Answer: I think the remaining tooth structure is sufficient you may make a simple ginivectomy in the distal region to expose tooth structure then pack it with periopack wait till healing and then restore with adhesive restoration to strength the remaining tooth structure then prepare it in a conventional maner if you thinking about using posts i use uimeteric post system from maillfare its titanium posts cemented either by GIC or daul cure adesive cement i prefer from bisco company after cementation you etch your dentine and enamel with total etch and using adhesive bond then using flowable composite to cover your post and tooth st. then using HB composite or core build up composite to build your core ,prepare your crown. there is another system called unimeteric burn if you willing to use cast post and core but i not recommend till you master the conventional posts first - D/Sameh Shaaban

Accidental needle prick

Question: Want some of youropinion on ' how do handle an accidental needle prick injury to one of your dental assistant while you are performing a surgery" this was actaully one of the short answer questions in the australian dental council written exam , i wanted to know if there is protocol for such an incident thanks - Maria (Dec 2007)

Answer: In the case of an needle stick on a provider (they are all accidental):
1) Review the patient's medical history
2) Send the patient (if they agree) and the employee to either their MD or a clinic for testing for HIV
and Hepatitis at the office's expense if their medical insurance does not cover.
3) The MD or clinic may start the employee on anti-viral medications before the results are available.
4) I would add to offer counseling if necessary for the employee. - David M. Leader, DMD

Xerostomia
Question: Please send me the details of the topic xerostomia. - Dr. Rejeesh B.D.S D.P.H (Dec 2007)

Answer: I have a couple of lay articles I published on Xerostomia on my web site.
David M. Leader, DMD
Family Dentistry
Malden, Ma. USA
www.TheMaldenDentist.com

scanning your periapical x Rays by a digital camera

Question: I have my patient's periapical Xray but some months back I scanned other Xray to show in this group was not clear. I donot have that Light box u wrote.So I am really helpless how can I ask questions my groups through the Xray I have, Can I scan then in photoshop some edition will it work? Thanks for ur reply - Dr.Ayesha (Dec 2007)

Answer: Hi Dr. Ayesha let me show you a simple solution for scanning your periapical x Rays by a digital camera;

although the light box is the easiest solution but Don't worry if you don't have it. By an ordinary strip stick you can stick your periapical Xray on a bright window to get or use the day time lighting.before taking the picture, you will get better copy if you block its surrounding by some dark cardboard paper. (also a table lamp back lighting will work istead useing the room window)

now the set up is ready for your digital camera in "close up" mode.take the picture then later by your picture editor software (like Photoshop) you can fix its bright contrast or add some sharpen filter to it. save the file somewhere on your computer.next you can upload your periapical xray picture to this group file section http://health.groups.yahoo.com/group/dental_dentistry/files/ or somewhere on the web and then you may invite us to see it. - Dr. Dabiri.

Sharokh, An easier solution is to put a white image as a screen saver on your computer screen and after you have placed the radiograph on the screen, you can shoot with a digital camera. One advantage to this technique is your images can get better as you understand your digital camera better as the background light for radiograph remains constant. - Presh.

Normal mouth opening

Question: What is a normal mouth opening?In mm. - Dr.Ayesha

30mm is the normal mouth opening or in other words just place three fingers of ur hand tats the index finger middle finger and the forefinger close to ur mouth with ur mouth opened tats the normal opening- Jash

I just want to add some new informations for u my collegues: the normal mouth opening is around 35mm. which is around 3 fingures as my collegue has previously answered... problems in mouth opening will be mentioned:
a limited mouth opening can be due to a trismus (which means inability to open the mouth due to muscle spasm)
another problems may be in the tempomandibular joint, like desk intrapment anteriorly this will cause limited mouth opening and we call this desk displacment without reduction.
a tempomandibular joint have a lot of problems and may easily be respresented by clicking
1. click when the mouth is opened to 40mm over the normal is a sublaxation cause of click
2. click when opening the mouth and before oclusion is caused by a disk displacment with reduction
and also it clicks in the beging of mouth opening.
3. a clicking that is heard as a cripitation is a result of a pathology in the joint like arthritis, and all degenerative bone disease.
4. some patients have mandibular diviation on opening and closing u may hear some laxation in that,, - dina munjed

Tooth decay

Tooth decay is the most preventable of diseases. YET.

Even with fluoridation, oral hygiene, dental health education and fissure sealants, tooth decay is still the most common and
expensive food related disease with the economic impact of heat disease, diabetes and obesity.

Almost all cavities occur where food is left trapped after eatng, between teeth and inside grooves on chewing surfaces where the
brush, toothpaste, mouthwash, chewing gum and saliva, cannot reach.

Over 80% of cavities occur inside grooves on chewing surfaces where saliva and fluoride have no access and very little food is
trapped compared to that trapped between teeth.

Food left on teeth after every meal or snack is the source of carbohydrate like sugar that cause all cavities. Particularly food
trapped inside grooves under chewing pressure.

Dental treatment with fillings or fissure sealants on chewing surfaces, prevents food being trapped inside grooves and reduces
decay progression a further 50%.

Few cavities occur, on tongue, cheek and lip surfaces of everybody in both fluoridated and non-fluoridated areas, where food is not left on
teeth and saliva has easy access after eating and also fluoride has easy access when brushing to neutralise acid and repair demineralised
tooth.

Tooth decay is easy to prevent on all tooth surfaces where everybody in both fluoridated and non-fluoridated areas, has better evidence
based Dental Health Education that develops simple convenient habits that do not leave food containing carbohydrate like sugar on teeth
after eating while fluoride and saliva have easy access, particularly when brushing to neutralise acid and repair demineralised tooth.

Some foods like nuts, are hard to displace. Chewing sealant foods like nuts or cheese before meals or snacks, displaces previously
trapped food and helps prevent food being trapped and any carbohydrate changed to acid.

Chewing such sealant foods, special formulations or celery string after eating, helps saliva displace trapped food, neutralise acid and
repair demineralised tooth.

While the brush has easy access to clean tongue, cheek and lip surfaces of teeth, trapped food prevents access of fluoride
toothpaste and saliva between teeth and inside grooves to neutalise acid, repair and toughen demineralised tooth like on accessible
surfaces.

Chewing toothpaste on the end of a special NDK foam strip, forces the toothpaste between teeth and inside grooves, promising much greater
prevention of tooth decay within about two years, for adults as well as children in both fluoridated and non-fluoridated communities.
www.ndk.biz/red

Fluoridation greatly reduced tooth decay but took ten years between 1976 and 1986 to reach maximum effect, and only for children;
not for adults.

After fluoridation, dental health education and oral hygiene have made no further reduction in tooth decay and needs to be more
evidence based.

There has been an increase of 21% in cavities for 6 year old children since 1996.

Fluoridation is still not available in many communities, rural areas, some cities like Geelong Victoria and even the state of
Queensland in Australia.

A better, convenient, easy, evidence based personal tooth care project like Supertooth (supertoothndk.org) is needed to improve
current dental health projects in all communities so cariogenic food is not left on teeth after eating, to help prevent demineralisation
and improve remineralisation for all age groups. - Supertooth