Clinical considerations

Question 1

what is erosion?

Answer 1

the wearing away of normal tooth structure via acidic substances upon the tooth

Question 2

what is abrasion?

Answer 2

• mechanical: wearing away of teeth by abnormal stresses, can result from abnormal tooth brushing habits or other abnormal stresses on teeth

Question 3

what is attrition?

Answer 3

the process of normal wear on the incisal/occlusal surface of a crown

Question 4

what is abfraction?

Answer 4

the process of wear at the CEJ from excessive occlusal forces such as bruxism and clenching

Question 5

when studying clinical considerations within the dentition of an existing dental condition, what are the 2 alternatives?

Answer 5

1 - the circumstances present are preventive in nature (oral tissues can protect themselves)
2 - the circumstances are potentially pathologic

Question 6

what are preventive considerations?

Answer 6

includes:

• tooth shape, form and arrangement
• preventive consideration aid in the prevention of decay, occlusal trauma and periodontitis

Question 7

when protecting against decay in preventive considerations, we must examine:

Answer 7

• intact enamel
• margins of restorations
  examine carefully for:
• smoothness
• correct anatomy
• sealant recommendations

Question 8

what causes caries?

Answer 8

• bacterially produced acids that decalcify the tooth surface
• will not occur if bacteria cannot accumulate and attach to the tooth surface

Question 9

what is enamel?

Answer 9

• the hard outer covering of teeth
• smoothness makes the adherence of biofilm more difficult
• protective against the accumulation of bacteria and debris = biofilm
• self cleansing ability of enamel helps resist decay

Question 10

what are examples of bacterial breeding grounds?

Answer 10

• rough pits
• rough grooves
• rough fissures
• rough margins on a restoration
• overhanging restoration
  then debris will accumulate and becomes a breeding ground for bacteria

Question 11

what does tooth decay lead to? gum inflammation? gum and bone inflammation?

Answer 11

• caries
• gingivitis
• periodontitis

Question 12

restorations must be…

Answer 12

• polished to a smooth finish without any excess material so that the tooth can resume normal function and does not become (plaque) trap

Question 13

what do dental sealants do?

Answer 13

• when placed into grooves and fissures provide a preventive coating which stops the accumulation of bacteria in these hard to clean areas

Question 14

how does periodontal disease affect cleaning?

Answer 14

• rough surfaces on roots and excess projections of cementum are biofilm retentive. proper scaling and root debridement is required to remove this

Question 15

what should we do after a patient experiences trauma?

Answer 15

• check patient’s occlusion to ensure proper bite with no interferences or premature contact

Question 16

how do the contours of teeth affect oral hygiene?

Answer 16

• buccal and lingual contours affect the angle to which the food is deflected off the teeth and onto the gingiva
• if these surfaces are under contoured, the food will be deflected into the gingival sulcus
• if the contours are over contourned, then the food passes onto the gingiva at a poor angle
• both can result in gingival inflammation due to excessive debris or lack of tissue stimulation

Question 17

what therapeutic considerations need to be made during restorations?

Answer 17

• restore proper shape and form
• overhangs present - excess filling material interproximal cause biofilm retention (use of a proper matrix band and wedge)
• ensure all margins of the tooth and filling are smooth to avoid biofilm retention
• pulp tissue should be protected during a restoration (liners, bases, etc.)

Question 18

how can we check a patient’s occlusion? when do we absolutely need to check a patient’s bite?

Answer 18

• with articulation paper

- always check post operative

Question 19

what are negative results of a high bite?

Answer 19

1 - tooth hitting becomes sore
2 - leads to inflammation of PDL
3 - increased inflammation leads to extrusion then more
4 - increased occlusal trauma more inflammation and pain
5 - if untreated, the cycle is irreversible

Question 20

pain:

Answer 20

• the nerve centers within the tooth are not the only ones to elicit pain
• even a dead tooth can elicit pain if the PDL are affected
• pulp only has a pain response, but the PDL has pain and pressure/temperature response
• careful thorough examination is necessary to diagnose properly

Question 21

what is tooth migration?

Answer 21

1 - when a tooth is extracted, the opposing tooth (in the opposite arch) will no longer have an antagonist - it will migrate within 24 hours
2 - proper placement of a temporary after a crown is cut down must occur if the permanent crown is to fit properly
3 - if a tooth is removed and is not replaced there can be over or supra eruption of the antagonistic tooth (erupts past the occlusal plane). mesial drifting or tilting (tipping) can also occur

Question 22

what will happen if a tooth that is not restored properly is removed prematurely?

Answer 22

can cause trauma and drama to a patient

Question 23

negative effects on a patient’s oral health are caused by:

Answer 23

• drifting
• supra-eruption
• poor contacts

Question 24

what other structures can be traumatized from premature removal of a tooth or improper restorations?

Answer 24

• TMJ

- surrounding muscles, especially the lateral pterygoid muscles

Question 25

what is the best dentistry?

Answer 25

• preventive dentistry!!
• if there are areas of concern that you as a hygienist have noted, then alert the dentist to your findings
• never cease to be alert and observant, your reward is the comfort of your patients, pride in your work and the progress of your dental profession