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Dental nurse revision (301-311) > 307 - support for control of periodontal disease, caries & restoration of cavities. > Flashcards

307 - support for control of periodontal disease, caries & restoration of cavities. Flashcards

1
Q

What is the main microorganism that causes caries?

A

Streptococcus Mutans

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2
Q

What does ANUG stand for?

A

Acute Necrotising Ulcerative Gingivitis

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3
Q

What is a consequence of advanced periodontal disease?

A

Mobility

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4
Q

Main advantage of Calcium Hydroxide lining?

A

Promotes secondary dentine formation

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5
Q

What is a push scaler used for?

A

Removal of interproximal calculus

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6
Q

What may indicate signs of bruxism?

A

Attrition

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7
Q

What is an additional advantage zinc oxide and eugenol cement has over other linings?

A

Chemically calms the tooth

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8
Q

What material requires the presence of undercuts to remain in place?

A

Amalgam

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9
Q

What instrument carefully removes carious tissue without exposing the pulp?

A

Spoon excavator

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10
Q

What is the main component of amalgam?

A

Silver

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11
Q

Which material chemically prepares tooth surface for a composite restoration?

A

Phosphoric acid (etch)

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12
Q

What lining should not be used under a composite restoration?

A

Zinc oxide and eugenol cement

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13
Q

What is used for a class II restoration?

A

Siqveland matrix band

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14
Q

What is the most likely classification for abrasion cavities?

A

Class V

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15
Q

What advantage does glass ionomer have over composite?

A

Releases fluoride

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16
Q

What are harmful sugars known as?

A

Non-milk extrinsic

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17
Q

What is the pH level of the mouth during demineralisation?

A

pH 5.5

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18
Q

Inflammation of the periodontum is periodontitis. What finding helps to diagnose it as not being gingivitis?

A

True pocket

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19
Q

Before periodontitis develops, chronic gingivits occurs. What is most likely to be present?

A

Gingival hyperplasia (inflamed/overgrowth of gums)

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20
Q

what are cavities caused by?

A

dental caries attacking hard structure of tooth

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21
Q

what is a treatment plan for a cavity based on?

A

cavity size
cavity position
tooth involved
extent of caries

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22
Q

who can carry out a filling in line with GDC scope of practice?

A

dentist or dental therapist

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23
Q

on what patients are temporary restorations placed on?

A

less co-operative patients

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24
Q

what materials are used as temporary restorations?

A

zinc oxide and eugenol cement
zinc phosphate cement
zinc polycarboxylate cement

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25
Q

where are amalgam restorations usually placed?

A

on posterior teeth

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26
Q

where are composite restorations placed?

A

anterior teeth for aesthetics and also in posterior teeth too

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27
Q

where are glass ionomer cement restorations placed?

A

in deciduous teeth and in cavities where retention is difficult

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28
Q

why is glass ionomer used in deciduous teeth?

A

releases fluoride

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29
Q

what are the aims of cavity preparation?

A

remove all caries without pulp exposure
avoid accidental pulp exposure
protect pulp by using linings/bases

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30
Q

how many classifications are there for cavities?

A

5

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31
Q

what are cavity classifications based on?

A

site of original caries attack

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32
Q

what is the name of cavity classifications?

A

Black’s classification

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33
Q

class I cavity

A

single surface
in pit/fissure
e.g. occlusal/buccal/lingual

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34
Q

class II cavity

A

at least 2 surfaces of posterior tooth
e.g. mesial/distal and occlusal
molar or premolar

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35
Q

class III cavity

A

mesial or distal surface of incisor or canine

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36
Q

class IV cavity

A

same as class III but extend to involve incisal edge of affected side
e.g. mesial incisal or distal incisal

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37
Q

class V cavity

A

cervical margin of any tooth
e.g. labial cervical filling in upper incisor

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38
Q

what does careful cavity prep ensure?

A

all plaque biofilm and soft carious dentine removed
conserve as much enamel as poss to maintain strength/structure of tooth
reduced chance of micro leakage

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39
Q

function of mouth mirror

A

aid dentist vision
reflect light onto tooth
retract and protect soft tissues

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40
Q

function of right angle probe

A

feel cavity margins
feel softened dentine within cavity
detect overhanging restorations

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41
Q

function of excavators

A

small/large spoon shaped to scoop out softened dentine

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42
Q

function of amalgam plugger

A

push plastic filling material into cavity and adapt them to cavity shape and leave no air space
force excess mercury out

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43
Q

function of burnisher

A

ball/pear shaped to press and adapt restoration margins against cavity for no leakages

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44
Q

function of flat plastic

A

remove excess filling material and create shaped surface

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45
Q

function of college tweezers

A

pick up. hold and carry items

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46
Q

function of gingival margin trimmer

A

trim margin of cavity to ensure no unsupported enamel or soft dentine remains

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47
Q

function of enamel chisel

A

remove unsupported enamel from cavity edges

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48
Q

what is a preconstructed restoration called?

A

inlay

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49
Q

what material can inlays be?

A

gold
porcelain
other ceramic material

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50
Q

how is retention for a filling made?

A

cutting tiny grooves in cavity walls

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51
Q

what is done if there can’t be an undercut in a restoration?

A

self tapping dentine pins
acid etching for composite
chemical bonding for glass ionomer

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52
Q

how are linings placed?

A

thin layer on floor of shallow cavity

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53
Q

what does a lining do?

A

protect underlying pulp against chemical irritation

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54
Q

name an example of a lining…

A

calcium hydroxide

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55
Q

how are bases placed?

A

in deeper cavities as thicker layer

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56
Q

what do bases do?

A

protect pulp against chemical irritation and insulate from thermal changes

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57
Q

name examples of bases…

A

zinc oxide and eugenol cements
zinc phosphate cements
zinc polycarboxylate cements

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58
Q

how does majority of post-restorative pulp damage occur?

A

microleakage
small amount of fluid/debris/bacteria leak through microscopic gaps
enter dentinal tubules
contaminate pulp tissue

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59
Q

properties of modern lining materials

A

chemically bond to dentine
physically seal dentine tubules
insoluble once set
radiopaque - can be seen on radiograph

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60
Q

why can some modern lining materials not be placed on cavity floor?

A

may cause pulp damage due to chemical composite

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61
Q

why is moisture control important?

A

protect patient airway from fluid inhalation
ensure patient is comfortable - mouth isn’t full of fluid
allow good visibility
allow restorative material to set correctly

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62
Q

methods used to control moisture?

A

high-speed suction with aspirator
low speed suction with saliva ejector
absorbent material e.g. cotton wool rolls
rubber dam
3 in 1 to air dry

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63
Q

what does high speed aspiration achieve?

A

fast removal of moisture during drilling

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64
Q

what does low speed aspiration achieve?

A

continual moisture control without sucking at soft tissues

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65
Q

what do absorbent materials do?

A

placed in buccal or lingual sulcus and absorb saliva
keep soft tissues away from teeth

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66
Q

what is a rubber dam?

A

thin vinyl sheet placed over tooth to isolate it from rest of mouth

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67
Q

what are the 2 main uses of rubber dams?

A

RCT to maintain sterile field and prevent inhalation
during insertion of fillings to avoid failure due to saliva contamination

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68
Q

at what speed can air turbine handpieces run?

A

500,000 revolutions per minute

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69
Q

what burs are used to cut through enamel and dentine?

A

friction grip diamond or tungsten carbide burs

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70
Q

advantage of air turbines?

A

ease and speed of cutting

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71
Q

disadvantage of air turbines?

A

little tactile sensation = excessive tooth removal

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72
Q

how fast do slow handpieces run?

A

40,000 revolutions per minute

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73
Q

what motors are slow handpieces driven by?

A

air or electric

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74
Q

what are burs for low speed procedures made of?

A

steel

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75
Q

what do steel burs do?

A

remove caries, cut dentine, trim dentures

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76
Q

what are burs for high speed procedures made of?

A

diamond or tungsten carbide cutting surface

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77
Q

what do the diamond/tungsten carbide burs do?

A

rapid removal of enamel, dentine and old fillings

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78
Q

use of round bur

A

gain access to cavities

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79
Q

use of pear bur

A

shaping and smoothing cavities

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80
Q

use of fissure bur

A

shaping and outlining cavities

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81
Q

what are finishing burs and stones used for?

A

smoothing cavity margins and trimming fillings

82
Q

what is a mandrel used for?

A

to attach larger wheels, stones and abrasive discs

83
Q

how are diamond burs cleaned?

A

in an ultrasonic cleaner and autoclaved

84
Q

do handpieces need to be lubricated regularly?

85
Q

what does air abrasion do?

A

remove hard tissue, soft carious tissue and surface stains

86
Q

what does air abrasion use?

A

compressed air and special hand piece to convey jet of abrasive particles

87
Q

why are temporary restorations used?

A

emergency measure to seal cavity and prevent carious ingress
during endo as need to access tooth repeatedly
during inlay construction to seal prep whilst waiting for permanent inlay
allow symptomatic tooth to settle and become symptom free

88
Q

why are temporary materials not used as permanent restorations?

A

too soft to chew on
soluble in saliva
wouldn’t remain intact for long periods

89
Q

main features of temporary restorations?

A

quick mixing & placement
cheaper
easily removable
some contain sedative ingredients - settle inflamed pulp

90
Q

how is zinc oxide powder and eugenol liquid mixed?

A

mixing powder with drop of eugenol liquid

91
Q

what is zinc oxide and eugenol mixed on?

A

glass slab

92
Q

what is the use of zinc oxide & eugenol?

A

temporary filling
non-irritant
sedative dressing
main constituent of impressions pastes/periodontal packs/root filling materials

93
Q

what filling material is zinc oxide & eugenol NOT compatible with?

A

composite
due to oily nature

94
Q

what is zinc phosphate made up of?

A

zinc powder and phosphoric acid liquid

95
Q

what are the 2 different mixes of zinc phosphate?

A

thick mix of putty consistency - used as temp fill or base
thin creamy mix for crown/inlay cementation

95
Q

how is zinc phosphate cement mixed?

A

powder and liquid on glass slab

96
Q

does a warm slab accelerate the setting time of zinc phosphate?

96
Q

which mix of zinc phosphate sets quicker - thin or thick?

A

thick mix sets quicker

97
Q

why must a dry slab be used when mixing zinc phosphate?

A

moisture accelerates setting

98
Q

advantage of zinc phosphate?

A

sets hard within few minutes
more durable material than zinc oxide & eugenol

99
Q

disadvantage of zinc phosphate?

A

in deep cavities it can irritate pulp
moisture sensitive and won’t adhere to damp cavity

100
Q

what is zinc polycarboxylate made up of?

A

zinc oxide powder and polyacrylic acid liquid

101
Q

what pad can zinc polycarboxylate be mixed on?

A

glass slab or waxed paper pad

102
Q

what is the use of zinc polycarboxylate?

A

thin mix as luting cement for fixed restorations and orthodontic bands
thick mix as cavity base

103
Q

advantage of zinc polycarboxylate?

A

less irritant and more adhesive to dentine

104
Q

disadvantage of polycarboxylate?

A

sticks easily to instruments so it is difficult to place ..

105
Q

how can calcium hydroxide be presented?

A

powder and resin - two pastes mixed together
premixed single paste - light cured

106
Q

what are the uses of calcium hydroxide?

A

cavity lining as it is non-irritant
promotes formation of secondary dentine
promotes remineralisation of hard tooth tissue
pulp capping
pulpotomy

107
Q

what properties do permanent restorations have?

A

set sufficiently hard
dont dissolve or deteriorate in saliva
biologically safe
reasonable lifespan of years
aesthetically acceptable

108
Q

what are the 3 common permanent restorations?

A

amalgam
composite
glass ionomer

109
Q

how is amalgam prepared?

A

mixing powdered ALLOY with liquid MERCURY

110
Q

what are the main constituents of amalgam alloy powder?

A

silver (up to 74%)
copper (up to 30%)
tin (variable quantities)
zinc (small quantities)

111
Q

what is alloy and mercury mixed in?

A

an amalgamator

112
Q

what condenses amalgam into the tooth?

A

an amalgam plugger

113
Q

fill in the blank

Amalgam contains ____ which is known to be toxic

114
Q

advantages of amalgam?

A

easy to use
can be condensed into cavity
cheap
good set strength - allow heavy chewing
excellent longevity

115
Q

disadvantages of amalgam?

A

mercury is toxic
constant corrosion in oral environment
not retentive to tooth - must have undercuts
can transmit thermal shocks
poor aesthetics

116
Q

on who should amalgam NOT be used on unless strictly necessary?

A

children under 15
pregnant women
breastfeeding women

117
Q

how can mercury poisoning occur?

A

inhalation of vapours
absorption
ingestion

118
Q

is mercury vapour released at higher or lower temperatures?

119
Q

what are the symptoms of mercury poisoning?

A

early symptoms - headache, fatigue, nausea, diarrhoea
later symptoms - hand tremors and visual defects
final stage - kidney failure

120
Q

how to avoid mercury absorption?

A

wear disposable gloves when handling
no open-toed shoes
no jewellery or wrist watch

121
Q

how to avoid pollution of air by mercury vapour?

A

preloaded capsules
full PPE
ventilated surgery
mercury spillage kit on site

122
Q

who collects waste amalgam and extracted teeth containing amalgam?

A

authorised hazardous waste contractors

123
Q

who must a mercury spillage be reported to?

A

dentist or other senior staff member

124
Q

what to do with mercury spillage globules?

A

draw up into disposable intravenous syringe or bulb aspirator and transfer into mercury container

125
Q

what steps to take with larger mercury spillage?

A

stop work and report immediately
put on full PPE
smear globules with mercury absorbent paste
leave to dry and remove with wet disposable towel
risk assess incident
evacuate premises
HSE notified under RIDDOR

126
Q

what is composite?

A

tooth coloured restorative material in a wide range of shades

127
Q

what does composite material consist of?

A

inorganic filler in resin binder and a catalyst

128
Q

how is composite set?

A

with a blue light cure

129
Q

how long should phosphoric acid (33%) be coated on to tooth for?

A

around 15 seconds

130
Q

what does acid etchant do?

A

chemically roughen enamel surface

131
Q

what are the risks of acid etchant?

A

acid burns and permanent scarring of soft tissues

132
Q

what damage can the blue light cure do?

A

damage the retina of eye if looked at directly

133
Q

what barrier can be used to with a blue light cure?

A

orange tinted protective shield

134
Q

what is fissure sealing?

A

caries prevention measure

135
Q

advantages of composite material?

A

aesthetically pleasing
adhesive to tooth - requires less tooth removal
little marginal leakage
fast set with curing light

136
Q

disadvantages of composite material?

A

more expensive
can’t be condensed into cavity
not as strong/hard-wearing
only use glass ionomer as base

137
Q

what is glass ionomer?

A

tooth-coloured restorative material adhesive to hard tissues of teeth.

138
Q

what class is glass ionomer usually used on?

139
Q

how do glass ionomers set?

A

chemically or by exposure to blue curing light

140
Q

advantages of glass ionomer?

A

adhesive to enamel, dentine and cementum
ideal for class V abrasion cavity
good marginal seal
releases fluoride
more aesthetic than amalgam

141
Q

disadvantages of glass ionomer?

A

low strength
technique sensitive
requires calcium hydroxide lining in deep cavity
protection from moisture contamination

142
Q

what demineralises dentine and enamel?

143
Q

what bacteria are associated with production of caries?

A

streptococcus mutans (initial stages)
streptococcus sanguis
some lactobacilli

144
Q

what is plaque biofilm?

A

combination of bacteria and food forming sticky film

145
Q

what is a stagnation area?

A

areas where plaque biofilm can easily stick to

146
Q

name examples of stagnation areas?

A

gingival margins
fissures
edges of dental restorations

147
Q

what is the build up of plaque at gingival margins associated with?

A

gingivitis and periodontal disease

148
Q

what food type can be turned into acid by bacteria?

A

carbohydrates

149
Q

what do early acid attacks show as on the teeth?

A

white spot lesions on enamel

150
Q

when caries enters deep into the enamel what will it reach?

A

amelodentinal junction

151
Q

will patient feel pain when caries enters the enamel?

152
Q

what is it called when there is a hole in the tooth?

153
Q

what do odontoblasts do at the ADJ?

A

lay down secondary dentine to protect underlying pulp tissue

154
Q

when will the patient begin to feel sensitivity from caries?

A

when nerve fibrils in dentine tubules are stimulated

155
Q

what is it called when the pulp settles after a filling?

A

reversible pulpitis

156
Q

what is it called when the pulp reaches the pulp chamber?

A

irreversible pulpitis

157
Q

what does saliva contain?

A

water
inorganic ions and minerals
ptyalin
antiobodies
leucocytes

158
Q

what is ptyalin?

A

a digestive enzyme which acts on carbohydrates

159
Q

what is the condition of reduced salivary flow called?

A

xerostomia (dry mouth)

160
Q

what can reduced salivary flow lead to?

A

reduced self cleaning in oral cavity = likelihood of caries and periodontal disease developing
food debris stagnates

161
Q

what is halitosis?

A

bad breath

162
Q

what is ptyalism?

A

excessive saliva production

163
Q

how can a dentist detect smaller carious lesions?

A

blunt dental probes to detect stickiness
transillumination
caries dyes
bitewing radiographs

164
Q

what probes can detect stickiness on occlusal surfaces?

A

sickle or right-angle

165
Q

what probe can detect stickiness in interproximal areas?

A

briault probe

166
Q

how can caries be prevented?

A

diet - fewer cariogenic foods and drinks
control of bacterial plaque
increase tooth resistance to acid attacks - fluoride

167
Q

what are the types of non-carious tooth loss?

A

erosion
abrasion
attrition
abfraction

168
Q

how does erosion occur?

A

extrinsic acids on enamel

169
Q

where are extrinsic acids found?

A

carbonated fizzy drinks
acidic fruits
pure juices
wines

170
Q

what medical conditions can cause erosion?

A

bullimia - from vomitting
hiatus hernia
stomach ulcers
reflux oesophagitis

171
Q

what tooth surfaces does erosion usually affect?

A

labial or palatal of upper incisors
occlusal of lower molars

172
Q

how does abrasion occur?

A

patient scrubs teeth using excessive side-to-side technique

173
Q

where is abrasion seen on the teeth?

A

cervical neck of tooth on buccal or labial surface

174
Q

what is attrition?

A

loss of enamel from biting surface of teeth

175
Q

what surfaces of teeth does attrition affect?

A

incisal or occlusal

176
Q

what causes attrition?

A

wear and tear from chewing
occlusion of natural teeth onto ceramic restorations
bruxing

177
Q

what is bruxing?

A

clenching or grinding of teeth

178
Q

what is abfraction?

A

specific loss of tooth in cervical region

179
Q

what causes abfraction?

A

shearing forces that occur by overloading single standing teeth

180
Q

what teeth are usually affected by abfraction?

A

single standing premolars

181
Q

what is periodontal disease?

A

bacterial infection of supporting structures of tooth

182
Q

what supporting structures of the teeth does periodontal disease affect?

A

gingivae
periodontal ligament
cementum
alveolar bone

183
Q

what is the early stage of periodontal disease called?

A

chronic gingivitis

184
Q

what is visible calculus called?

A

supragingival calculus

185
Q

what is calculus beneath gingival margins called?

A

subgingival calculus

186
Q

what is a false pocket?

A

when inflamed gingivae becomes red and there is swelling of gingivae

187
Q

what is bacteria that can survive without oxygen called?

A

anaerobic bacteria

188
Q

what is a true pocket?

A

when bacterial toxins destroy periodontal ligament and attachment of tooth to supporting tissues

189
Q

what can worsen periodontal disease?

A

smoking
hormonal changes
open lip posture

190
Q

what medical condtions/drugs affect periodontal disease?

A

diabetes
aids
leukaemia
epilepsy treated with epanutin
vitamin C deficiency

191
Q

what are the clinical signs of periodontal disease?

A

periodontal probing detects pockets greater than 3mm
supra/sub gingival calculus present
some teeth are mobile
radiographs showing destruction of alveolar bone

192
Q

what probe is used for BPE?

A

WHO or BPE probes

193
Q

what are the BPE scores?

194
Q

what BPE scores will need detailed periodontal charting?

195
Q

what is periodontal charting (6ppc)?

A

mouth is divided into quarters to chart

196
Q

what instruments are used for subgingival scaling and root surface debridement?

A

gracey curette
periodontal hoe
ultrasonic scaler

197
Q

what instruments are used for supragingival calculus removal?

A

sickle scaler
push scaler
jacquette scaler

198
Q

what is pericoronitis?

A

infection of gingival flap lying over partially erupted tooth

199
Q

what is the operculum?

A

gingival flap over partially erupted tooth

200
Q

what bacteria is involved with ANUG?

A

bacillus fusiformis
treponema vincenti

Dental nurse revision (301-311) (11 decks)

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