Showing posts with label ARTICLES. Show all posts
Showing posts with label ARTICLES. Show all posts

How to set up a new Dental Clinic

This article focuses on young dentists , who with long standing MDS dream were not able to crack MDS entrance and are unable to pay heavy capitation fees.... DON'T GIVE UP

With increased  competition in mds entrance exams for few govt. seats have let down lot of MDS aspirants. The fee structure for  MDS seats in private colleges have gown up to 6-7 lakhs a year, which is beyond the reach of common middle class family. So once again comes the big question,





WHAT NEXT?

WHAT AFTER BDS ?

For all my dear aspirants,

DON'T GIVE UP.


You are already a professional BDS doctor. Don't underestimate your BDS skills and Qualifications. Obviously the best scenario is in being able to pursue a PG degree. But, this is not always possible as mentioned above.



If you still don't believe me, here are few facts:

1. On an average , a BDS practitioner is making one lakh a month.
2. There is huge demand for dentists in outskirts of all cities in INDIA.
3. Why do you want to setup clinic only in central hubs , there is huge potential in sub urbs.
4. Paying capacity of patients is less in remote areas but number of patients is more.
5. Some of the best dentists are the ones with only a bachelor’s degree. They have reached the pinnacle of their profession through the dint of hard work & constant self-examination.

So , its high time now take the big decision.START your own private practice.

What you require ?

1. A BDS degree. (which you already have)
2. Get 6 month experience of clinical work  in a reputed dental clinic under a qualified dental practitioner.This will boost your confidence and you will how to handle patients at private clinics.
3. A diploma or a short course in aesthetic dentistry or endodontics is always a help.
4. Preferably look for a shop in good commercial area or near by a hospital. You need not buy it, you can always start on a rented shop.
5. If you can get associated with an ENT or MS (eye) , you can start a PolyClinic in patnership.
6. Minimum space advised is 250 sqft. More than this is a luxury.

Equipment and Material : (costs range between 3 to 5 lakhs )




1. A Dental Chair : Go for a brand which provides service in your area.  (1 to 4 lakhs)
2. Compressor : min. 20 litres capacity ( 10 to 20 thousand)
3. Dental chair should be equipped with motorised suction, 3 way syringe and micromotor.
4. x-ray machine which supports use of RVG later on. (25 to 70 thousand)
5. Ultrasonic Scaler  : preferably good brand (5 to 30 thousand)
6. Cordless Light Cure unit ( 5 to 25 thousand)
7. A straight hand piece
8. A contra angle hand piece
9. Airrotor ( 3 in number)
10. Autoclave (min. 5 lit. , top loading, newer front loading are better)
11. Glass bead sterliser

12. UV chamber
13. A full set of upper and lower teeth extraction forceps...go for the best brand (150 to 600 a piece)
14. A needle cutter
15. PMT sets ( best brand ) min. 15 in number.
16. Kidney trays 15
17. Enamel trays 3
18. Intrument drums 2
19. Ultrasonic bath
20. A portable X- ray developing chamber.
21. Dental burs
22. Alginate
23. Rubber Based impression material
24. Conservative filling instruments
25. Prosthodontic Instument Kit
25. Endo box
26. Endo gauge
27. Bur box
28. K- files all sizes, broaches , spreader etc.
29. Endo MOTOR ( optional)
30. RVG (optional)
31. Apex locator (optional)
32. All endo related material e.g. sealer, gp points, paper points,
33. Ca hydoxide
34. Temporary filling material
35. Composite starter kit
36. Lathe (optional)
37. Suction tips
38. Cotton holder
39. Developer and fixer
40. Gates glidden and paeso reamers
41. Plaster, stone and die stone
42. Impression trays both perforated and non perforated
43. Articulators
44. Posts and core material
45. Prophylactic paste
46. Instant Hand sanitizer
47. Filling materials like amalgam, GIC, compomer , miracle mix and posterior composites.
48. Pain OFF
49. Alveogyl
50. Irrigants


This is a brief list.

What more do you need ?

Dental office and waiting area furniture which may consists of

- Doctor's Table
- Doctor's Chair
- 2 patients chairs

One reception table
- receptionists chair
- waiting chairs from 6 to 20 depending on size of OPD

OTHER MUST HAVE FEATURES IN YOU CLINIC

A LCD/LED TV in waiting area.
A Water filter with hot/cold water facilities
A magazine stand with newspaper in regional language and few magazines


All is done I guess.... Along with all these things your courteous attitude and humble approach with a smile on your face is required to treat patients even before they sit on your dental chair.





ALL THE BEST !!





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Bitten By a Snake : Things you should know



►    3500   SPECIES
►    300     VENOMOUS
►    30000  - 40000 DEATHS ANNUALLY


POISONOUS SNAKES

INDIAN SCENARIO
►    5 DANGEROUSLY POISONOUS SNAKES
          KING COBRA
          COMMON COBRA
          COMMON KRAIT
          RUSSELL’S VIPER
          SAWSCALED VIPER
MOST COMMON POISONOUS SNAKE IS COMMON KRAIT

►    216  SPECIES

►    52  VENOMOUS



SNAKE VENOM

►    Toxic saliva secreted by modified parotid glands of a venomous snake
►    Amber coloured when fresh
►    Constituents               Toxins
                                       Enzymes
                                       Miscellaneous : neurotoxins
                                                                cardiotoxins
                                                                hemolysin


VENOM CLASSIFICATION

►    Neurotoxic              elapids(cobra,krait)
►    Hemotoxic               viperidae
►    Myotoxic                  sea snake
►    Krait and russell’s viper is much more toxic than that of cobra


SYMPTOMATOLOGY OF NON VENOMOUS SNAKES

►    Universal fear associated induce a state of shock
►    Bite site may demonstrate multiple teeth impressions
►    Lack of significant local pain or swelling
►    Adequate reassurance and symptomatic treatment measures lead to full recovery


SYMP..VENOMOUS SNAKE BITES

►    ELAPID BITE
►    Local features :
►        indistinct fang marks ,
►        burning pain,
►        swelling and discolouration,                                                                        
►        serosanguinous discharge

       
Systemic features

►    preparalytic stage  :     emesis,
                                             headache,
                                              LOC.
      paralytic stage      : ptosis,
                                           ophthalmoplegia
                                           drowsiness,
                                           dysarthria,
                                           dysphagia,
                                           convulsions,
                                           bulbar paralysis,
                                           resp failure .

     

VIPERID BITE

Local features:
                         rapid swelling,
                         discolouration,
                         blister formation,
                         bleeding from bite site,
                         severe pain
    
Generalised bleeding manifestations.                       
                          epistaxis,
                          hemoptysis,
                          bleeding gums
                          hemauria
                          purpuric spots
 Renal failure

      

HYDROPHID BITE

►    Local features: minimal swelling and pain
►    Systemic features: myalgia muscle stiffness
                  myoglobinuria , renal tubular
                  necrosis                  


DIAGNOSIS OF SNAKE BITE
►    FANG MARKS:classically, two puncture                wounds seperated by a distance varying from 8mm to 4cm, depending on the species involved.
►    However a side swipe may produce only a single puncture,while multiple bites could result in numerous fang marks.
►    Baileys method
  
      



Management of snake bite


FIRST AID


►    DELAY ENRY OF VENOM
►    TOURNIQUET
►    ABOVE KNEE
►    ABOVE ELBOW


CLINICAL ASSESMENT
►    VITAL SIGNS—PULSE
                           --B P
                           --RESPIRATION –SBC
OBSERVE – BITE MARK
                   --LOCAL REACTION
                   --PAINFUL LNE
►               


NEUROTOXICITY
►    PTOSIS
►    OPHTHALMOPLEGIA
►    MYASTHENIA LIKE SYMPTOMS
►    ASSES SBC



HEMATOTOXICITY

►    PURPURA
►    ECHYMOSIS
►    GINGIVAL SULCUS BLEED
►    HEMATURIA

CAPILLARY LEAK SYNDROME
►    PUFFINESS
►    CHEMOSIS
►    PAROTID SWELLING




Lab. Investigations

  
Haematological-
                             leucocytosis(>20,000-
                                     severe envenomation)                          
                            elevated PCV
                             thrombocytopenia
                             evidence of hemolysis
                             prolonged CT,PT,PTT
                             elevated FDP



►    CT     >    20 MINUTES

►    SURE SIGN OF ENVONOMATION

►    PITVIPER   > 2 WEEKS

►    ECG: bradycardia
             ST    /
             Twave inversion
             QT Prolongation
             changes due to hyperkalemia
             

►    Metabolic
         hyperkalemia
         hypoxemia with resp.Ac
         met.Ac or lactic Ac
►    Urine
         hematuria,proteinuria,Hburia
         Mburia
        


►    Renal : ARF -- BU S.Cr   S E
►    CXR :  pulm.edema
               intrapulm.Hgs
               pleural effusion
►     Immunodiagnosis: by ELISA….
     highly sensitive but specificity inadequate to diff b/w diff species of snakes



SPECIFIC MANAGEMENT  ASV

►    HORSE SERUM
►    ASV IN INDIA
                        COBRA
                        KRAIT
                        RUSSEL’S VIPER
                        SAW SCALED VIPER
 1 mi ASV     ---    0.6m6 cobra R viper
                     ---    0.45mg krait S viper
                       


Indication ---- systemic manifestaiton
►    NEUROTOXICITY
►    REPEATED VOMITING
►    HAEMOTOXICITY
►    NEPHROTOXICITY
►    CARDIOTOXICITY
►    RHABDOMYOLYSIS


►    PROLONGED  CT  ALONE

                       PIT VIPER  --  NO
                       SNAKE NOT IDENTIFIED


NEUROTOXIC ENVONOMATION
►    INITIAL DOSE  10  -  15 VIALS
►    REASSESS
►    IMPROVEMENT   30  --  60 MIN
►    REPEAT  5 VIALS AFTER 60  -- 90 MINS
►    SUPPORTIVE – NEOSTIGMINE AFTER ATROPINE


HAEMOTOXIC ENVONOMATION
►    MILD            CT  <  30 MINS
                        CLOT SIZE  =  50% blood col
                        initial dose  = 5 vials
►    MODERATE   CT   >  30 MINS
►                           CLOTS ONLY SPECKLES
►                           intial dose   = 10 vials
►    SEVERE      INCOAGULABLE
►                         initial dose  = 15 vials


►    REPEAT  CT  AFTER 6 – 9 HOURS
►    IF CT PRONGED REPEAT 5- 10  VIALS
►    LOW DOSE INFUSION – FOLLOWING
                                            DAYS


SUPPORTIVE CARE


  ANTIBIOTICS
  METHYL PREDNISOLONE
  FFP,FRESH BLOOD
  PREVENTION AND Rx OF HYPOTENSION
  PRVENTION OF SHOCK



PREVENTION OF ARF

►    PROPER FLUID ADMINISTRATION
►    CORRECT MYOCARDIAL DYSFUNCTION
►    MONITOR OUTPUT BU S.Cr SE
►    AVOID  NEPHROTOXIC DRUGS
►    PROTEIN RESTRICTION



Management of local reactions

►    BULLAE   - LEFT INTACT
►    NECROSIS  - DEBRIDEMENT
►    COMPARTMENT SYNDROME – FASCIOTOMY
►    MOST COMFORTABLE POSITION


REACTIONS TO ANTIVENOM

►    ANAPHYLACTOID  10 – 90 MINS

►    PYROGENIC 2 HOURS

►    SERUM SICKNESS  5 – 21 DAYS
►    Rx  local anaesthetic ice pack













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15 Discoveries/Scientists you should C.T.M (commit to memory)


             Discovery                                                           Scientist
1.    Acidogenic (chemicoparasitic)               Miller
2.    Proteolysis theory                                      Gottieb
3.    Proteolysis chelation                                 Schartz and Martin
4.    Flourosis index                                            Dean
5.    Pit & fissure sealant                                   Buonocore
6.    Prophylactic odontotomy                        Hyatt
7.    Procaine                                                        Einhorn
8.    Epidemiology                                               Thomas Sidenham
9.    Bis—GMA                                                      Bowen
10.          OHI—S                                                      Green and Vermilion
11.          Psychoanalytic theory                          Sigmond Freud
12.          Conditioning theory                              Pavlov
13.          Cognitive development                        Piaget
14.          Social learning                                           Bandura
15.          Fermentation/putrifaction                    Louis Pasteur (1857)

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36 Characterstic features of various diseases


1.    Foreign body giant cells—Leprosy, TB, and chronic infective granuloma.
2.    Tuton giant cells—Xanthoma
3.    Aschoff cells—Rheumatic nodule
4.    Reed-Sternberg cells--Hodgkins disease
5.    Kupfer cells—Acute viral hepatitis
6.    Gaucher cells—Niemann-Pick disease
7.    Target cells—Beta thalassaemia
8.    Mallorys hyaline—Alcoholic hepatitis
9.    Tumour giant  cells---Osteosarcoma
10.          Anitschkow cells—Rheumatic fever
11.          Foam cells---Atherosclerosis
12.          Basaloid cells—Basal cell carcinoma
13.          Heart failure cells—CVS lung
14.          Gamma-gandy---CVS spleen
15.          LE cells---SLE
16.          Congo red---Amyloid
17.          Toludene blue---Amyloid
18.          Periodic acid suhiff---Carbohydrate, glycogen and mucin
19.          Alician blue---Acidic mucin
20.          Von Gieson---Extracellular collagen
21.          Verhoffs elastic---Elastic fibres
22.          Oilred o---Fats
23.          Sudan Black B---Fats
24.          Osmium tetroxide---Fats
25.          Gram---Bacteria
26.          Ziehi Neelsen—Tubercle bacilli
27.          Fite Wade---Leprosy bacilli
28.          Giemsa---Protozoan parasite
29.          Groccots silver---Fungi
30.          Shikata orcein---Hepatitis B surface
31.          Kossas---Osteomalacia for calcium, vit. D deficiency
32.          Perls prussian blue---Haemosiderin, iron
33.          Masson-Fontana---Melanin
34.          Alizarin red---Calcium deposit
35.          Von kossa---Mineralised bone
36.          Rubeanic acid—Copper


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40 Most Commons in Dentistry



1. Most common impacted anterior tooth--- maxillary canine


2. Most common supernumerary tooth—mesiodens


3. Most common ectopically erupted tooth—maxillary permanent first molar


4. Most common malignancy of oral cavity—squamous cell carcinoma


5. Most common benign tumour of oral cavity—fibroma


6. Most common retained tooth – primary mandibular second molar


7. Most common recurring cyst—odontogenic keratocyst


8. Most common cyst in oral cavity—periapical cyst


9. Most common lichen planus- reticular lichen planus.


10. Most common dermatosis to affect oral cavity- lichen planus


11. Most common chemical burn in oral cavity –aspirin burn


12. Most common topical fluoride in adults – stannous fluoride


13. Most common topical fluoride in children—1.23 APF gel.


14. Most common burshing technique-scrub technique


15. Most common developments cyst-nasopalatine cyst


16. Most common complication of GA (op)-nausea


17. Most common used drug for petitmal epilepsy-ethosuximide


18. Most common used drug for grand mal-phenytoil


19. Most common drug used for temporal epilepsy- carbomezepine


20. Most common treatment for cyst – enucleation


21. Most common used clasp-simple circlet clasp


22. Most common used face bow in fpd- kinematic


23. Most common complication of RA involves TMJ-fibrous ankylosis


24. Most common salivary malignancy in children –mucoepidermoid carcinoma.


25. Most common salivary malignancy in palate area-ACC


26. Most common type of haemophilia--- haemophilia A


27. Most common type of gingivitis in children--- eruption gingivitis


28. Most common type of cerebral palsy is –athetoid/ spastic.


29. Most common nerve involved in C sinus thrombosis – abducent nerve


30. Most common type of impaction ---mesoangular


31. Most common benign epithelial tumour---- papilloma


32. Most common complication of surgical extraction of lower third molar—loss of blood clot


33. Most common used instrument grasp—pen grasp


34. Most common susceptible tooth for caries—mandibular first molar


35. Most common contrast media - iodine in oil


36. Most common cause of light radiographs — exhausted developer


37. Most common cause of failure of RCT— incomplete obturation


38. Most common isolated yeast strain from RCT— Candida


39. Most common bacteria found in root canals --- gram positive


40. Most common part of oral cavity affected by L planus –buccal mucosa.


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5 must read books for dental MDS entrance aspirants !!



1. DENTAL PULSE : The best of the lot. Must book for any dental entrance examination across india and abroad. Authored by Dr. Satheesh , Dental Pulse is by far the most essential and recommended books.Thoroughly read pulse including synopsis can help you clear any entrance exam.


2. DENTEST BY Dr. Gauri Shanker : Again one of the best books. If Dr. Gauri is reading this ,well sir I'm one among the long list of fans you have. Oldest and still most read book by MDS entrance aspirants.I'm often asked whether , reading both dental pulse and gauri shanker is essential and my answer is "yes". Although lot of content of dental pulse and dentest is same but both have there own specialities.

3. NEERAJ WADHWAN'S AIPG SOLVED 10 YEAR PAPERS: Dr. Wadhawan and Akhil Rajput came up with this excellent book , containing All India Dental PG entrance exam papers solved and with authentic answers. Sailent feature of this book is , its explanations . Each and every question is nicely explained and answers are dependable compared to most other books on AIPG  papers.

4. DENTAL MATRIX  AIIMS Solved 2001 to 2010: I 'm (Dr. Madaan) including my book in this list only after overwhelming response from the market and immense appreciations from students across the country. Sailent feature here is , each question has been treated like 4 questions and explained accordingly.

5.MUDIT KHANNA & AMIT ASHISH : These are two books . Both are by far the best for medical entrance exams but has been greatly instrumental for our dental Pg exams due to repition of Questions between two exams.


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MDS ASPIRANTS : FREQUENTLY ASKED QUESTIONS !! (FAQ'S)


 GUEST ARTICLE : AUTHORED BY Dr. SURESH (ALL CREDIT TO HIM)

Respected Aspirants :)

I guess u all must have already experienced the heat of entrance prep by now..
I know half of you must be actually worrying about the way u have been preparing and rest I Guess must be worrying whether you all be getting a seat this time…

There are two best thoughts which needs to be remembered each moment when u sailing through these stressful days.

For the first half the people who r worrying.. “Success belongs only to those who are willing to work harder than anyone else”

And for those who are prepared well I guess u all should remember one thing.. "There is always a light at the end of tunnel”

I know the feeling which each one faces in those days of entrance prep.. but No FEAR.. that’s actually needed the most to keep you r clock ticking..


“THE MOST FREQUENTLY ASKED QUESTIONS ABOUT MDS ENTRANCE”

Have received many mails, calls, asking many question.. most of the time they r repeated so often that sometimes I even felt like just copying and pasting my earlier response.. I am sure may be for the next 5 years these following questions will arise in each of the budding aspirants who keeps the first step in the path of entrance prep. I have tried sincerely to explain each of them, in the way so that each one of u understands it. I have surely made the language simple , just to make u feel that u almost talking to a person who have always tried to make support the new aspirants… Believe in one thing.. U HELP SOMEONE TODAY, GOD WILL SURELY HELP U SOMEDAY.. HERE IT GOES :)


HOW MUCH TIME IS NEEDED FOR PREPARATION?

Now time is money here.. it all depends on whether u r dropping or just preparing during internship.. keeping that point apart, u should make a time table of urs in which u should mark a deadline for each subject.. make sure the amount of time u allot for successive revisions are less than the earlier one,, so if u plan ur study this way then u will get a rough idea about the level of preparation u will be doing at the end of prep.

IS IT NECESSARY TO DO THEORY?

Now there are many people who give a different formula for entrance prep.. but u all should know one thing.. nobody guaranties u the success.. but yes.. they do give a hope.. somebody has said the truth.. “ to know the path ahead, ask those who are coming back” . This just means that if somebody has got success then u surely have a hope in that path.. but each u all should remember one thing.. every individual is different. Hence the amount of effort put by each individual is different and luck too.. but one thing u all should remember is, U REALLY CANT SAIL IN TWO BOATS AT A TIME.. “ the best advice to u all .. trust one , and follow it… don’t complicate things by listening to too many people.. ask one person who got a true success and follow it.,, what matters is the amount of trust u put in his words.. that’s what is imp to keep urself motivated.. It also depends on ur time and how much u have read in ur BDS days.. I never had time to read theory in my internship but I had worked hard during in my UG, so I was not much scared about the standard book.. but those who have taken a break of another year , I advise them to read the theory to because they have lot lot time for prep..