Clinical DH Flashcards
Examples of regulated waste?
Sharps, items w/saturated blood and/or saliva and hard or soft tissues removed from the patient’a mouth.
Provides the employee with info regarding hazards of chemicals and how to protect themselves from these hazards.
Safety Data Sheets
What is PPE?
Personal protective equipment (mask, examination gloves, protective eye wear, and protective clothing). Minimizes exposure to aerosol, spatter, direct transmission, and indirect transmission.
Invisible airborne particles that remain in the air for awhile?
Aerosol
Visible airborne particles of blood and/or saliva.
Spatter
Direct transmission
Occurs through touching of infectious agent, saliva, or blood.
Occurs through a contaminated object.
Indirect transmission
What are the qualities of a disinfectant?
Rapid, broad-spectrum antimicrobial, bactericidal, tuberculocidal, virucidal. Odorless, compatible, residual effect, non toxic, EPA registered, cleans and disinfects.
Types of Disinfecting agents?
Chlorine-based compounds; corrosive to metals and strong odor.
Iodophors-discolor surfaces yellow.
Phenols-leave film or residue on surface.
Quaternary-not corrosive, lower kill spectrum, and limited efficacy.
Why should Glutaraldehydes NOT be used as a surface disinfectant?
Toxic effects of fumes and also corrosive.
What are the levels of disinfectants?
High-surgical areas
Intermediate-dental offices, must kill TB.
Low-used at home
What kills ALL pathogenic microbes, including spores?
Sterilization
Chemical Sterilization
273 degrees for 20mins w/ kPa 25 psi.
Spore test= geo bacillus stearothermophilus
Requires ventilation
340 degrees for 1 hour or 320 degrees for 2 hours.
Metal instruments.
NOT for handpieces.
Spore test= bacillus atrophaeus.
Dry Heat
Steam
250 degrees with 15 or 20 lbs psi for 30 mins.
Corrodes non stainless steel instruments.
Fills instruments and burs.
Spore test= geobacillus stearothermophilus.
What does NOT guarantee sterility?
External indicators that change color only indicate instruments have been heat processed.
When should Spore testing be completed?
Weekly.
What’s always addressed with the patient first?
Chief complaint
Pits/fissures on lingual of ant teeth and occlusal, buccal, and lingual surfaces of post teeth.
Class 1 GV Black
Class 2 GV Black
Proximal surface of post teeth; commonly occlusal surfaceS.
Proximal surface of ant teeth; does not involve incisal edge.
Class 3 GV Black
Class 4 GV Black
Proximal surface ant teeth; involves incisal edge.
Cervical (gingival) 1/3 facial or lingual surfaces of any tooth. Root caries.
Class 5 GV Black
Class 6 GV Black
Incisal edge of ant and/or cusp tips of post teeth.
Class 1 Occlusion (mesognathic)
Molar: Mesiobuccal cusp of max 1st molar positioned in buccal groove of mand 1st molar.
Canine: max canine occluded w/distal half of mand canine and mesial half of mand 1st premolar.
Class 2 occlusion (Retrognathic)
Molar: buccal groove mand 1st molar distal to mesiobuccal cusp of max 1st molar by at least a width of a premolar.
Canine: distal portion of max canine is mesial to mesial portion of mand canine by at least width of a premolar.
Class 2, Division 1 Occlusion
Retruded mandible w/max ant teeth protruded facially.
Class 2, Division 2 Occlusion
Retruded mandible w/max ant teeth inclined lingually.
Class 3 Occlusion (prognathic)
Molar: buccal groove mand 1st molar mesial to mesibuccal cusp of max first permanent molar by width of a premolar.
Canine: mesial portion of max canine is distal to distal surface of mand canine by width of a premolar.
Usually have cross bite.
Class 1 Furcation
Early bone loss; instrument enters depression leading to the furcation.
Moderate bone loss; instrument can enter furcation, but cannot pass between roots.
Class 2 Furcation.
Class 3 Furcation
Severe bone loss; instrument can pass between roots.
Same as Class 3, but with evidence of recession.
Class 4 Furcation.
How do you assess a Furcation?
Naber probe
Mobility
Class 1: slight horizontal mobility
Class 2: moderate horizontal mobility, greater than 1 mm- no vertical displacement.
Class 3: severe mobility w/possible combined horizontal and vertical movement.
What is Calculus?
Mineralized plaque, provides an irritant to gingiva.
What’s the nutrient source for supragingival calculus?
Saliva
What’s the nutrient source for subgingival calculus?
Crevicular fluid and inflammatory exudate.
How can you detect calculus?
11/12 and pigtail for posteriors; orban-type for anteriors and cervical 1/3s of posterior teeth.
Compressed air and radiographs.
What causes Extrinsic stain (exogenous)-removable?
Certain bacteria or other sources, such as food, beverages, and tobacco.
Gram positive bacteria; located on cervical 1/3 facials and linguals
Black line extrinsic stain
Associated w/poor oral hygiene and dark colored beverages.
Brown extrinsic stain
Associated with tobacco use
Dark brown or black extrinsic stain
Chromogenic bacteria in plaque; poor oral hygiene located on anterior teeth.
Orange extrinsic stain
Standouts fluoride/chlorhexidine use. Standouts Fluoride stain results from reaction of tin ion in the fluoride.
Yellow-brown and brown extrinsic stain
Associated poor oral hygiene, chromogenic bacteria, fungi, and gingival hemorrhage.
Green extrinsic stain.
What’s the choice of removal if stain is located on the cementum?
Instrumentation
What causes Intrinsic (endogenous) stain?
Pulpal necrosis, internal resorption, excessive systemic fluoride and/or tetracycline use during tooth development.
When does Demineralization occur?
When the pH drops below 4.5 to 5.5 for enamel and 6.0 to 6.7 for cementum-known as critical pH levels.
When is fluoride bactericidal?
In high concentrations, professional application.
When is fluoride bacteriostatic (inhibits growth or multiplication of bacteria)?
In low concentrations, daily at home application.
Ability to bind to pellicle, plaque, and tooth surface and be released over a period of time with retention of potency.
Substantivity o
Where is fluoride rapidly absorbed?
Stomach and small intestine
The amount of fluoride no used is excreted through?
Kidneys
What’s the most cost-effective and efficient method of delivering the benefits of fluoride to a community?
Water Fluoridation
What’s the optimal fluoride level?
0.7 ppm mg/L
What monitors the concentration level in community drinking water?
EPA
What sets limits in bottled water?
FDA
What compounds are used to fluoridate water?
Sodium fluoride
Sodium silicofluoride
Hydrofluorosilic acid
When is defluoridation recommended by the EPA?
If F levels is between 2 and 4 mg F/L of water.
What foods contain large amounts of fluoride?
Tea and fish
Used in presence of tooth-colored and porcelain restorations. Tray method, most effective for rampant caries, 4 minute application, recommended for bulimics.
Sodium fluoride
Contain 5% NaF, sensitizing exposes roots and caries prevention, retained for 24-48 hours, repeat applications 2-4 times per year, 14% more effective than topical gels, not for home use-professional application only.
Sodium Fluoride Varnishes
Contraindicated in presence of tooth-colored restorations and porcelain-acid in fluoride etches the glass components in restoration, causing surface roughening or pitting over time.
Acidulated Phosphate Fluoride
Must be mixed right before use, unpleasant taste due to tin ion in compound, stains demineralized areas and margins of tooth-colored restorations due to tin ion, causes possible gingival sloughing.
Stannous Fluoride
Certainly Lethal Dose
Amount of drug likely to cause death if not intercepted by antidotal therapy.
Safely Tolerated Dose
One fourth of CLD
Acute fluoride toxicity
Symptoms begins within 30 minutes of ingestion and may persist for as long as 24 hours. GI symptoms: nausea, vomiting, diarrhea, abdominal pain, increased salivation and thirst.
Systemic Involvement: hypocalcemia, hyperreflexi, convulsions, paresthesia, cardiac failure.
What’s the TX for Acute Fluoride Toxicity?
Administer fluoride binding agent
Induce vomiting (emesis)
Seek medical treatment
Cardiac monitoring
Long-term exposure (10+ years) of water containing 8-10 PPM fluoride.
Skeletal fluorosis
Hypomineralization results from excessive ingestion of fluoride (2ppm+) during amelogenesis, typically between ages 1-4.
Dental fluorosis
Indications for use of power-assisted toothbrushes?
Children Physically/mentally challenged Elderly Arthritic patients Poorly motivated individuals Implant care
Angle bristles 45 degree toward apex at gingival 1/3, placing bristles into the sulcus ( Perio patient)
Bass
Stillman
Angle bristles 45 degree toward the apex with 1/2 of bristles placed on tooth, other half on the gingiva.
Position bristles perpendicular to crown of teeth; brush in circular motion (pedo patient).
Fones
Charters
bristles 45 degrees towards occlusal/incisal plane; move bristles in small rotary motions keep in contact with gingival margin. (ortho patient).
What is an Interdental brush used for?
open embrasures, exposed class IV furcations, orthodontic appliances, fixed prostheses, dental implants. Inner wire must be plastic coated to avoid scratching the cementum.
What is a tufted brush used for?
open proximal spaces, hard to assess areas, fixed dental partials, poetics, and orthodontic appliances.
What is a toothpick holder (per aid) used for?
Exposed class IV furcations and interdental cleaning.
When is a floss holder recommended?
people who are physically challenged and caregivers providing oral hygiene care.
What dentrifices prevent caries?
Fluoride
What denitrifices prevent tartar-control?
Pyrophosphates.
What denitrifies are in anti hypersensitivity agents?
Potassium nitrate, strontium chloride, and sodium citrate.
What dentrifice is in antibacterial agents?
Triclosan.
What denitrifies are in whitening agents?
Carbamide peroxide or hydrogen peroxide.
What is an area-specific curet (Graceys)?
Only has one cutting edge per working end, begin stroke coronal to edge of junctional epithelium.
What areas does a Gracey 1-2 clean?
All anterior teeth
What areas does a Gracey 11-12 clean?
Mesial, facial, and lingual surfaces of posterior teeth.
What areas does a Gracey 13-14 clean?
Distal surfaces of posterior teeth.
What areas does a Gracey 15-16 clean?
Mesial surfaces of posterior teeth.
What areas does a Gracey 17-18 clean?
Distal surfaces of posterior teeth.
How do Ultrasonic scalers work?
Through cavitation.
How do Sonic scalers work?
Use compressed air; less power.
Operates 18,000 to 45,000 CPS, uses stack of metal strips, elliptical or orbital, all sides of tip are active w/the most active being the point.
Ultrasonic Magnetostrictive.
Operates 25,000 to 50,000 CPS, uses ceramic rod, rapid linear strokes, lateral sides of tip most active.
Ultrasonic Piezoelectric.
Operates 2,500 to 7,000 CPS, uses compressed air, elliptical or orbital, all sides of tip are active.
Sonic.
What are the indications for use of Rubber cup polishing?
Removes extrinsic stain not accomplished with hand scaling or with toothbrush and toothpaste. Use light and consistent pressure.
When is polishing avoided?
Xerostomia, demin/decay, tooth sensitivity, newly erupted teeth, severe gingivitis, lack of extrinsic stain/plaque, exposed root surfaces, and respiratory conditions.
What is Air Polishing?
Slurry formed by forced air, water and powder (sodium bicarbonate, aluminum trihydroxide, glycine, calcium carbonate, or calcium sodium phosphosilicate).
When is air polishing indicated?
Stain/biofilm removal, root detoxification, sealant prep, and soft debris removal around orthodontic appliances.
Contraindications for use of air polishing?
HTN, spongy gingiva, respiratory conditions, restorative materials, exposed root surfaces, immunocompromised, and patients taking potassium, anti-diuretics, or steroid therapy.
What color is the Nitrous Oxide tank?
Blue.
What color is the oxygen tank?
Green.
When should a saline be used?
after nonsurgical periodontal therapy.
When should a fluoride rinse be used?
To prevent dental caries.
What’s the mechanism of action of Chlorhexidine Gluconate?
(0.12%). Bactericidal and high substantivity.
Whats the clinical use of Chlorhexidine?
Preprocedural rinse, decreases supragingival bacterial plaque formation, short-term adjunctive therapy following surgical treatment, implants, and suppresses Streptococcus mutants.
Side effects of chlorhexidine?
Stains teeth, tongue, and tooth-colored restorations. Alters taste sensation (dysgeusia) including a bitter taste. Increase in supra gingival calculus formation.
