Bismillah..
Kesihatan umum atau public health ini merujuk kepada kesihatan masyarakat umumnya dan juga pengkhususan dalam bidang pergigian yang mengurus kesihatan mulut dalam masyarakat berbanding individu. Pakar perlu menasihati dan menggalakan polisi untuk mempromosikan penjagaan mulut yang baik dan terlibat dengan aktiviti yang memelihara masyarakat daripada preventable disease dan juga kemudharatan yang lain. Praktis public health ini juga dikenali dengan nama
*public health dentistry
* community dentistry
bergantung kepada saintifik asas dalam epidemiology, yang mana berkaitan dengan study of distribution and determinants of health and disease in populations. Semua dentist perlu sedar akan faktor sosial dan persekitaran yang mempengaruhi status kesihatan pesakit tersebut.
Ukuran kepada public health untuk faktor individu seperti kandungan florida dalam air dan tempat kerja yang bebas daripada tembakau. Faktor kepada masyarakat pula seperti kawasan perumahan, nutrisi dan employment adalah sama atau signfikan. Dentist jarang boleh rawat faktor sosial kepada individu pesakit walaupun mereka sepatutnya rujuk pesakit tersebut kepada social service yang lain. Walau bagaimana pun mereka boleh menyumbang secara tidak langsung kepada solusi jangka masa panjang dengan partisipasi dalam public health dan aktiviti pendidikan kesihatan, memantau dan melaporkan persekitaran yang berbahaya, mengenal pasti dan menghebahkan kesan kesihatan daripada masalah sosial seperti penderaan, dan menggalakkan penambahbaikan untuk perkhdmatan kesihatan umum.
Kadang2 kehendak public health boleh menghadapi konflik dengan individu pesakit.
Contohnya, apabila notification diperlukan untuk penyakit berjangkit atau kes penderaan. Ini adalah contoh kes dual loyalty. Secara umumnya, dentist perlu berusaha untuk minimumkan bahaya kepada individu pesakit yang mungkin akan sengsara selepas memenuhi tuntutan public health. Contohnya, apabila melaporkan sesuatu kes, confidentiality pesakit perlu dijaga dengan sebaiknya.
Terdapat konflik yang berlaku antara kehendak pesakit dan masayarakat apabila dentist disuruh untuk membantu pesakit untuk mendapatkan keuntungan yang tidak layak bagi pesakit untuk menerimanya, contohnya pembayaran insuran. Dentist punya kuasa untuk 'membantu' pesakit dalam hal ini dan melayakkan pesakit untuk menerimanya. Walaupun ada sesetengah dentist yang rela utk certificate ini mereka sepatutnya membantu pesakit yang tidak melibatkan unethical behaviour.
Saturday, 8 August 2015
Resource allocation
Bismillah...
Setiap negara di dunia ini termasuklah negara kaya, ada gap yang besar antara keperluan dan kehendak health-care servis dan kewujudan sumber untuk menyediakan khidmat ini.
Health-care rationing berlaku 3 peringkat.
1) Highest level (macro)
kerajaan menentukan berapa banyak bajet keseluruhan yang diperuntukkan untuk kesihatan; yang mana perbelanjaan kesihatan tidak dikenakan sebarang bayaran dan keperluan pembayaran secara terus daripada pesakit atau plan insuran. Dalam bajet tersebut, berapa banyak yang akan dibayarkan kepada pekerja keshiatan, modal dan perbalanjaan untuk hospital, kajian, pendidikan kesihatan professional, rawatan kondisi yang tertentu seperti tuberculosis atau AIDS dsb.
2) Instituional level (meso)
Termasuklah hospital, klinik, agensi kesihatan, pegawai pergigian, atau autoriti yang lain tentukan berapa banyak yang hndak diperuntukkan utnuk sumber: yang mana servis yang hendak ditawarkan, berpa banyak yang dibelanjakan untuk staff, peralatan, keselamatan, perbelanjaan yang lain, renovasion db.
3) Individual ( micro)
dentist menentukan berapa kali untuk buat radiographic test, simple atau copex treatment, perlu rujukan dentist yang lain.Meskipun ada pengurusan kesihatan yang makin berkembang, dentist ada kebebasan yang mana sumber yang sepatutnya pesakti assess.
Pilihan yang dibuat setiap peringkat, ada major ethical component kerana berdasarkan kepada nilai dan kesan yang signifikan kepada kesihatan dan perkembangan individu dan masyarakat. Dentist terlibat dalam menentukan keputusan di semua peringkat.
Dentist ini diharap untuk bertindak berdasarkan kepada kehendak pesakit. Core ethical values of compassion, competence and autonomyare dircted towards servind thier own patients.. This individualistic approcah ti dental ethics has survived the transition from dentist paternalism to patient autonomy, di mana kehendak pesakit adalam kriteria utama dalam menentukan sumber apa yang perlu dia terima. Walau bagaimanapun, keadilan (justice) jadi isu utk dental decsion making. ia melibatkan pendekatan sosial yang melihat kepada pesakit ynag lain juga. Dentist bukan sahaj bertanggungjawab kepada pesakitnya sahaj tetapi juga kepada yang lain.
Pemahaman baharu tentang tanggunjawab seorang drgigi ini ada termaktub dalam FDI International Principles of Ethics for the Dental Profession di mana
"Dentist perlu sokong dan promote ukuran yang diterima untuk meningkatkan penjagaan mulut masyarakat. "
Satu cara yang dentist boleh aplikasikan tanggungjawab ini dengan cara mengelakkan diri daripada rawatan yang membazirdan yang tidak efektif walaupun datang daripada permintaan pesakit. Terdapat panduan yang untuk rawatan pergigian., mereka membantu untuk membezakan rawatan yang efektif dan tidak efektif. Dentist perlu membiasakan diri mereka dengan panduan ini , kedua-duanya utk memelihara tindakan dan menyediakan rawatan yang optimum kepada pesakit.
Satu keputusan yang dentist perlu ambil adalah dengan memilih pesakit yang memerlukan penjagaan termasuklah mereka yang tidak mampu untuk membayar rawatan tersebut. Dentist mesti memutuskan pesakit mana yang perlukan rawatannya dan yang mana tidak, mengetahui siapa yang tidak menerima rawatannya akan menderita.
Antara pendekatan yang boleh dentist gunakan.
libertarian- resources mesti diedarkan mengikut prinsip pasaran( pilihan individu dengan kemampuan dan kerelaan untuk membayar, dengan kebajikan yang terhad kepada golongan susah.
utilitarian- resources mesti diedarkan mengikut prinsip faedah yang maksimum kepada semua.
egalitarian- resources mesti diedarkan mengikut keperluan
restorative- resources mesti diedarkan so as to favour the historically disadvantaged.
Tidak seperti perubatan, pergigian dulunya telah menggunakan pendekatan libertarian, yang mana diterima oleh kerajaan yang tidak meletakkan penjagaan mulut sebagai prioriti. Walau bagaimanapun, kesedaran terhadap penjagaan oral dan kesihatan secara umumnya kepada masyarakat semakin meningkat. Dari perspektif ini, pendekatan libertarian tidak mencukupi kerana ianya meninggalkan satu bahagian daripada populasi yang tidak mendapat penjagaan mulut dengan baik. Dentist mula menyedari bahawa mereka mempunyai tanggungjawab terhadap golongan ini dan kepada mereka yang menerima rawatan penjagaan mulut dengan baik ( patients). Tanggungjawab ini tidaklah berada di atas bahu dentist semata tetapi memerlukan sokongan daripada badan2 politik untuk menyediakan dana untuk rawatan asas penjagaan mulut kepada mereka yang kurang berkemampuan. Dentist perlu berfikir bagaimana hendak memenuhi keperluan pesakit . Persatuan dr2 gigi perlu memainkan peranan, dengan cara
1) mewujudkan polisi mempromosikan penjagaan kesihatan mulut (universal access)
2) mempengaruhi badan2 politik yang berautoriti untuk memberi dana
Sekiranya pendekatan libertarian ini tidak memenuhi keperluan penjagaan mulut, adakah 3 yang lain boleh mencapai matlamat ini? Tiada persetujuan yang dicapai siapa yang berada di atas siapa ( pendekatan) . Setiap daripada pendekatan itu berbeza hasilnya apabila diaplikasikan dalam isu di atas sama ada pada peringkat macro, meso atau micro. Pendekatan utilitarian bermanfaat untuk health planners, tetapi sukar diamalkan oleh dentist kerana ia memerlukan pengumpulan data yang menghasilkan pelbagai keputusan, bukan hanya pesakit dentist sahaja tetapi kepada semua. Pemilihan antara 2 yang lain bergantung kepada morality dentist dan juga keadaan sosio-poltik tempat dentist bekerja.
USA: libertarian
Sweden: egalitarian
South Africa: restorative approach.
Meskipun dengan perbezaan pendapat ini, 2 atau lebih konsep keadilan ini wujud dalam sistem kesihatan kebangsaan, dan dalam negara ini dentist boleh untuk memilih setting ( wealthy or poor neighbourhood, urban or rural community) mengikut kepada pemilihan pendekatannya.
Setiap negara di dunia ini termasuklah negara kaya, ada gap yang besar antara keperluan dan kehendak health-care servis dan kewujudan sumber untuk menyediakan khidmat ini.
Health-care rationing berlaku 3 peringkat.
1) Highest level (macro)
kerajaan menentukan berapa banyak bajet keseluruhan yang diperuntukkan untuk kesihatan; yang mana perbelanjaan kesihatan tidak dikenakan sebarang bayaran dan keperluan pembayaran secara terus daripada pesakit atau plan insuran. Dalam bajet tersebut, berapa banyak yang akan dibayarkan kepada pekerja keshiatan, modal dan perbalanjaan untuk hospital, kajian, pendidikan kesihatan professional, rawatan kondisi yang tertentu seperti tuberculosis atau AIDS dsb.
2) Instituional level (meso)
Termasuklah hospital, klinik, agensi kesihatan, pegawai pergigian, atau autoriti yang lain tentukan berapa banyak yang hndak diperuntukkan utnuk sumber: yang mana servis yang hendak ditawarkan, berpa banyak yang dibelanjakan untuk staff, peralatan, keselamatan, perbelanjaan yang lain, renovasion db.
3) Individual ( micro)
dentist menentukan berapa kali untuk buat radiographic test, simple atau copex treatment, perlu rujukan dentist yang lain.Meskipun ada pengurusan kesihatan yang makin berkembang, dentist ada kebebasan yang mana sumber yang sepatutnya pesakti assess.
Pilihan yang dibuat setiap peringkat, ada major ethical component kerana berdasarkan kepada nilai dan kesan yang signifikan kepada kesihatan dan perkembangan individu dan masyarakat. Dentist terlibat dalam menentukan keputusan di semua peringkat.
Dentist ini diharap untuk bertindak berdasarkan kepada kehendak pesakit. Core ethical values of compassion, competence and autonomyare dircted towards servind thier own patients.. This individualistic approcah ti dental ethics has survived the transition from dentist paternalism to patient autonomy, di mana kehendak pesakit adalam kriteria utama dalam menentukan sumber apa yang perlu dia terima. Walau bagaimanapun, keadilan (justice) jadi isu utk dental decsion making. ia melibatkan pendekatan sosial yang melihat kepada pesakit ynag lain juga. Dentist bukan sahaj bertanggungjawab kepada pesakitnya sahaj tetapi juga kepada yang lain.
Pemahaman baharu tentang tanggunjawab seorang drgigi ini ada termaktub dalam FDI International Principles of Ethics for the Dental Profession di mana
"Dentist perlu sokong dan promote ukuran yang diterima untuk meningkatkan penjagaan mulut masyarakat. "
Satu cara yang dentist boleh aplikasikan tanggungjawab ini dengan cara mengelakkan diri daripada rawatan yang membazirdan yang tidak efektif walaupun datang daripada permintaan pesakit. Terdapat panduan yang untuk rawatan pergigian., mereka membantu untuk membezakan rawatan yang efektif dan tidak efektif. Dentist perlu membiasakan diri mereka dengan panduan ini , kedua-duanya utk memelihara tindakan dan menyediakan rawatan yang optimum kepada pesakit.
Satu keputusan yang dentist perlu ambil adalah dengan memilih pesakit yang memerlukan penjagaan termasuklah mereka yang tidak mampu untuk membayar rawatan tersebut. Dentist mesti memutuskan pesakit mana yang perlukan rawatannya dan yang mana tidak, mengetahui siapa yang tidak menerima rawatannya akan menderita.
Antara pendekatan yang boleh dentist gunakan.
libertarian- resources mesti diedarkan mengikut prinsip pasaran( pilihan individu dengan kemampuan dan kerelaan untuk membayar, dengan kebajikan yang terhad kepada golongan susah.
utilitarian- resources mesti diedarkan mengikut prinsip faedah yang maksimum kepada semua.
egalitarian- resources mesti diedarkan mengikut keperluan
restorative- resources mesti diedarkan so as to favour the historically disadvantaged.
Tidak seperti perubatan, pergigian dulunya telah menggunakan pendekatan libertarian, yang mana diterima oleh kerajaan yang tidak meletakkan penjagaan mulut sebagai prioriti. Walau bagaimanapun, kesedaran terhadap penjagaan oral dan kesihatan secara umumnya kepada masyarakat semakin meningkat. Dari perspektif ini, pendekatan libertarian tidak mencukupi kerana ianya meninggalkan satu bahagian daripada populasi yang tidak mendapat penjagaan mulut dengan baik. Dentist mula menyedari bahawa mereka mempunyai tanggungjawab terhadap golongan ini dan kepada mereka yang menerima rawatan penjagaan mulut dengan baik ( patients). Tanggungjawab ini tidaklah berada di atas bahu dentist semata tetapi memerlukan sokongan daripada badan2 politik untuk menyediakan dana untuk rawatan asas penjagaan mulut kepada mereka yang kurang berkemampuan. Dentist perlu berfikir bagaimana hendak memenuhi keperluan pesakit . Persatuan dr2 gigi perlu memainkan peranan, dengan cara
1) mewujudkan polisi mempromosikan penjagaan kesihatan mulut (universal access)
2) mempengaruhi badan2 politik yang berautoriti untuk memberi dana
Sekiranya pendekatan libertarian ini tidak memenuhi keperluan penjagaan mulut, adakah 3 yang lain boleh mencapai matlamat ini? Tiada persetujuan yang dicapai siapa yang berada di atas siapa ( pendekatan) . Setiap daripada pendekatan itu berbeza hasilnya apabila diaplikasikan dalam isu di atas sama ada pada peringkat macro, meso atau micro. Pendekatan utilitarian bermanfaat untuk health planners, tetapi sukar diamalkan oleh dentist kerana ia memerlukan pengumpulan data yang menghasilkan pelbagai keputusan, bukan hanya pesakit dentist sahaja tetapi kepada semua. Pemilihan antara 2 yang lain bergantung kepada morality dentist dan juga keadaan sosio-poltik tempat dentist bekerja.
USA: libertarian
Sweden: egalitarian
South Africa: restorative approach.
Meskipun dengan perbezaan pendapat ini, 2 atau lebih konsep keadilan ini wujud dalam sistem kesihatan kebangsaan, dan dalam negara ini dentist boleh untuk memilih setting ( wealthy or poor neighbourhood, urban or rural community) mengikut kepada pemilihan pendekatannya.
Friday, 7 August 2015
Dual loyalty
Bismillah..
Apabila dr gigi mempunyai tanggungjawab dan diperlukan oleh pesakit dan pihak ketiga (third parties) dan apabila tanggungjawab ini tidak dapat dipenuhi menimbulkan masalah 'dual loyalty'. Pihak ketiga demand dr gigi termasuklah kerajaan, majikan, pegawai tentera, pols, pegawai penjara dan ahli keluarga, Apabila Principles of Ethics for Dental Professiion itu bukan lagi menjadi concern , kadang2 dr gigi perlu meletakkan kehendak orang lain melebihi pesakit. Cabaran timbul apabila dr gig terpaksa untuk memutuskan bagaiaman untuk melindungi pesakit daripada pengaurh pihak ketiga.
Dual loyalty terdiri daripada spektrum yang bermula dengan kehendak masyarakat yang sepatutnya diberi keutamaan dan kebajikan pesakit yang sudah terang lagi bersuluh kepentingannya. Antara skala itu, adanya 'grey area' yang memerlukan kecerdikan dr gigi untuk mnegatasai masalah tersebut.
Dari satu sudut, keperluan melaporkan pesakit yang menghidap penyakit yang berjangkit atau kes2 seperti penderaan. Dr gigi perlu memenuhi keperluan ini tanpa rasa berat hati walaupun pesakit sepattunya diberitahu terlebih dahulu akan laporan ini. Dari sudut yang lain pula, arahan daripada pihak polis atau tentera untuk terlibat dalam hal yang mengangg hak2 manusia seperti penderaan. Dalam situasi ini dr gigi perlu memenuhi tanggungjawab professional nya dengan menentukan yang terbaik bagi kehendak pesakit dan sepatutnya memerhati sejauh yang mungkin normal ethical requirements of informed consent and confidentiality. Sekiranya ada pelanggaran dalam requirements ini perlu diadili dan mesti dimaklumkan kepada pesakit. Dr gigi perlu melaporkan kepada pihak berwajib tentang perkara yang tidak adil dalam penjagaan pesakit lagi2 jika hak2 manusia dinafikan. Jika pihak berwajib tidak membalas, boleh rujuk kepada persatuan pergigian negara, FDI dan organisasi hak2 manusia.
Semakin dekat dengan pertengahan spektrum, praktis program pengurusan kesihatan yang menterhadkan autonomi untuk menentukan bagaimana pesakit harus dirawati. Walaupun praktis itu tidak semestinya bertentangan untuk pesakit, dr gigi perlu timbang tara dengan baik sama ada mereka perlu melibatkan diri atau tidak dalam program tersebut, Sekiranya mereka tidak punya pilihan seperti tiada alternatif program, dr gigi perlu memberi sokongan yang kuat kepada pesakitnya dan melalui persatuan pergigian, untuk keperluan pesakit yang dipengaruhi oleh polisi tersebut.
Isu dual loyalty yang dihadapi oleh dentist apabila berlaku konflik kehendak antara organisasi komersial dengan pesakit dan masyarakat. Syarikat farmasi, pengeluar alatan pergigian dan pembekal kerap kali menawarkan dentist hadiah atau keuntungan dengan menawarkan ia dengan percuma atau melancong atau mengadakan program pendidikan sehinggalah gaji yang lumayan terhadap kajian tertentu. Ini dilakukan atas sebab untuk meyakinkan dentist menggunkan produk mereka, yang mana mungkin tidak sesuai untuk pesakit atau tidak diperlukan oleh pesakit yang hanya menambahkan kos rawatan.
Primary ethical principle of dentist:
Dentist mesti selesaikan masalah antara kehendak sendiri dan keadaan pesakit. Dengan lebih spesifik, dentist digalakkan untuk mengikuti nasihat ADA Principles of Ethics and Code of Professional Conduct:
Perkara2 yang berkaitan dengan health-related product, tidak mencukupi dentist hanya bergantung kepada pengeluar atau pengedar tenatang keselamatan dan kualiti produk tersebut. Dentist boleh bertanya tentang kebenaran dan ketepatan dakwaan dan menilai berdasarkan ilmu atau kajian saintifik.
Apabila dr gigi mempunyai tanggungjawab dan diperlukan oleh pesakit dan pihak ketiga (third parties) dan apabila tanggungjawab ini tidak dapat dipenuhi menimbulkan masalah 'dual loyalty'. Pihak ketiga demand dr gigi termasuklah kerajaan, majikan, pegawai tentera, pols, pegawai penjara dan ahli keluarga, Apabila Principles of Ethics for Dental Professiion itu bukan lagi menjadi concern , kadang2 dr gigi perlu meletakkan kehendak orang lain melebihi pesakit. Cabaran timbul apabila dr gig terpaksa untuk memutuskan bagaiaman untuk melindungi pesakit daripada pengaurh pihak ketiga.
Dual loyalty terdiri daripada spektrum yang bermula dengan kehendak masyarakat yang sepatutnya diberi keutamaan dan kebajikan pesakit yang sudah terang lagi bersuluh kepentingannya. Antara skala itu, adanya 'grey area' yang memerlukan kecerdikan dr gigi untuk mnegatasai masalah tersebut.
Dari satu sudut, keperluan melaporkan pesakit yang menghidap penyakit yang berjangkit atau kes2 seperti penderaan. Dr gigi perlu memenuhi keperluan ini tanpa rasa berat hati walaupun pesakit sepattunya diberitahu terlebih dahulu akan laporan ini. Dari sudut yang lain pula, arahan daripada pihak polis atau tentera untuk terlibat dalam hal yang mengangg hak2 manusia seperti penderaan. Dalam situasi ini dr gigi perlu memenuhi tanggungjawab professional nya dengan menentukan yang terbaik bagi kehendak pesakit dan sepatutnya memerhati sejauh yang mungkin normal ethical requirements of informed consent and confidentiality. Sekiranya ada pelanggaran dalam requirements ini perlu diadili dan mesti dimaklumkan kepada pesakit. Dr gigi perlu melaporkan kepada pihak berwajib tentang perkara yang tidak adil dalam penjagaan pesakit lagi2 jika hak2 manusia dinafikan. Jika pihak berwajib tidak membalas, boleh rujuk kepada persatuan pergigian negara, FDI dan organisasi hak2 manusia.
Semakin dekat dengan pertengahan spektrum, praktis program pengurusan kesihatan yang menterhadkan autonomi untuk menentukan bagaimana pesakit harus dirawati. Walaupun praktis itu tidak semestinya bertentangan untuk pesakit, dr gigi perlu timbang tara dengan baik sama ada mereka perlu melibatkan diri atau tidak dalam program tersebut, Sekiranya mereka tidak punya pilihan seperti tiada alternatif program, dr gigi perlu memberi sokongan yang kuat kepada pesakitnya dan melalui persatuan pergigian, untuk keperluan pesakit yang dipengaruhi oleh polisi tersebut.
Isu dual loyalty yang dihadapi oleh dentist apabila berlaku konflik kehendak antara organisasi komersial dengan pesakit dan masyarakat. Syarikat farmasi, pengeluar alatan pergigian dan pembekal kerap kali menawarkan dentist hadiah atau keuntungan dengan menawarkan ia dengan percuma atau melancong atau mengadakan program pendidikan sehinggalah gaji yang lumayan terhadap kajian tertentu. Ini dilakukan atas sebab untuk meyakinkan dentist menggunkan produk mereka, yang mana mungkin tidak sesuai untuk pesakit atau tidak diperlukan oleh pesakit yang hanya menambahkan kos rawatan.
Primary ethical principle of dentist:
Dentist mesti selesaikan masalah antara kehendak sendiri dan keadaan pesakit. Dengan lebih spesifik, dentist digalakkan untuk mengikuti nasihat ADA Principles of Ethics and Code of Professional Conduct:
Perkara2 yang berkaitan dengan health-related product, tidak mencukupi dentist hanya bergantung kepada pengeluar atau pengedar tenatang keselamatan dan kualiti produk tersebut. Dentist boleh bertanya tentang kebenaran dan ketepatan dakwaan dan menilai berdasarkan ilmu atau kajian saintifik.
Keistimewaan hubungan dr gigi dan masyarakat
Bismillah..
Pegigian in adalah satu profession. Profession ada 2 maksud..
1)pekerjaan yang kena buat baik pada org lain, mempunyai moral yang tingggi, berilmu dan berkemahiran dan ada autonomi yang tinggi.
2) individu yang mempraktikkan pekerjaan ini.
Dental profession boleh membawa maksd
* practice of dentistry
*dentist (in general)
dr gigi bukan hanya berinteraksi dengan pesakit semata . Dr gigi juga terlibat dgn masyarakat. Hubungan ini dinamakan sebagai social contract atau kontrak sosial yang mana masyarakat membenarkan hak keistimewaan profession (privilege)ini termasuklah
* exclusive or primary responsibility for the provision of certain services and high degree of self-regulation.
dan sebagai balasannya, profession bersetuju untuk menggunakan keistimewaan ini untuk memberi keutamaan (manfaat) pada orang lain dan yang kedua baru keutamaan untuk dirinya. (secondarily for its own benefit)
Walaupun kebanyakan dr gigi menyatakan bahawa mereka adalah "private practicioners" pergigian ini merangkumi aktiviti sosial dan individu. Ia mengambil tempat dalam konteks kerajaan ( and corporate regulation and funding. Dr gigi bergantung kepada akademik dan kajian pergigian serta kemajuan produk sebagai asas kepada ilmu dan rawatannya di mana mereka merawat punca utama penyakit yang mana berpunca dari sudut biologinya atau masyarakat.
Teori Hippocrates tidak banyak membincangkan soal hubungan dr gigi dan masyarakat. Untuk mengatasi isu ini dental ethics cuba menaikkan hal ini dan menyediakan kriteria dan proses untuk hadapi isu ini.
Apa makna masyarakat?
Masyarakat merujuk kepada masayarakat atau "nation". Bukan bermakna kerajaan kerana kebiasaanya kerajaaan tidak mewakili kehendak masyarakat dan sekiranya mereka memenuhi kehendak masyarakat ia dipanggil perbuatan untuk masyarakat bukan masyarakat itu sendiri.
Hubungan antara dr gigi dan masyarakat ini pelbagai. Hal ini kerana masyarakat dan keadaan persekitaran fizikalnya adalah faktor yang signifikan yang mempengaruhi kesihatan pesakit. Dental profession dan dr gigi sendiri berperanan dalam kesihatan umum, pendidikan kesihatan, perlindungan persekitaran, undang2 yang mempengaruhi kesihatan atau 'well being' masyarakat dan bukti dalam prosiding mahkamah. Dr gigi berperanan dalam peruntukan masyarakat sebagai sumber penjagaan kesihatan dan bertanggungjawab dalam mengelakkan pesakit daripada rawatan yang tidak layak baginya untuk merawat. Mempraktikkan tanggungjawab ini boleh menimbulkan konflik etics terutamanya kehendak masyarakat yang seolah-olah bermasalah pada individu pesakit. Tambahan lagi, hubungan dr gigi dan masyarakat ini berubah dan perlu review yang berterusan untuk memastikan keperluan masyarakat dapat dipenuhi.
Jenuh jugakla nak menterjemah ni..huhu =,=
Pegigian in adalah satu profession. Profession ada 2 maksud..
1)pekerjaan yang kena buat baik pada org lain, mempunyai moral yang tingggi, berilmu dan berkemahiran dan ada autonomi yang tinggi.
2) individu yang mempraktikkan pekerjaan ini.
Dental profession boleh membawa maksd
* practice of dentistry
*dentist (in general)
dr gigi bukan hanya berinteraksi dengan pesakit semata . Dr gigi juga terlibat dgn masyarakat. Hubungan ini dinamakan sebagai social contract atau kontrak sosial yang mana masyarakat membenarkan hak keistimewaan profession (privilege)ini termasuklah
* exclusive or primary responsibility for the provision of certain services and high degree of self-regulation.
dan sebagai balasannya, profession bersetuju untuk menggunakan keistimewaan ini untuk memberi keutamaan (manfaat) pada orang lain dan yang kedua baru keutamaan untuk dirinya. (secondarily for its own benefit)
Walaupun kebanyakan dr gigi menyatakan bahawa mereka adalah "private practicioners" pergigian ini merangkumi aktiviti sosial dan individu. Ia mengambil tempat dalam konteks kerajaan ( and corporate regulation and funding. Dr gigi bergantung kepada akademik dan kajian pergigian serta kemajuan produk sebagai asas kepada ilmu dan rawatannya di mana mereka merawat punca utama penyakit yang mana berpunca dari sudut biologinya atau masyarakat.
Teori Hippocrates tidak banyak membincangkan soal hubungan dr gigi dan masyarakat. Untuk mengatasi isu ini dental ethics cuba menaikkan hal ini dan menyediakan kriteria dan proses untuk hadapi isu ini.
Apa makna masyarakat?
Masyarakat merujuk kepada masayarakat atau "nation". Bukan bermakna kerajaan kerana kebiasaanya kerajaaan tidak mewakili kehendak masyarakat dan sekiranya mereka memenuhi kehendak masyarakat ia dipanggil perbuatan untuk masyarakat bukan masyarakat itu sendiri.
Hubungan antara dr gigi dan masyarakat ini pelbagai. Hal ini kerana masyarakat dan keadaan persekitaran fizikalnya adalah faktor yang signifikan yang mempengaruhi kesihatan pesakit. Dental profession dan dr gigi sendiri berperanan dalam kesihatan umum, pendidikan kesihatan, perlindungan persekitaran, undang2 yang mempengaruhi kesihatan atau 'well being' masyarakat dan bukti dalam prosiding mahkamah. Dr gigi berperanan dalam peruntukan masyarakat sebagai sumber penjagaan kesihatan dan bertanggungjawab dalam mengelakkan pesakit daripada rawatan yang tidak layak baginya untuk merawat. Mempraktikkan tanggungjawab ini boleh menimbulkan konflik etics terutamanya kehendak masyarakat yang seolah-olah bermasalah pada individu pesakit. Tambahan lagi, hubungan dr gigi dan masyarakat ini berubah dan perlu review yang berterusan untuk memastikan keperluan masyarakat dapat dipenuhi.
J
Friday, 24 July 2015
Does dental ethics change
Bismillah..
There can be a little doubt that some aspects of dental ethics have changed over the years. Until recently dentists had the right and the duty to decide how patients should be treated and there was no obligation to obtain the patient's informed consent. In contrast, the UK General Dental Council now advises dentist that : " It is a general legal and ethical principle that you must get valid consent before starting treatment or physical investigation, or providing personal care, for a patient. This principle reflects the right of patients to determine what happens to their own bodies and is a fundamental part of good practice. " Many individuals now consult the Internet and other sources of health information and are not prepared to accept the recommendations of dentists unless these are fully explained and justified. Although this insistence on informed decision making is far from universal, it does seem to be spreading and is symptomatic of a more general evolution in the patient-dentist relationship that gives rise to different ethical obligations for dentist than previously.
Until recently, dentist generally considered themselves accountable only to themselves, to their colleagues in the dental profession and, for religious believers, to god. Nowadays, they have additional accountabilities- to their patients, to third parties such as managed health care organisations, to dental licensing and regulatory authorities, and often to court of law. These different accountabilities can conflict with one another.
Dental ethics has changed in other ways. Whereas until recently the sole responsibility of dentist was to their individual patients, nowadays it is generally agreed that dentist should also consider the needs of society for example, in allocating scarce health care resources. Moreover advances in dental science and technology raise new ethical issues that cannot be answered by traditional dental ethics. Health informatics and electronic patient records, changing patterns of practice and expensive new devise have great potential for benefiting patients but also potential for harm depending on how they are used. To help dentists decide whether and under what conditions they should utilise these resources, dental associations need to use different analytic methods than simply relying on existing codes of ethics.
Despite these obvious changes in dental ethics, there is widespread agreement among dentists that the fundamental values and ethical principles of dentistry do not, or at least should not change. Since it is inevitable that human beings will always be subject to oral disease, they will continue to have need of compassionate, competent and autonomous dentist to care for them.
Does Dental Ethics Differ from One Country to another?
Just as dental ethics can and does change over time, in response to developments in dental science and technology as well as in societal values, so does it vary from ome country to another depending on these same factors. On advertising for example, there is a significant difference of opinion among national dental associations. Some associations forbid it but others are neutral and still others it under certain conditions. Likewise, regarding access to oralhelath care, some national associations support the equality of all citizens whereas others are willing to tolerate great inequalitues. In some countries there is considerable interest in the ethical issues posed by advances dental technology whereas in countries that do not have access to such technology there ethical issues do not arise.
Dentist in some countries are confident that they will not be forced by their government to do anything unethical while in other countries it may be difficult for them to meet their ethical obligations, for example, to maintain the confidentiality of patients in the face of police or army requirements to report suspicious injuries; any such encouragement of dentist to act unethically shoul be matter of great concern. Although these differences may seem significant, similarities are far greater. Dentist throughout the world have much in common, and when they come together in organisations such as the FDI, they usually achieve agreement on controversial ethical issues, though this often requires lengthy debate. The fundamental values of dental ethics such as compassion, competence and autonomy, along with dentists' experience and skills in all aspects of dentistry, provide a sound basis for analysing ethicaliissues in dentistry and arriving at solutions that are in the best interest of individual patients and citizens and public health in general.
There can be a little doubt that some aspects of dental ethics have changed over the years. Until recently dentists had the right and the duty to decide how patients should be treated and there was no obligation to obtain the patient's informed consent. In contrast, the UK General Dental Council now advises dentist that : " It is a general legal and ethical principle that you must get valid consent before starting treatment or physical investigation, or providing personal care, for a patient. This principle reflects the right of patients to determine what happens to their own bodies and is a fundamental part of good practice. " Many individuals now consult the Internet and other sources of health information and are not prepared to accept the recommendations of dentists unless these are fully explained and justified. Although this insistence on informed decision making is far from universal, it does seem to be spreading and is symptomatic of a more general evolution in the patient-dentist relationship that gives rise to different ethical obligations for dentist than previously.
Until recently, dentist generally considered themselves accountable only to themselves, to their colleagues in the dental profession and, for religious believers, to god. Nowadays, they have additional accountabilities- to their patients, to third parties such as managed health care organisations, to dental licensing and regulatory authorities, and often to court of law. These different accountabilities can conflict with one another.
Dental ethics has changed in other ways. Whereas until recently the sole responsibility of dentist was to their individual patients, nowadays it is generally agreed that dentist should also consider the needs of society for example, in allocating scarce health care resources. Moreover advances in dental science and technology raise new ethical issues that cannot be answered by traditional dental ethics. Health informatics and electronic patient records, changing patterns of practice and expensive new devise have great potential for benefiting patients but also potential for harm depending on how they are used. To help dentists decide whether and under what conditions they should utilise these resources, dental associations need to use different analytic methods than simply relying on existing codes of ethics.
Despite these obvious changes in dental ethics, there is widespread agreement among dentists that the fundamental values and ethical principles of dentistry do not, or at least should not change. Since it is inevitable that human beings will always be subject to oral disease, they will continue to have need of compassionate, competent and autonomous dentist to care for them.
Does Dental Ethics Differ from One Country to another?
Just as dental ethics can and does change over time, in response to developments in dental science and technology as well as in societal values, so does it vary from ome country to another depending on these same factors. On advertising for example, there is a significant difference of opinion among national dental associations. Some associations forbid it but others are neutral and still others it under certain conditions. Likewise, regarding access to oralhelath care, some national associations support the equality of all citizens whereas others are willing to tolerate great inequalitues. In some countries there is considerable interest in the ethical issues posed by advances dental technology whereas in countries that do not have access to such technology there ethical issues do not arise.
Dentist in some countries are confident that they will not be forced by their government to do anything unethical while in other countries it may be difficult for them to meet their ethical obligations, for example, to maintain the confidentiality of patients in the face of police or army requirements to report suspicious injuries; any such encouragement of dentist to act unethically shoul be matter of great concern. Although these differences may seem significant, similarities are far greater. Dentist throughout the world have much in common, and when they come together in organisations such as the FDI, they usually achieve agreement on controversial ethical issues, though this often requires lengthy debate. The fundamental values of dental ethics such as compassion, competence and autonomy, along with dentists' experience and skills in all aspects of dentistry, provide a sound basis for analysing ethicaliissues in dentistry and arriving at solutions that are in the best interest of individual patients and citizens and public health in general.
Who decides what is Ethical
Bismillah..
Ethics is pluralistic. Individuals disagree among themselves about what is right and what is wrong, and even when they agree, it is often for different reasons. In some societies, this disagreement is regarded as normal and there is a great deal freedom of freedom to act however who wants, as long as it does not violate the rights of others. This individual freedom may present a challenge for dentist and their patients, whose ethical differences must be overcome in order to reach their common goal. In more traditional societies, there is greater agreement on ethics and greater social pressure, sometimes back by laws, to act in certain ways rather than others. In such societies culture and religion often play a dominant role in determining ethical behaviour.
The answer to the question," who decides what is ethical for people in general?" therefore varies from one society to another and even within the same society. In liberal societies, individuals have a great deal of freedom to decide for themselves what is ethical, although they will likely be influenced by their families, friends, religion, the media and other external sources. In more traditional societies, family and clan elders, religious authorities and political leaders usually have a greater role than individuals in determining what is ethical.
Despite these differences, it seems that human beings everywhere can agree on some fundamental ethical principles, namely the basic human rights proclaimed in the United Nations Universal Declaration of Human Rights and other widely accepted and officially endorsed documents. The human rights that are especially important for dental ethics include the rights to freedom from discrimination, to freedom of opinion and expression, to equal access to public services in one's country and to health care.
For dentist, the question, "who decides what is ethical?" has until recently had a somewhat different answer than for people in general. During the past two centuries the dental profession has developed its own standards of behaviour for its members, which are expressed in codes of ethics and related policy documents. At a global level, FDI has set forth a broad range of ethical statements that specify the behaviour required of dentist no matter where they live and practice. In many, if not most, countries dental association have been responsible for developing and enforcing the applicable ethical standards. Depending on the country's approach to health law, these standards may have legal status.
The dental profession's privilege of being able to determine its own ethical standards has never been absolute, however. For example:
Dentist have always been subject to the general laws of land and have sometimes been punished for acting contrary to these laws.
Some dental organisations are strongly influenced by religious teachings, which impose additional obligations on their members besides those applicable to all dentist.
In many countries the organisations that set the standards for dentists' behaviour ad monitor their compliance now have a significant non-dentist membership.
The ethical directives of dental associations are general in nature; they cannot deal with every situation that dentists might face in their practice. In most situations, dentist have to decide for themselves what is the right way to act, but in making such decisions, it is helpful to know what other dentist in similar situatins. Dental codes of ethics and policy statements reflect a general consensus about the way dentist should act and they should be followed unless there are good reasons for acting otherwise.
Ethics is pluralistic. Individuals disagree among themselves about what is right and what is wrong, and even when they agree, it is often for different reasons. In some societies, this disagreement is regarded as normal and there is a great deal freedom of freedom to act however who wants, as long as it does not violate the rights of others. This individual freedom may present a challenge for dentist and their patients, whose ethical differences must be overcome in order to reach their common goal. In more traditional societies, there is greater agreement on ethics and greater social pressure, sometimes back by laws, to act in certain ways rather than others. In such societies culture and religion often play a dominant role in determining ethical behaviour.
The answer to the question," who decides what is ethical for people in general?" therefore varies from one society to another and even within the same society. In liberal societies, individuals have a great deal of freedom to decide for themselves what is ethical, although they will likely be influenced by their families, friends, religion, the media and other external sources. In more traditional societies, family and clan elders, religious authorities and political leaders usually have a greater role than individuals in determining what is ethical.
Despite these differences, it seems that human beings everywhere can agree on some fundamental ethical principles, namely the basic human rights proclaimed in the United Nations Universal Declaration of Human Rights and other widely accepted and officially endorsed documents. The human rights that are especially important for dental ethics include the rights to freedom from discrimination, to freedom of opinion and expression, to equal access to public services in one's country and to health care.
For dentist, the question, "who decides what is ethical?" has until recently had a somewhat different answer than for people in general. During the past two centuries the dental profession has developed its own standards of behaviour for its members, which are expressed in codes of ethics and related policy documents. At a global level, FDI has set forth a broad range of ethical statements that specify the behaviour required of dentist no matter where they live and practice. In many, if not most, countries dental association have been responsible for developing and enforcing the applicable ethical standards. Depending on the country's approach to health law, these standards may have legal status.
The dental profession's privilege of being able to determine its own ethical standards has never been absolute, however. For example:
Dentist have always been subject to the general laws of land and have sometimes been punished for acting contrary to these laws.
Some dental organisations are strongly influenced by religious teachings, which impose additional obligations on their members besides those applicable to all dentist.
In many countries the organisations that set the standards for dentists' behaviour ad monitor their compliance now have a significant non-dentist membership.
The ethical directives of dental associations are general in nature; they cannot deal with every situation that dentists might face in their practice. In most situations, dentist have to decide for themselves what is the right way to act, but in making such decisions, it is helpful to know what other dentist in similar situatins. Dental codes of ethics and policy statements reflect a general consensus about the way dentist should act and they should be followed unless there are good reasons for acting otherwise.
Tuesday, 21 July 2015
Maxillary Infiltration Technique ( infiltration vs block)
Bismillah..
Kita masih lagi bercakap taju yg sama iaitu maxillary infiltration technique.
cuma kali ini kita ini tak guna infiltration. Kita guna block
Persoalannya..bila masa kita nak guna maxillary block ni?will not work
>Bila mana ada local imflammatory abscess..so local infiltration disebabkan byk faktor..anataranya acidic environment.
jadi kita guna block anesthesia kat kawasan yang distal to tooth atau in large procedures.
Nerve anesthesized: large terminal branch of dental plexus.
Area anesthesized: pulp and root area of buccal periosteum, connective tissue and mucus membrane
Area of insertion: height of the mucobuccal fold (mucogingival junction) above the apex of the tooth anesthesized> buccal or slightly distal to the apex of the tooth so it will anesthesize it.
cukup ke kalau buat pulpal anesthesia?
> kalau buat anesthesia utk extraction, kena infiltrate both sides bucally and palatally
> kalau buat conservative treatmen: buccal infiltration cukup je sbb dia akan bagi pulpal anesthesia
> kalau utk central incisor: boleh jadi yes or no..sbb? ada sesetengah kes,, you dont get good pulpal anesthesia after bone infiltration, kena buat infiltration kat opposite CI
Post SAN block
Kita masih lagi bercakap taju yg sama iaitu maxillary infiltration technique.
cuma kali ini kita ini tak guna infiltration. Kita guna block
Persoalannya..bila masa kita nak guna maxillary block ni?will not work
>Bila mana ada local imflammatory abscess..so local infiltration disebabkan byk faktor..anataranya acidic environment.
jadi kita guna block anesthesia kat kawasan yang distal to tooth atau in large procedures.
Supra periosteal infiltration injection.
Area anesthesized: pulp and root area of buccal periosteum, connective tissue and mucus membrane
Area of insertion: height of the mucobuccal fold (mucogingival junction) above the apex of the tooth anesthesized> buccal or slightly distal to the apex of the tooth so it will anesthesize it.
cukup ke kalau buat pulpal anesthesia?
> kalau buat anesthesia utk extraction, kena infiltrate both sides bucally and palatally
> kalau buat conservative treatmen: buccal infiltration cukup je sbb dia akan bagi pulpal anesthesia
> kalau utk central incisor: boleh jadi yes or no..sbb? ada sesetengah kes,, you dont get good pulpal anesthesia after bone infiltration, kena buat infiltration kat opposite CI
Maxillary block anesthesia
either we give to
- maxillary nerve
- posterior superior alveolar nerve
- middle SAN
- ant SAN
- infraorbital nerve
- palatal nerve (nasopalatine posteriorly and greater palatine anteriorly)
-innervates roots of max 7 &8 and distal and mesiobuccal root of upper 6
-area of insertion: height of the mucobuccal fold between first and second molars.
-angle of insertion: 45 degree upward and backward (1-1.5cm) so you will not get a bony contact.
-we insert it a little bit medially, then we inject 1 carpule to get anesthesia of post SAN
-insert about 15-20mm
penting nak kena study pasal anatomy ni. contohnya kalau kat post SAN if you insert 2cm instead of 1 cm so you will anesthesize whole maxillary nerve.
you may anesthesize the branch only or the main trunk by controlling the insertion
Middle SAN block
- anesthesize maxillary premolars and mesiobuccal root of upper 6, corresponding alveolus and buccal gingival tissue
-ada kat 28% population. kalau xde ni maknanya teeth are innervated by ant SAN
-area of insertion: height of mucobuccal fold between first and second premolar. sama macam infiltration tapi a little bit higher.
-insert about: 10-15 mm
-inject around: 0.9-1.2 cc
kdg2 bila kita infiltrate upper 4, upper 5 is anesthesized. Ini disebabkan infiltration and block in the same area.
kalau kita buat infiltration to the middle SAN and it didnt work so kita buat infraorbital block. this means that the middle superior alveloar is absent.
Ant SAN block.
used to anesthesize max canine, LI, CI, alveolus and buccal gingiva.
area of insertion: height of mcobuccal fold in area of LI and canine> distal aspect of LI.
Lagi cerita tentang mandibular LA
Bismillah...
Kalau tersilap dalam anesthesize orang mc mne?
-too deep injection may cause transient hemifacial paralysis Facial and Palsy.
-kalau pg dalam sgt nti boleh reach parotid gland..kalau dah sampai tahap ini memang dah posterior sangat..huhu
so apa masalahnya?
-nti kena kat facial nerve..bukan IDN so sebab tu jadi facial palsy.
-too superficial injection will not work..makanya: bersederhanalah:)
Bilateral anesthesia in the mandible
It is preferable to avoid bilateral ID and lingual blocks. Use combinations of different technique whenever possible.
x digalakkan buat untuk pediatric patient sbb he may bite his tongue or lips and make trauma to himself.
nerve yang supply motor innervation to the tongue is hypoglossal nerve bukan lingual nerve.
bila buat bilateral block to the ID nerve, lingual nerve will be anesthesized so if the patient is a child , there maybe a risk of trauma to his lips, but in adult no problem:)
scienctifically, there is no any medical contraindication to do bilateral ID block.
Mental block(incisive block)
aim: nak anesthesize insicive nerve bukan mental nerve
sbb mental nerve dah anesthesized waktu buat ID block lagi.
location of mental foramen: between 4 and 5
it is given to avoid giving ID block.
Technique
*put the needle in 45 at the depth of vestibule between 4 and 5
* insert the needle until touch the bone.
*go little bit away from the bone
*give infiltration: 1 ml of anesthesia
Anesthesia of incisor teeth.
Infiltration sama macam maxilla.
-anesthesia of incisor teeth is done by infiltration because the bone in that area is thin.
-kalau nak cabut gigi depan, kena bagi infiltration and kena bagi juga ID block that you give posteriorly
-infiltration dah mencukupi tapi kalau dah bagi ID block kena bagi infiltration jugak la..
cross innervation: central and lateral incisors is innervated from both sides left and right.
Mandibular anesthesia in chlidren.
children buccal plate of bone is much less dense than that of adults.
great variation: xsure sama ada infitration cukup atau x so kita guna :
rule of 10
1) each tooth is allocated a score ( A=1, B=2, C=3, D=4, E=5)
2)add the score to the most distal tooth to be restored to the child's age (rounded up to the nearest year)
3) _> 10: ID block is indicated
4)_< 10 infiltration is suffiecient
Example:
A 4-years old child needs to extract B & E
The score of the most distal tooth 5 + 4= 9 ( 9<10~ infiltration is sufficient)
This rule is not a must just nak bg senang je.
kalau score 9 nak buat ID block pun okay je tp better bg infiltration sbb lagi convenient.
Anesthesia of surrounding gingivae.
simple procedures:
* Infiltration in the sulcus
* Infiltration in the gingival papillae
more extensives procedures
*long buccal block
*lingual nerve block.
Long buccal nerve
Branches from the mandibular nerve high in the infratemporal fossa.
Crosses the anterior aspect of the ramus from medial to lateral in the coronoid notch region.
can be anesthesized by:
* block technique distobuccal to the third molar
* infiltration opposite to the target tooth.
kalau simple procedure mcm small procedures in the gingiva, kita kena bagi long buccal block, but not ID sbb ia utk bone.
Lingual nerve
usually blocked with ID injection.
you anesthesize the lingual nerve when you do ID block as they are in same space.
its terminal branches can be anesthesized by infiltration in the lingual sulcus opposite to the target tooth
Kalau tersilap dalam anesthesize orang mc mne?
-too deep injection may cause transient hemifacial paralysis Facial and Palsy.
-kalau pg dalam sgt nti boleh reach parotid gland..kalau dah sampai tahap ini memang dah posterior sangat..huhu
so apa masalahnya?
-nti kena kat facial nerve..bukan IDN so sebab tu jadi facial palsy.
-too superficial injection will not work..makanya: bersederhanalah:)
Bilateral anesthesia in the mandible
It is preferable to avoid bilateral ID and lingual blocks. Use combinations of different technique whenever possible.
x digalakkan buat untuk pediatric patient sbb he may bite his tongue or lips and make trauma to himself.
nerve yang supply motor innervation to the tongue is hypoglossal nerve bukan lingual nerve.
bila buat bilateral block to the ID nerve, lingual nerve will be anesthesized so if the patient is a child , there maybe a risk of trauma to his lips, but in adult no problem:)
scienctifically, there is no any medical contraindication to do bilateral ID block.
Mental block(incisive block)
aim: nak anesthesize insicive nerve bukan mental nerve
sbb mental nerve dah anesthesized waktu buat ID block lagi.
location of mental foramen: between 4 and 5
it is given to avoid giving ID block.
Technique
*put the needle in 45 at the depth of vestibule between 4 and 5
* insert the needle until touch the bone.
*go little bit away from the bone
*give infiltration: 1 ml of anesthesia
Anesthesia of incisor teeth.
Infiltration sama macam maxilla.
-anesthesia of incisor teeth is done by infiltration because the bone in that area is thin.
-kalau nak cabut gigi depan, kena bagi infiltration and kena bagi juga ID block that you give posteriorly
-infiltration dah mencukupi tapi kalau dah bagi ID block kena bagi infiltration jugak la..
cross innervation: central and lateral incisors is innervated from both sides left and right.
Mandibular anesthesia in chlidren.
children buccal plate of bone is much less dense than that of adults.
great variation: xsure sama ada infitration cukup atau x so kita guna :
rule of 10
1) each tooth is allocated a score ( A=1, B=2, C=3, D=4, E=5)
2)add the score to the most distal tooth to be restored to the child's age (rounded up to the nearest year)
3) _> 10: ID block is indicated
4)_< 10 infiltration is suffiecient
Example:
A 4-years old child needs to extract B & E
The score of the most distal tooth 5 + 4= 9 ( 9<10~ infiltration is sufficient)
This rule is not a must just nak bg senang je.
kalau score 9 nak buat ID block pun okay je tp better bg infiltration sbb lagi convenient.
Anesthesia of surrounding gingivae.
simple procedures:
* Infiltration in the sulcus
* Infiltration in the gingival papillae
more extensives procedures
*long buccal block
*lingual nerve block.
Long buccal nerve
Branches from the mandibular nerve high in the infratemporal fossa.
Crosses the anterior aspect of the ramus from medial to lateral in the coronoid notch region.
can be anesthesized by:
* block technique distobuccal to the third molar
* infiltration opposite to the target tooth.
kalau simple procedure mcm small procedures in the gingiva, kita kena bagi long buccal block, but not ID sbb ia utk bone.
Lingual nerve
usually blocked with ID injection.
you anesthesize the lingual nerve when you do ID block as they are in same space.
its terminal branches can be anesthesized by infiltration in the lingual sulcus opposite to the target tooth
The inferior dental nerve block
Bismillah..
The inferior dental nerve block
needle: 35 mm
kenapa panjang sgt???
- because it will go through too many structures "medial pterygoid muscle, buccinator till reaches its space.
The nerve is usually blocked at the mandibular foramen, jadi patient should be seated with the mouth widely open. For the right-handed operator:
right ID block: stand in front of the patient
left ID block: stand behind the patient
kalau left-handed: sebaliknya.
macam mana nak cari pterygomandibular space?
-kena cari landmarks
1)maximum concavity on the anterior and post aspect of the ascending ramus.
2) pterygomandibular raphe
prominent soft tissue band yang connect antara mandible and maxilla
consist of muscular fibers: supr constrictor muscle
buccinator muscle insert in it.
pterygomandibular space:
lateral: ant border of mandible
medial: pterygomandibular raphe
3)buccal pad of fat
4)mandibuar occlusoplane.
place the thumb (intraorally) and index finger (extraorally) of your left hand on the max concavities of the ramus.
kat mne perlu inject local anesthesia?
-inject inside the pterygomandibular space (exactly between the ant border of the mandible & the pterygomandibular raphe) not to the nerve itself, so it will anesthesize the trunk itself.
how does it give its action?
-pterygomandibular space is surrounded by muscle so when injecting a solution to the space it will rach all the tissues in the space.
-sbb tu kalau anesthesize, kita aim to reach the space not the nerve.
Entry point of the needle.
1) the thumb is in the mouth ( ant border of the ramus of mandible)
2) index is outside the mouth on the post border of ramus of mandible
3) injection will be between the raphe and your fingers.
lat to the pterygomandibular raphe
medial to the ascending ramus
at the tip of buccal pad of fat above the mandibular occlusal approx 5-10mm
at the level of the maximum concavities of the ramus. (at the tip of the midpoint of your thumb)
approach from the opposite premolar region.
advance the needle until it touches the bone.
aim to touch bone midway between your thumb and index finger.
aspirate
inject around 2 ml of anesthethic solution (the amount of anesthesia to achieve the block is 2ml
try to give some anesthesia while you are entering or while advancing the needle. this reduces the pain.
wait up until 5 minutes and ask for altered sensation in the lower lip.
The inferior dental nerve block
needle: 35 mm
kenapa panjang sgt???
- because it will go through too many structures "medial pterygoid muscle, buccinator till reaches its space.
The nerve is usually blocked at the mandibular foramen, jadi patient should be seated with the mouth widely open. For the right-handed operator:
right ID block: stand in front of the patient
left ID block: stand behind the patient
kalau left-handed: sebaliknya.
macam mana nak cari pterygomandibular space?
-kena cari landmarks
1)maximum concavity on the anterior and post aspect of the ascending ramus.
2) pterygomandibular raphe
prominent soft tissue band yang connect antara mandible and maxilla
consist of muscular fibers: supr constrictor muscle
buccinator muscle insert in it.
pterygomandibular space:
lateral: ant border of mandible
medial: pterygomandibular raphe
3)buccal pad of fat
4)mandibuar occlusoplane.
place the thumb (intraorally) and index finger (extraorally) of your left hand on the max concavities of the ramus.
kat mne perlu inject local anesthesia?
-inject inside the pterygomandibular space (exactly between the ant border of the mandible & the pterygomandibular raphe) not to the nerve itself, so it will anesthesize the trunk itself.
how does it give its action?
-pterygomandibular space is surrounded by muscle so when injecting a solution to the space it will rach all the tissues in the space.
-sbb tu kalau anesthesize, kita aim to reach the space not the nerve.
Entry point of the needle.
1) the thumb is in the mouth ( ant border of the ramus of mandible)
2) index is outside the mouth on the post border of ramus of mandible
3) injection will be between the raphe and your fingers.
lat to the pterygomandibular raphe
medial to the ascending ramus
at the tip of buccal pad of fat above the mandibular occlusal approx 5-10mm
at the level of the maximum concavities of the ramus. (at the tip of the midpoint of your thumb)
approach from the opposite premolar region.
advance the needle until it touches the bone.
aim to touch bone midway between your thumb and index finger.
aspirate
inject around 2 ml of anesthethic solution (the amount of anesthesia to achieve the block is 2ml
try to give some anesthesia while you are entering or while advancing the needle. this reduces the pain.
wait up until 5 minutes and ask for altered sensation in the lower lip.
Mandibular Anesthesia Techniques
Bismillah..
Nak buat anesthesia ni mmg kena banyak practice. Bukan sekadar teori practice makes perfect :)
Infiltration techniques tak berkesan pun kat mandible org dewasa sbb mandible dyorg ada dense cortical bone. kalau maxilla lain la sbb dia cancellous bone je. Infiltration may be used for lower incisors.
Guna kat budak boleh la sbb bone dia thinner lagi.
Nerve block technique: hitting the area where the root of the nerves gets off- will anesthesize the nerve and all its branches.
kat bahagian mana IDN free from bone?
pterygomandibular foramen
-jadi kalau kita hit the nerve at that area before it gets into the foramen, we will anesthesize the main trunk and nerve after the trunk.
more challenging than maxillary anesthesia
requires good knowledge of local anatomy
nerve blocks are utilized to anesthesize IAN, lingual nerve, buccal nerve
provide anesthesia to the pulpal, alveolar, lingual and buccal gingival tissue and skin of lower lip and medial aspect of chin on side injected.
Fascial space
fascia ye bukan face..hee
apa tu fascia?
-potential spaces which means they aren't real spaces. bukan empty space
-ada boudaries, maknanya lies within substructures which make that area ease to be isolated from other areas.
jadi..kalau one of these space kena infection habisla yg lain sbb infection will be easily infiltrate to the whole space, but it will be difficult to spread...why????
-each space ada borders or walls that made from muscles or bones, jadi infection stay in place and takes a longer time to go to other place.
Submandibular space
anterior & lateral: medial surface of mandible
posterior: hyoid bone
inferior & lateral: skin, superficial fascia, platysma muslce, and superficial layer of deep cervical fascia.
medial: anterior belly
superior: mylohyoid muscle
gambar screenshot je mampu..hee
Pterygomandibular space.
-is the fascia space that contains the IAN and the lingula borders.
Ant: pterygomandibular raphe and fibers of the superior constrictor and the buccinator muscles inserted in.
Post: parotid gland
Lateral wall: the inner surface of the ascending ramus
Medial (floor) and deep boundary: medial pterygoid muscle.
medial pterygoid muscle
-origin: medial surface of lateral plate of pterygoid muscle
-insert: angle of mandible( from inside:medially)
the lingual nerve is ada je dalam pterygomandibular space ni..so it will be anesthesized as well when u give the ID block coz it will be escorting the ID nerve.
Roof (superiorly) : lateral pterygoid muscle
note: masseter muscle inserts in the lateral surface of the mandible
Medial: medial pterygoid muscle and above the lateral pterygoid
Nak buat anesthesia ni mmg kena banyak practice. Bukan sekadar teori practice makes perfect :)
Infiltration techniques tak berkesan pun kat mandible org dewasa sbb mandible dyorg ada dense cortical bone. kalau maxilla lain la sbb dia cancellous bone je. Infiltration may be used for lower incisors.
Guna kat budak boleh la sbb bone dia thinner lagi.
Nerve block technique: hitting the area where the root of the nerves gets off- will anesthesize the nerve and all its branches.
kat bahagian mana IDN free from bone?
pterygomandibular foramen
-jadi kalau kita hit the nerve at that area before it gets into the foramen, we will anesthesize the main trunk and nerve after the trunk.
more challenging than maxillary anesthesia
requires good knowledge of local anatomy
nerve blocks are utilized to anesthesize IAN, lingual nerve, buccal nerve
provide anesthesia to the pulpal, alveolar, lingual and buccal gingival tissue and skin of lower lip and medial aspect of chin on side injected.
Fascial space
fascia ye bukan face..hee
apa tu fascia?
-potential spaces which means they aren't real spaces. bukan empty space
-ada boudaries, maknanya lies within substructures which make that area ease to be isolated from other areas.
jadi..kalau one of these space kena infection habisla yg lain sbb infection will be easily infiltrate to the whole space, but it will be difficult to spread...why????
-each space ada borders or walls that made from muscles or bones, jadi infection stay in place and takes a longer time to go to other place.
Submandibular space
anterior & lateral: medial surface of mandible
posterior: hyoid bone
inferior & lateral: skin, superficial fascia, platysma muslce, and superficial layer of deep cervical fascia.
medial: anterior belly
Pterygomandibular space.
-is the fascia space that contains the IAN and the lingula borders.
Ant: pterygomandibular raphe and fibers of the superior constrictor and the buccinator muscles inserted in.
Post: parotid gland
Lateral wall: the inner surface of the ascending ramus
Medial (floor) and deep boundary: medial pterygoid muscle.
medial pterygoid muscle
-origin: medial surface of lateral plate of pterygoid muscle
-insert: angle of mandible( from inside:medially)
the lingual nerve is ada je dalam pterygomandibular space ni..so it will be anesthesized as well when u give the ID block coz it will be escorting the ID nerve.
Roof (superiorly) : lateral pterygoid muscle
note: masseter muscle inserts in the lateral surface of the mandible
Medial: medial pterygoid muscle and above the lateral pterygoid
Mandibular LA & Complication
Bismillah..
3)inferior alveolar nerve (IAN/IDN)
-Medial: lateral pterygoid
-Posterior: lingual nerve
-Enters mandible at the lingula: the IAN come beside the lingula then run in the canal; the lingual determine the area where the mandibular foramen open.
-the lingula: a bony projection: where there is a tendon attached to it.( gives attachment to sphenomandibular ligament)
-ditemani oleh IA artery and vein ( artery di depan nerve)
-travels within the inf alveolar canal until mental foramen.
- in the 1st 1/3 canal: mainly medial
-angle of mandible: canal become exactly at the middle of the mandible in the central
-then, it goes laterally (outside)
-finally,: open in small opening called mental foramen; then IDN dived into incisive nerve and mental nerve.
-incisive nerve: continues inside mandible canal, innervates mandibular canines and incisors
-mental nerve(sensory): gives sensation to lips and chin
-mental nerve branch of IDN, IDN branch of V3
-mental nerve emerges at the mental foramen (between base of 4 & 5, its mainly soft tissue nerve)
-kalau nak anesthesize mental nerve kita guna mental block( utk extract lower 4) sbb nanti dia anesthesize sekali main nerve ID and insicive branch.
4) nerve to mylohyoid( motor nerve)
IDN provides innervation to the mandibular teeth pulp + buccal + lingual bone + buccal gingiva of the anterior teeth by mental nerve
buccal gingiva of posterior teeth: innervated by long buccal nerve.
kalau nak cabut lower 6, kena anesthesize(ID block) : long buccal nerve, and lingual nerve.
Terminal branches of IVN:
1) insicive nerve- remains within incisive canal from mental foramen to midline
2) mental nerve: exits mental foramen and divides into 3 branches: innervate skin, lips and labial mucosa.
3)inferior alveolar nerve (IAN/IDN)
-Medial: lateral pterygoid
-Posterior: lingual nerve
-Enters mandible at the lingula: the IAN come beside the lingula then run in the canal; the lingual determine the area where the mandibular foramen open.
-the lingula: a bony projection: where there is a tendon attached to it.( gives attachment to sphenomandibular ligament)
-ditemani oleh IA artery and vein ( artery di depan nerve)
-travels within the inf alveolar canal until mental foramen.
- in the 1st 1/3 canal: mainly medial
-angle of mandible: canal become exactly at the middle of the mandible in the central
-then, it goes laterally (outside)
-finally,: open in small opening called mental foramen; then IDN dived into incisive nerve and mental nerve.
-incisive nerve: continues inside mandible canal, innervates mandibular canines and incisors
-mental nerve(sensory): gives sensation to lips and chin
-mental nerve branch of IDN, IDN branch of V3
-mental nerve emerges at the mental foramen (between base of 4 & 5, its mainly soft tissue nerve)
-kalau nak anesthesize mental nerve kita guna mental block( utk extract lower 4) sbb nanti dia anesthesize sekali main nerve ID and insicive branch.
4) nerve to mylohyoid( motor nerve)
IDN provides innervation to the mandibular teeth pulp + buccal + lingual bone + buccal gingiva of the anterior teeth by mental nerve
buccal gingiva of posterior teeth: innervated by long buccal nerve.
kalau nak cabut lower 6, kena anesthesize(ID block) : long buccal nerve, and lingual nerve.
Terminal branches of IVN:
1) insicive nerve- remains within incisive canal from mental foramen to midline
2) mental nerve: exits mental foramen and divides into 3 branches: innervate skin, lips and labial mucosa.
Mandibular Local Anesthesia & Complications
Bismillah..
Mand branch
> branch yg paling besar
composed of sensory and motor roots (mixed)
sensory root
* originates at anterioborder of trigeminal ganglion
motor root
* arises in motor cells located in the pons and medulla lies medial to sensory.
The sensory and motor of the mandibular branch merge from foramen ovale of greater wing of sphenoid.
initially merge outside of the skull and divide about 2-3 mm inferiorly.
branches:
undivided nerve (main trunk)
*nerve spinosus (meningeal branch)
* medial pterygoid motor
anterior division (trunk)
*buccal nerve (long buccal ) sensory
*deep temporal nerve
*masseteric nerve
posterior division (trunk)
* auriculotemporal sensory
*lingual snsory
*inferior alveolar mixed
*mylohyoid nerve (motor)
Main trunk..
1) Branch go up > Nerve spinosus: innervates mastoids and dura
2)Branch go down > media pterygoid: innervates medial pterygoid msucle
ada jugak branches to tensor veli palatini and tensor tympani.
Rule:
1) Anterior trunk ada 3 motor nerves and 1 sensory nerve
( innervates muslce of mastication)
muscle of mastication(mylohyoid) yg innervated by post trunk called : nerve to mylohyoid
a) Buccal nerve (long buccal): sensory
-kalau nak anesthesize inject 2mm distobuccal to the tooth that you want to extract.
Travels anteriorly and lateral to the lateral pterygoid muslce
kat mand 3rd molar: exit through buccinator and provide innervation to skin of cheek.
branches also stay within the retromandibular triangle providing sensory innervation to the buccal gingiva of mand molars and buccal vestibule.
b) Muscles of mastication
V3: gives branches to deep temporal muslce (temporalis muscle), masseter and lateral pterygoid muscle (motor branches of ant division of V3
Post trunk: 3 sensory 1 motor nerve
So kat ant of V3 sensory: buccal nerve...yg lain tu motor (nerves to mastication muscle)
travels inferior and mesial to lateral pterygoid
1) lingual nerve
lies between ramus and medial pterygoid within pterygomandibular raphe.
provide sensation to ant 2/3 rds of tongue, lingual gingiva, floor of mouth mucosa and gustation (chorda tympani)
carries nerve yg bukan part of trigeminal nerve including chorda tmypani nerve of the facial nerve, which provides special sensation (taste) to anterior 2/3 part of tongue)
sgt ada kaitan dgn mandible, esp in the mandibular posterior wisdom area.
lies inferior and mesial to mand 3rd molar
descend from post trunk of V3> go down to lingual plate "lingual cortex"
sgt berisiko utk terkena nerve ni bila cabut 3rd molar(gigi bongsu).
kalau nerve ni rosak ggu sensation
auriculotemporal nerve (sensory)
-depan telinga
- transverses the upper part of parotid gland and post portion of zygomatic arch.
Branches: supply
Anterior auricular: skin over helix and tragus
External auditory meatus: skin over meatus and tympanic
communicates with facial nerve to provide sensory innervation to the skin over areas of zygomatic, buccal and mandibular.
communicates with otic ganglion for sensory, secretory and vasomotor fibers to the parotid gland a
articular-posterior TMJ sensation to the capsule of TMJ.
superficial temporal - skin over temporal region.
TO BE CONTINUE....
Mand branch
> branch yg paling besar
composed of sensory and motor roots (mixed)
sensory root
* originates at anterioborder of trigeminal ganglion
motor root
* arises in motor cells located in the pons and medulla lies medial to sensory.
The sensory and motor of the mandibular branch merge from foramen ovale of greater wing of sphenoid.
initially merge outside of the skull and divide about 2-3 mm inferiorly.
branches:
undivided nerve (main trunk)
*nerve spinosus (meningeal branch)
* medial pterygoid motor
anterior division (trunk)
*buccal nerve (long buccal ) sensory
*deep temporal nerve
*masseteric nerve
posterior division (trunk)
* auriculotemporal sensory
*lingual snsory
*inferior alveolar mixed
*mylohyoid nerve (motor)
Main trunk..
1) Branch go up > Nerve spinosus: innervates mastoids and dura
2)Branch go down > media pterygoid: innervates medial pterygoid msucle
ada jugak branches to tensor veli palatini and tensor tympani.
Rule:
1) Anterior trunk ada 3 motor nerves and 1 sensory nerve
( innervates muslce of mastication)
muscle of mastication(mylohyoid) yg innervated by post trunk called : nerve to mylohyoid
a) Buccal nerve (long buccal): sensory
-kalau nak anesthesize inject 2mm distobuccal to the tooth that you want to extract.
Travels anteriorly and lateral to the lateral pterygoid muslce
kat mand 3rd molar: exit through buccinator and provide innervation to skin of cheek.
branches also stay within the retromandibular triangle providing sensory innervation to the buccal gingiva of mand molars and buccal vestibule.
b) Muscles of mastication
V3: gives branches to deep temporal muslce (temporalis muscle), masseter and lateral pterygoid muscle (motor branches of ant division of V3
Post trunk: 3 sensory 1 motor nerve
So kat ant of V3 sensory: buccal nerve...yg lain tu motor (nerves to mastication muscle)
travels inferior and mesial to lateral pterygoid
1) lingual nerve
lies between ramus and medial pterygoid within pterygomandibular raphe.
provide sensation to ant 2/3 rds of tongue, lingual gingiva, floor of mouth mucosa and gustation (chorda tympani)
carries nerve yg bukan part of trigeminal nerve including chorda tmypani nerve of the facial nerve, which provides special sensation (taste) to anterior 2/3 part of tongue)
sgt ada kaitan dgn mandible, esp in the mandibular posterior wisdom area.
lies inferior and mesial to mand 3rd molar
descend from post trunk of V3> go down to lingual plate "lingual cortex"
sgt berisiko utk terkena nerve ni bila cabut 3rd molar(gigi bongsu).
kalau nerve ni rosak ggu sensation
auriculotemporal nerve (sensory)
-depan telinga
- transverses the upper part of parotid gland and post portion of zygomatic arch.
Branches: supply
Anterior auricular: skin over helix and tragus
External auditory meatus: skin over meatus and tympanic
communicates with facial nerve to provide sensory innervation to the skin over areas of zygomatic, buccal and mandibular.
communicates with otic ganglion for sensory, secretory and vasomotor fibers to the parotid gland a
articular-posterior TMJ sensation to the capsule of TMJ.
superficial temporal - skin over temporal region.
TO BE CONTINUE....
Monday, 20 July 2015
Intraoral examination 2
Bismillah...
Cerita hari tu terhenti sampai gingiva je..kali ni ktas
Sambung teeth dan occlusion.
Teeth
Kena buat full dental charting
Penting utk tahu eruption of deciduos and permanent teeth. Sbb kalau lambat or premature eruption alert the clinician to poten
tial problem. Kne observe juga tooth's condition, structure and shape is also required.
Masa clinical examination for carious lesion gigi kena kering and inspected under good light
Definite routine of examination should be setablished. Contohnya dentist start upper right quadrant> upper left quadrant>lower left quadrant> lower right quadrant.
Feature yg kena note
1) caeies: arrested ke restorable ke.
2) restoration..intacr ke kurang ke
3) fissure sealants
4) tooth surface loss
Occlusion
Kena check juga rooth alignment and occlusion, kira ni sebagai early prompt kalau2 kena buat interceptive orthodontics treatment.
Certainly worth noting:
Severe skeletal abnormality
Overjet and overbite
First molar relationships
Presence of crowding/spacing
Deviations/displacement
2 keys stages of dental development
1) age 8-9 years- selalu waktu ni upper permanet incisor patient dah erupt. Jadi kena check
Increased over jet
Cross-bite
Traumatic bite
Ant open bite
Failure of eruption
2) age 10: pt dah ada upper permanent canine..jadi kena note
Permanent canine are palpable buccaly
Pŕimary canines are becoming mobile
Radiographic examination
Routine radiographic certainly not indicated for children.
Tp ada jgk kebaikan radiographs ni utk facilitate
1) caries diagnosis
2)trauma diagnosis
3) orthodontic treatment planning
4)Identification of any abnormalities in dental development
5) detection of any bone or dental pathology
Cerita hari tu terhenti sampai gingiva je..kali ni ktas
Sambung teeth dan occlusion.
Teeth
Kena buat full dental charting
Penting utk tahu eruption of deciduos and permanent teeth. Sbb kalau lambat or premature eruption alert the clinician to poten
tial problem. Kne observe juga tooth's condition, structure and shape is also required.
Masa clinical examination for carious lesion gigi kena kering and inspected under good light
Definite routine of examination should be setablished. Contohnya dentist start upper right quadrant> upper left quadrant>lower left quadrant> lower right quadrant.
Feature yg kena note
1) caeies: arrested ke restorable ke.
2) restoration..intacr ke kurang ke
3) fissure sealants
4) tooth surface loss
Occlusion
Kena check juga rooth alignment and occlusion, kira ni sebagai early prompt kalau2 kena buat interceptive orthodontics treatment.
Certainly worth noting:
Severe skeletal abnormality
Overjet and overbite
First molar relationships
Presence of crowding/spacing
Deviations/displacement
2 keys stages of dental development
1) age 8-9 years- selalu waktu ni upper permanet incisor patient dah erupt. Jadi kena check
Increased over jet
Cross-bite
Traumatic bite
Ant open bite
Failure of eruption
2) age 10: pt dah ada upper permanent canine..jadi kena note
Permanent canine are palpable buccaly
Pŕimary canines are becoming mobile
Radiographic examination
Routine radiographic certainly not indicated for children.
Tp ada jgk kebaikan radiographs ni utk facilitate
1) caries diagnosis
2)trauma diagnosis
3) orthodontic treatment planning
4)Identification of any abnormalities in dental development
5) detection of any bone or dental pathology
Sunday, 19 July 2015
FDI World Dental Federation International Principles of Ethics for the Dental Profession
Bismillah..
should be considered as guidelines for every dentist. These guidelines cannot cover all local, national, traditions, legislation or circumstances.
The professional dentist:
should be considered as guidelines for every dentist. These guidelines cannot cover all local, national, traditions, legislation or circumstances.
The professional dentist:
- will practice according to the art and science of dentistry and to the principles of humanity
- will safeguard the oral health of patients irrespective of other individual status.
The primary duty of dentist is to safeguard the oral health of patients. However the dentist has the right to decline to treat a patient, except for the provision of emergency care, for humanitarian reasons or where the laws of the country dictate otherwise.
- should refer for advice and/or treatment any patient requiring a level of competence beyond that held
- must ensure professional confidentiality of all information about patients and their treatment.
- the dentist must ensure that all staff respect patients confidentiality except where the laws of the country dictate otherwise.
- must accept responsibility for, and utilise dental auxiliaries strictly according to the law.
The dentist must accept full responsibility for all treatment undertaken, and no treatment or service should be delegated to a person who is not qualified or is not legally permitted to undertake this.
- must deal ethically in all aspects of professional life and adhere to rules of professional law.
- should continue to develop professional knowledge and skills.
- should support oral health promotion
- The dentist should behave towards all members of the oral health team in a professional manner and should be willing to assist colleagues professionally and maintain respect for divergence of professional opinion.
- should act in a manner which will enhance the prestige and reputation of the profession.
What's special about Dental Ethics
Bismillah..
Compassion, competence and autonomy are not exclusive to dentistry. However, the practice of dentistry requires dentists to exemplify these values to a higher degree than in other occupations, icluding some other professions.
Compassion
defines as understanding and concern for another person's distress, is essential for the practice of dentistry. In order to deal with the patient's problems, the dentist must identify the symptoms that the patient is experiencing and their underlying causes and must want to help the patient achieve relief. Patients respond better to treatment if they perceive that the dentist appreciates their concerns and is treating them rather than just their illness.
Competence
A lack of competence can have serious consequences for patients, Dentist undergo a long training period to ensure competence, but considering the rapid advance of dental knowledge, it is a continual challenge for them to maintain their competence. Moreover, it is not just their scientific knowledge and technical skills that they have develop and maintain but their ethical knowledge, skills and attitudes as well, since new ethical issues arise with changes in dental practice and its social and political environment
Autonomy
Self-determination, is the core value of dentistry that has evolved the most over the years. Individual dentists have traditionally enjoyed a high degree of clinical autonomy in deciding where and how to practice. Dentist collectively (the dental profession) have been free to determine the standards of dental education and dental practice. As do physicians, dentists consider that clinical and professional autonomy benefits not just themselves but patients as well, since it frees dentist from government and corporate restraints on providing optimal treatment for patients. Government and other authorities are increasingly restricting the autonomy of dentist. Nevertheless, dentists still value their autonomy and try to preserve it as much as possible. At the same time, there has been a widespread acceptance by dentists worldwide of patient autonomy, which means that patients should be the ultimate decision makers in matters that affects themselves.
Beside its adherence to these 3 core values, dental ethics differs from the general ethics applicable for everyone by being publicly proclaimed in a code of ethics or similar document. Codes vary from one country to another and even within countries, but they have many common features, including commitments that dentist will consider the interest of their patients above their own, will not discriminate against patients on the basis of race, religion or other human rights grounds and will protect the confidentiality of patient information. In 1997, the FDI adopted International Principles of Ethics for the Dental Profession for dentists everywhere.
Compassion, competence and autonomy are not exclusive to dentistry. However, the practice of dentistry requires dentists to exemplify these values to a higher degree than in other occupations, icluding some other professions.
Compassion
defines as understanding and concern for another person's distress, is essential for the practice of dentistry. In order to deal with the patient's problems, the dentist must identify the symptoms that the patient is experiencing and their underlying causes and must want to help the patient achieve relief. Patients respond better to treatment if they perceive that the dentist appreciates their concerns and is treating them rather than just their illness.
Competence
A lack of competence can have serious consequences for patients, Dentist undergo a long training period to ensure competence, but considering the rapid advance of dental knowledge, it is a continual challenge for them to maintain their competence. Moreover, it is not just their scientific knowledge and technical skills that they have develop and maintain but their ethical knowledge, skills and attitudes as well, since new ethical issues arise with changes in dental practice and its social and political environment
Autonomy
Self-determination, is the core value of dentistry that has evolved the most over the years. Individual dentists have traditionally enjoyed a high degree of clinical autonomy in deciding where and how to practice. Dentist collectively (the dental profession) have been free to determine the standards of dental education and dental practice. As do physicians, dentists consider that clinical and professional autonomy benefits not just themselves but patients as well, since it frees dentist from government and corporate restraints on providing optimal treatment for patients. Government and other authorities are increasingly restricting the autonomy of dentist. Nevertheless, dentists still value their autonomy and try to preserve it as much as possible. At the same time, there has been a widespread acceptance by dentists worldwide of patient autonomy, which means that patients should be the ultimate decision makers in matters that affects themselves.
Beside its adherence to these 3 core values, dental ethics differs from the general ethics applicable for everyone by being publicly proclaimed in a code of ethics or similar document. Codes vary from one country to another and even within countries, but they have many common features, including commitments that dentist will consider the interest of their patients above their own, will not discriminate against patients on the basis of race, religion or other human rights grounds and will protect the confidentiality of patient information. In 1997, the FDI adopted International Principles of Ethics for the Dental Profession for dentists everywhere.
Principles Features Of Dental Ethics
Bismillah..
What's special about dentistry?
People come to dentists for help with some of their most pressing needs-relief from pain and suffering and restoration of oral health and well-being. They allow dentist to see, touch, and manipulate their bodies and they disclose information about themselves that they would not others to know. They do this because they trust their dentist to act in their best interest.
Dentistry is a recognised profession. At the same time, however it is a commercial enterprise, whereby dentists employ their skills to earn a living. There is potential tension between two aspects of dentistry and maintaining an appropriate balance between them is often difficult.Some dentist may be tempted to minimise their commitment to professionalism in order to increase their income, for example by aggrasive advertising and/or specialising in lucrative cosmetics procedures. If taken too far, such activities can diminish the public's respect for and trust in the entire dental profession,with the results that dentist will be regarded as just another set of enterpreneurs who place their own interest above those of the people they serve. Such behaviour is in conflict with the requirement of the FDI International Principles of Ethics for the Dental Profession that " the dentist should act in a manner which will enhance the prestige and reputation of the profession"
Because the commercial aspect of dentistry sometimes seems to prevail over the professional aspect, the status of dentist is deteriorating in some countries. Patient who used to accept dentist's advice unquestioningly sometimes ask dentists to defend their recommendations if these are different from other oral health practicioners or the internet. If they are dissatisfied with the results of dental treatment, no matter what the cause, an increasing number of patients are turning to tHe courts to obtain their compensation from dentist. Moreover, many dentists feel that they are no longer as respected as they once were. In some countries, control of oral health care has moved steadily away from dentist to non-dental managers and bureucarts, some of whom tend to see dentist as obstacles to rather than partners in the provision of health care for all in need. Some procedures that formerly only dentist were capable of performing are done by dental hygienists, therapist, assistants or denturists
Despite these changes impinging on the status of dentist, dentistry continues to be a profession that is highly valued by the people who need its services. It also continues o attract large numbers of the most gifted, hardworking and dedicated students.In order to meet the expectations of the patients, students and general public, it is important that dentists know and exemplify the core values of dentistry, especially compassion, competence and autonomy. These values, along with respect for fundamental human rights, serve as the foundation of dental ethics.
What's special about dentistry?
People come to dentists for help with some of their most pressing needs-relief from pain and suffering and restoration of oral health and well-being. They allow dentist to see, touch, and manipulate their bodies and they disclose information about themselves that they would not others to know. They do this because they trust their dentist to act in their best interest.
Dentistry is a recognised profession. At the same time, however it is a commercial enterprise, whereby dentists employ their skills to earn a living. There is potential tension between two aspects of dentistry and maintaining an appropriate balance between them is often difficult.Some dentist may be tempted to minimise their commitment to professionalism in order to increase their income, for example by aggrasive advertising and/or specialising in lucrative cosmetics procedures. If taken too far, such activities can diminish the public's respect for and trust in the entire dental profession,with the results that dentist will be regarded as just another set of enterpreneurs who place their own interest above those of the people they serve. Such behaviour is in conflict with the requirement of the FDI International Principles of Ethics for the Dental Profession that " the dentist should act in a manner which will enhance the prestige and reputation of the profession"
Because the commercial aspect of dentistry sometimes seems to prevail over the professional aspect, the status of dentist is deteriorating in some countries. Patient who used to accept dentist's advice unquestioningly sometimes ask dentists to defend their recommendations if these are different from other oral health practicioners or the internet. If they are dissatisfied with the results of dental treatment, no matter what the cause, an increasing number of patients are turning to tHe courts to obtain their compensation from dentist. Moreover, many dentists feel that they are no longer as respected as they once were. In some countries, control of oral health care has moved steadily away from dentist to non-dental managers and bureucarts, some of whom tend to see dentist as obstacles to rather than partners in the provision of health care for all in need. Some procedures that formerly only dentist were capable of performing are done by dental hygienists, therapist, assistants or denturists
Despite these changes impinging on the status of dentist, dentistry continues to be a profession that is highly valued by the people who need its services. It also continues o attract large numbers of the most gifted, hardworking and dedicated students.In order to meet the expectations of the patients, students and general public, it is important that dentists know and exemplify the core values of dentistry, especially compassion, competence and autonomy. These values, along with respect for fundamental human rights, serve as the foundation of dental ethics.
Intraoral examination
Bismillah..
Baru2 ini aku ada post berkaitan dengan extraoral examination.
Kali ini kita bincang pasal intraoral examination pula..:)
Ada step yang nak kena follow:
mneumonic yg aku buat :SOTO/SOGTO (sebab skg ni tgh raya kan..asyik fikir makan aje la..hehe)
S: Soft tissue
G: gingiva
T: teeth
O: occlusion
Soft tissue
abnormal appearance pada soft tissue ni boleh indicate systemic disease or nutritional deficiency.
mungkin ada juga oral pathology, jadi sgt penting untuk examine palate, throat, cheeks, noting any colour changes, ulceration,swelling
kena check juga kat frenal attachment or tongue tie yg boleh mengganggu speech, chewing and eating.
kena tahu juga impression of salivary flow rate and consistency.
Gingival and periodontal tissue
periodontal disease jarang berlaku kat budak2.
kena take note kalau ada colour changes ke, swelling ke, ulceration ke, spontaneous bleeding ke, atau recession.
kalau ada gingival inflammation in the absence of gross plaque deposits, lateral periodontal abscess, prematurely exfoliating teeth @ mobile permanent teeth- indicate a more serious underlying problem.
during inspection, assessment of cleanliness kena buat, and kena take note presence of any plaque or calculus.
Indices- to provide an objective record of oral cleanliness.
contoh: the oral debris index ( Green and Vermillion index 1964)
perlukan disclosing agent prior to an evaluation of the amount of plaque on selected teeth (1st permanent molar, upper right and lower left central incisor.
scale
0: no debris or stain present
1: soft debris covering not more than 1/3 of tooth surface being examined or the presence of extrinsic stains without debris regardless of surface area covered
2: soft debris covering more than 1/3 but not more than 2/3
3: soft debris covering more than 2/3 of exposed tooth surface.
contoh lain: Gingival Index ( Loe 1967): created untuk assessment of gingival condition and records changes in the gingiva . It scores the marginal and interproximal tissues separately on basis of 0-3
0: normal gingiva
1: mild inflammation: slight change in colour and slight edema but no bleeding on probing.
2: moderate inflammation: redness, edema and glazing, bleeding on probing.
3: severe inflammation: marked redness and edema, ulceration with tendency to spontaneous bleeding.
Specific periodontal probing- jarang pada young children.kecuali kalau ada specific problem.
Baru2 ini aku ada post berkaitan dengan extraoral examination.
Kali ini kita bincang pasal intraoral examination pula..:)
Ada step yang nak kena follow:
mneumonic yg aku buat :SOTO/SOGTO (
S: Soft tissue
G: gingiva
T: teeth
O: occlusion
Soft tissue
abnormal appearance pada soft tissue ni boleh indicate systemic disease or nutritional deficiency.
mungkin ada juga oral pathology, jadi sgt penting untuk examine palate, throat, cheeks, noting any colour changes, ulceration,swelling
kena check juga kat frenal attachment or tongue tie yg boleh mengganggu speech, chewing and eating.
kena tahu juga impression of salivary flow rate and consistency.
Gingival and periodontal tissue
periodontal disease jarang berlaku kat budak2.
kena take note kalau ada colour changes ke, swelling ke, ulceration ke, spontaneous bleeding ke, atau recession.
kalau ada gingival inflammation in the absence of gross plaque deposits, lateral periodontal abscess, prematurely exfoliating teeth @ mobile permanent teeth- indicate a more serious underlying problem.
during inspection, assessment of cleanliness kena buat, and kena take note presence of any plaque or calculus.
Indices- to provide an objective record of oral cleanliness.
contoh: the oral debris index ( Green and Vermillion index 1964)
perlukan disclosing agent prior to an evaluation of the amount of plaque on selected teeth (1st permanent molar, upper right and lower left central incisor.
scale
0: no debris or stain present
1: soft debris covering not more than 1/3 of tooth surface being examined or the presence of extrinsic stains without debris regardless of surface area covered
2: soft debris covering more than 1/3 but not more than 2/3
3: soft debris covering more than 2/3 of exposed tooth surface.
contoh lain: Gingival Index ( Loe 1967): created untuk assessment of gingival condition and records changes in the gingiva . It scores the marginal and interproximal tissues separately on basis of 0-3
0: normal gingiva
1: mild inflammation: slight change in colour and slight edema but no bleeding on probing.
2: moderate inflammation: redness, edema and glazing, bleeding on probing.
3: severe inflammation: marked redness and edema, ulceration with tendency to spontaneous bleeding.
Specific periodontal probing- jarang pada young children.kecuali kalau ada specific problem.
Type of examination
Bismillah..
Examination yang dentist selalu buat ada dua.
1.Extraoral (luar mulut) examination
2. Intraoral (dalam mulut) examination
Tapi untuk post kali ini aku nak bincang tentang extraoral examination. Jom kita discover apa yang dentist buat.:)
Extraoral examination terbahagi kepada 4
a. General examination
b. The head and neck
c. Facial examination
d. Speech assessement
a) General examination
Dentist nak tahu child's overall health, development or even habits can often be determined by noting.
-height: kena buat standard growth chart
-weight: ada eating disorder tak/ adakah GA tak berkesan sebab child's obesity/ ada endocrine problem x?
-skin: ada injury x
-Hands
b) The head and neck
-head: note size, shape, facial symmetry
-hair: sparse, quality, quantity
-eyes: ada visual impairment @ abnormality pd sclera x
-ears:
-skin
-muscle of mastication
-Lymph nodes
-Lips
c)Facial examination
-buat ni selalunya as part of orthodontic evaluation
-do the evaluation in three spatial planes: anteroposterior, vertical and transverse
Antero-poterior termasuklah
* description of overall facial pattern
*position of mandible and maxilla
*vertical facial relationship
*position of lips( competent/incompetent)
*facial symmetry and maxillary dental midline is located relative to the facial midline.
Facial profile can be examined by drawing
-Line connecting: Midpoint between eyebrows + base of the nose + lowest point of chin
Facial profile classify into:
*straight profile: in patient with class I occlusion.
*convex profile with retronagthic mandible / protracted maxilla with class II malocclusion
*concave profile: retronagthic maxilla/ protracted mandible with class III malocclusion.
Examination yang dentist selalu buat ada dua.
1.Extraoral (luar mulut) examination
2. Intraoral (dalam mulut) examination
Tapi untuk post kali ini aku nak bincang tentang extraoral examination. Jom kita discover apa yang dentist buat.:)
Extraoral examination terbahagi kepada 4
a. General examination
b. The head and neck
c. Facial examination
d. Speech assessement
a) General examination
Dentist nak tahu child's overall health, development or even habits can often be determined by noting.
-height: kena buat standard growth chart
-weight: ada eating disorder tak/ adakah GA tak berkesan sebab child's obesity/ ada endocrine problem x?
-skin: ada injury x
-Hands
b) The head and neck
-head: note size, shape, facial symmetry
-hair: sparse, quality, quantity
-eyes: ada visual impairment @ abnormality pd sclera x
-ears:
-skin
-muscle of mastication
-Lymph nodes
-Lips
c)Facial examination
-buat ni selalunya as part of orthodontic evaluation
-do the evaluation in three spatial planes: anteroposterior, vertical and transverse
Antero-poterior termasuklah
* description of overall facial pattern
*position of mandible and maxilla
*vertical facial relationship
*position of lips( competent/incompetent)
*facial symmetry and maxillary dental midline is located relative to the facial midline.
Facial profile can be examined by drawing
-Line connecting: Midpoint between eyebrows + base of the nose + lowest point of chin
Facial profile classify into:
*straight profile: in patient with class I occlusion.
*convex profile with retronagthic mandible / protracted maxilla with class II malocclusion
*concave profile: retronagthic maxilla/ protracted mandible with class III malocclusion.
Vertical relation
should be evaluated for the steepness of mandibular angle ( angle between Frankfort and mandibular plane)
a large mandibular angle indicates- long lower face height ( open anterior bite )
a small angle: short lower face height (deep anterior bite )
Transverse relation
-presence of cross-bite and evident as a deviation in the mandible in some cases
d) Assessment of speech
-assess the ability to talk and pronounce letters properly, no marked lips
-esp pt with: cleft, down syndrome, mentally retarded and deaf patient
Dental examination.
Bismillah..
First impression masa jumpa patient tu penting. Dentist boleh tengok reaksi patient bermula daripada first greeting lagi. Dentist boleh lihat physical appearance dgn cara:
-general health: dia nampak sihat ke tak
-overall physical/mental development: dia ni nampak normal tak dgn budak2 yang sebaya dgn dia
-weight: underweight/overweight
-coordination: dia ada abnormal gait atau motor impairment tak
-tgk dia punya rambut, kepala, muka, leher, tangan,
-cold, clammy hands(tangan berpeluh) or bitten fingernails: petanda awal abnormal anxiety
- unusual clean digit : persistent sucking habit.
-clubbing of fingers or bluish colour: congenital heart disease.
-variation in the size, shape,symmetry or function of head and neck structures sbb boleh indicate syndrome lain.
Dentist pun kena buat unofficial assesment dari segi cooperation of the patient itself.
Category of prospective young patients..
1) Happy and confident
2) A little anxious or shy but displaying some rapport with dental team.
-boleh je buat rawatan selepas dipujuk
3) A very frightened, crying, clutching their parent, avoiding eye contact or not responding to direct questions.
- susah untuk terima conventional treatment..kena pujuk lagi.
4) severe behavioural problem or learning disability
-kena guna sedation atau general anesthesia
Techniques of examination of children
infant and toddlers ( less than 2 years)
- dentist and parent are seated face to face with their knees touching (knee-to-knee position)
-Their upper arms dijadikan examination table utk child
-the child's leg straddle the parents' body, which allow the parent to restrain the child legs and hands.
young children ( 2-6 years)
-parents sit in the dental chair and the child lies across her or his lap. The child's head positioned in the parents arm
older children ( >6 years)
-child sit on the dental chair
First impression masa jumpa patient tu penting. Dentist boleh tengok reaksi patient bermula daripada first greeting lagi. Dentist boleh lihat physical appearance dgn cara:
-general health: dia nampak sihat ke tak
-overall physical/mental development: dia ni nampak normal tak dgn budak2 yang sebaya dgn dia
-weight: underweight/overweight
-coordination: dia ada abnormal gait atau motor impairment tak
-tgk dia punya rambut, kepala, muka, leher, tangan,
-cold, clammy hands(tangan berpeluh) or bitten fingernails: petanda awal abnormal anxiety
- unusual clean digit : persistent sucking habit.
-clubbing of fingers or bluish colour: congenital heart disease.
-variation in the size, shape,symmetry or function of head and neck structures sbb boleh indicate syndrome lain.
Dentist pun kena buat unofficial assesment dari segi cooperation of the patient itself.
Category of prospective young patients..
1) Happy and confident
2) A little anxious or shy but displaying some rapport with dental team.
-boleh je buat rawatan selepas dipujuk
3) A very frightened, crying, clutching their parent, avoiding eye contact or not responding to direct questions.
- susah untuk terima conventional treatment..kena pujuk lagi.
4) severe behavioural problem or learning disability
-kena guna sedation atau general anesthesia
Techniques of examination of children
infant and toddlers ( less than 2 years)
- dentist and parent are seated face to face with their knees touching (knee-to-knee position)
-Their upper arms dijadikan examination table utk child
-the child's leg straddle the parents' body, which allow the parent to restrain the child legs and hands.
young children ( 2-6 years)
-parents sit in the dental chair and the child lies across her or his lap. The child's head positioned in the parents arm
older children ( >6 years)
-child sit on the dental chair
What should dentist do during first meeting with patient?
Bismillah
First and foremost dentist should ask about their patients' history
What are the component of history?
1) Chief complaint
-the reason patient comes to the clinic
(routine checkups, referral, toothache pain, aesthethic,swelling)
2) History of chief complaint
-if the chief complaint was pain, then you should know these information about the pain
( location, onset, duration,, nature, frequency, aggravating factors, relieving factors, awake from sleep, day or night, severity, radiation to other parts, temperature.
3)Medical history: systemic review.
a- CVS;congenital heart disease, risk of bacterial endocarditis.
b- respiratory; asthma, hay fever, infections
c- Hematological; anemia, bleeding, bruising
d- Gastrointestinal; hepatitis, jaundice
e- endocrine; diabetes
f- CNS; epilepsy, mental and physical handicap
g- urogenital; renal disease
h- skin; thin, fragile.
Dentist need to check:
*immunization
*medication
*hospitalization
*allergies (allergy for latex (rubber material)
Dentist need to know the birth details of the patient
Prenatal
-Mum health during pregnancy
-any complication, trauma, infection, drugs taken
-gestational age (premature birth)
-delivery (oxygen deprivation)
Neonatal
-Birth weight, height and defect
-jaundice
-rhesus
-incompatibility
Perinatal/postnatal
-bottle or breast fed, bottle content
-immunization
-childhood illnesses
Dentist must know about:
# growth: height, weight, growth charts
#family history
Dental History, social history, behaviour
First and foremost dentist should ask about their patients' history
What are the component of history?
1) Chief complaint
-the reason patient comes to the clinic
(routine checkups, referral, toothache pain, aesthethic,swelling)
2) History of chief complaint
-if the chief complaint was pain, then you should know these information about the pain
( location, onset, duration,, nature, frequency, aggravating factors, relieving factors, awake from sleep, day or night, severity, radiation to other parts, temperature.
3)Medical history: systemic review.
a- CVS;congenital heart disease, risk of bacterial endocarditis.
b- respiratory; asthma, hay fever, infections
c- Hematological; anemia, bleeding, bruising
d- Gastrointestinal; hepatitis, jaundice
e- endocrine; diabetes
f- CNS; epilepsy, mental and physical handicap
g- urogenital; renal disease
h- skin; thin, fragile.
Dentist need to check:
*immunization
*medication
*hospitalization
*allergies (allergy for latex (rubber material)
Dentist need to know the birth details of the patient
Prenatal
-Mum health during pregnancy
-any complication, trauma, infection, drugs taken
-gestational age (premature birth)
-delivery (oxygen deprivation)
Neonatal
-Birth weight, height and defect
-jaundice
-rhesus
-incompatibility
Perinatal/postnatal
-bottle or breast fed, bottle content
-immunization
-childhood illnesses
Dentist must know about:
# growth: height, weight, growth charts
#family history
Dental History, social history, behaviour
Sayangilah dr gigi sejak dari kecil ;)
Bismiillah...
Dalam pergigian sendiri ada satu bidang khusus yang memang fokus pada bayi dan kanak2. Nama bidang ini pediatric. Kebanyakan orang perempuan suka pada bidang ini tapi mungkin tidak bagi aku..hee..aku tak berapa minat layan budak2. Mungkin sebab aku anak bongsu kot..
kaitan? haha
Walau pediatric ini bukanlah bidang aku, tapi kena kuasai juga ilmu Allah ini. Kena ikhlaskan hati :)
Soalan cliche:
Bila sepatutnya kanak2 dibawa jumpa dentist?
> apabila bdk itu dah tumbuh gigi pertamanya. Kebiasaannya umur 6-7 bulan tu dah tumbuh gigi pertama.
Kebanyakan ibu bapa tidak tahu akan fakta ini. Atau mungkin mereka tahu cuma tidak tahu apa kepentingan untuk jumpa dgn dentist. Dengan kata lain, kurangnya kesedaran dalam kalangan masyarakat tentang penjagaan gigi sejak dari kecil. Aku juga tidak tahu tentang perkara ini sebenarnya tetapi bila aku mendalami bidang ini baru aku tahu betapa pentingnya untuk jaga gigi sejak bayi.
Jadi, kenapa mesti jumpa dentist seawal usia 6 bulan?
Secara umum, aku lihat ini adalah salah satu langkah pencegahan. Pencegahan lebih baik daripada mengubati kan? Kerana kondisi gigi kita tidak sama untuk setiap orang. Ada kecacatan gigi yang boleh kita betulkan sejak bayi. Jadi, ia tidak memerlukan kos yang banyak pun untuk mencegah berbanding merawat. Dentist boleh merancang rawatan awal untuk mengatasi masalah tersebut.
Sebagai contoh, kebanyakan rahang (jaw) orang Asia kecil dan bergigi besar. Jadi kemungkinan untuk gigi bertindih (crowding) itu sangat lah tinggi. Sekiranya perkara ini dirujuk sejak daripada bayi, dentist ada cara untuk mencegah masalah ini tanpa perlu menelan kos yang tinggi. Tetapi jika perkara ini dibiarkan sehingga kanak2 itu meningkat dewasa, maka ia perlu untuk memakai braces. Memakai braces pula memerlukan sekurang-kurangnya 5k dalam tangan. Mungkin kalau pergi ke klinik kerajaan boleh dapat harga yang lebih murah, tetapi perlu tunggu giliran untuk tempoh masa yang panjang. Takut2 jika terlambat nanti, akan menyebabkan berlakunya masalah yang lain pula.
kebaikan untuk kanak2
> memperkenalkan kanak2 dengan dunia penjagaan gigi
>membina hubungan dengan kanak2 dengan bertanya soalan (history) secara direct.
>untuk mengurangkan rasa takut pesakit kepada prosedur dentist dengan memulakan rawatan yang mudah
>sebagai motivasi buat kanak2 dengan memupuk sikap positif pada dental care.
kebaikan untuk ibu bapa
> membina hubungan yang baik dengan ibu bapa
> sebagai emotional support pada pesakit.
> success rate yang meningkat.
kebaikan untuk dentist
> untuk diagnose dan merancang rawatan yang terbaik untuk pesakit.
Dalam pergigian sendiri ada satu bidang khusus yang memang fokus pada bayi dan kanak2. Nama bidang ini pediatric. Kebanyakan orang perempuan suka pada bidang ini tapi mungkin tidak bagi aku..hee..aku tak berapa minat layan budak2. Mungkin sebab aku anak bongsu kot..
kaitan? haha
Walau pediatric ini bukanlah bidang aku, tapi kena kuasai juga ilmu Allah ini. Kena ikhlaskan hati :)
Soalan cliche:
Bila sepatutnya kanak2 dibawa jumpa dentist?
> apabila bdk itu dah tumbuh gigi pertamanya. Kebiasaannya umur 6-7 bulan tu dah tumbuh gigi pertama.
Kebanyakan ibu bapa tidak tahu akan fakta ini. Atau mungkin mereka tahu cuma tidak tahu apa kepentingan untuk jumpa dgn dentist. Dengan kata lain, kurangnya kesedaran dalam kalangan masyarakat tentang penjagaan gigi sejak dari kecil. Aku juga tidak tahu tentang perkara ini sebenarnya tetapi bila aku mendalami bidang ini baru aku tahu betapa pentingnya untuk jaga gigi sejak bayi.
Jadi, kenapa mesti jumpa dentist seawal usia 6 bulan?
Secara umum, aku lihat ini adalah salah satu langkah pencegahan. Pencegahan lebih baik daripada mengubati kan? Kerana kondisi gigi kita tidak sama untuk setiap orang. Ada kecacatan gigi yang boleh kita betulkan sejak bayi. Jadi, ia tidak memerlukan kos yang banyak pun untuk mencegah berbanding merawat. Dentist boleh merancang rawatan awal untuk mengatasi masalah tersebut.
Sebagai contoh, kebanyakan rahang (jaw) orang Asia kecil dan bergigi besar. Jadi kemungkinan untuk gigi bertindih (crowding) itu sangat lah tinggi. Sekiranya perkara ini dirujuk sejak daripada bayi, dentist ada cara untuk mencegah masalah ini tanpa perlu menelan kos yang tinggi. Tetapi jika perkara ini dibiarkan sehingga kanak2 itu meningkat dewasa, maka ia perlu untuk memakai braces. Memakai braces pula memerlukan sekurang-kurangnya 5k dalam tangan. Mungkin kalau pergi ke klinik kerajaan boleh dapat harga yang lebih murah, tetapi perlu tunggu giliran untuk tempoh masa yang panjang. Takut2 jika terlambat nanti, akan menyebabkan berlakunya masalah yang lain pula.
kebaikan untuk kanak2
> memperkenalkan kanak2 dengan dunia penjagaan gigi
>membina hubungan dengan kanak2 dengan bertanya soalan (history) secara direct.
>untuk mengurangkan rasa takut pesakit kepada prosedur dentist dengan memulakan rawatan yang mudah
>sebagai motivasi buat kanak2 dengan memupuk sikap positif pada dental care.
kebaikan untuk ibu bapa
> membina hubungan yang baik dengan ibu bapa
> sebagai emotional support pada pesakit.
> success rate yang meningkat.
kebaikan untuk dentist
> untuk diagnose dan merancang rawatan yang terbaik untuk pesakit.
Maxillary Injection Technique
Bismillah..
Seperti yang kita tahu utk beri bius pada orang ni bukan senang.Dentist memang kena kuasai nerve (urat) lagi2 yang dekat muka dengan kepala. Kalau tersalah nerve boleh menyebabkan patient merana seumur hidup..naudzubillah
doakan aku agar aku boleh menguasai ilmu dgn baik ;)
Selalu technique yang kita pakai untuk maxilla ni infitration..tapi boleh je kalau nak pakai block anesthesia pun.
First and foremost mesti kena tahu tentang anatomy dulu.
Trigeminal nerve
ha itula trigeminal nerve. Kira nerve besar jugakla..sbb ada 3 branches.
V1: Opthlamic division (sensory)
V2: Maxillary division (sensory)
V3: Mandibular division (motor and sensory)
V2: Maxillary division
exit melalui foramen rotundum of greater wing of sphenoid
Branches: divided by location.
1) intercranial: within cranium ( before getting out from foramen rotundum).
.middle meningeal nerve- providing sensory innervation to the dura matter
2) pterygopalatine ( within pterygopalatine fossa)
a-Zygomatic nerve
zygomaticofacial nerve- skin to cheek prominence
zygomaticotemporal nerve- skin to lateral forehead
b-pterygopalatine nerve: serve as communication for the pterygopalatine ganglion and the maxillary nerve. Carry postganglionic secretomotor fibers through the zygomatic branch to the lacrimal gland.
orbital branch: supply periosteum of the orbits.
nasal branch: supply mucous membranes of superior and middle conchae, lining of posterior ethmoid sinuses and posterior nasal septum.
Nasopalatine nerve: travels across the roof of nasal cavity giving branches off to the anterior nasal septum dan floor of nose. Enters incisive foramen and provides palatal gingival innervation of premaxilla.
Palatine branches: greater (ant) and lesser (middle or post) palatine nerves
Greater palatine: travels through the pterygopalatine canal , enters the palate via greater palatine foramen. Innervates palatal tissue from premolars to soft palate.
Lesser palatine: merges from lesser palatine foramen and innervates the mucous membranes of soft palate and parts of tonsillar region.
Pharyngeal branch: exits the pterygopalatine ganglion and travels through the pharyngeal canal. Innervates mucosa of the portions of nasal pharynx
Nerve paling penting: Nasopalalatine, greater palatine and lesser palatine..sbb apa?
they innervate the palate. boleh buat sama ada guna infiltration or block.
c)Post sup alveolar nerves.
into infraorbital groove- innervates molars
infraorbital (within the infraorbital fissure)
infraorbital branch: middle, anterior
middle: innervates premolars
anterior: ant teeth
branches from 6-8 mm posterior to the infraorbital nerve exit from infraorbital foramen.
facial: emerge from infraorbital foramen
inferior palpebral: lower eyelid
external nasal: lateral skin of the nose
superior labial branch: upper lip skin and mucosa
Seperti yang kita tahu utk beri bius pada orang ni bukan senang.Dentist memang kena kuasai nerve (urat) lagi2 yang dekat muka dengan kepala. Kalau tersalah nerve boleh menyebabkan patient merana seumur hidup..naudzubillah
doakan aku agar aku boleh menguasai ilmu dgn baik ;)
Selalu technique yang kita pakai untuk maxilla ni infitration..tapi boleh je kalau nak pakai block anesthesia pun.
First and foremost mesti kena tahu tentang anatomy dulu.
Trigeminal nerve
ha itula trigeminal nerve. Kira nerve besar jugakla..sbb ada 3 branches.
V1: Opthlamic division (sensory)
V2: Maxillary division (sensory)
V3: Mandibular division (motor and sensory)
V2: Maxillary division
exit melalui foramen rotundum of greater wing of sphenoid
Branches: divided by location.
1) intercranial: within cranium ( before getting out from foramen rotundum).
.middle meningeal nerve- providing sensory innervation to the dura matter
2) pterygopalatine ( within pterygopalatine fossa)
a-Zygomatic nerve
zygomaticofacial nerve- skin to cheek prominence
zygomaticotemporal nerve- skin to lateral forehead
b-pterygopalatine nerve: serve as communication for the pterygopalatine ganglion and the maxillary nerve. Carry postganglionic secretomotor fibers through the zygomatic branch to the lacrimal gland.
orbital branch: supply periosteum of the orbits.
nasal branch: supply mucous membranes of superior and middle conchae, lining of posterior ethmoid sinuses and posterior nasal septum.
Nasopalatine nerve: travels across the roof of nasal cavity giving branches off to the anterior nasal septum dan floor of nose. Enters incisive foramen and provides palatal gingival innervation of premaxilla.
Palatine branches: greater (ant) and lesser (middle or post) palatine nerves
Greater palatine: travels through the pterygopalatine canal , enters the palate via greater palatine foramen. Innervates palatal tissue from premolars to soft palate.
Lesser palatine: merges from lesser palatine foramen and innervates the mucous membranes of soft palate and parts of tonsillar region.
Pharyngeal branch: exits the pterygopalatine ganglion and travels through the pharyngeal canal. Innervates mucosa of the portions of nasal pharynx
Nerve paling penting: Nasopalalatine, greater palatine and lesser palatine..sbb apa?
they innervate the palate. boleh buat sama ada guna infiltration or block.
c)Post sup alveolar nerves.
into infraorbital groove- innervates molars
infraorbital (within the infraorbital fissure)
infraorbital branch: middle, anterior
middle: innervates premolars
anterior: ant teeth
branches from 6-8 mm posterior to the infraorbital nerve exit from infraorbital foramen.
facial: emerge from infraorbital foramen
inferior palpebral: lower eyelid
external nasal: lateral skin of the nose
superior labial branch: upper lip skin and mucosa
Saturday, 18 July 2015
Selection of syringes and needles
Bismillah
nak inject orang kena pilih jarum@needle yg sesuai..dan nak biar pilihan itu kena tgk beberapa faktor..
Antara cirinya ialah..
1) either shirt, long or ultrashort
2)high/low gauge
3)block anesthesia>long needles
4)infiltartion anesthesia> short needles
5) children> ultrashort
6)the higher the gauge the shorter the needle
dentist kena la pilih needle berdasarkan standard America Dental Association (ADA)
short needle kita guna utk soft tisuue yang mempunyai ketebalan kurang daripada 20mm
23-through 30 gauge needle boleh digunakan utk intraoral injections blood can be aspirated through them, aspiration akan jadi susah kalau guna smaller gauge
extra-short, 30-gauge digunakan utk infiltration injections.
amaran: jangan sesekali bengkokkan jarum
nak inject orang kena pilih jarum@needle yg sesuai..dan nak biar pilihan itu kena tgk beberapa faktor..
Antara cirinya ialah..
1) either shirt, long or ultrashort
2)high/low gauge
3)block anesthesia>long needles
4)infiltartion anesthesia> short needles
5) children> ultrashort
6)the higher the gauge the shorter the needle
dentist kena la pilih needle berdasarkan standard America Dental Association (ADA)
short needle kita guna utk soft tisuue yang mempunyai ketebalan kurang daripada 20mm
23-through 30 gauge needle boleh digunakan utk intraoral injections blood can be aspirated through them, aspiration akan jadi susah kalau guna smaller gauge
extra-short, 30-gauge digunakan utk infiltration injections.
amaran: jangan sesekali bengkokkan jarum
Local Anesthesia
Local AnesthesiaJ
Local anesthesia ni kalau nak mudah faham ia berkaitan
dengan bius.Kalau ktorg nak senang panggil LA je..hee.. Bius setempat. Ada
banyak jenis LA ni. Antaranya surface anesthesia, Infiltration anesthesia dan
regional block anesthesia.
Ni yang main type punya. Jadi kita go through satu2..
Surface anesthesia
Nama lain kita panggil topical anesthesia..sebab dia
berkaitan kulit kan..
Ada banyak form, mcm: ointments, gelly,spray dan cream
Most common ointment: EMLA (2.5%: lidocaine, 2.5%: prilocaine
=5%)
Gelly banyak flavor
and selalu guna utk intraorally (dalam mulut) dan untuk budak2..
LA spray: 10%
Ethyl chloride spray: produce surface anesthesia by cooling.
Infiltration
anesthesia.
Yang ni banyak..tapi cara aku ingat macam ni..conventional injection
technique
Periosteal ada 3: supra, para and sub
Intra ada 2: osseous and ligamental
Submucosal
Yang paling common: supra periosteal.
Regional block
anesthesia
Conduction anesthesia
Nak bius orang bukan senang.kena tahu technique. Salah
technique je boleh menyebabkan patient merana seumur hidup..naudzubillah.
Dan ni antara yang biasa @ conventional injection technique.
LA technique:
Target: small nerve ending. (flooded with LA solution)
Selalu guna: maxillary teeth and mandibular incisors(lower
anterior)
Nerve block technique: conduction technique
Target: main trunk
So bila dah block main trunk..maka nye terblock la jugak
v
Nasopalatine nerve
v
Greater palatine nerve
v
Lesser palatine nerve
v
Buccal nerve
v
Lingual nerve(mandible)
v
Buccal nerve
Kenapa guna block anesthesia dekat mandible and infiltration
dekat maxilla?
Ø
Sebab anesthesia solution tak boleh penetrate
masuk ke compact vestibular bone in the mandible jd LA tak successful..
Ø
Mandible: thick cortical plates..and
infiltration tak kan penetrate cortex to reach the apices of teeth.
Ø
Maxilla: tulang dia soft and thin( spongy) bone
jadi infiltration sufficient je
Disadvantage block anesthesia.
·
Increased risk of trauma of nerve trunk.
·
Accidental intravascular injection in of LA
solution.
Ada technique lain juga..(other technique)
1)Periodontal Ligament, PDL technique
Selalu guna: mandibular molars (alternative pada nerve block
technique)mungkin sbb ID block tak working so bagi je la technique ni.
Technique ni simple je; hanya inject LA solution within
periodontal ligament space. Perlu small amount (0.2ml) sbb PDL ni kecik je.
Letak needle dkt gingical sulcus and advances along the root
surface until resistance is met. Masa inject tu patient akan rasa slight
pressure because it is very small space.
Injection ni tak
sakit and anesthethic effect dia hnaya pada pulp and desmodontal nerve
Duration: 10-15 minutes
PDL injection ni sesuai utk extremely anxious patients and
children
2) Intrapulpal injection.
Guna injection ni bila block and infiltration tak berkesan
Small quantity (0.1ml)
Duration: 10 minutes
Fast and sakit sikit masa mula2 introduce injection.
3) Intraosseous injection.
Force the needle in cortical plate and cancellous bone
Guna injection ni kalau block ansthesia pun tak berkesan
pada mandible. Sesuai guna untuk mandible sebab perforate the cortex then
introduce wthin the bone.
Mcm mana perforate the cortex?
·
Guna hand-piece with a very fine bur. There is
small piece will guide the hanpiece where to drill, then the needle will go
through the same piece to get the anesthesia inside the bone.
4) Jet injection( non-needle, needle-less dentistry)
Very recent technique
Principle jet instrument: small quantities of liquids forced
through very small opening under high pressure can penetrate mucus membrane or
skin without causing tissue trauma.
Good utk surface anesthesia
One jet injection : hold 1.8 ml cartridge of LA, it can be
adjusted to expel (0.05-0.2 ml solution under 2000 psi pressure.
Monday, 13 July 2015
Plak, Caries dan Cavity
Bismillah
Baru2 ini saya ditanya tentang beza plak, caries dan cavity. Ini jawapannya
Plak
Proses fisiologi (semula jadi) yang terbentuk daripada
komuniti mikroorganisma yang melekat pada permukaan gigi. Ini bermakna
kewujudan plak adalah proses semula jadi yang Allah telah tetapkan. Namun, jika
kita biarkan plak ini berkumpul dalam jangka masa yang lama, ia akan menyebab
berlakunya caries. Oleh itu, untuk mengelakkan daripada berlakunya caries ,plak
boleh dikurangkan dengan memberus gigi, floss, atau bersiwak. Lagi baik , jika menggunakan
mouthwash seperti Listerine, Colgate
Plax dan sebagainya
Caries
Proses yang berlaku pada permukaan gigi yang membenarkan
plak membiak pada jangka masa tertentu. Proses ini juga proses semula jadi yang
mana kita tidak boleh elak. Namun, jika kita biarkan dalam masa yang lama,
caries akan membahayakan gigi dan boleh merebak hingga ke dalam gigi dan
merosakkan struktur yang ada dalam gigi tersebut. Caries tidak boleh dibuang
dengan hanya memberus gigi, floss atau bersiwak tetapi haruslah berjumpa dengan
dr gigi untuk membuangnya.
Cavity
Cavity terhasil apabila berlakunya pemecahan (breakdown)
enamel gigi yang berlaku semasa mengunyah atau semasa rawatan gigi dijalankan.
Ianya berlaku apabila caries merebak hingga ke dentine (struktur dalam gigi).
Akhirnya berlakulah gigi berlubang. Untuk mengatasi masalah cavity gigi ini,
pesakit perlulah berjumpa dengan dr gigi
untuk tampalan.
Rujukan: Essentials of Dental Caries Third Edition Edwina A.M. Kidd
Cabut gigi..batal puasa atau tidak
Suatu hari di sebuah klinik gigi
Pesakit: Dr..dr sy sakit gigi. Sy rasa mcm nak cabut je gigi ni tapi masalahnya sy puasa hari ni. Tak batal ke nanti?
Dr H: owh..tak pe..tak batal selagi mana awk tak telan darah dan bahan rawatan bersama air liur. Cuma kalau ikut hukum ia makruh saja.
Pesakit: mestila masa dr rawat sy nanti sy tertelan air liur. Dah tu mcm mana sy nak tahu sy telan air liur yg bercampur dgn bahan tu ke tak?
Dr : Jangan risau..zaman sekarang ni kan ada alat teknologi yg canggih. Alat penyedut air liur kuasa tinggi atau dalam bahasa org putih dipanggil High Volume Suction. Alat ini nanti akan menyedut air liur agar awak tak tertelan nanti. Selain itu, dr akan guna empangan getah( rubber dam) . In shaa Allah alat2 ni akan menghalang awk daripada tertelan air liur smile emoticon
Pesakit: owh..*mengangguk faham.
Selepas rawatan...
Pesakit: terima kasih dr. Sy ingat ke puasa sy terbatal kalau sy buat rawatan gigi. Sbb tu sy tak pergi jumpa dr gigi bulan puasa ni. Tp semalam sy xtahan sgt. Sampaikan sy terbaring dan xboleh buat apa2 pun.
Dr :dah tu awak berbuka tak?
Pesakit: tak..hee
Dr :adik, dalam Islam Allah tak pernah susahkan kita. Kalau awk sakit sgt, awk boleh buka puasa. Syeikh Yusuf Al-Qardhawi kata dalam fatwa, pesakit diharuskan berbuka puasa jika kesakitan itu memudharatkan.
Dalam Al-Quran pun Allah ada sebut
ومن كان مريضا أو على سفر فعدة من أيام أخر
Maksudnya: " Sesiapa dalam keadaan sakit atau musafir (harus baginya berbuka puasa), maka diganti pada hari lain
ومن كان مريضا أو على سفر فعدة من أيام أخر
Maksudnya: " Sesiapa dalam keadaan sakit atau musafir (harus baginya berbuka puasa), maka diganti pada hari lain
Awk boleh check surah Al-Baqarah ayat 2
Pesakit: Baiknya Allah.*terharu...baru sy tahu. Terima kasih dr smile emoticon
Dr :sama2 kasih;)
Ketahuilah Allah tidak akan memberatkan hamba2Nya
يريد الله بكم اليسر ولا يريد بكم العسر
Allah menghendaki kemudahan bagimu dan tidak menghendaki kesukaran bagimu
Allah menghendaki kemudahan bagimu dan tidak menghendaki kesukaran bagimu
Rujukan: Tanyalah Pakar Tentang Fiqh
Hukum jaga gigi
Apakah hukum menjaga gigi?
Bersiwak atau dalam bahasa Melayu menggosok gigi adalah satu cara utama penjagaan gigi. Sekalipun para ulama berselisih pendapat mengenai hukum bersiwak, namun jumhur ulama mengatakan hukum bersiwak adalah tidak lebih drpd sunat muakad, iaitu sunat yang sangat dituntut, kerana Rasulullah saw amat mengambil berat soal bersiwak. Sabda Rasulullah saw
السواك مطهرة للفم، مرضاة للرب.
Ertinya " Siwak dapat membersihkan mulut dan diredhai Allah".
Ertinya " Siwak dapat membersihkan mulut dan diredhai Allah".
(Riwayat al-Bukhari, Ahmad, Al-Nasa'i dan Ibnu Hibban
Hukum bersiwak adalah sunat muakkad seperti yang ditegaskan oleh jumhur ulama bersandarkan kepada beberapa hadis, yang mencakupi
لو أن أشق على أمتي لأمرتهم بالسواك عند كل وضوء.
Ertinya
"Jika bukan kerana memberatkan umatku maka aku perintahkan mereka untuk bersiwak setiap kali wuduk"
(Riwayat al-Bukhari)
Tanyalah Pakar Tentang Fiqh Dental
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