resto attachy with cool sp

assalamualaikum wbt..

'bes'nye lah posting resto kan...1st day aku kuar rehat kul 145, then balik kul 6 T_T..

oh ya, my sp has a flexible working time. waktu kerja dia bergantung kepada ada kerja atau tidak. so dah kul 5 sekalipun, bila ada pt, still gotta work on it sampai habis. xde kata nak bg appt lain or pape je lah kan.. saya belajar dari dia yang kita datang untuk kerja, dan will not ever2 makan gaji buta..see, overtime tau, without claim pon kott.

and she's very cool. xpernah marah sesapa sekalipun. she is a yes yes sp. everything is just ok with her. phewww, cool gilalah!

she can ask my experience pulaklah, padahal ima fydo u know..blushing i tau x! hehe

okehh..

1) expasyl - macam gel-like, we inject at around sulcus, act like retraction cord. after 1 minute, wash it away with 2 in 1.
2) rely x - for temporary cementation
3) protemp - for construction of temporary crown

steps for bridges:

1) assesment - abutments. ( ada jugak buat bridge from 3-3, replacing both laterals and centrals.)
2) alginate imp. putty imp (for temporary) - kat sini buat temporary bridge. so lepas preparation, isi protemp kt sume gigi antara dua abutments to kat putty okeyh.
3) preppppp.
4) temporary crown - sometimes need crown lengthening so need to refer perio. (antara sebab for CL : short clinical crown, restorations subgingiva-coz finish line should be on tooth, esthetic reason for gummy smile pt)
5) check occlusion.

nxt visit : 2ry imp. (kalo xyah CL, bleh amek 2ry imp dah masa 1st visit then issue the next visit)

Os thing

Instrument =
Maxenbom
Langerhan retractor


Tranexamic acid mouthwash
Difflam
Gengigel
Kenalog on orabase
B complex
Tramadol
Morphine
Codeine


BIPP

being useful

lately at OS, me got more than 2 patients per day. its an improvement ppl!!!!
not that i hope people get sick, but please attract more people, than letting small clinic getting crowded. right? hurrrmmmm!!!!

hokkay...updating infossss...

1) we wait until patient got 8 g/dL hemoglobin for extractions. (but for hemodyalisis patients, they mioghbt always got low hemoglobin level because of no erythropoietin that is responsible for rbc production. erythropoietin is produced in kidney. renal failure patients have low erythropietin or none at all.)

2) withdrawing blood. usually for admitting patients, we fill up for FBC, coag and buse. fill up the blue bottle first, then purple then yellow.

3) during admittance, patients aged 40 years old and above plus smoking habits, will need an ecg and chest xray before, fear of any heart problem. and this is to be reviewed by anaesth clinic.

a traumatized fydo doing examinaion on trauma case

beauty is pain.
no pain no gain.
no gain no knowledge.

me is traumatized but like i told ya, i need to be strong. *crying*.
i was told to manage a trauma case(tiba2 je) so macam oncall sket.
someone didnt have the common sense.
me is small hearted.
male assistants are there. they tend to underestimate a female doctor. i said tend to, not really doing it.
i kesiankan patient tu. dia tua, dia sakit, aku terbayangkan ba. i feel like i'm his daughter, not his doctor. (shouldnt feel like this - should balance it)

so todayyyyyyy, an examination is done under fulllll supervision.

1) c/o - LOC? ent bleeding? retrograde amnesia?
2) hpc - how mva happen, what vs what, when,
3) pmh
4) pdh
5) sh - smoke, drink, work
6) fh
7) eo - check for fracturessss


palpate
face - periorbital, nasal, maxillae, mandible
tmj -

mouth opening
lateral excurion

look for
hematoma (accumulation of blood=swelling)
ecchimosis (bleeding under skin without swelling)
abrasion
laceraion

check
eye - diplopia (ask patient to follow your finger) , blurred vision, subconjunctival haemorrhage

I/O

occlusion deformity
dento-alveolar fractures
crown fractures
tooth mobility

management :

toilette and suturing (this case, l/w at lip) - cari n cantumkan betul2 dekat vermilion border, baru cantik bibir dia.

bagi cloxacillin because its extraoral. if intraoral only, can give ampicillin(x ingt)

later, we ordered omv and opg to rule out infraorbital fracture (Ihe pt have periorbital hematoma)



DONE FOR TODAY. STRESSSSSSEDDD

electrolytes lecture by Dr F

writing this with api membara dalam hati.
but after all, disebabkan aku nak ilmu, semuanya harus ditempuhi dan dilupakan. whatever it is. me have to be kuat.

usually, everyday we'll lose 2500 mililiter of water(urine,sweat,respiration,faeces).
so, for patients who cannot tolerate orally, unconcious, dehydrated, we need to give them water through IV drip(ye kot) around that 2500ml jugak.

Important body electrolytes are sodium and potassium. Daily, we need 1-2 mmol/l perkg, per24hours of sodium and 1 mmol/l perkg per24hours potassium. (mostly potassium is inside cells and sodium is outside cells). Potassium will be lost only if we have trauma, when cells are damaged.

so normally we take standard weight : 70 kg. So what a patient need daily are :

1-2mmol sodium x 70kg = 70-140 mmol sodium
1 mmol potassium x 70 kg = 70 mmol potassium
2500 ml h20

a bottle of normal saline usually used in hospital contains :

150 mmol/l sodium
0 potassium

its content is actually 500ml, so actually it contains

75 mmol sodium

so how do we give patient enough sodium and saline?

if we use only normal saline, we could have give 2500 ml h20 using 5 bottles of ns, but then we will over saturate the patient with a 75x5 mmol of sodium which is (375mmol)- extracellular fluid (intravascular and interstitial) will be hypertonic, and cells (intracellular fluid will be hypotonic)will shrink to achieve osmolarity equlibrium. we dont want this.

how to give normal saline and sodium, perfectly as neede by patient?

we use other solutions, which is dextrose 5%(D5) solution. it contains glucose, no sodium nor potassium.

so, 2 bottles of ns will give :

150 mmol sodium
1000 h20

and plus 2 botlles of D5 will give :

1000 h20

which sums up to be :

150 mmol sodium
2000 h20

nearly what the patient need.

one other solution is ringer's lactate (hartmann) it contains electrolyte nearly the same like in plasma(ye ke???) bacaan dia aku lupa tapi lbh krg 131, 5,...xingt dah.

ok korg..tadi kita bagi 2 bottles of ns and 2 bottles of d5 kan...that makes it 4 bottles in 24 hours. so one bottle is given in 6 hours. we dont wanna give it faster nor slower than it should be, so the drop of water is counted/estimated so it is controlled for 1 bottle=6hours.

for patients with brain injury, to prevent brain edema, we give fluid that is hypertonic to intracellular fluid, to prevent water accumulation in cells.

and in cases of severe trauma/burns(ye ke?) there might be need for potassium.


lastly, i admire you Mr F coz u taught it in a very easy way. u are Dr Y the 2nd.

i am periodontally attached!

haa.. i lurveeee my perio specialist coz she respected me for who i am. and i think she has a good fikrah too in Islam.. lovedddd herrrr sooo muchhhh, argh!

these are the things i learnt at perio

1) calcium sulphate. used to prevent gum from going back to its place after open flap surgery. example : calcium sulphate is placed at furcation area, to hold the site from getting exposed again. it will resorbed later but takes time (rather than not placing anything)

2) collaplug. to support bone from further resorption. example : after extraction, we put allograft inside the socket. then we put collaplug on top - to induce blood clot too?? not sure. and to maintain the thickness of the bone (plan for implant later)

3) perio stick / fiber stick . my sp used this to splint acrylic teeth. the stick is bonded with composite to teeth surfaces and also to acrylic teeth. concept : maryland bridge + splint.

4) colgate pro relief - just like in the iklans.

5) creosote (xtau eja camne) - this thing will mummify nerves, and also has analgesic effect. leave it 2-3 days inside canal, then patient will come again with no bleeding inside canal.

6) biotene mouthwash - we use this for an SLE patient. this thing will reduce formation of plaque.

7) we do reviews like this : if fmps and fmbs more than 20%, patient should be reviewed again after 2 weeks. if less, make it 6 weeks (not sure). if no more pockets (pocket depth all less than or equal to 5mm), and fmps/fmbs less than 20%, patient can be put in maintainence phase (meaning active treatment completed). so the review will be 3 months, 6 months and 9 months. EASY right???

i remembered my lecturer, Dr Rola said that supportive periodontal treatment never stopped. its a lifetime treatment! --> kalau kita apply this to gomen clinic, imagine how many patient can we kumpul through out hundreds of years working. patient akan stop bilamana dia mati saja! auwh

we've got to plan meh!

ok, since i dont have any plans to make now,as i'm truly freely single independent women, (huaha,that isnt desperate okay), so i think i need to plan now. managing my money.

kepuasan yang sebenar bagi aku adalah ada klinik sendiri. so aku tgh kumpul duit untuk buka klinik. but before that, i need to plan...buka klinik ni belanja besar weh..aku nak plan dan plan tu jadi..bukan berangan dan last2 tak jadi. so here it goes..

1) aku dengar kena buat swot analysis dulu.

http://www.bplans.com/family_medicine_clinic_business_plan/executive_summary_fc.cfm



if we can see, the net profit for the 1st 2 years is negative. lol, we got kerugian there.
but bussiness is like that. u need to be patient ey. 2 years isnt enough to put your bussines on a very strong base.(camtu ke..ahahh bantai la) unless you're anak millionaire kan. sila berhenti berangan.
so what can we do in the 1st 2 years? 2 tahun tu lama ok, nak makan apa kalau duit habis untuk klinik. ada kerja baru yag lebih membebankan, bukan memudahkan..pasti mengecewakan namun harus sabar. jadi apa perlu buat ye?

Dr Detroit do this :

2) mula2 dia supported by general medical centre (aku rasa dia buat francais kah?) so mula2 tu general medical centre yang support gaji dia n gaji para pekerja...bila dah lama2 sikit baru subsidi tu berkurangan dan dia akan tanggung sendiri.,

so aku pun search la pula francais under pusrawi kaan...cemana plak nak dapatkan bantuan n support for the 1st years of bussines? dan search punya search, takjumpa la, ngantok da..tido dulu...nanti sanbung. huarghh

perio - review thingy

assalamualaikum wbt.

biasanya bila pt baru datang, buat charting. then if fmbs/fmps dia lebih 20%, kita review after 2 weeks. pastu after 6 weeks of 1st pocket charting, kita chart pocketing lagi. after OH controlled, kita boleh start buat root planing if there's any pocketing. if there's no pocketing, the active treatment done. continue with maintenance phase.

soalan aku :

1) adakah selepas root planing, pocketing akan reduced, meanins that the gum will be receded(hence the loss of pocket?).

- is recession means the gum healed?

2) adakah bone can regenerated/remodel after root planing?

3) can a mobile tooth be nonmobile after treatment? (i thought bone cannot grow back after loss)

hari ini aku adalah seorang dentist yang sangat berguna. kerja dari 8-5 nonstop with patients. aku harap kehidupan bekerja aku dari 8-5pm adalah penuh dengan aktiviti membuat pahala. kalau gaya bekerja aku gaya membuat dosa, aku taktahu lah bergunung ganang dosa aku astaghfirullah. semoga Allah membantu!

teringat mummy poko pants!

perio attachment

now i'm at periodontics specialist attachment, hosp taiping with Dr K.
today is my 3rd day, so these are my experiences for 3days attachy.

1) charting.

cek pocketing, sekali dengan bleeding presence or not upon probing. six point charting, mesiobuccal, buccal,distobuccal,distolingual,lingual and mesiolingual surfaces. (gila kan perio?). pastu kalau ada recession bgtau juga, at six points gak. next is apply disclosing agent, then tanda presence of plaque. pastu kira FMBS(blood) ngan FMPS(plaque) percentage. dia bahagikan dengan jumlah bilangan surfaces. (kalau ada 32 gigi meaning 6surfacesx32gigi)

2) BPE (basic periodontal examination??)
ada score dia, 0-4. ni kira 6 tmpt. 1) gigi 14 hingga 18, 2) 13-23 3) 24-28, 4) 34-38 5) 43-33 6) 44-48. tadaaa.. pastu kat satu2 sextant tu, kalo 3 paling tinggi, maka tigalah score BPE dia. kalau satu sextant tu tinggal satu gigi je, score dia masukkan ke sextant sebelah dia. ok guys?! its verry simple!

3) pastu, kalo score fmbs/fmps dia lebih 20%, biasanya kita buat scaling then review after 2 weeks. pastu ada yg kene review 6/52, 6/12..yg ni aku nak baca notes dulu ya! its annoying kan.bila takbiasa lg ngan satu2 benda.

OKAY GUYS, NEXT TOPIC IS IMPLANTS!!!

hari ni aku tengok sp aku extract roots, dia guna curette instead of drill to remove bone. dia guna periodontome(not sure!) to elevate the root. she extracted it normally. patient ni akan buat implant at that site so sp aku nk conserve bone kot. guna curette akan mengurangkan pe remove an bone. lagi, dia buat sulcular incision at buccal to see wether there's penetration of bone(pt had post before) there.

pastu dalam socket to sp aku drill sikit bone, supaya ada aliran darah. katanya bila ada darah, graft akan cepat blend with tissue. ok, dalam socket tu dia letak purous graft(an allograft) . sebelum masukkan graft tu, dia campurkan darah from apex( she syringed it from apex inside socket)dengan graft tu, then pack inside socket. then dia letak plak collaplug ( sejenis collagen) untuk pastikan ketebalan bone (mengelakkan bone jadi nipis lepas heal-resorption etc) dan juga untuk mengelakkan graft tu terkeluar, lastly dia sutured it. bila dah buat sulcular incision, gum lebih mobile so bleh tarik sampai tutup socket.

yahooooo dah habis!!!

unsolved patients' complaint

1) sakit yang intense, from angle of mandible to ear area(left side) - pt got no medical problems, except that he experienced something like inflammation of vertebral(not sure), now healed as told. intraorally, no pus, no swelling. no dry socket, no abnormalities except bad oral hygiene. u got mygraine kot pakcik! coz neuralgia - sudden pain.

2) sensitivity at teeth that got composite restoration ( is the composite shrinks, thats why the sensitivity?) or, is it bcoz operator dries the dentine too much? why the sensitivity??

3) localized bone loss at interdental, causes food impaction - really painful, disturbs eating. good oral hygiene. no calculus.no gingivitis. do we have other tx option other than guided tissue regeneration? a more conservative tx.

thats all for now.
my theme for the day is - dont know who to trust.

aku fydo lagi kan

hari ni ada dua kesedihan :

1) pakcik yang poyo dan rude to me.
2) tukang jahit telah merosakkan baju aku yang santeeek tuh! ROARRRR!!

citer pasal paccek nih - die sendiri pun confuse nak komplen pasal pe sebab die sakit kapla bukan gigi! pahtu nak salahkan aku cabut gigi dia n sakit tu tak hilang after 1 week...heck, aku cek extraction socket - healed! no pus. xray taken - no roots retained. dey uncle, u are over acting! (hehehe..xdela cakap camtu)

banyaknye paccik ni cakap, antaranya yang dapat aku ringkaskan(banyak cakap tol) ialah :

a) pacik ni rasa aku cabut sampai tertinggal roots. - tapi dalam masa sama, dia cakap masa aku cabut tu senang je, xsusah-meaning, no root retained. (paccek ni mmg confuse dgn diri sendiri)

b) paccek ni tak percaya pada budak muda cun melecun macam aku, katanya aged person more skillful - of course, thats why actually i want to reject you, but being a polite doctor, i wont do that. lepas kata macam 'me, trust more on doctor tua' dia kata jangan terasa ya - what the fish!!!

c) dia kata dia datang klinik krajaan ni sebab sambil2 lalu saja, bukan sebab betul2 nak datang-bukan sebab no money, so jangan pandang rendah. (mind ko yang memandang rendah pada orang tak berduit, sebab tu ko fikir org lain pun macam ko,tp sebenarnya dalam dunia ni ada macam2 jenis orang dan aku bukan jenis memandang rendah pada orang tak berduit, aku memandang rendah pada orang tak berakhlak!)

history - paccek ni penah ada vertebral ....itis. what the...macam penyakit2 yang hanya menyerang org hati busuk aja. bhahaha..

the pain elicited by drinking cold drinks, pain was intense, from jaw, going up to left ear. patient smokes a lot! patient has bad attitude(very important point). bad oral hygiene, several mobile teeth.

to come to the diagnosis, i'll do the scaling first ya pacek jahat!

paeds clerking

aku baru teringat nak tulis cmne nk clerk patients kt paeds. banyak ok, pasal sp paeds aku nih cerewet gilak!

c/o : yg lengkapla.. sakit bila etc.

G/C(General condition) : walk in unaided, on wheel chair, on piggy back etc..

FH (family history) : buat kotak untuk lelaki, bulat untuk pmpuan. tls umur dan medical illnes kalo ada.

SH (social hx) : seklah ke pe ke...ibubapa bercerai ke..

MH (medical hx) : ada 4 benda ( medical illness, pernah hosp[italized ke tak, ada amik ubat ke, ade allergic ke.NKDA-no known drug allergy)

DH (dental hx) : LA experience

EO (xtraoral) : mouth opening, lip

IO (intraoral) : bape bnyk caries, oral hygiene cmne

Habit : thumbsucker ke, bottlefeed lg ke, brush teeth aided or not, if aided, patient tu bg tak orang lain gosok gigi dia..atau find difficulties in brushing the pt's teeth...blabla...
- bottlefeed till sleep or not, toothpaste fluoridated or not...bosannyee haih bicara hal nih!

Diet : ada campur gula/honey ke dlm susu, frequency amek coklat..ape fav drinks- ribena/milo etc..bagi diet sheet ok.

Dx : kalo caries lebih dr 3, pt bawah 6 thn, tu ECC tau.
Mx : OH reinforcement must be one of them. do prophy or oral toilette if pt uncooperative. tooth mousse pun jgn lupa sapu
Tx plan :comprehensive dental tx under GA is the last choice orait!



LASTLY, nasib baik dh habis paeds! hehe

ortho specialist attachment is very yummy!

hehe..orthodontist ni mmg relax je. 1st week die biar jek aku buat sesuke hati aku. nak ilmu, datanglah jenguk dia, kalau tak, aku lepak bilik oficer die bukan kesah pon. heheheh....tapi sebab aku bosan tahap GIGA, so aku jenguk pe dia buat sambil tanya2 soklan yang amat bodo aku rasa. well..aku kan fydo, study 1 lecture jek, pastu stopped already (malasnye!) - aku berpendapat, daripada aku baca, then still kena marah, baiklah aku tak baca dan kena marah. (malasnya aku!!)

hari ni is the 5th day. i think i've done a lot, for a 5th day attached fydo. everything happened naturally, sp memang cakap awal2, dia takkan suruh2. so aku sndiri minta ngan staff nurse..nak buat!! kekeke..bagi aku, asalkan kita hormat skill dan pengalaman mereka, mereka akan baik dengan kita. kalau diorg btau kita sesuatu yg kita dah tau, atau kita rasa dia salah, senyap je la. show respect to them yg ada lebih pengalaman (walaupun dalam bidang tugas berbeza).Then sp ternampak aku buat2...baru la dia ada confidence in me, n dia rasa aku sndiri ada confidence, then dia akan bagi aku hands on patients dia. (begitu juga sister yg agak strict tu, asalkn kita respect dia, dia akan betul2 respect kita balik taw!! seriously!.

Tak macam paeds, aku bodo2 1st month as fydo, dia dah suruh tgk patient sesuka hati, then expect kita tahu semua benda, dapat telan sistem kat paeds tu dalam masa 1 hari, pastu fire aku ngan soklan2 yg dia je tahu jawapannya! HAIIIIIHHH...

Lately, i've learnt on how to let things happen naturally, without force. rasa tenang, senang dan tidak complicated!

O R T H O D O N T I C S N O T E S

Nak increase anchorage, kita tie 6 with 7 with a ligature wire. ataupun letak transpalatal arch (sambungkan ring kt 6 on right side to left side)

Nama2 instruments kat ortho sangat macho ok!

(xsure eja cmne)

- weingart ( untuk hold archwire)
- mathiu ( rasanya forcep utk pegang ligature wire then pusing2)
- tucker ( or tugger?) untuk masukkan lebihan ligature wire ke dalam supaya xmengganggu pt.

- distal end cutter, artery forcep, nama2 biasa.

ortho yummy

ARCHWIRE

ususally starts with size 0.012, 0.014 Ni-Ti

ada 2 types : round and rectangular.
- round guna masa 1st time pasang archwire. usually for tipping movement.
- rectangular usually used for bodily movement.

ada 2 types of material where archwire is made of :
- Nickel Titatnium(NiTi) - used for allignment ( 1st archwire used)
- Stainless steel (S/S) - late stages.

Patients can still use functional appliances when (girls) 11-12 years old, (boys) 12-13 years old. Depending on their menstruation timing, voice changes etc.

kes 1

Canine totally out of occlusion, buccally displaced. So extract canine itself to ease the treatment. If extract 4, we have to make a very good anchorage so that when we retract the canine back, 6 will not move forward (losing anchorage)

extirpate pulp sampai habis, sakitlaaa!!

hey you, the very unexperienced fydo yang agak bo***, kau banyak buat salah ok...patient datang aku plak yang kene habiskan kerja ko! tapi kalo ko tanya, aku malas nak jawab...bila ko buat salah barulah aku nak condemn ko...aii..ko bukan tanggungjawab aku...lantak ko la nak buat apa, salah, ko tanggung sendiri..aku malas nak ajar. lagipun ko dari mana..jordan? tak pernah dengar..kitorang dari UM beeeb~class!

petikan di atas ni ialah apa yang aku rasa beberapa senior aku pk. what? perbezaan sebab kaum? ---> absolutely right!!

about pulp extirpation, aku tak habes extirpate pulp dia..aku at least nak la backing diri, kata sini tak guna NaOCL, so aku 1st time buat, memangla something wrong. aku memang tak pernah kluarkan pulp seketul, sebab kalo gune NaOCL tu,pulp dia hancur kot.
dia kata tak, ko memang kene gune mechanical instrumentation walaupun gune NaOCL sekalipun. YELA, aku tahulah, tapi at least mechanical cleaning tak perlu so harsh kan, kalo dah gune NaOCL? hmmm....memangle aku salah, pueh hati? suruh ajar tak mao! eeeeeee...............!!!!!!!!!!!!

kalo extirpate pulp, sila pusing2kan barbed broach, engage pulp bebaik, then tarik kluar. memang die warna kekuningan sikit, bercampur darah. seketul panjang. macam ulat. tapi tak bergerak.

pastu, kalo ko rasa ada tertinggal lagi, janganla letak CaOH oiii....letaklah ledermix or endopaste. mereka ada analgesic property.
kalo tertinggal pulp lagi memang saket nak mati. macam patient semalam yang menjerit 'shit' dan macam mati jek, kata senior aku. (dia bukan kata macam nak mati, tapi macam mati terus...hahahah). aku rasa CaOH ada induce inflammation sket, so memang saket r. bila dah cleaning n shaping, baru boleh letak CaOH okeh!!


AKU BELAJAR HARI INI, ALHAMDULILLAH.

tapi tobat takmao panggil/tanya/minta counter sign dengan senior kaum lain tu. sombongnya, sakit hati aku, kalo bab2 kerja.
tapi time bukan bab kerja nak borak2 ngan aku baiknya...nampak sangat kaki ampu, sebab aku melayu, ko nak kiss my butt so u think i'll jaga you???

menikmati belajar sepenuhnya

Hari ni, credits to Dr Reem Abdelhafez, such a lovely, polite yet still telling me the mistakes i did and this is what we need from lecturers! A very basic thing about perio and i misunderstood it for 2years. i should be punished for this.

A perio probe grid is : 1,2,3 mm then 5mm, 8,9,10 mm. thats it.
So what if i got 7/10 for not knowing these basics, at least i learnt,now.
Compared to certain lectrs, kalau buat salah kang, jawapan tak dapat, marah dapat, akhirnya aku balik dan grad dengan kebodohan sebab tak tahu jawapan sebenar, dan bengang ngn lectrs. Rugi kan? Semua pun rugi. Rugi, rugi rugi.

Memang perio ni sekecil2 perkara tu adalah penting. Yaaa.. currettes yang halus tu nak dijolok dalam celahan gusi berdarah merah. Maaak! Pastu nak dikira berapakah milimeter die masok..mereeng..

Currettes sizes :
(gracey)
1-2 n 3-4 : anterior teeth
5-6 : anteriors and premolars
7-8 n 9-10 : posteriors facial n lingual
11-12 : posteriors mesial
13-14 : posteriors distal

abesla masa die tanya, kamu tahu kan saiz2 ni?, pastu aku buat muka biasa jek, tak jawab. Saya jawab kat sini ye doc , : saya tahu, tapi saya tak ingat sebab jarang gunakannya di klinik. Kalau kene scaling or root planing tu kan doc, saya amik je mana2 instrument yang saya suka, then kerjakan ptn tu. Patutla calculus xbanyak kluar ye doc! hehehe..Pastu, baru tahu yang currettes tu ada sharpener die sendiri. Macam asah pisau jek. Lenkali nak buat gak cam doc la! hehe..thanx Dr Reem Abdelhafez! Luv ya!!

my works today

aslmkm..
hello dear me

today you gonna do examination for a complete denture patient, so do study and equip yourself with full knowledge about history taking and treatments. Be calm and think before you start any steps. Dr B will never let you go before telling your mistakes and before telling you that you need to study more. There's just no escape exit from Dr B.

then you gonna do border molding and secondary impression for your deary patient, hukmiyah, which you're studying right know. Just remember that for a dentate patient like her, you'll use low viscosity alginate as a secondary impression material. Do check your special tray extensions by doing cheek, lip and tongue movements before proceeding with border molding. And again, be calm! There already a 2 mm spacer at dentate area and 1 mm spacer at edentulous area.

so now,gtg study..enshalla 3la 5er.

final countdown - yesterday's first ortho

Its my final year already,. what a bless.
1st year,2,3,4...semua ni adalah semata-mata rahmat Allah yang membolehkan saya naik hingga tahun 5. Sungguh, usaha aku sekecil zarah, semata-mata rahmatNya yang membolehkan aku lepas and smoothly went to 5th yr.

SEMANGAT! Motivasi aku untuk tahun ini sangat kuat, sebab target aku adalah graduate pada bulan 6, then going home for gooood.it sooo goooood yeah.

So, insyaAllah, usaha sungguh-sungguh, study tak kira masa(isk!!), hafal, jangan main...uwaaaaa..

semalam, ortho clinic was very dissapointing.

Remember, nur :

diagnosis : class 1 complicated with anterior diastema.
ideal treament : fix appliance

p/s : u must have an eagle eye, check everything and especially that relates to your case.

e.g : a patient needs headgear, so check his upper 6s if they're carious or else.
if a patient needs headgear and has increased lower facial height, the patient is not a suitable candidate for low pll headgear orait!!!

So nur, keep it up!

wrong answer!

I never answer Dr M's question correctly. NEVER. What in the world i've been studying?

IN SMOKER PATIENT : GINGIVAL INFLAMMATION WILL DECREASED AND THE PATIENT IS IMMUNOSUPRESSED

Here the details about Effect of smoking

Microbiology : no eefect on microb acumulation
Immunological : altered neutrophil chemotaxis function, increased neutrophil collagenase and elastase in GCF, increased production of PGE
Physiology : increased gingival blood vessels with increased inflammation (gingival bv only increased with increasing inflamm.!)

gingivitis : decreased inflammation and bleeding on probing
periodontitis : increase prevalence and severity of periodontal destruction, increase pocket depth,attachment loss and bone loss, increase rate of destruction and prevalence of severe periodontitis, increase tooth loss, increase prevalence with increased number of cigarette per day, decrease prevalence and severity with smoking cessation.

Fuh, gotta study more and more and moree

What are the local factors affecting the gingiva?
- unreplaced missing teeth
- malocclusion
- occlusal trauma
- mouth breathing
- parafunctional habits (clenching,bruxism,tongue thrust,trauma from objects)

hallo friends lets STUDY

prostho 5 - still fail, some ortho thingy

I'm taking prostho 5 right now, and still failed taking impression...what the!

Obviously i need to study more and increase my memory capasity.

How does a good impression looks like?

Actually what we need from an impression is just the area which will be covered by the denture and few soft tissue areas which will affect masticatory functions and also soft tissues that will be touching the denture.

Usually in upper impression, impression should cover the functional depth of labial sulcus till beyond posterios border of hard palate, and laterally from functional depth of buccal sulcus of one side to the other side.

As for lower impression, impression should cover from the functional depth of labial sulcus till the retromolar pad and laterally from buccal sulcus to buccal sulcus of each side. Tongue should be protruded to the extent required to moisten the lips to make the impression with the floor of the mouth raised to functional position.

The position of the patient should be upright as to avoid patient choked by the material in used.

Impression trays
Selection of Stock Trays
Should cover :

-maxillary : entire alveolar ridge, maxillary tuberosities and both hamular notch, provide enough space for impression material

-mandibular : entire alveolar ridge, retromolar pad, should not be short in posterior lingual pouch area, tongue should not be trapped under lingual flange.

Modification of stock tray
- stock tray can be modified by addition of wax to the borders to ensure correct tray xtension (if alginate used)
-metal tray could be modified by using pliers to create space for impression material.

*believe it or not, these was what i've been questioning this morning and gosh, i got hampes-marks for i dont study. I only knew the answers this evening and grr!!


Ortho examination

1) Name, cc, MH
2) extraoral exm. : soft and hard tissue( profile, skeletal class, lower facial height, ricketts line(lip competence), frankfort line to ....angle)
2) intraoral exm.
- anterior posterior : overjet (eg:class 2 div 1)
- vertical : overbite
- transverse : presence of crossbite
3) treatment plan : removable appliance if not so severe, functional appliance if still growing, fix appliance if severe crowding and beyond growth time.