Dental Examination and Charting

Question 1

Development of dental caries

Answer 1

Development of carious lesions require:

1.Miroorganisms
Streptococcus mutans
Streptococcus sobrimus
Acidogenic lactobacilli
Nonmutans streptococci
Actinomyces

2.Carbohydrates (sucrose)

3.Susceptible tooth surface
>partially weakened
>difficult to keep clean > pits and fissures, interprox

Question 2

Steps in formation of dental caries

Phase I & Phase II

Answer 2

›Phase I incipient lesion
»remineralization can occur if treated in this phase

›Phase II untreated incipient lesion
>> breakdown of enamel
>> see and feel irregularities
>> spread to DEJ
>> subsurface demineralization - biofilm can seep thru pores to dentin

Question 3

GV Black’s Classification of dental caries

Answer 3

›Class I - pits and fissures
›Class II - prox of post
›Class III - prox of ant.
›Class IV - prox of ant involving incisal edge
›Class V - facial / lingual of cerv. 3rd
›Class VI - incisal edge of cusp

Question 4

Early childhood caries

Answer 4

›Microbiology
high levels of Streptococcus
mutans and Lactobacilli in biofilm

Risk factors
teaching parents
Significant risk factors: nursing bottle containing sugary fluid, including milk.
Pacifier sugar-dipped. Prolonged at-will breast feeding.

Effects
›max ant teeth and primary molars first to be affected

›children need should be seen for an examination no later than 6 months after eruption of first tooth

Question 5

Root caries

Answer 5

Steps in formation
recession must occur first to expose cemental surf.
start near CEJ where cementum is thinnest

Effects

Clinical recognition
active lesion = soft or leathery
inactive / arrested lesion = hard
color = yellow to brown black

Question 6

pH of mouth, cementum and enamel

Answer 6

mouth = 6.2

cementum = 6.2 - 6.7

enamel = 4.5 - 5

Question 7

Types of pulp vitality testing

Answer 7

Thermal

Electric

Question 8

Thermal testing

Answer 8

Cold test
›Materials - air blast, cold drink, ice stick, ethyl chloride in a spray or on a cotton swab, or a carbon dioxide dry-ice stick
›Isolate test teeth and dry with gauze

Heat test
›Temporary stopping (gutta percha) - Apply to tooth dried with gauze
›Water - Isolate tooth and bathe in very warm water

Question 9

Electric testing

Answer 9

• not used with pts who have pacemakers or other electronic life-supporting devices
  > must be place on non-restored tooth - false positive on metalic restorations
  > placed in middle of tooth

Question 10

Causes of loss of pulp vitality

Answer 10

›Baterial – invasion of pulp from caries or perio

›Physical – mechanical or thermal injuries

Vitality depends on blood supply not nerve

Question 11

Clinical obs of loss of pulp vitality

Answer 11

›Clinical – intrinsic discoloration, fracture, large caries or restoration, fistula

›Radiographic – bone loss w/widening PDL extending to apex, fractured root, large caries or restoration close to pulp chamber

Question 12

Noncarious Dental Lesions (4)

Answer 12

Enamel hypoplasia

Attrition

Erosion

Abrasion

Question 13

Enamel hypoplasia

Answer 13

Defect that occurs as result of disturbance in formation of organic enamel matrix

Question 14

Types of Enamel hypoplasia

Answer 14

1. Hereditary
2. Systemic - nutrition deficiency, chicken pox, disease
3. Local - usually due to trauma, occurs while tooth is forming

Question 15

Attrition

Answer 15

Wearing away of tooth as result of tooth-to-tooth contact

Bruxism

 with age, more seen on men than women

Question 16

Appearance of attrition

Clinical and Radiographic

Answer 16

Initial lesion.
›Small polished facet on a cusp tip or ridge, or slight flattening of an incisal edge

Advanced
›Gradual reduction in cusp height; flattening of incisal or occlusal plane
›Staining of exposed dentin, usually is brown

Radiographic
›Pulp chamber and canals may be narrowed and sometimes obliterated as result of formation of secondary dentin

Question 17

Erosion

Answer 17

Loss of tooth substance by chemical process that doesn’t involve known bacterial action

Facial, lingual, or occlusal depending on cause

Cause  may be idiopathic, chronic vomiting, atmospheric/dietary acid

Question 18

Abrasion

Answer 18

Wearing away of tooth substance by mechanical forces other than mastication

Occurs @ exposed root surfaces or @ incisal edge

Question 19

Abfraction

Answer 19

Theoretical, still unproven

Deep, V-shaped lesions 1 or 2 teeth

Occlusal interferences

Question 20

Tooth fractures causes

Answer 20

›Automobile, bicycle, and diving accidents

›Contact sports when mouth protectors are not worn

›Blows incurred while fighting

›Falls

Question 21

Tooth fracture description

Answer 21

Line of fracture

May be horizontal, diagonal, or vertical

Question 22

Radiographic signs of recent trauma

Answer 22

Widened periodontal ligament space

Radiolucent fracture line

Radiopaque areas where fracture segments overlap

Tooth displacement

Question 23

Types of facial profiles

Answer 23

›Orthoognathic - normal

›Mesognathic -

›Retrognathic -overbite

›Prognathic - underbite

Question 24

Malocclusion examples

Answer 24

1. Crossbites
2. Edge-to-edge
3. End-to-end
4. Open bite
5. Overjet
6. Underjet
7. Overbite

Question 25

Overbite classification

Answer 25

Normal - incisal 3rd

Moderate - middle 3rd

Deep, severe - cerical 3rd

Question 26

Malposition of teeth

Answer 26

Labioversion: a tooth that has assumed a position labial to normal.

Linguoversion: position lingual to normal.

Buccoversion: position buccal to normal.

Supraversion: elongated above the line of occlusion.

Torsiversion: turned or rotated.

Infraversion: depressed below the line of occlusion, for example, primary tooth that is submerged or ankylosed.

Question 27

Occlusion classes

Answer 27

Angle’s Classification:
›Normal (ideal)
›Class I
›Class II
 -Division 1 - max ant flared out
 -Division 2 - max ant retruded
›Class III

Question 28

Functional occlusion

Answer 28

Occlusion consists of all contacts during chewing, swallowing, or other normal action
Types of occlusal contacts
›Functional – normal contacts made

›Parafunctional – contacts outside normal range of function, result of occlusal habits/neuroses

Question 29

Proximal contacts - purpose

Answer 29

›Stabalize position of teeth

Question 30

Migration

Answer 30

›Drifting – natural tendency for mesial migration

›Pathologic migration – occurs when disease present

Question 31

Trauma from occlusion

Answer 31

Perio tissue injury caused by repeated occlusal forces that exceed the physiologic limits of tissue tolerance

Question 32

Types of occlusion trauma

Answer 32

›Primary trauma – excessive occlusal force with normal bone support

›Secondary trauma – excessive occlusal force with bone loss

Question 33

Effects of occlusion trauma

Answer 33

›Excessive forces
Circulatory disturbances, tissue destruction from crushing under pressure, bone resorption, and other pathologic processes are initiated

›Relation to inflammatory factors
Does not cause gingivitis, perio, or pocket formation***

Question 34

Clinical Signs of occlusion trauma

Answer 34

• Tooth mobility. Fremitus.
• Sensitivity of teeth to pressure and/or percussion.
• Pathologic migration.
• Wear facets or atypical incisal or occlusal wear.
• Open contacts related to food impaction.
• Neuromuscular disturbances in the muscles of mastication.
• muscle spasm can occur.
• TMJ symptoms.

Question 35

Radiographic findings of occlusion trauma

Answer 35

-Widened PDL spaces, particularly angular thickening (triangulation).
-Angular (vertical) bone loss in localized areas.
-Root resorption. -
Furcation involvement.