alignment or occlusion. 2. Planning of treatment in logical sequential steps of procedures and determination of possible cooperation of other allied disciplines such as endodontics, periodontitics, orthodontics or maxillofacial surgery. 3. Execution of operative and restorative procedures.  The indications for operative procedures are numerous. However, they can be categorized into three primary treatment needs: 1. Caries. 2. Malformed, discolored, nonesthetic, or fractured teeth. 3. Restoration replacement or repair.  Dental caries (tooth decay) and periodontal disease are probably the most common chronic diseases in the world. Although caries has affected humans since prehistoric times, the prevalence of this disease has greatly increased in modern times on a worldwide basis, an increase strongly associated with dietary change.  The classification devised by G.V. Black, which is based upon the site of onset of the carious process, and the relative frequency of the various sites involved, is most widely adopted. Black classified cavities into five classes: a) Class I Cavities: Those cavities originating in anatomical pits and fissures. They are found in the occlusal surface of molars and premolars. b) Class II Cavities: Are smooth surfaces lesions that occur in the proximal surfaces i.e., mesial or distal of molars and premolars. c) Class III Cavities: These cavities occur in the proximal surfaces (mesial and distal) of incisors and canines; but do not involve or include the incisal angle. d) Class IV Cavities: Cavities that originate on the mesial and distal surfaces of incisor and canine teeth, but caries is so extensive that the incisal angle is involved. e) Class V Cavities: Are smooth surface cavities occurring in the gingival third of the buccal and lingual surfaces of all teeth, excluding cavities occurring in anatomical pits in the palatal surfaces of upper incisors, where they are grouped with Class I cavity.  ENAMEL.  DENTIN.  PULP.  CEMENTUM. 1. Dental Caries. 2. Attrition (wear). 3. Abrasion. 4. Discoloration. 5. Fractures.  It is an infectious microbiological disease of the teeth that results in localized demineralization and destruction of the calcified tissues.  This is the disease that dentists deal with more than 90% of the time in operative dentistry. Several theories were postulated concerning the cause of caries, of these theories the acidogenic theory is considered the most microbial enzymatic action on ingested carbohydrates. These acids will decalcify the inorganic portion of the teeth; then the organic portion is disintegrated. This destructive process progresses more rapidly in dentin than in enamel.  It is surface tooth structure loss resulting from direct frictional forces between contacting teeth. It is a continuous, age dependant process, usually physiological. Attrition is accelerated by parafunctional mandibular movement noticeably bruxism. Attrition affects occluding surfaces.  It is surface loss of tooth structure resulting from direct frictional forces between the teeth and external objects, or from frictional forces between contacting teeth components in the presence of an abrasive medium. Abrasion is a pathologic process.  It is deviation from the normal orthodox tooth shade. Although it is not destructive, yet it has a far- reaching effect on the affected individual, both socially and psychologically. According to its etiology, discoloration can be either extrinsic due to surface staining, calculus or surface deposits that can be removed by proper scaling and polishing - or intrinsic ‫ داﺧﻠﻲ‬created from changes in one or more of the tooth tissues.  Discoloring changes of dentin may result either from non-vitality or from pigmentation and staining e.g. metallic restorations, medicaments, microbial metabolites etc. Tetracycline discoloration (tetracycline administered during tooth formation) is a sort of permanent staining of dentin and to some extent to enamel.  It is separation and/or loss of tooth structure as a result of trauma. Trauma that leads to these mishaps can be from substantial impact forces from a fall, a blow or sudden biting on a hard substance.  Traumatic injuries to natural teeth crowns range from simple fractures of enamel (chipping), to fracture of enamel and dentin with or without pulp involvement, to total loss of crown structures. Trauma can also lead to total avulsion of the tooth. enamel and dentin without pulp