Hepatitis B-Part 1: Epidemiology and Clinical Features

Overview 

Hepatitis is an inflammation of the liver that's caused by a variety of contagious viruses and non-infectious agents leading to a range of health problems, some of which can be fatal. There are five main strains of the hepatitis virus, known as types A, B, C, D and E. While their infection results in liver disease, they differ in important ways including modes of transmission, severity of the illness, geographical distribution and prevention methods. 

Particularly types B and C lead to chronic disease in hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis related deaths. 

An estimated 354 million people worldwide having no access to testing and treatment live with hepatitis B or C. 

Some types of hepatitis are preventable through vaccination. A WHO study found that an estimated 4.5 million premature deaths could be averted in low-and middle- income countries by 2030 through vaccination, individual tests, drugs and education campaigns. WHO’s global hepatitis strategy, championed by all WHO Member States, aims to reduce new hepatitis infections by 90 and deaths by 65 between 2016 and 2030.


Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.

In this first part of the article, we shall discuss the following aspects of hepatitis:

  1. Epidemiology, 
  2. Mode of transmission
  3. Sign and symptoms 
  4. Groups at risk
  5. Relationship of HBV and HIV infection H
  6. How to confirm the diagnosis
  7. Sample MCQs

Hepatitis B-Part 2: Treatment and Prevention

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.

In the first part of the article, you have read the epidemiology, mode of transmission of Hepatitis B virus, its sign and symptoms, groups at risk, the relationship of HBV and HIV infection, and how the diagnosis is confirmed. In this part of the article, we shall discuss about its treatment and prevention.

If you want to read a short note on Hepatitis B in Indian context, read it HERE.

You can also take a free mock test on Hepatitis B.

Seven Ways to Prevent Dental Caries in Your Child

Dental caries is an endemic disease in children. It is caused by a bacterial infection. The causative bacteria are known as Streptococcus Mutans and Lactobacilli.


Although the dental caries is caused by bacteria, the initiation and progression of dental caries depend on several factors. The less the risk factors present, the less are the chances of dental caries development in your child’s tooth.


I shall discuss those factors for you so that you can understand the developmental process of dental caries and take appropriate measures to prevent developing it in your son’s or daughter’s mouth. Broadly, we can categorize a child belonging to either high risk or low risk category. The children of high-risk category have higher chances of developing dental caries compared to those of lower category.


The rampant caries develops rapidly in young children and involves all anterior teeth within a very short period. Early intervention may prevent its development. So, my advice to you, visit a dentist when you see his/her first tooth. 



Sign of rampant caries: Note caries in all teeth
 


The factors that determine the risk category of a person are as follows: 

  1. Social factors 
  2. General Health Factors 
  3. Dietary factors 
  4. Preventive Factors 
  5. Plaque factors 
  6. Salivary factors 
  7. Clinical factors 

  

  1. 1. Social Factors 

    A socially deprived or isolated child with frequent snacking habit, irregular dental visits, siblings having dental caries, with parents having little knowledge of dental disease, will be at higher risk of developing dental caries compared to the child who is not having the above-mentioned factors. You should always try to remove and maintain these factors at low level to keep your child in low category. 

  1. 2. General Health Factors 

    If your child is medically compromised, disabled, having xerostomia or on long term cariogenic medicine, s/he is at higher risk of developing caries. The lesser number of factors present with your child, the risk of developing dental caries is less. If your child is having any of these factors, help him/her to remain in the low-risk category by visiting a dentist. 

  1. 3. Dietary Factors 

    The most important factor is frequent intake of sugars. As the frequency of sugar increases, the risk goes up. So, encourage your child to reduce the frequency of sugar intake. For example, you can give him/her two chocolates/candy instead of one and encourage him/her to eat them all together. Afterwards, you can clean his/her teeth off of sticky chocolates/candy. 

  1. 4. Preventive Factors- Uses of Fluoride/CPP-ACP 

    If your child is living in a non-fluoridated area, with no fluoride supplementation and using non-fluoridated toothpaste, s/he is at high risk. Living in an area supplied by fluoridated water, or using fluoride supplement or using a toothpaste containing fluoride decreases the risk of caries development. 
    The newly developed protective material Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), a milk derivative helps in remineralization of the carious lesion by replenishing lost minerals like calcium, phosphate ions into the tooth structure. Using a toothpaste containing CCP-ACP will remineralize the enamel of your child and make it more resistant to caries development. 

  1. 5. Plaque Control Factors 

    If your child does infrequent or ineffective tooth brushing s/he is at higher risk. Teaching him or her regular and effective tooth brushing to remove plaque. This habit decreases the risk of developing tooth decay. If s/he cannot perform effective tooth brushing, help him/her. 

  1. 6. Salivary Factors 

    Low flow of saliva, low buffering capacity of saliva and higher Streptococcus Mutans and Lactobacilli count in saliva put your child in a high-risk category. Removing these factors with the help of a dentist will shift your son/daughter into the low-risk category. 

  1. 7. Clinical Factors 

    New carious lesions, premature extractions, caries or restorations (fillings) in anterior teeth, multiple restorations, history of repeated restorations, no fissure sealants, multi-band orthodontics and presence of partial dentures increase the risk of caries development and put the child in high risk. As these factors decrease, the child moves from high to low-risk category.


Conclusion 


So, now you know the causes that may put your child at high risk for developing dental caries. I advise you to understand these factors and take appropriate action. The first step you must take is to start using a toothpaste that contains either fluoride or CCA-ACP. Also, plan for and have your child get checked by a dentist. 

Oral Malodour / Foetor / Bad Breath / Halitosis


Halitosis is a common social condition that affects a considerable portion of the general population. The prevalence of halitosis is close to 50% in a few populations. Under few circumstances, this oral condition may cause embarrassment, depression and make relationships more difficult. Some studies have investigated whether the psychology of the patients might have some influence on the complaints about halitosis, or even on halitosis itself. In a study that included more than one thousand participants and self-reported halitosis, scientists have reported that poor oral hygiene and general anxiety are associated with halitosis.[1]
Halitosis is divided into intraoral, extraoral, pseudohalitosis and halitophobia. Intraoral halitosis, responsible for 85% of the cases of halitosis, is subdivided into physiologic (genuine) halitosis or pathologic halitosis. Extraoral halitosis occurs when malodor appears with no oral cause, as in the case of pulmonary causes. Both patients with pseudohalitosis and halitophobia present with complaints of halitosis, but without any diagnostic evidence of malodor.[1]
The most common cause of oral malodor is the poor oral hygiene. Due to poor oral hygiene, a large number of bacteria belonging to different species make their home in the mouth. They survive on the food particles entangled in between the teeth and as a by-product, produce different substances like Sulphides, Mercaptans and Amines in gas form. These gases are perceived as bad breath by other people.  

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.

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

 

 

Measures to Evaluate a Screening Test

For ADC examination, both prelims and practical viva voce, and NEET MDS,  the various measures of evaluating a screening test must be known to the students.

There are various measures to evaluate a screening test that are as follows:

Oral Ulcers: Clinical features, Causes & Treatment

Traumatic ulcers in healing stage caused by sharp teeth

An ulcer is a tissue defect which has penetrated the epithelial-connective tissue border, with its base at a deep level in the submucosa, or even within muscle or periosteum. An ulcer is a deeper breach of the epithelium than an erosion or an excoriation, and involves damage to both epithelium and lamina propria.

Vitamin D: Functions & Diseases

In Australian Dental Council’s examination, the indirect question related with Vitamin D are asked but in NEET MDS there may be direct question.

Terminology:

Calciferol: Vitamin DCalcidiol : 25-hydroxyvitamin D [25(OH)D]Calcitriol: 1,25-dihydroxyvitamin D [1,25(OH)2D]Vitamin D2: ErgocalciferolVitamin D3: Cholecalciferol

NEET MDS Practice Course

This is a course that aims to help you practice the MCQs on a weekly basis topic wise. In this course you can study on your own and keep on tracking your progress by taking weekly test. In case you need any help, you may be provided by an experienced faculty.

To buy this course with 40% off, click HERE.

 

Buccinator Muscle

 

 

 

Image source: Internet

NEET MDS: All You Need to Know

National Board of Examinations is the Government authorized body that conducts the National Eligibility come Entrance Test for getting a seat for studying for the Master of Dental Surgery degree in various dental colleges of India, both government as well as private. 

Pay only Rs.  5,999.49 instead of Rs. 9,998.98 to Buy NEET MDS Practice Course Now

Extensive Facial Injury in an Unconscious patient: Case Discussion & Treatment Planning

This case presentation is about the emergency management of a traumatized patient. The questions related with this type of accidental cases may be asked in part one examination. I can guarantee you that at least once, you will be asked about the management of an accident case in viva voce session of ADC part 2 practical examination. You are supposed to prepare a treatment plan for this patient. 

If you wish, you can submit your treatment plan in the comment box. If need arises, you will get a positive response.

 

Case Description:

This male patient, in mid 40s was brought to the emergency room with the condition shown in the picture. He was unconscious with a GCS score of three and without any history. He was intubated to maintain airway in the emergency room. As a member of the emergency management team, you were called upon to perform your role. You were the first person to reach the emergency room. While other members are on their way, what will you do to manage this case? 

 

Extensive facial injury
Extensive facial injury of a male patient of mid 40s.

 

Do not copy or re-use this photograph.

Oral Manifestations of Leukaemia

The oral manifestation of leukaemia can be summarized as follows.

In acute leukaemia- localized or generalized gingival hyperplasia is generally observed. It mainly affects the interdental papillae and the marginal gingiva.