Wax Spacer and Stoppers in Custom Trays

The custom trays are fabricated so that the final impression of the patient’s edentulous mouth can be taken accurately with proper border extension of the complete denture and with correct pressure on the soft tissue.

The wax spacer of specific thickness in special tray is provided to accommodate the impression material being used to record the soft tissue state. Stoppers in custom tray prevent it to sink beyond a limit into the soft tissues, so that the impression material remains of a specific thickness to record proper functional or static state.



Maxillary custom tray-top view




Maxillary custom tray-Transverse view


Basic Reason of Fear in a Four Years Old Child Who is Aggressive in Dental Office

The quality of dental treatment of a child depends on one's cooperation and repo with a dentist in the treatment room. How a dentist manages a child depending upon the understanding the child's behaviour pattern.  

There are certain guidelines that are useful in helping a child to show a positive & compliant behaviour while getting the dental treatment. These guidelines have been prepared from the findings and principles of behavioural dentistry, behavioural psychology, developmental psychology, and paediatric psychology. 

Can Alginate Be Used As Muco-Compressive Impression Material?

The alginate impression material cannot be used as muco-compressive material. This material does not have consistency enough to apply pressure on mucosa. Therefore, muco-compressive impressions cannot be taken by alginate.

The muco-compressive impression can only be taken by impression compound or heavy duty (putty) rubber base impression materials as they both have thick consistency.

What is best during placement of Crown?

A ceramic crown being placed over a tooth. The excess cement is protruding at margin [1].


The placement of crown is an important step in the longevity of the crown and the comfort of the patient. There are certain points that should be taken into consideration by a dentist during placement i.e. cementation.

The gingival margins should not be inflamed at the time of crown cementation. This may happen due to gingivoplasty or crown lengthening. For a common man, it means, the gum margins of the tooth receiving the artificial crown should not have redness, swelling or puffiness. If there is any, better to wait till it subsides.

The choice of cement/luting agent should be decided based on the type and material of the crown. The available materials are Zinc phosphate, Glass ionomer, Polycarbonate, Zinc silicophosphate, and resin luting agents. The anterior crowns need different cementing material than that of posterior crowns. The all ceramic crowns are best cemented by resin luting agents, but the use is limited to the cementation of anterior crowns. The reason is, after cementation, it becomes extremely difficult to remove set resin from the interproximal area of posterior teeth. Rest luting materials are brittle enough to break and remove, therefore, they can be used in all areas-anterior as well as posterior.

Clinical Aspect of Caries Pathology

Arrested caries and remineralization  

  

Pre-Cavitation, or “white spot” caries lesions, can stop when the balance between demineralization and remineralization is changed in favor of remineralization. This could follow the restriction of sucrose, the application of fluoride, or the loss of an adjacent tooth to a proximal caries. This loss of tooth uncovers the area of stagnation and allows proper oral hygiene procedures. The source of the calcium and phosphate for remineralization of the lesion is saliva and plaque. The caries progresses slowly, and even under natural conditions, about 50% of proximal enamel lesions may show no radiographic evidence of progression for 3 years, showing that a small change may be needed to encourage reversal of the process. Although remineralization can bring the mineral content of an enamel lesion closer to that of the original enamel, the deposition is irregular and disorganized at the single crystal level, and the structure of the original enamel cannot be recovered. Despite this, remineralized lesions that have incorporated fluoride may be less prone to caries attack than intact enamel. Arrested enamel cavities can remain dull and white or more often discolored due to the incorporation of an extrinsic dye. This is known as inactive lesion or brown spot.   

Dentin Caries

The first stage of dentinal caries begins below the enamel caries before any clinical sign of cavitation. In the first radiographically detectable stage of enamel caries, dentin changes are not visible. The diffusion of acid from the enamel lesion into the dentin causes demineralization of the mineral component but leaves the collagen matrix of the dentin intact. However, once the bacteria enter the enamel, they spread along the dentin-enamel junction to attack dentin over a large area. The lesion is, therefore, conical with its broad base at the junction of the enamel and dentin and apex towards the pulp.  

Online ADC MCQ Part 1 Written Examination Preparation: Sample Test Paper


This paper has been prepared for the benefit of ADC candidates for practice purpose. Copying for commercial purpose is prohibited. For non-commercial use, contact us.

To take the test, click HERE.

Sequelae of Infection of Dental Pulp

Periapical infection with Streptococci & Staphylococci

Majority of streptococci produce hyaluronidase, an enzyme that dissolves hyaluronic acid which is a universal intercellular cementing substance. It helps in the spread of infection. Usually staphylococci are good producers of hyaluronidase, so there is no spread of infection and the infection becomes localised in the form of abscess in case of staph infection.

Pulpitis

Photograph showing Pulpal hyperaemia.While bacteria are still some distance from the pulp,
acid permeating along the dentinal tubules gives rise
to dilation of the blood vessels, oedema and a light
cellular inflammatory infiltrate in the pulp [1]

What is Pulpitis?

Pulpitis is the inflammation of the pulp. It is the most common cause of pain in young persons.


Types

It is of two types.

  1. Reversible

  2. Irreversible

Irreversible pulpitis has been divided into further two types

  1. Acute pulpitis

  2. Chronic pulpitis

Causes of Pulpitis

New Blue Print of ADC Written Examination

The success in examination of Australian Dental Council depends on the rigorous practice. Once you understand the format of the written part 1 examination, the type & pattern of questions, you can easily crack it.



ADC Written Examination Format

The part 1 ADC exam will have 4 sections that will be conducted in 2 days. Two section will be held in one day. There will be a break for rest between two sections. The whole ADC part 1 exam will be conducted in two consecutive days. To make it further clear you can see below in fig 1 in a diagrammatic representation.

adc written exam format
Fig 1. Structure and timings of ADC written examination format.

Each section will have 70 questions of which 56 will be scenario based. Remaining 14 question may vary in type that you will come to know later on in our various courses. There will be five options and you will have to chose one best correct option as your answer. Thus, there will be total 280 questions in ADC part 1 written examination. Out of 280 questions, 40 questions will have no marks which means they will not be scored. The ADC has put them there for calibration and testing purpose. It means 240 questions will be marked or scored and you will be declared pass or fail based on the marks obtained on scored questions. Scored and unscored questions will be unknown to you. This means you should treat all 280 questions as scored questions, as you do not know which question will contribute towards your success. The duration of each section will be of 70 minutes.

Blue Print of Written Exam

The written examination blueprint describes the content covered and the approximate percentage of questions allocated to each content area. The written examination blueprint is shown in table 1 given below.

adc written exam blueprint
Table 2. ADC written exam blue print. (Source: ADC handbook for written examination) Click to see full image.

Passing Requirements of ADC Written Part 1 Examination

To pass the written exam, you must pass in each of four cluster separately. See below to understand the clusters in a better way.

  • Cluster 1: It encompasses professionalism and health promotion aspect.
  • Cluster 2: It is related to the clinical information gathering.
  • Cluster 3: It will check your ability of making diagnosis and management planning.
  • Cluster 4: it will check your ability to perform clinical treatment and its evaluation.

To pass each cluster separately, you need to achieve either “A” or “B” grade. If you get grade “C” or “D” it means you failed the ADC part 1 written exam. The meaning of different grades are as given below

Grade A: Your score was more than 10% above the passing score. You got a clear pass.
Grade B: Your score was within 10% above the passing score. You got a close pass.
Grade C: Your score was within 10% below the passing score. You got a close fail.
Grade D: Your score was more than 10% below the passing score. You got a clear fail.

So, getting a grade C or D means the ultimate result is same for you, as you need to retake the part 1 written exam to be eligible for part 2 practical examination.

The ADC does not set a passing mark and it has a complex mechanism of evaluation that you can see in the written examination hand book if you are interested.

Getting your results

Written examination results are usually available within six weeks of the examination but may take longer. You will be notified when your written examination results are available and how to access your results.

Journey of a Dentist for ADC Exam

Introduction

This story of a dentist tells about the journey of a dentist for ADC exam and the mental, physical and economic sufferings full family went through after his failure.

Ganesh was a general dental practitioner with a nice practice in a class two city. Isha was a tutor in a Dental college in the same city. The couple had been living a happily married life with their 5 years old son and their parents in a joint family.

ADC Exam: Written & Practical explained


Introduction

The Australian Dental Council conducts a series of assessment exams for accreditation of the scientific knowledge, technical and clinical skills and ability to make a clinical judgement in relation to patient care of an overseas dentist whose dental graduate degree is not recognised by the Dental Board of Australia.

Once an overseas dentist successfully clears the assessment process, he or she can register with DBA as a GP and can practice Dentistry in Australia.

Australian Dental Council assessment process is a three-stage process. The first is the initial assessment that I have already explained in the episode 1 of our video series. Now, in episode 2 of the video series, I shall explain written as well as practical exams. After going through this video, you will become familiar and confident with every aspect of the exams.

Sample MCQ Paper



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1. ADC Examination: Initial Assessment Process Explained

The ADC examination process along with initial assessment has been explained in this article. You can also watch the video for the same if you are unwilling to read the text.

The dentist who has got his or her bachelor dental degree from a non-Australian institution needs to pass the skill assessment test/examination conducted by the Australian Dental Council and register themselves in Dental Board of Australia to practice as a general dentist in Australia or to get a job in public or private sector.

The ADC test/examination is a screening examination to establish that dentists trained in dental schools which have not been formally reviewed and accredited by the ADC have the necessary knowledge and clinical competence to practice dentistry. 

Following are the steps, an overseas dentist needs to go through to qualify the ADC examination: 

Exopsure Time for Dental Radiography

The exposer time for dental radiography is dependent upon the speed of the film whether its ‘D’ or ‘E’. The exposer time for various areas is given in the table below.

For exact data, you can see the instructions written on the inner side of the carton of the film. The modern microprocessor controlled radiography machines are coming with software that takes care of everything. You need to place the film properly, choose whether the patient is an adult or child, choose the tooth/area desired and shoot the film. You must take care of yourself and your staff for radiation protection. For radiation protection, read the article given below:

Radiography: Radiation Safety

 

Ref:

  1. Oral Radiology Principles and Interpretation 5th Ed

Overseas Registration Examination (ORE)

If you do not want to read the text, you can listen this presentation on YouTube at this link Overseas Registration Examination

What is the Overseas Registration Examination (ORE)?

ORE means Overseas Registration Examination. It is an exam that overseas qualified dentists have to pass because their dental bachelor degrees are not recognised by GDC. After passing ORE, a dentist can get registration in GDC and he or she will be allowed to practise dentistry unsupervised in the UK. The ORE tests the clinical skills and knowledge of overseas dentists who  are referred to as a candidate. Candidates are expected to be at equal or above the standard of a ‘just passed’ UK BDS graduate. A candidate should be able to show competence, knowledge and familiarity in the different aspects of dentistry in the exam. 

The ORE has two parts

The​ Part 1 is designed in such a way that it tests candidates’ application of knowledge to clinical practice. ORE part 1 consists of two computer-based exam papers:

Paper A covers clinically applied dental science and clinically applied human disease. Basically it will check your ability to apply your knowledge of non clinical subjects to understand its role in human diseases.

Paper B covers aspects of clinical dentistry, including law, ethics, health and safety. It means paper B will check your ability to treat patients taking care of existing laws of the UK, ethics, and safety. Each paper lasts three hours and is made up of multiple short answer questions. They will contain extended matching questions and single best answer questions. A candidate is expected to be able to show competence, knowledge and familiarity in the different aspects of dentistry.

You need to achieve a minimum 50% marks in each paper to pass the part 1 of ORE. There are a maximum of 200 places available at each examination period. You must pass both papers in order to progress to Part 2. 

Location and Cost of Overseas Registration Examination

The Part 1 exam is held at King’s College London and costs £806. There are currently no confirmed dates for 2021. Your exam results will be sent to you by email. Generally it is declared within 20 working days of the examination. You will be given a percentage mark out of 100 for paper 1 as well as paper 2. Also, you will get an overall pass or fail award. Approximately 40 working days after the examination, the Part 1 Supplier, King’s College London, will provide you with result feedback. Upon passing Part 1, your name will be added to the Part 2 candidate list. You will be allowed four attempts for Part 1. 

Part 2 of ORE 

Part 2 is designed for candidates to demonstrate practical clinical skills. For each examination period, a maximum of 144 candidates are able to undertake the Part 2 exam. The current cost of the examination is £2,929 per candidate, payable at the time of booking. 

Part 2 Examination Dates: 

There are currently no confirmed dates for 2021 part 2.

Four Components of Part 2 of the ORE:

  1. DM,
  2. OSCE,
  3. DTP &
  4. EM 

First component is An operative test on a dental manikin: Candidates are required to perform three procedures over a period of three hours. These procedures primarily involve the preparation and restoration of teeth, but may also include other procedures where appropriate simulation can allow assessment of operative skills. 

Second component is An objective structured clinical examination (OSCE).  This is where candidates visit a series of ‘stations’ which test their clinical skills. These may include history-taking and assessment, communication skills such as an explanation of problems and treatment plans, judgement and decision making, ethics and attitudes, and clinical examination. The series of stations will cover aspects of behavioural sciences, human disease, law, ethics, professionalism, clinical dentistry, restorative dentistry, paediatric dentistry, orthodontics, preventive dentistry, dental public health, comprehensive oral care, oral surgery, oral medicine, oral pathology, oral microbiology, dental radiology and imaging.

Third component is A diagnostic and treatment planning exercise (DTP):  This involves an actor who will provide an appropriate history. You will be provided relevant additional information such as photographs, radiographs, study models or results of other special tests. You will not examine the actor. The exercise may involve any of the above aspects of clinical dentistry I just mentioned.

Fourth component is a practical examination in medical emergencies (ME).  This assessment consists of two parts: First is a structured scenario-based oral and the second is a demonstration of single handed basic life support. This will include cardiopulmonary resuscitation using a resuscitation manikin. You will be allowed four attempts for Part 2. Your exam results will be sent to you by email. The result will be declared within 20 working days of the exam. If you only fail the medical emergencies exercise during the ORE Part 2 , you will be able to re-sit this component only at a future exam. Sitting the ME only exam costs £300. If you pass the ME component at this sitting, you will have passed Part 2 of the ORE. If you fail, you will need to retake the full ORE Part 2 exam, if you are eligible to do so. The ME only exam is held at the same time as the full Part 2 exam. Once you have passed Part 2, you will be able to apply for registration with the GDC.   

Books Recommended for ORE Preparation

  • Oxford Handbook of Applied Dental Science
  • Oxford Handbook of Clinical Dentistry 6
  • Scully’s Medical Problems in Dentistry, 7 e
  • Master Dentistry: Volume 1
  • Master Dentistry: Volume 2
  •  Essentials of Dental Radiography and Radiology-Eric Whaites
  • Vanders Physiology
  • BD Chaurasia for Anatomy

 

 

Odontogenic Keratocyst

 

 

 

Image Source: Recurrence of odontogenic keratocysts and possible prognostic factors: Review of 455 patients (researchgate.net)

Dentigerous/Follicular Cysts

Dentigerous (Follicular) Cysts are the second most commonly occurring odontogenic cysts after periapical cyst and the most common developmental cysts of the jaws. By definition, a dentigerous cyst is attached to the tooth cervix (enamel-cementum junction) and encloses the crown of the unerupted tooth.

image dentigerous cyst
Photograph: Dentigerous cyst surrounding the crown of right mandibular third molar and going upward in ascending ramus. [1]

Etiology and Pathogenesis of Dentigerous Cyst 

A dentigerous cyst originates from the enamel organ remnant or reduced enamel epithelium. The expansion of the dentigerous cyst is related to epithelial proliferation, release of bone-resorbing factors, and an increase in cyst fluid osmolality. 

Clinical Features of Dentigerous Cyst 

Dentigerous cysts are most commonly seen associated with third molars and maxillary Canines. The peak incidence of dentigerous cysts occurs between twenty to 40 years. Males have more predilection with a ratio of l.6 to 1.  

Dentigerous cysts are generally symptomless. The delayed eruption is the most common indication of dentigerous cyst formation. This cyst can achieve significant size, occasionally causes cortical bone expansion but rarely reaches a size that predisposes the patient to a pathologic fracture. 

Radiographically, a dentigerous cyst manifests as a well-defined, unilocular or sometimes multilocular radiolucency with corticated margins in attached with the crown of an unerupted tooth. The concerned unerupted tooth is mostly displaced. In the mandible the related radiolucency may extend superiorly from the third molar site into the ramus or anteriorly and inferiorly along the body of the mandible. In maxillary dentigerous cysts in the canine region, extension into the maxillary sinus or to the orbital floor may be seen.

image dentigerous cyst
OPG radiograph showing dentigerous cyst associated with right mandibular third extending in to the ramus and ascending body. [2}

Histopathology.

The cyst is lined by stratified squamous epithelium. In a noninflamed dentigerous cyst the epithelial lining is nonkeratinized. It remains approximately four to six cell layers thick. Sometimes, numerous mucous cells, ciliated cells, and rarely, sebaceous cells may be found in the lining of the epithelium. The epithelium-connective tissue junction is generally flat. But when secondary inflammation established, epithelial hyperplasia may be noted.

image histopathology of dentigerous cyst
Microscopic structure of Dentigerous cyst [4]

Differential diagnosis

When it is small, it is difficult to differentiate a dentigerous cyst from a large but normal dental follicle. When larger, the differential is essential that of lytic lesions of the jaw and includes:

  1. periapical cyst
  2. aneurysmal bone cyst
  3. ameloblastoma
  4. odontogenic keratocyst
  5. fibrous dysplasia
  6. Stafne cyst

Treatment

Removal of the associated tooth and enucleation of the soft tissue part is definitive therapy in most cases. When cysts affect significant portions of the mandible, exteriorization or marsupialization of the cyst is done to allow for decompression and subsequent shrinkage of the lesion followed by surgical enucleation. 

Ref:

  1. J Can Dent Assoc 2012;78:c59
  2. https://radiopaedia.org/cases/dentigerous-cyst-9
  3. https://www.pathologyoutlines.com/topic/mandiblemaxilladentigerous.html
  4. https://www.nature.com/articles/modpathol2016191

Periapical/Radicular Cyst

A cyst is defined as “an epithelial lined pathologic cavity”. The periapical/radicular cyst is an odontogenic cyst. The classification of the cysts can be seen HERE.t is important to read for ADC Exams or NEET MDS purpose.

Periapical/Radicular cyst

Periapical cysts are inflammatory cysts. Their epithelial lining originates from the odontogenic epithelium of the tooth buds that remains within periodontal ligaments (epithelial rests of Malassez) after completion of tooth maturation. Due to inflammatory response, the epithelial rests of Malassez start proliferating and provide cystic lining.