• Decrease Thyroid hormones

Classification

• primary hypothyroidism – due to cause within the thyroid gland itself.

• secondary hypothyroidism – due to failure of TSH production following pituitary or hypothalamic disease.

Causes

• spontaneous atropic thyroidism

• iodine deficiency

• iodine therapy

• thyroidectomy

• hashimoto’s thyroiditis

• dyshormonogenesis

• drug-induced ( lithium , amiodrone etc)

• radiation therapy

clinical features

A. Thyroid gland enlargement

B. Gastrointestinal

• weight gain

• decrease in appetite

• constipation

• acsite

C. Cardiorespiratory

• angina

• bradycardia

• hypertension

• pericardial effusion

• Pleural effusion

• cardiac failure

D. Neuromuscular

•ache and pain

•muscle stiffness

•carpal tunnel syndrome

•delayed relaxation of tendon reflex • •depression

•psychosis

•cerebral ataxia

•myotonia

•deafness

E. Dermatological

• mycoderma(non- pitting edema of skin of hands , feet and eyelid)

• dry flaky skin and hair

• Alopecia

• purplish lips

• malar flush

• xanthelasma

• carotenaemia

F. Reproduction

• menorrhagia

• infertility

• galacoma

• impotence

G. Haemtological & miscellaneous

• macrocytosis

• anaemia

• cold intolerance

• tiredness

• harseness of voice

• low pitched sound

Slurred speech

Investigation

• serum T4 decrease; TSH increase ( > 20mU/l)

• serum cholesterol & triglycerides increase

• serum LDH, Ck increase

• serum Na+ decrease

• ECG – sinus bradycardia, low voltage QRS complex, ST – T wave abnormalities

• chest radiograph – Enlargement of cardiac shadow

Treatment

D.o.c – Thyroxine – 50 microgram/day for 3 weeks

then

100microgram/day for 3weeks

then

150microgram/day for maintenance dose

• pt with heart disease angina may worsen with thyroxine therapy -treated with beta block and vasodilators or CABG

It’s hard to believe that a sheet of rubber can make you feel more comfortable during a dental treatment and allow dentists to do better, but a “RUBBER DAM” can . S.C. BARNUM

It is a direct method of isolation. It is a safeguard against the bacterial contamination from saliva and accidental swallowing of instruments.

HISTORY :

ADVANTAGES:

• Dry , aseptic working field
• Patient and operator protection
• Improved visibility and access to working area.
• Minimum interference of saliva
• Prevents aspiration of instruments .
• Maximum tissue retraction.

INDICATIONS:

ARMAMENTARIUM:

1. RUBBER DAM SHEET:

• SIZE: “5*5” and “6*6”
• COLOR: black ,blue , green , translucent
• SURFACES: Shiny (tissue), dull(occlusal)
• MATERIAL : Latex or non latex
• THICKNESS:

2, RUBBER DAM CLAMPS:

• Devices that hold the rubber dam in place .
• TYPES: winged and wingless.
• winged have projections at the jaw whereas wingless dont

3. RUBBER DAM PUNCH :

It is an instrument which have a metal table and a tapered , sharp, pointed plunger to produce clear cuts holes on the rubber dam sheet so that the teeth can be isolated. It is of 2 types: Single hole punch and multi hole punch.

4. RUBBER DAM FRAME:

• Retracts soft tissues
• Improves access
• Maintains borders of rubber dam in position.
• TWO TYPES : Plastic and Stainless steel

5. RUBBER DAM FORCEPS:

• Used to carry the rubber dam clamp to the tooth.
• DESIGNS USED : Ash or stokes pattern, Ivory pattern, Washington pattern.

6. RUBBER DAM TEMPLATE:

• It provides a very efficient and convenient way of marking the dam for punching of a particular tooth .
• The holes in the rubber dam should be made approximately over the centre of the incisal or occlusal surface of the teeth to be engaged using a rubber dam template under the rubber dam sheet.

7. RUBBER DAM NAPKIN :

• Placed between rubber dam and the patient’s skin .
• Avoid allergic reactions.

8. WEDGET CORDS:

• Elastic, flexible cord
• Used to stabilize inter-proximal area of rubber dam .

9. FLOSS:

• Required for testing inter-dental contacts
• Aids in flossing the rubber dam through tight contacts.
• Safety measure during removal of clamp.

REFERENCE: GROSS-MAN’S ENDODONTIC PRACTICE 13TH EDITION .