Clinical considerations Flashcards
what is erosion?
the wearing away of normal tooth structure via acidic substances upon the tooth
what is abrasion?
- mechanical: wearing away of teeth by abnormal stresses, can result from abnormal tooth brushing habits or other abnormal stresses on teeth
what is attrition?
the process of normal wear on the incisal/occlusal surface of a crown
what is abfraction?
the process of wear at the CEJ from excessive occlusal forces such as bruxism and clenching
when studying clinical considerations within the dentition of an existing dental condition, what are the 2 alternatives?
1 - the circumstances present are preventive in nature (oral tissues can protect themselves)
2 - the circumstances are potentially pathologic
what are preventive considerations?
includes:
- tooth shape, form and arrangement
- preventive consideration aid in the prevention of decay, occlusal trauma and periodontitis
when protecting against decay in preventive considerations, we must examine:
- intact enamel
- margins of restorations
examine carefully for: - smoothness
- correct anatomy
- sealant recommendations
what causes caries?
- bacterially produced acids that decalcify the tooth surface
- will not occur if bacteria cannot accumulate and attach to the tooth surface
what is enamel?
- 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
what are examples of bacterial breeding grounds?
- rough pits
- rough grooves
- rough fissures
- rough margins on a restoration
- overhanging restoration
then debris will accumulate and becomes a breeding ground for bacteria
what does tooth decay lead to? gum inflammation? gum and bone inflammation?
- caries
- gingivitis
- periodontitis
restorations must be…
- polished to a smooth finish without any excess material so that the tooth can resume normal function and does not become (plaque) trap
what do dental sealants do?
- when placed into grooves and fissures provide a preventive coating which stops the accumulation of bacteria in these hard to clean areas
how does periodontal disease affect cleaning?
- rough surfaces on roots and excess projections of cementum are biofilm retentive. proper scaling and root debridement is required to remove this
what should we do after a patient experiences trauma?
- check patient’s occlusion to ensure proper bite with no interferences or premature contact
how do the contours of teeth affect oral hygiene?
- 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
what therapeutic considerations need to be made during restorations?
- 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.)
how can we check a patient’s occlusion? when do we absolutely need to check a patient’s bite?
- with articulation paper
- always check post operative
what are negative results of a high bite?
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
pain:
- 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
what is tooth migration?
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
what will happen if a tooth that is not restored properly is removed prematurely?
can cause trauma and drama to a patient
negative effects on a patient’s oral health are caused by:
- drifting
- supra-eruption
- poor contacts
what other structures can be traumatized from premature removal of a tooth or improper restorations?
- TMJ
- surrounding muscles, especially the lateral pterygoid muscles
what is the best dentistry?
- 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
