ART - Atraumatic Restorative Treatment.pptx

WATER In 1981, the 34th Word Health Assembly in a resolution emphasized that safe drinking water is a basic element for “primary health care” which is the key to the attainment of “Health for All by the year 2000 AD.” More recently, Millennium Development Goals included safe water and sanitation in the attainable goals. In 1990, more than 1 billion people in developing world lacked access to safe drinking water and nearly 2 billion lacked an adequate system for disposing off their excreta. POTABLE WATER Also called as “Safe and Wholesome Water” Defined as water that is Free from pathogenic agents Free from harmful chemical substances Pleasant to taste, i.e., free from colour and odour; and Usable for domestic purposes Uses of water Domestic use Public purposes Industrial purposes Agricultural purposes Power production Carrying away wastes Sources of Water Rain Surface water Impounding reservoirs Rivers and streams Tanks, ponds and lakes Sea water Ground water Shallow wells Deep wells Springs WATER PURIFICATION Storage Filtration Chlorination Storage a) Physical Action b) Chemical Action c) Biological Action Filtration 98 – 99% of the bacteria are removed by filtration apart from other impurities. Two types of filters are in use The Biologic or Slow sand filters Rapid or Mechanical filters 1. Slow Sand or Biologic Filters Elements: Supernatant (raw) water A bed of graded sand An under drainage system A system of filter control values Supernatant (raw) water Depth – 1 – 1.5 metres A bed of graded sand Vital layer Slimy growth covering the surface of the sand bed “Schmutzdecke/ Zoogleal/ Biological layer” Consists of thread like algae, plankton, diatoms and bacteria. It extends 2-3 cms into the top portion of the sand bed. Formation of vital layer - “Ripening” of the filter. It is the “Heart” of the slow sand filter. It removes organic matter, Holds back bacteria Oxidizes ammonical nitrogen into nitrates and Helps in yielding bacteria free water. An under drainage system Filter box – Open rectangular box of 2.5 – 4 meters deep A system of filter control values To maintain a constant rate of filtration Venturi meter – measure the bed resistance or loss of head 2) Rapid/Mechanical filters Steps involved Coagulation Rapid mixing Flocculation Sedimentation Filtration Filter bed: Each unit of filter bed has surface of about 80 to 90 sq. feet Sand is the filtering medium. Back washing Rapid sand filters require frequent washing either daily or weekly depending upon the loss of head. Washing is accomplished by reversing the flow of water through sand bed which is called “Backwashing”. Helps in dislodging the impurities and cleaning up the sand bed. Time - 15 to 20 minutes Chlorination: Chlorine kills pathogenic bacteria but has no effect on spores and certain viruses except in high doses. It oxidizes Fe, Mn and HS; It destroys taste and odour-producing constituents It controls algae and slime organism

WATER PURIFICATION.pptx

DENTAL AUXILIARY Dental auxiliary is a person who is given responsibility by a dentist so that he or she can help the dentist render dental care, but who is not himself or herself qualified with a dental degree. The duties undertaken by dental auxiliaries range from simple tasks such as sorting instruments to relatively complex procedures which form part of the treatment of patients. DENTAL SURGERY ASSISTANT Non-operating auxiliary who assists the dentist or dental hygienist in treating patients, but is not legally permitted to treat the patient independently. Also known as Dental assistant, Chair side dental assistant, Dental nurse DUTIES Reception of the patient Preparation of the patient for any treatment Provision of all necessary facilities such as mouthwashes and napkins. Sterilization, care and preparation of instruments. Preparation and mixing of restorative materials including both filling and impression materials. DENTAL SECRETARY/ RECEPTIONIST Assists the dentist with his secretarial work and patient reception duties DENTAL LABORATORY TECHNICIAN Non–operating auxiliary who fulfils the prescriptions provided by dentists regarding the extra oral construction and repair of oral appliances and bridge-work. Also known as Dental Mechanics DUTIES Casting of models from impressions made by the dentist Fabrication of dentures, splints, orthodontic appliances, inlays, crowns and special trays. DENTURIST Dental laboratory technicians who are permitted to fabricate dentures directly for patients without a dentists’ prescription. ADA defines denturism as fitting and dispensing of dentures illegally to the public. DENTAL HEALTH EDUCATOR A person who instructs in the prevention of dental disease and who may also be permitted to apply preventive agents intra-orally. SCHOOL DENTAL NURSE Who is permitted to diagnose dental disease and to plan and carry out certain specified preventive and treatment measure, including some operating procedures in the treatment of dental caries and periodontal disease in defined groups of people, usually school children. FUNCTIONS Prophylaxis Topical fluoride application Administration of local anesthetic DENTAL THERAPIST Permitted to carry out the prescription of a supervising dentist, certain specified preventive and treatment measures including the preparation of cavities and restoration of teeth DUTIES Vital pulpotomy DENTAL HYGIENIST Is an operating auxiliary licensed and registered to practice dental hygiene under the laws of the appropriate state, province, territory or nation. DUTIES Fluoride and sealant application screening EXPANDED FUNCTION DENTAL AUXILIARY Who has received further training in duties related to the direct treatment of patients, though still working under the direct supervision of a dentist. Undertake reversible procedures which could be either corrected or redone without harm to the patients health. DUTIES Placing and removing rubber dams, matrix bands and temporary restorations

DENTAL AUXILIARIES.pptx

INDEX definition: An Index can be defined as a numerical value describing the relative status of a population on a graduated scale with definite upper and lower limits, which is designed to permit and facilitate comparison with other populations classified by the same criteria and methods. - Russell A. L Ideal requisites of an index: Clarity, simplicity, objectivity Validity Reliability Quantifiability Sensitivity Acceptability CLASSIFICATION OF INDICES 1) Direction in which the scores can fluctuate a) Reversible – Measures conditions that can increase/ decrease on subsequent examinations Eg: Loe and Silness Gingival Index b) Irreversible – Measures conditions whose scores will not decrease on subsequent examinations Eg: DMFT Index 2) The extent to which areas of oral cavity are measured a) Full Mouth Index - Measures the patients’ entire periodontium or dentition. Eg: Russell’s Periodontal Index b) Simplified Index - Measures only a representative sample of the dental apparatus. Eg: Greene & Vermillion’s Oral Hygiene Index-Simplified (OHI-S) 3) The entity they measure a) Disease Index - ‘D’ portion of the DMFT b) Symptom Index – Indices measuring gingival/ sulcular bleeding c) Treatment Index - ‘F’ portion of the DMFT 4) The special categories a) Simple Index - Measures the presence or absence of a condition. Eg: Silness and Loe Plaque Index b) Cumulative Index - Measures all the evidence of a condition, past and present. Eg: DMFT Index for dental caries INDICES FOR ASSESSING DENTAL CARIES 1. Decayed, Missing, Filled Teeth (DMFT) Index 2. Decayed, Missing, Filled Surfaces (DMFS) Index 3. Modified DMFT Index 4. Caries indices for primary dentition: a. def index b. dmf index c. df index d. Simplified index for dental caries experience e. Dental Caries Severity Index for primary tooth (CSI) 5. Root caries index 6. Caries Severity Index 7. Dental Caries Severity Classification Scale (D1-D3) 8. Czechoslovakian caries Index 9. Stone’s Index 10. Caries susceptibility Index 11. D-M-F- surface percentage Index 12. Restorative Index 13. Moller’s Index 14. WHO Index for caries 15. Functional measure index 16. T- Health index (Tissue Health Index) 17. Dental health index Recent Developments on Caries Indices: 1. Nyvad’s criteria 2. Significant Caries (SiC) Index 3. Specific Caries Index 4. ICDAS II 5. PUFA 6. Caries assessment spectrum and treatment (CAST) index 7. FDI World Dental Federation Caries Matrix Different criteria for diagnosing pit and fissure caries: 1. Anglo-Saxon system (Liberal) 2. European system (Conservative) SIGNIFICANT CARIES INDEX (SiC Index): • Introduced in 2000 by Bratthall D, to identify group of individuals with the highest caries scores among population Procedure: Individuals are scored according to their DMFT values. SiC Index is the mean DMFT of one third of the population with the highest caries scores is selected The index is used as a complement to the mean DMFT

CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx

CONTENTS Plaque control Types of Plaque control Chemical Plaque Control Goals of Chemical Plaque Control Factors influencing effects of Chemical Plaque Control Types of Chemical Plaque Control 1. Chlorhexidine Gluconate 2. Non prescription Essential oil rinses 3. Other Plaque Control Agents a. Triclosan b. Delmopinol c. Metallic ions d. Quarternary Ammonium Compounds e. Enzymes f. Antibiotics Plaque control “The removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival tissues”. TYPES Mechanical plaque control Chemical plaque control CHEMICAL PLAQUE CONTROL Chemical plaque control should always be regarded as needs-related supplement to and not a substitute for mechanical plaque control. Therefore, based on individual patients' predicted risk for oral disease, the choice of agent and frequency of use. Goals of Chemical Plaque Control 1. To prevent plaque formation 2. To control plaque formation 3. To reduce, disrupt or remove existing plaque 4. To alter composition of plaque flora 5. To exert bactericidal or bacteriostatic effects on micro flora implicated in caries and periodontal disease 6. To alter surface energy of the tooth, in turn, affecting the plaque adherence Factors Influencing Effects of Chemical Plaque Control 1. Substantivity 2. Penetrability 3. Selectivity 4. Solubility 5. Accessibility Ideal requisites of an Antiplaque agent Plaque and gingivitis Pathogenic bacteria Resistant bacteria Compatible Stains/ taste Retentive property Inexpensive and easy to use CHLORHEXIDINE GLUCONATE: Cationic bisbiguanide Both antiplaque and antibacterial properties Mechanism of action: Substantivity Bacteriostatic and bactericidal 5 hours – antibacterial, over 12 hours – bacterial count 80-90% reduction Inhibits plaque by: Preventing pellicle formation Preventing adsorption of bacterial cell wall Preventing binding of mature plaque Adverse effects Brownish staining Taste sensation Hypersensitivity Stenosis of parotid duct Indications of Chlorhexidine Gluconate 1. As an adjunct to mechanical oral hygiene 2. As root canal disinfectant 3. Following oral surgical procedures, including periodontal therapy, periodontal surgeries root planning, gingivectomy and after extraction. 4. In patients with intermaxillary fixation, removable and fixed orthodontic appliance and prosthesis. 5. Effective plaque control among physically and mentally handicapped individuals. 6. Management of recurrent aphthous ulceration NON PRESCRIPTION ESSENTIAL OIL RINSES: Thymol Eucalyptol Menthol Methyl salicylate Other Plaque Control Agents: Triclosan : Phenol derivative Synthetic, non-ionic, antimicrobial Mycobacterium spores and candida species Bacteriolysis In combination with zinc citrate Delay plaque maturation Inhibit formation of prostaglandins and leukotrienes Delmopinol: Morpholino ethanol derivative Pre-brushing mouthrinse Adverse effects: Numbness of Tongue Staining of tooth and tongue staining

CHEMICAL PLAQUE CONTROL.pptx

DEFINITIONS Plaque “A structured, resilient, yellow-grayish substance that adheres tenaciously to the intraoral hard surfaces including removable or fixed restorations. Plaque control “The removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival tissues”. TYPES Mechanical plaque control Chemical plaque control TOOTHBRUSHES Tooth brush is designed to promote cleanliness of teeth and oral cavity. - ADA’s Council on Dental Therapeutics Objectives of Tooth brushing Clean teeth and interdental areas Prevent plaque formation Disturb and remove plaque Stimulate and massage gingiva Clean tongue TOOTHBRUSH Parts: Handle Head Tufts Brushing plane Shank Types of tooth brushes Manual Powered Sonic and ultrasonic Ionic MANUAL TOOTHBRUSHES Toothbrush bristles Stiffness varies: Diameter of bristles Length of bristles Number of bristles in a tuft Curvature of bristles POWERED TOOTHBRUSHES Automatic, mechanical or electric toothbrushes Fredrick Tornberg – Mechanical toothbrush – 1885 First Powered toothbrush – 1939 The heads of these toothbrushes oscillate in a side-to-side motion or in a rotary motion – 40Hz Indications Young children handicapped children Individuals lacking manual dexterity Orthodontic patients Institutionalized patients Patients with prosthodontic or endosseous implants Patients on supportive periodontal therapy Advantages: Increase patient motivation increased accessability Helps the patient to brush for a required duration No specific brushing technique Uses less brushing force Sonic and Ultrasonic Toothbrushes High frequency vibrations (1.6 MHz) DENTIFRICES “A dentifrice is a substance used with a toothbrush for the purpose of cleaning the accessible surfaces of the teeth”. ADA 1-1.25 inches in Length 5/16 - 3/8 inches in width 2 – 4 rows of bristles 5-12 tufts/ row Functions 1. Minimizes plaque build up 2. Anti-caries action 3. Removal of stains 4. Mouth freshener Sonic and Ultrasonic Toothbrushes High frequency vibrations (1.6 MHz) Ionic Toothbrushes INTERDENTAL CLEANING AIDS 1. Dental floss Multifilament – twisted or non twisted Bonded/ Non bonded Thick/ thin Waxed/ non waxed Functions Disadvantages Techniques: 1. The spool method 2. The circle or loop method AIDS FOR GINGIVAL STIMULATION Gingival massage Increases Keratinization Blood flow GCF Water irrigation devices (Water pik) Tongue scrapers: “The process of removing debris from the surface of the tongue with some form of scraper designed for this purpose”. Techniques : Brushing Tongue cleaning devices

PLAQUE CONTROL.pptx

DEFINITION “Actions directed to preventing illness and promoting health to reduce the need for secondary or tertiary health care. Mosby’s Medical dictionary, 8th edition, 2009 “The action of stopping something from happening or arising”. Oxford English Dictionary. Lexico 2020 GOALS OF PREVENTION To promote health To preserve health To restore health when it is impaired To minimize suffering and distress Successful prevention depends upon: a knowledge of causation dynamics of transmission identification of risk factors and risk groups availability of prophylactic or early detection and treatment measures, LEVELS OF PREVENTION 1) Primordial Prevention 2) Primary Prevention 3) Secondary Prevention 4) Tertiary Prevention PRIMORDIAL PREVENTION It is the prevention of emergence or development of risk factors in countries or population groups in which they have not yet appeared. Main intervention is through individual and mass education. Eg: Efforts directed towards discouraging children from adopting harmful lifestyles. PRIMARY PREVENTION “Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.” Intervention is in the pre- pathogenesis phase of a disease or health problem. The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established: – A) Population (mass) strategy B) High -risk strategy SECONDARY PREVENTION Definition “ An Action which halts the progress of a disease at its incipient stage and prevents complications.” Modes of intervention – Early Diagnosis and Specific treatment The health programmes initiated by governments are usually at the level of secondary prevention. Advantages: Important in reducing the high mortality and morbidity of certain diseases like hypertension, cancer cervix and breast cancer. Disadvantages: More expensive and less effective than primary prevention. Patient is already subjected to mental anguish, physical pain; TERTIARY PREVENTION It is defined as “all the measures available to reduce or limit impairments and disabilities, and to promote the patients adjustment to irremediable conditions”. It is the intervention in the late pathogenesis phase. Treatment, even in late stages of disease, may prevent sequelae and limit disability. Modes of Intervention - Disability limitation and Rehabilitation. MODES OF INTERVENTION “Intervention” can be defined as any attempt to intervene or interrupt the usual sequence in the development of disease in man. 5 modes of intervention 1. Health promotion 2. Specific protection 3. Early Diagnosis and treatment 4. Disability limitation 5.Rehabilitation CONCLUSION To initiate preventive measures it is not necessary to know everything about natural history of the disease. Main objective of preventive medicine - to intercept or oppose the “cause” and thereby the disease process

LEVELS OF PREVENTION.pptx

Prevention is defined as “Actions directed to preventing illness and promoting health to reduce the need for secondary or tertiary health care. GOALS OF PREVENTION 1. To promote health 2. To preserve health 3. To restore health when it is impaired 4. To minimize suffering and distress LEVELS OF PREVENTION 1) Primordial Prevention 2) Primary Prevention 3) Secondary Prevention 4) Tertiary Prevention 5 modes of intervention Health promotion Specific protection Early Diagnosis and treatment Disability limitation Rehabilitation Recent advances in Caries Prevention 2 approaches 1. Measures to prevent demineralization 2. Measures to promote remineralization a. Newer remineralizing agents b. Ozone therapy c. Recent advances in fluoride 1. Measures to prevent Demineralization a. Newer chemoprophylactic agents – mineral binding micellar drug delivery system b. Anti microbial peptides (AMPs) c. Probiotics d. Replacement therapy - S. mutans strain BCS3-L1 is a genetically modified effector strain – to prevent dental caries e. Bacteriophage therapy f. Photodynamic therapy g. Sugar substitute - stevia h. Immunizations 2) Measures to prevent Remineralization a. Newer remineralizing agents CPP-ACP TCP (Tricalcium phosphate) Pronamel Novamin Enamelon DCPD (Dicalcium phosphate dihydrate) IER (Ion exchange resins) b) Ozone therapy c) Recent advances in fluoride Fluoride glass device Copolymer membrane device Fluoride releasing pellets DCPA Nano composite Specialized phosphonate Hydroxyapatite- Eudragit RS 100 Diffusion controlled “F” system Synergistic effect of fluoride and laser Newer topical fluoride- amine fluoride and stannous hexafluorozirconate Recent advances in Periodontal Disease Prevention 1. Microscopic identification 2. Cultures 3. Enzymatic assay – 2 tests- BANA test and perio-check test 4. Immuno assay 5. Polymerase chain reaction 6. Biosensors – Perio 2000 – measures sulfur levels 7. Genetic analyses 8. Regenerative treatment 9. Photodynamic therapy 10. Enamel matrix derivatives 11. Bisphosphonates 12. Local antimicrobial delivery systems Metronidazole in ointment form (Elyzol) Chlorhexidine as Periochip Doxycycline in fibre form (Actisite) Polymeric delivery system (Atridox) 13. Inhibition of matrix degradation - Periostat Recent advances in Oral Cancer Prevention 1. Green tea – bunopyrene - decreased 2. Vitamin A, C, E and minerals such as Fe, Zn, Cu, Se, Mn have preventive effects. 3. L1 DNA Vaccine- prevent Papilloma associated oral cancer. 4. Tretinoin biofilm

RECENT ADVANCES IN PREVENTIVE DENTISTRY.pptx

MECHANISMS OF PAYMENT 1. Private fee - for services 2. Post payment plans 3. Private third party prepayment plans -Commercial insurance companies -Non-profit health service corporations -Prepaid group practice -Capitation plans 4. Salary 5. Public programs 1. Private fee - for service • The two party arrangement, traditional form of reimbursement for dental services. • Integral part of private practice as a delivery method. Advantages: 1) Culturally acceptable 2) Flexibility 3) Administratively simple 4) Can be used in expensive situations Disadvantages: 1. Major percent of the population cannot afford dental care. Post Payment Plans or Budget Plans • First started in Late 1930's - local dental societies in Pennsylvania & Michigan • Mechanisms for the individual purchase of service Advantages: 1. Helpful for middle income people 2. Primarily used to finance prosthetic and other costly treatment Disadvantages: 1. Lower income people cannot use to the full 2. Problem of defaulted loans Private Third Party Prepayment Plans Defined as payment for service by some agency rather than directly by the beneficiary of those services. 1st Party-Dentist; 2nd Party-Patient; 3rd Party-Administrator of Finances Third Party/ Carrier/ Insurer/ Underwriter/ Administrative Agent. • Defined as The party to a dental prepayment contract that may collect premiums, assume financial risk, pay claims and provide administrative services Reimbursement of Dentist in Third Party Plans The major forms of third-party reimbursement currently in use are: Usual fee: The fee that an individual dentist most frequently charges for a given dental service. Customary Fee: The fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure. Reasonable Fee: the fee charged by the dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications may differ from the dentists usual fee or the benefit administrators customary fee. A table of allowances: A list of covered services with an assigned amount that represents the total obligation of the plan with respect to payment for such service but that does not necessarily represent the dentists full fee for that service”. Fee schedule: A list of charges established or agreed to by a dentist for specific dental services. A fee schedule is usually taken to represent payment in full, whereas a table of allowances may not. Capitation: A capitation fee is usually a fixed monthly payment paid by a carrier to a dentist based on the number of patients assigned to the dentist for treatment. SALARY Dentists in some group practices, those in the armed forces and those employed by public agencies are salaried. PUBLIC PROGRAMS Medicare Medicaid NHI

FINANCE IN DENTISTRY.pptx

• Non parametric tests are distribution free methods, which do not rely on assumptions that the data are drawn from a given probability distribution. As such it is the opposite of parametric statistics • In non- parametric tests we do not assume that a particular distribution is applicable or that a certain value is attached to a parameter of the population.  When to use non parametric test??? 1) Sample distribution is unknown. 2) When the population distribution is abnormal  Non-parametric tests focus on order or ranking 1) Data is changed from scores to ranks or signs 2) A parametric test focuses on the mean difference, and equivalent non-parametric test focuses on the difference between medians. 1) Chi – square test • First formulated by Helmert and then it was developed by Karl Pearson • It is both parametric and non-parametric test but more of non - parametric test. • The test involves calculation of a quantity called Chi square. • Follows specific distribution known as Chi square distribution • It is used to test the significance of difference between 2 proportions and can be used when there are more than 2 groups to be compared. Applications 1) Test of proportion 2) Test of association 3) Test of goodness of fit Criteria for applying Chi- square test • Groups: More than 2 independent • Data: Qualitative • Sample size: Small or Large, random sample • Distribution: Non-Normal (Distribution free) • Lowest expected frequency in any cell should be greater than 5 • No group should contain less than 10 items Example: If there are two groups, one of which has received oral hygiene instructions and the other has not received any instructions and if it is desired to test if the occurrence of new cavities is associated with the instructions. 2) Fischer Exact Test • Used when one or more of the expected counts in a 2×2 table is small. • Used to calculate the exact probability of finding the observed numbers by using the fischer exact probability test. 3) Mc Nemar Test • Used to compare before and after findings in the same individual or to compare findings in a matched analysis (for dichotomous variables). Example: comparing the attitudes of medical students toward confidence in statistics analysis before and after the intensive statistics course. 4) Sign Test • Sign test is used to find out the statistical significance of differences in matched pair comparisons. • Its based on + or – signs of observations in a sample and not on their numerical magnitudes. • For each subject, subtract the 2nd score from the 1st, and write down the sign of the difference.  It can be used a. in place of a one-sample t-test b. in place of a paired t-test or c. for ordered categorial data where a numerical scale is inappropriate but where it is possible to rank the observations. 5) Wilcoxon signed rank test • Analogous to paired ‘t’ test 6) Mann Whitney Test • similar to the student’s t test 7) Spearman’s rank correlation - similar to pearson's correlation.

NON-PARAMETRIC TESTS.pptx

TESTS OF SIGNIFICANCE Deals with techniques to know how far the difference between the estimates of different samples is due to sampling variation. Standard error (S.E) of Mean = S.D/√n Standard error (S.E) of Proportion = √pq/n Tests of significance: Can be broadly classified into 2 types 1. Parametric tests (or) standard tests of hypothesis 2. Non – Parametric tests (or) distribution free-test of hypothesis PARAMETRIC TESTS: Parametric test is a statistical test that makes assumptions about the parameters of the population distribution(s) from which ones data is drawn. When to use parametric test??? Subjects should be randomly selected Data should be normally distributed Homogeneity of variances The important parametric tests are: 1) z-test 2) t-test 3) ANOVA 4) Pearson correlation coefficient Z - Test: This is a most frequently used test in research studies. Z - test is based on the normal probability distribution and is used for judging the significance of several statistical measures, particularly the mean. Z - test is used when sample size greater than 30. Test of significance for large samples Z = observation – mean SD Prerequisites to apply z- test Sample must be selected randomly Data must be quantitative Variable is assumed to follow normal distribution in the population Sample size must be greater than 30. if SD of population is known, z test can be applied even sample size is less than 30 2) t- Test • In case of samples less than 30 the Z value will not follow the normal distribution • Hence Z test will not give the correct level of significance • In such cases students t test is used • It was given by “WS Gossett” whose pen name was student. So, it is also called as Student test.  There are two types of student t Test 1. Unpaired t test 2. Paired t test Criteria for applying t- test 1. Random samples 2. Quantitative data 3. Variable normally distributed 4. Sample size less than 30 Unpaired test: • Applied to unpaired data of independent observation made on individuals of 2 separate groups or samples drawn from the population. • To test if the difference between the 2 means is real or it can be due to sampling variability. Paired t - test: • It is applied to paired data of observation from one sample only (observation before and after taking a drug) Examples: 1. Pulse rate before and after exertion 2. Plaque scores before and after using oral hygiene aid 3) ANOVA ( Analysis of Variance): • Investigations may not always be confined to comparison of 2 samples only • In such cases where more than 2 samples are used ANOVA can be used. • Also when measurements are influenced by several factors playing their role e.g. factors affecting retention of a denture, ANOVA can be used. Indications: To compare more than two sample means Types: 1. one-way ANIVA 2. Two-way ANOVA 3. Multi-way ANOVA Pearson’s correlation

PARAMETRIC TESTS.pptx

Steps in conducting a RCT 1. Drawing up a protocol 2. Selecting Reference & Experimental population 3. Randomization 4. Manipulation or Intervention 5. Follow up 6. Assessment of outcome 1. Drawing up a protocol Aims and objectives of the study Questions to be answered Criteria for the selection of study and control groups Size of the sample & allocation of subjects in both groups Treatment to be applied - when, where, how Standardization of working procedures and Schedules as well as responsibilities of persons involved in the trial up to the stage of evaluation of outcome of the study. 2. Selecting Reference and Experimental Populations Reference or target population - Population to which the findings of the trial, if found successful, are expected to be applicable (Eg: drugs, vaccines, etc.) Experimental or Study population Derived from the Reference population Has same characteristics as the Reference population Actual population that participates in the experimental study Must give informed consent - Should be qualified or eligible for the trial 3. Randomization Heart of the control trial Procedure: Participants are allocated into study and control groups Eliminates bias and allows comparability By random allocation every individual gets an equal chance for being allocated in to either groups. 4. Manipulation/ Intervention Having formed the study and control group, the next step is to intervene or manipulate the study (experimental) group by deliberate application or withdrawal or reduction of a suspected causal factor Eg: Drug, Vaccine, Dietary component, a habit 5. Follow up Implies examination of the experimental and control group subjects at defined intervals of time in a standard manner, with equal intensity, under the same given circumstances in the same time frame till final assessment of outcome. Attrition: Inevitable losses to follow up (death, migration, loss of interest) 6. Assessment a. Positive results: Reduced incidence or severity of disease Reduced cost to health service Appropriate outcome in the study b. Negative results: Increased severity or frequency of side effects Complications Deaths BIAS: Any systematic error in the determination of association and outcome. Bias may arise from errors of assessment of outcome due to human element Subjective bias Observer bias Evaluation bias 1. Subjective Bias: Participants, subjectively feel better or report improvement if they knew they were receiving a new form of treatment. This is known as “Subject variation”. 2. Observer Bias: Investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected. 3. Evaluation Bias: Investigator may subconsciously give a favorable report of the outcome of the trial. Blinding: 1. Single Blind Trial: Participant 2. Double Blind: Partcipant + Investigator 3. Triple Blind: Participant + Investigator + Data Analyzer

RCT.pptx

INTRODUCTION • Gingival and periodontal diseases in their various forms have affected humans since the dawn of the history. • Studies in paleopathology have indicated that destructive periodontal disease, as evidenced by bone loss, affected early humans in such diverse cultures as ancient Egypt and pre-columbian America. • Epidemiologic studies identify risk factors for diseases and provide guidance for primary prevention, recommendations and identify where to intervene in disease process. PERIODONTAL DISEASES GINGIVITIS • Inflammation of the gingival soft tissues with no loss of alveolar bone or apical migration of periodontal ligament along root surface. • It may be characterized by edema, erythema, bleeding, and occasionally pain. • Gingivitis is usually reversible with appropriate therapy. PERIODONTITIS • An inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession, or both. • The clinical feature that distinguishes periodontitis from gingivitis is the Loss of clinical attachment CLASSIFICATION OF PERIODONTAL DISEASES CHRONIC PERIODONTITIS • The most common form of periodontitis • Most prevalent in adults but can occur in children • Amount of destruction consistent with local factors • Associated with a variable microbial pattern • Associated with accumulations of plaque and calculus • Slow to moderate rate of progression with possible periods of rapid progression • Localized form: < 30% of sites involved • Generalized form: > 30% of sites involved • Slight: 1 to 2mm CAL (clinical attachment loss) • Moderate: 3 to 4 mm CAL • Severe: 5mm or greater CAL AGGRESSIVE PERIODONTITIS • Rapid attachment loss and bone destruction • Amount of microbial deposits inconsistent with disease severity • Familial aggregation of diseased individuals • Generally diseased sites are infected with a specific bacteria (Actinobacillus actinomycetemcomitans) • Abnormalities in phagocyte function • Hyper-responsive macrophages, producing elevated PGE2 and IL1B • Disease progression may be self-limiting • It is of two types- localized and generalized LOCALIZED AGGRESSIVE PERIODONTITIS • Circumpubertal onset of disease • Localized first molar/ incisor • Interproximal attachment loss on at least two permanent teeth • Robust serum antibody response to infecting agents GENERALIZED AGGRESSIVE PERIODONTITIS • Usually affecting persons under 30 years of age (however, may be older) • Generalized interproximal attachment loss affecting at least three teeth other than first molars and incisors • Pronounced episodic nature of destruction • Poor antibody response to infecting agents Periodontitis as a manifestation of Systemic disease Hematologic disorders A) Acquired neutropenia B) Leukemias Genetic disorders A) Familial & cyclic neutropenia B) Down’s syndrome c) Papillon-Lefevre syndrome

EPIDEMIOLOGY OF PERIODONTAL DISEASES 1.pptx

INTRODUCTION Vitamins may be regarded as organic compounds required in the diet in small amounts to perform specific biologic functions for normal maintenance of optimum growth and health of the organisms Generally, vitamins are not synthesized by the body, and need to be supplied through the diet History and Nomenclature HOPKINS - Coined term ACCESSORY FACTORS to unknown and essential nutrients present in the natural foods FUNK - 1) Isolated an active principle from rice polishing's and in yeast cured Beri - Beri in pigeons 2) Coined the term VITAMINE from the words vital + amines 3) Later it was called “ VITAMIN ” Mc COLLUM and DAVIS - Introduced the usage of A, B, and C to vitamins CLASSIFICATION There are about 13 vitamins, essential for humans classified as follows Vitamers: Chemically similar substances that possess qualitatively similar vitamin activity VITAMIN A Fat soluble vitamin Present only in foods of animal origin Carotenes - Plants Dietary Sources: Animal sources Liver Kidney Egg yolk Milk Cheese Fish liver oils Plant sources Carrots Papaya, Mangoes Avocado, Melon Pumpkins RDA (Recommended Dietary Allowance): Men - 1000 RE (3500 IU) Women - 800 RE (2500 IU) Children - below 6 years - 350 - 400 µg Retinol - 6-17 years – 600 µg Retinol Pregnancy – 800 µg Retinol Lactation – 950 µg Retinol 1 RE – 1 µg of Retinol 1 IU – 0.3 mg of Retinol Biochemical Functions: Vision - the role of vit A in the process of vision was first elucidated by GEORGE WALD(1968) The events occur in a cyclic process known as Rhodopsin Cycle (or) Wald’s Cycle RODS and CONES: Retina of eye possesses rods and cones Human eye - 10 million rods 5 million cones Rods –Periphery – Dim light vision Cones – Centre – Bright light and color vision Deficiency of Vitamin A: 1) Night Blindness 2) Conjuctival X VITAMIN D ANGUS – Isolated and named it as CALCIFEROL Resembles sterols in structure Functions like hormone Dietary Sources: Fatty acids Fish liver oils Egg yolk Cheese Butter RDA: 400 IU or 10 mg of cholecalciferol Countries with good sunlight – 200 IU or 5 mg Deficiency: 1) RICKETS - In young children aged 6 months to 2 years Due to reduced calcification of young bones Characterized by Growth failure Bone deformity Muscular hypotonia Tetany and convulsions Elevated conc. Of alkaline phosphatase in serum Bony deformities - Bow legs, Deformed pelvis, Pigeon chest, Harrison’s sulcus walking and teething are delayed. OSTEOMALACIA In adults, women, during pregnancy and lactation Prevention: Educating parents to expose their children regularly to sunshine.

VITAMINS.pptx

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