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Clinical Skills > Advice > Flashcards

Advice Flashcards

1
Q

when is the main risk period for a child to get dental fluorosis?

A

between 18 months and 3 years.

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2
Q

what concentration is in the fluoride varnish used in clinic?

A

??????

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3
Q

How does fluoride prevent dental caries?

A
  • decreases demineralisation of enamel
  • increases remineralisation of enamel
  • incorporated in developing enamel
  • interferes with metabolism of some plaque bacteria.
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4
Q

what is the recommended concentration of fluoride TP for an adult with high caries risk?

A

200 or 5000ppm Fluoride Toothpaste (need to be given under a px)

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5
Q

How does fluoride decrease demineralisation?

A

less calcium is lost under acid conditions where fluoride is present.
the demineralised enamel will also take up fluoride.

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6
Q

what does pH have to be blow for enamel to dissolve?

A

5.5pH

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7
Q

what is needed for enamel to remineralise?

A
  • enamel needs calcium and phosphate.
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8
Q

where can you get calcium and phosphate from?

A

from saliva, dairy foods and CPP-ACP.

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9
Q

what layer/s of enamel does high concentration of fluoride (e.g. fluoride varnishes) reach?

A

surface layers in enamel as its over a short period of time.

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10
Q

what layer/s of enamel does lower concentration of fluoride (e.g. water and toothpaste) reach?

A

surface layer and lesion body as it will be over a long period of time.

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11
Q

how does fluoride interfere with some bacterial metabolism?

A

fluoride changes the bacterial cell pH to acid conditions. It also interferes with the glycolytic pathway.

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12
Q

what is it called when fluoride is condo-orated in developing enamel?

A

fluoridated HAP or fluoropataite.

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13
Q

what are some sources of systemic fluorides?

A
  • swallowed TP
  • water
  • Food (e.g. fish and tea)
  • tabletes/ drops.
  • milk
  • salt.
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14
Q

what is the % of fluoride in daily Mouthwash?

A

0.05% fluoride

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15
Q

what is the % of fluoride in weekly Mouthwash?

A

0.2% fluoride

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16
Q

what do you need to consider when prescribing fluoride mouthwash?

A
  • age of patient
  • appropriate instructions
  • alcohol content.
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17
Q

how often should a professional topical fluoride be applied?

A

every 3-6 months depending on caries risk.

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18
Q

what dental materials provide amount of fluoride release?

A
  • GIC
  • FS
  • Compomers
  • some resin composites.
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19
Q

when does dental fluorosis occur?

A

when more than trace amounts of fluoride are ingested during tooth development.

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20
Q

what teeth arte most at risk of dental fluorosis?

A

permanent anterior theta.

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21
Q

what teeth are most at risk of dental fluorosis?

A

permanent anterior theta.

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22
Q

when do children learn to spit correctly?

A

3-4 years old.

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23
Q

enamel with fluoride has a tighter consent of what? and why is this?

A

protein - because high fluoride prevents the effective removal of the protein matrix during maturation.

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24
Q

is dental fluorosis in teeth hyper or hypo mineralised?

A

hyper mineralised.

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25
Q

what is most likely the cause of dental fluorosis?

A
  • water with naturally high fluoride levels or eating fluoride toothpaste.
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26
Q

what ages should additional systems fluorides be avoided?

A

before the age of 3.

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27
Q

how much toothpaste should be given to a patient under 3?

A

smear of TP

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28
Q

how much toothpaste should be given to a patient under 6?

A

pea sized amount

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29
Q

what is the concentration of fluoride in the plaque, saliva and enamel dependent upon?

A
  • how often fluoride is applied.
  • how the fluoride is applied
  • the concentration of the fluoride.
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30
Q

what does caries need to occur?

A
  • plaque
  • time
  • tooth surface
  • refined carbs
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31
Q

what is the main microbe in the plaque biofilm?

A

streptococcus.

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32
Q

after 14 of the plaque biofilm what is the dominant bacterial?

A

Actinomyces.

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33
Q

name 6 professional caries preventative methods?

A
  • diet diary
  • nutritional support
  • 0 behaviour modification
  • engaging patients
  • PFS
  • OHI
  • Topical fluoride
  • FS
  • fluoride tooth moose.
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34
Q

what else should be considered when looking at a patients diet sheet ?

A

if they have any brothers or sisters and what their diet isa like. Or if they are an adult if they have children and what their diet is like.

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35
Q

what patients have the highest risk of developing caries?

A
  • infants (with night drinks)
  • its with reduced salivary flow.
  • increased carb intake due to medical history
  • recreational drug users.
  • drinking sports drinks
  • food tasters
  • special diets.
  • young children
    medically physically impaired
  • low socio-economic groups
  • language and cultural barriers.
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36
Q

what’s the main pieces of diet advice we should be giving too patients?

A
  • confectionary only at meal times.
  • only milk or water for children with feeder cups
  • reduce soft drinks, only at meal times and to use a straw.
  • only water at bedtime.
  • sugar intake 4x per day
  • sugary food at meal times.
  • use sweetness
  • non cariogenic snacks.
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37
Q

how can plaque deposits be minimised?

A
  • mechanically
  • use of fluoride TP (1450ppm)
  • chemical plaque control (chlorhexidine)
  • assess saliva flow.
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38
Q

what causes caries to occur?

A

cause by the action of sugars on the bacterial plaque covering the teeth, Caries occurs when demineralisation of the tooth structure exceeds remineralisation.

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39
Q

what are the steps to dietary counselling?

A

1) identify higher risk patients
2) take detailed dietary history
3) set goals
4) develop action plan
5) monitor and review.

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40
Q

what concentration fluoride TP should a child under 3 have?

A

1000ppm fluoride.

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41
Q

until what ages should a parent brush or supervise a childs toothbrushing?

A

at least 7 years old.

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42
Q

what concentration fluoride TP should a child 3-6yrs have?

A

1350-1500ppm fluoride,

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43
Q

what products could you recommend to help with desensitisation?

A
  • fluoride mouthrinses/ varnish
  • fluoride paste - GelKam
  • low abrasively toothpaste
  • sugar free chewing gum
  • dentine bonding agents
  • ‘Anti-erosion’ toothpastes
  • tooth mousse.
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44
Q

what are the 3 main types of tooth wear?

A

erosion, abrasion, attrition

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45
Q

what is erosion?

A

progressive loss of dental hard tissue by an acidic chemical process not involving bacteria.

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46
Q

what is attrition?

A

loss of tooth substance or a restoration caused by tooth-to-tooth contact

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47
Q

what is abrasion?

A

abnormal wearing away of tooth substance or a restoration by a mechanical process other than tooth contact.

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48
Q

what are the different types of erosion and whats the difference between them?

A
  • intrinsic - acid coming up

- extrinsic - acid going in

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49
Q

what could be some examples of an intrinsic acid that would cause erosion?

A
  • Gastro oesphageal reflux
  • vomiting
  • ruminant eating
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50
Q

An eating for example bulimia nervosa would cause what type of tooth wear?

A
  • erosion from intrinsic acid.
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51
Q

what are some examples of extrinsic acids?

A
  • dietry acid sources (soft drinks, alcoholic drinks etc)
  • OH acidic products (mouthwash, saliva substitutes)
  • medications ( Vit C, asthma inhalers)
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52
Q

what are the important factors for dietary erosion?

A
  • amount
  • frequency
  • method of consumption
  • timing of consumption.
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53
Q

how does erosion differ from caries?

A
  • caries is from plaque acid leading to demineralisation but the organic matrix is not affected.
  • in erosion extrinsic/ intrinsic acid leads to demineralisation and loss of the organic matrix.
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54
Q

what other clinical presentations are associated with bruxism?

A
  • tongue scalloping
  • cheek ridging
  • masseteric hypertrophy in severe cases
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55
Q

what can cause abrasion?

A
  • tooth brushing
  • abrasive dentifricies
  • abrasive food particles
  • piercings
  • habits (nail biting, chewing, pen chewing, pipe smoking, wire stripping)
  • latrogenic (unglazed porcelain)
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56
Q

what is the theory behind the cause of abfraction?

A

occlusal forces cause compressive and tensile stresses, which are concentrated at the cervical region of the tooth and cause micro-fracture of cervical enamel rods - creating a deep v-spaced notch on a single tooth.

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57
Q

how do we manage tooth wear?

A

1) identify presence and severity of tooth wear
2) identify aetiology
3) monitoring
4) prevention

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58
Q

how could we monitor tooth wear?

A
  • models
  • silicone index
  • photographs
  • measurements
  • review 4-6 monthly then annually.
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59
Q

what advice/ treatments can you do to aid in the prevention of erosion?

A
  • diet advice
  • avoid brushing immediately after acidic foods.
  • control of GPRD/ eating disorders.
  • water and sodium bicarbonate mouthwash
  • desensitisation and protection.
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60
Q

what advice/ treatments can you do to aid in the prevention of attrition?

A
  • patient awareness and education
  • splints
  • composites
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61
Q

what advice/ treatments can you do to aid in the prevention of abrasion?

A
  • patient education and habits
  • OHI
  • abrasive restorations.
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62
Q

what questions would you ask a patient who has abrasive cavities?

A
  • bristle stiffness
  • toothbrushing force
  • toothbrushing frequency
  • paste abrasively
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63
Q

when should you intervene with a patient who has tooth wear?

A
  • early rather than late
  • protect pulp
  • aesthetics
  • functional problems
  • loss of structures integrity
  • prevention of further complex treatment
  • patients wishes / cooperation.
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64
Q

what is the purpose of binding agents in dentifrices?

A

holds all the ingredients together and assist in creating the texture of toothpaste

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65
Q

what is the purpose of preservatives in dentifrices?

A

prevent contamination by bacteria and to maintain purity of the product.

66
Q

what is the purpose of colour/flavourings in dentifrices?

A

mask the flavour of other ingredients (especially SLS) and promotes used compliance.

67
Q

what is the purpose of water in dentifrices?

A

solvency for some ingredients and provides consistency

68
Q

what is the purpose of inhibitors in dentifrices?

A

stops the corrosion of the tube especially metal tubes.

69
Q

what is the purpose of humectants in dentifrices?

A

prevents evaporation of water keeping the toothpaste moist.

70
Q

what is the purpose of detergents/foaming in dentifrices?

A

lower surface tension and losens debris which assists removal with a toothbrush

71
Q

what is the purpose of polishing/abrasive agents in dentifrices?

A

cleans and polishes the tooth surface without damaging enamel., keep pellicle thin and prevent accumulation of stain.

72
Q

what is the purpose of buffering agents in mouthwash?

A

reduce acidity

73
Q

what is the purpose of anodynes in mouthwash?

A

assist with pain relief

74
Q

what is the purpose of astringents in mouthwash?

A

shrink tissues and aid in healing.

75
Q

what is the purpose of sodium laureth sulphate in dentifrices?

A

added to make toothpaste foam.

76
Q

what are the problems associated with SLS in toothpaste?

A
  • can cause skin irritation
  • disolves proteins- has been shown to cause damage to oral tissues
  • linked to gingivitis, receding gums and recurrent mouth ulcers.
77
Q

you are seeing a patient with recurrent ulcers what would you recommend they change in their OHR?

A

use a SLS free toothpaste, as these can demising ulcers up to 45%.

78
Q

what are the cosmetic roles of dentifrices and mouthwash?

A
  • feeling of well being (fresh mouth)
  • whitening
  • removal of plaque and stain.
79
Q

what are the therapeutic roles of dentifrices and mouthwash?

A
  • prevent plaque and gingivitis
  • prevent and reduce dental caries
  • desensitisation
  • relief of some oral conditions.
80
Q

what can cause extrinsic satin on the teeth?

A
  • mouthwash and toothpaste ingrediants.
  • medications
  • tea and coffee
  • red wine
  • diet
  • poor Oh
  • smoking / chewing tobacco.
81
Q

what is the difference between whitening and bleaching the teeth?

A

whitening = removal of extrinsic stains (abrasive)

bleaching = changes colour of teeth intrinsically.

82
Q

what are the names of some whitening agents in toothpaste?

A
  • sodium bicarbonate
  • hydrogen peroxide
  • carbamide peroxide
83
Q

what is the purpose of sodium bicarbonate in toothpaste?

A
  • mildly abrasive so removes staining.

- neutralizes mouth acids and freshens breath.

84
Q

what are the 2 most common fluorides found in toothpaste (525-1450ppm)?

A
  • sodium monofluorophoshate

- sodium fluoride

85
Q

what are the dangers of using fluoride?

A
  • can cause fluorosis.
86
Q

what is the lethal done per kilo of fluoride?

A
  • 5mg fluoride.
87
Q

what is the purpose of Tricolsan in dentifrices and mouthwash?

A
  • borad spectrum of activity against oral bacterial and yeast. - anticbacterial agent that reduces plaque, inflamed bleeding gums and decay.
88
Q

to increase the effectiveness of tricolsan what can it be combined with?

A

zinc citrate

89
Q

what is the purpose of arginine and calcium carbonate in dentifrices and mouthwash?

A

neutralise plaque acid and repair enamel.

90
Q

what is the purpose of cetylpyridium chloride (CPC) in dentifrices and mouthwash?

A

anticeotic

91
Q

what baceria does cetylpyridium chloride (CPC) work best on?

A

gram positive bacteria

92
Q

what is the purpose of chlorhexidine digluconate in dentifrices and mouthwash?

A

abti-calculus.

93
Q

what are the names of desensitising agents in toothpaste?

A
  • strohtium chloride hexahydrate
  • potassium citrale
  • potassium chloride
  • strannous fluoride
  • potassium nitrate
94
Q

what is the purpose of strohtium chloride hexahydrate in toothpaste?

A

promotes the deposition, by odontolblasts, of irregular secondary dentine on the pulpal walls of the dentinal tubulas.
- physically blocks the tubules.

95
Q

what is the purpose of strannous fluoride in toothpaste?

A
  • block tubule holesm

- helps treat.prevent sensitivity

96
Q

what is the purpose of potassium nitrate in toothpaste?

A
  • interacts at the nerve synapses.
  • prevents the nerve from passing the pain signal along the synapse.
  • numbs the nerve.
97
Q

what age and below should you not recommend sensitive toothpaste?

A

12 and below.

98
Q

name 6 things that can cause halitosis…

A
  • food
  • tobacco products
  • poor OH
  • dry mouth
  • medications
  • infections in the mouth
99
Q

What causes an individuals nutrient requirements to change?

A
  • metabolism
  • age
  • health
  • malnutrition
  • body size
  • utilisation of food
100
Q

what is the max amount of fat should a male adult be eating per day?

A

up to 30g.

101
Q

what is the max amount of fat should a female adult be eating per day?

A

up to 20g

102
Q

what is the max amount of salt should an adult be eating per day?

A

up to 6g

103
Q

what is the max amount of sugar a 4-6 year old should have per day?

A

19g per day (5 sugar cubes)

104
Q

what is the max amount of sugar a 6-10 year old should have per day?

A

24g per day (6 sugar cubes)

105
Q

what is the max amount of sugar a 11+ year old should have per day?

A

30g per day (7 sugar cubes)

106
Q

what is the main function of protein in the body?

A
  • formation of muscles, bones, blood enzymes and some hormones.
  • Cell membrane tissue repair
  • regulates water/acid base balance.
107
Q

what is the main function of carbs in the body?

A
  • supplies energy to brain cells, nervous system, blood ad muscles during exercise.
108
Q

what is the main function of fats in the body?

A
  • supplies energy
  • insulates and cushions organs
  • assists with vit absorption
109
Q

what is the main function of vitamines in the body?

A
  • promotes chemical reaction in cells
110
Q

what is the main function of minerals in the body?

A
  • regulates body functions
  • assists growth
  • catalyst fir energy release
111
Q

what is the main function of water in the body?

A
  • provides medium for and transports chemical reactions
  • regulates temp
  • removes waste.
112
Q

what in the your diet provides proteins?

A
  • meat
  • fish
  • poultry
  • eggs
  • dairy
  • nuts
113
Q

what in the your diet provides carbs?

A
  • grains
  • fruits
  • veg
114
Q

what in the your diet provides fats?

A
  • saturated = animal fat, milk, cheese, butter, eggs, meant, oily fish.
  • unsaturated = veg fat, margarine, veg, oil nuts.
115
Q

what in the your diet provides vitamines?

A
  • fruit
  • veg
  • grains
  • meat
  • dairy
116
Q

what in the your diet provides minerals?

A
  • most food groups.
117
Q

what in the your diet provides waters?

A
  • water
  • liquids
  • fruit
  • veg
118
Q

what is an oral manifestation of a Vit A deficiency?

A
  • Leukoplakia

- hyperkeratosis of oral epithelium

119
Q

what is an oral manifestation of a thiamin B deficiency?

A
  • none.
120
Q

what is an oral manifestation of a riboflavin B2 deficiency?

A
  • angular stomatitis

- glossitis

121
Q

what is an oral manifestation of a Nicotinamide (niacin B3) deficiency?

A
  • glossitis
  • stomatitis
  • gingivitis
122
Q

what is an oral manifestation of a Vit B12 deficiency?

A
  • glossitit

- aphthae

123
Q

what is an oral manifestation of a Vit C deficiency?

A
  • gingival swelling and bleeding
124
Q

what is an oral manifestation of a folic acid deficiency?

A
  • glossitis
  • aphthae
  • atrophy of lingual papillae
125
Q

what is an oral manifestation of a Vit D deficiency?

A
  • hypocalcification of teeth

- malformation.

126
Q

what is the main cause of leukoplakia?

A

smoking

127
Q

what is very brief advice?

A
  • Ask
    -Advise
  • Act
    smoking cessation.
128
Q

why is it important for dental professionals to carry out very brief advice?

A
  • smoking is a secondary risk factor for smoking
  • smoking will modify how perio tissues respond to plaque
  • smoking reduces saliva flow
  • epidemiology shows smokers have greater bone loss and attachment loss.
129
Q

what are some of the effects of smoking on the oral cavity?

A
  • melanin
  • fibrotic gingiva
  • increased calc and staining
  • black hairy tongue
  • leukoplakia
130
Q

what is the golden ratio in denistry?

A

1:6

131
Q

what type of caries is diagnosed most using a bitewing on the permanent dentition, compared to a visual exam?

A

proximal carious lesions.

132
Q

what is transillumination? and why would it be used?

A
  • shinning light through contact points, to assist with diagnosis of approximal caries.
  • dark= caries.
133
Q

describe an active carious lesion

A

progressive
orange/brown
soft

134
Q

describe an arrested or inactive carious lesion

A

formed earlier then stopped
dark brown/black
hard
leathery

135
Q

what does ICDAS stand for?

A

international caries detection and assessment system.

136
Q

what probes are used for a clinical examination? and why?

A

ball-ended - this is so it will not cause any damage to potential white spot lesions.

137
Q

With ICDAS caries code what is meant by 0?

A

sound tooth surface

138
Q

With ICDAS caries code what is meant by 1?

A

1st visual change in enamel

139
Q

With ICDAS caries code what is meant by 2?

A

distinct visual change in enamel

140
Q

With ICDAS caries code what is meant by 3?

A

enamel breakdown, no dentine visible

141
Q

With ICDAS caries code what is meant by 4?

A

dentinal shadow (not cavitated into dentine)

142
Q

With ICDAS caries code what is meant by 5?

A

distinct cavity with visible dentine

143
Q

With ICDAS caries code what is meant by 6?

A

extensive distinct cavity with visible dentine

144
Q

what is understood by ICDAS caries codes 1-2?

A

initial caries

145
Q

what is understood by ICDAS caries codes 3-4?

A

moderate caries

146
Q

what is understood by ICDAS caries codes 5-6?

A

extensive caries

147
Q

what are the 4 D’s in caries care? Set out by ICDAS

A 
1= Determine
2= Detect
3= Decide
4= Do
148
Q

what can cause trauma related gingival recession?

A
  • foreign bodies - piercings
  • nail picking
  • tooth brushing
  • partial dentures ( poor design/ poorly maintained)
  • direct from malocclusion (gingival stripping)
  • chemical trauma (topical cocaine )
149
Q

what is key to recession and gingival inflammation in regards to probable recession?

A

thickness of the keratinised tissue - thin tissue is pre-disposed to recession in presence of plaque-indiced inflammation or trauma.

150
Q

what are the possible consequences of recession?

A
  • fear of tooth loss
  • PRF and bleeding gingiva
  • aesthtics
  • root caries
  • abrasion
151
Q

what type of pain is normally associated with dentine hypersensitivity?

A

short sharp pain

152
Q

does dentine hypersensitivity get worse or better with age and why?

A

better as more dentine is deposited in the tubules preventing fluid flow.

153
Q

what can act as a stimuli for dentine hypersensitivity?

A
  • thermal
  • osmotic (hypertonic solutions eg sweet, spicy, acid)
  • desiccation (drying of lesion)
  • electric (galvanic reactions and electric pulp test)
  • tactile (touching, probing, TB)
154
Q

what is the hydrodynamic mechanism?

A

dentine hypersensitivity caused by the movement of dentinal tubules content increased outward fluid flow causing a pressure change across the dentine.

155
Q

what needs to be recorded in regards to recession?

A
  • record extent of recession
  • description
  • index
  • identify etiological factors
156
Q

How can you manage dentine hypersensitivity?

A
  • Tubule occlusion - application of an artificial barrier eg varnish, fills etc.
157
Q

what is the purpose of tubule occlusion?

A

prevent dentine hypersensitivity.

promotes formation of new tissue

158
Q

what are the ideal qualities of a barrier material for dentine hypersensitivity?

A
  • retentive
  • insoluble
  • penetrate tubules
  • forms mechanical tags into tubules
  • seals the end of the tubules.
159
Q

how can a patient manage dentine hypersensitivity at home?

A
  • TP, gels and mouthwash
160
Q

how can a professional manage dentine hypersensitivity in surgery?

A
  • varnish
  • resin bonding systems
  • desensitising polishing pasta
  • reinforced GIC where there is abrasion cavity progression
161
Q

what advice can you give a patient to aid in the prevention of recession?

A
  • change TB techniques
  • smoking cessation
  • reduce risk factors - acidic drinks/foods, brushing after acid attack, night splint if brixist etc.
162
Q

what is the treatment plan for root caries?

A
  • x-rays to detect interproximal caries
  • prevention, diet and OHI, fluorides.
  • recontouring of shallow lesion
  • GIC restoration

Clinical Skills (7 decks)

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