1. Fill the pulp chamber with either Protaper Glyde or Sodium Hypochlorite (NaOCl) for all initial negotiation procedures. Explore the coronal two-thirds of the canal with stainless steel No. 10 and 15 hand files, using a reciprocating back and forth motion. Work these instruments passively and progressively until they are loose.
2. Start the Protaper sequence with S1 (purple). The apical extent of S1 will passively follow the portion of the canal secured with hand files. S1 is designed to cut dentin, in a crown down manner, with its bigger, stronger and more active blades. Irrigate, recapitulate with the 10K File to break up debris and then re-irrigate.
3. In more difficult canals, one, two or three recapitulations with S1 may be necessary to pre-enlarge the coronal two-thirds of the canal. Frequently clean the blades, then continue using this file until it reaches the depth of the 15 hand file. Irrigate, recapitulate and then re-irrigate.
4. Once the pre-enlargement procedure is finished, use a precurved No. 10K File in the presence of NaOCl or Glyde to negotiate the rest of the canal and to establish patency. Determine working length with No. 15K File.
5. When a smooth glide path to the terminus is verified, sequentially carry first S1 then S2 to the full working length. Remember to irrigate, recapitulate and re-irrigate after each Protaper instrument.
6. With the canal flooded with irrigant, work the F1 to length in one or more passes. If the F1 ceases to advance deeper into the canal, remove the file, clear its blades, then continue with its use until it reaches length. Irrigate, recapitulate and re-irrigate.
7. Following the use of F1 to length, gauge the foramen with a 20 hand file. If the 20 hand file is snug at length, the canal is shaped and ready to fill. If the 20 hand file is loose at length, proceed to the F2 and, when necessary, the F3, gauging after each Finisher with the 25 and 30 hand files, respectively.

High risk conditions patient in dental treatment include:

• Prosthetic valves
• Bacterial endocarditis history
• Single Ventricel states
• Great arteries' transposition
• Tetralogy of fallot

• High risk of bacterial endocarditis secondary to dental treatment that resulting in significant bleeding. Patient that have had surgical repair to their heart could also have this risk.
• Patients that have been using long term anticoagulant therapy are at high risk of excessive bleeding.
• Patient with cyanosis may be prone to infection and have excessive bleeding.

• No oral manifestation for prosthetic valves or history of previous bacterial endocarditis patient.
• Possible cyanotic appearance of oral mucosa for complex cyanotic congenital heart disease.
• Patient with heart problem also have possibility to get hematologic abnormalities. This condition could manifest as petechiae or ecchymosis in oral mucosa.

• Administration of prophylactic antibiotics before doing dental procedure that result in significant bleeding.
• Standard: oral amoxicillin
• Unable to take oral medications: IV or IM ampicillin
• allergic to penicillin: oral clindamycin
• Allergic to penicillin and unable to take oral medication: IV clindamycin

• Administration of prophylactic antibiotics 1-3 hours before procedures likely to result in significant bleeding.
• Administration of second antibiotics if dental procedure take more than 4-6 hours or if multiple appointments occur on the same day.
• Patients that using anticoagulants medication may need to alter it doses depending on the level of anticoagulation and the extent of planned dental procedure.
• Take a break at least 9 days between dental treatment sessions so that penicillin-resistant organisms disapear from the oral flora. If treatment session must be done sooner than 9 days, select one of the alternative antibiotics for prophylaxis.

Red hair people seem particularly more nervous to dental treatment than other pigmented hair. New study explain it because of their genetics that may play role in processing anxiety and fear.

Particular variations in what is called themelanocortin-1 receptor (MC1R) gene resulting this red pigmented hair. This gene helps determine pigmentation in human. It was once thought that the gene was active only in the skin, hair and eyes. But now, more-recent research has shown that it also functions in the brain, where it may play a role in processing pain, anxiety and fear.

Researchers led by Dr. Catherine J. Binkley, of the University of Louisville in Kentucky, try to find whether red hair and MC1R variations were related to people's aversion to seeing the dentist.

They found that among the 144 white adults they recruited, those with MC1R variations reported more anxiety about dental procedures and were twice as likely to say they avoided the dentist altogether.

Not surprisingly, nearly all of the natural redheads in the study carried at least one copy of an MC1R variation linked to red hair -- 65 of 67 participants. The same was true of roughly one-quarter of the 77 dark-haired study participants.

When the researchers took a closer look at the data, they found that the presence of these MC1R variations was more strongly linked to dental anxiety than was hair color itself.

From this study, the researches suggest that dentists should ask all patients, especially people with red hair, about their anxiety over any procedures they must have and then use appropriate approaches to help them manage the problem.

Fluoride is most known as a dental hygiene products and tooth protection. Most people are exposed to this material through treated drinking water or products such as mouthwash and toothpaste or even their food (such as meat, fish, eggs, and tea leaves).

Fluoride is very useful for preventing cavities and strengthening teeth. If ingested, fluoride enters the bloodstream and is eventually absorbed by the teeth and bones.

Fluoride can also be applied topically to teeth by a dental professional in a dental office. The teeth will readily absorb topical fluoride treatments, and the chemical will remain in the mouth for several hours. Topical fluoride can also be applied at home using products such as toothpaste, mouthwash or mouth rinse, fluoride gels, or fluoride supplements.

Is it safe? When it used properly, fluoride is usually considered a safe for your health. However, high levels of fluoride exposure for extended periods of time may result in harm. For example dental fluorosis, a discoloration of tooth enamel that caused by to much exposure of ingested fluoride. High and long exposure to fluoride could also lead to bone weakening and skeletal fluorosis (joint stiffness and pain).

More extreme, toxic effects may result if someone consumes too much fluoride, this called fluoride overdose. For example, if a small child consumes an entire tube of tooth paste. The symptoms include nausea, vomiting blood, diarrhea, stomach pain, salivation, watery eyes, general weakness, shallow breathing, faintness, tiredness, and convulsions.

So, pay attention to your fluoride use. If you're using fluoride suplements to protect your teeth, you should be watched by your dentist. And if you have childrens, make sure to remain them not to swallow their toothpaste.